Association between education in EOL care and variability in EOL practice: a survey of ICU physicians

• Published in: Intensive care medicine 2012-03, Vol.38 (3), p.404-412
• Main Authors: Forte, Daniel Neves, Vincent, Jean Louis, Velasco, Irineu Tadeu, Park, Marcelo
• Format: Article
• Language: English
• Subjects: Adult; Advance directives; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Antibiotics; Attitude of Health Personnel; Biological and medical sciences; Brazil; Clinical death. Palliative care. Organ gift and preservation; Critical care; Critical Care - ethics; Critical Care - methods; Critical Care - standards; Critical Care Medicine; Decision Making; Do-not-resuscitate orders; Education; Education, Medical - standards; Education, Medical - statistics & numerical data; Emergency Medicine; Ethics; Ethics Committees, Clinical; Female; Health Care Surveys; Hospital patients; Hospitals; Humans; Intensive; Intensive care; Intensive care medicine; Intensive Care Units - manpower; Intensive Care Units - standards; Intensive Care Units - statistics & numerical data; Male; Medical sciences; Medical societies; Medicine; Medicine & Public Health; Original; Pain Medicine; Pediatrics; Persistent vegetative state; Physician-Nurse Relations; Physicians; Pneumology/Respiratory System; Practice; Practice Patterns, Physicians; Questionnaires; Resuscitation Orders - ethics; Surveys; Terminal Care - ethics; Terminal Care - methods; Terminal Care - standards; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-011-2400-4

Purpose This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Methods Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians’ personal, professional and EOL educational characteristics. Results The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356–0.848), P  = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271–13.845), P  = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply “full code” had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012–0.710), P  = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122–0.361), P