Education, ethics, and end-of-life decisions in the intensive care unit.

Full Abstract

OBJECTIVE:
To examine the influence of education and clinical experience on residents' attitudes toward withdrawal of life support.

DESIGN:
Self-administered survey.

SETTING:
Four Canadian teaching hospitals.

SUBJECTS:
Residents rotating through four intensive care units.

MEASUREMENTS AND MAIN RESULTS:
The survey examined ethics education and experience regarding end-of-life care, importance of factors influencing withdrawal of life support, confidence in decisions, and recommendations for enhancing end-of-life education. The response rate was 83.9% (52 of 62). A minority of residents reported an appropriate amount of formal teaching on ethical principles (17.3%), patient-centered education (28.8%), and informal discussion (28.8%) before their intensive care unit rotation. During their rotation, most residents cared for patients in whom withdrawal of life support was considered. Although they usually attended family meetings, residents were never (34.6%) or rarely (42.3%) the primary discussant. Before the intensive care unit rotation, confidence in withdrawal decisions was related to male sex (p =.001) and previous patient-centered ethics education (p =.02). At the end of the intensive care unit rotation, only resident involvement in family meetings (p =.02) and being the primary discussant at such meetings (p =.01) were associated with confidence. After we adjusted for pre-rotation confidence in withdrawal of life support decision-making, the only predictor of post-rotation confidence was family meeting involvement (p <.001). Residents recommended more patient-centered discussion, observation of attending physicians discussing end-of-life issues, and opportunity to lead family meetings.

CONCLUSIONS:
Experiential, case-based, patient-centered curricula are associated with resident confidence in withdrawal of life support decisions in the intensive care unit.

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Author information

Author/s: Stevens, Lesley (L); Cook, Deborah (D); Guyatt, Gordon (G); Griffith, Lauren (L); Walter, Steven (S); McMullin, Joseph (J);

Affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.

Journal and publication information

Publication Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

Journal: Critical care medicine (Crit Care Med), published in United States. (Language: eng)

Reference: 2002-Feb; vol 30 (issue 2) : pp 290-6

Dates: Created 2002/03/12; Completed 2002/03/27; Revised 2006/11/15;

PMID: 11889295, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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