title: Who decides? Physicians' willingness to use life-sustaining treatment.
abstract: BACKGROUND
  Physician specialty training is associated with variations in the use of medical treatment for specific diseases.
  
  
  OBJECTIVE
  To examine whether physicians' specialties predict differences in willingness to use life-sustaining treatments.
  
  
  METHODS
  One hundred fifty-eight physicians (response rate, 85%) who cared for 378 hospitalized patients with end-stage congestive heart failure, chronic obstructive pulmonary disease, malignant neoplasms, or hepatic cirrhosis were interviewed to assess their thresholds for use of specific life-sustaining treatments. Their patients were then followed up to determine whether decisions were made to use or withhold cardiopulmonary resuscitation, ventilator support, or intensive care. Physicians' attitudes, their stated thresholds for treatment use, and their use of these treatments in daily practice were compared by specialty group.
  
  
  RESULTS
  Physicians recommended cardiopulmonary resuscitation and ventilator support for patients with end-stage congestive heart failure or chronic obstructive pulmonary disease if the chance for survival was at lease 48%, but they required a predicted survival of at least 74% for patients with cancer. For a patient with end-stage congestive heart failure or chronic obstructive pulmonary disease, cardiologists were consistently more willing than other physicians to use life-sustaining treatments. In practice, decisions to use or withhold such treatments were made for 151 patients with end-stage diseases. Compared with other physicians, cardiologists were least likely to issue orders to withhold treatment and most likely to use life-sustaining treatments for patients they treated. Oncologists rarely used such treatments and issued orders to withhold these treatments much more often.
  
  
  CONCLUSIONS
  Physician specialty is associated with differences in willingness to use, and in actual use of, life-sustaining treatments.
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Hanson
authors.forename: M
authors.initials: M
authors.lastname: Danis
authors.forename: J M
authors.initials: JM
authors.lastname: Garrett
authors.forename: E
authors.initials: E
authors.lastname: Mutran
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D006801:Humans; D008020:Life Support Care; D008511:Medicine; D010820:Physicians; D011446:Prospective Studies; D013038:Specialization; D028761:Withholding Treatment