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- Title
Recommendations to limit life support: a national survey of critical care physicians.
- Authors
Brush DR; Rasinski KA; Hall JB; Alexander GC; Brush, David R; Rasinski, Kenneth A; Hall, Jesse B; Alexander, G Caleb
- Abstract
<bold>Rationale: </bold>There is debate about whether physicians should routinely provide patient surrogates with recommendations about limiting life support.<bold>Objectives: </bold>To explore physicians' self-reported practices and attitudes.<bold>Methods: </bold>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.<bold>Measurements and Main Results: </bold>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%).<bold>Conclusions: </bold>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.
- Publication
American Journal of Respiratory & Critical Care Medicine, 2012, Vol 186, Issue 7, p633
- ISSN
1073-449X
- Publication type
journal article
- DOI
10.1164/rccm.201202-0354OC