Recommendations to limit life support: A national survey of critical care physicians

David R. Brush, Kenneth A. Rasinski, Jesse B. Hall, G. Caleb Alexander

Research output: Contribution to journalArticlepeer-review

Abstract

Rationale: There is debate about whether physicians should routinely provide patient surrogates with recommendations about limiting life support. Objectives:To explore physicians' self-reported practices and attitudes. Methods: A cross-sectional, stratified survey of 1,000 randomly selected US critical care physicians was mailed. We included a vignette to experimentally examine how surrogate desire for a recommendation and physician agreement with the surrogate modified whether physicians would provide a recommendation. Measurements and Main Results: Proportion of respondents reporting they routinely provide surrogates with a recommendation and how responses varied based on vignette characteristics. A total of 608 (66%) of 922 eligible physicians participated. Approximately one (22%) in five reported always providing surrogates with a recommendation, whereas 1 (11%) in 10 reported rarely or never doing so. Almost all respondents reported comfort making recommendations (92%) and viewed them as appropriate (93%). Most also viewed recommendations as a critical care physician's duty (87%) and did not view them as unduly influential (80%). Approximately two-fifths (41%) believed recommendations were only appropriate if sought by surrogates. In response to the vignettes, nearly all respondents (91%) provided a recommendation when the surrogate requested a recommendation and the physician agreed with the surrogate's likely decision. Physicians were less likely to provide an unwanted recommendation, both when physicians agreed (29%) and disagreed with the surrogate's likely decision (44%). Conclusions: There is substantial variation among physicians' self-reported use of recommendations to surrogates of critically ill adults. Surrogates' desires for recommendations and physicians' agreement with surrogates' likely decisions may have important influence on whether recommendations are provided.

Original languageEnglish (US)
Pages (from-to)633-639
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume186
Issue number7
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Keywords

  • Intensive care
  • Life support
  • Medical ethics
  • Physician recommendations
  • Surrogate decision maker

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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