title: Confidence in life-support decisions in the intensive care unit: a survey of healthcare workers. Canadian Critical Care Trials Group.
abstract: OBJECTIVE
  To examine the relationship between intensive care unit (ICU) healthcare workers' confidence and their decision to withdraw life support.
  
  
  METHODS
  Cross-sectional survey of Canadian intensivists, ICU housestaff, and bedside nurses. Respondents chose the level of care (from comfort measures only to full aggressive care) for 12 patients described in clinical scenarios, and rated their confidence in their decisions.
  
  
  METHODS
  Thirty-seven Canadian university-affiliated hospitals.
  
  
  METHODS
  None.
  
  
  METHODS
  We used discrete data analysis models to examine the association between the chosen level of care, confidence in the decisions, the clinical scenario, and healthcare worker group.
  
  
  RESULTS
  The response rate was 1,361 (76%)/1,795; for this analysis, we used data from 1,306 respondents with completed questionnaires. Responses for each scenario varied widely among respondents. The level of care chosen was dependent on the scenario, the healthcare worker group, and the confidence with which the decisions were made (p < .001 for each). Intensivists were less aggressive than the ICU nurses, who were less aggressive than the housestaff, but the magnitude of effect was small. Overall, respondents were very confident about their decisions 34% of the time. After adjustment for clinical scenario and chosen level of care, intensivists were more confident than nurses, who were more confident than housestaff (40% of intensivists, 29% of nurses, and 23% of housestaff were very confident). In general, healthcare workers tended to be more confident when they chose extreme levels of care than when they chose intermediate levels of care. Considerable variability in responses to scenarios remained even when we considered only those responses made with the highest level of confidence.
  
  
  CONCLUSIONS
  While confidence in decisions about withdrawal of life support increases with seniority and authority, consistency of decisions may not. When given standard information, healthcare workers can make contradictory decisions yet still be very confident about the level of care they would administer.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
authors.forename: S D
authors.initials: SD
authors.lastname: Walter
authors.forename: D J
authors.initials: DJ
authors.lastname: Cook
authors.forename: G H
authors.initials: GH
authors.lastname: Guyatt
authors.forename: A
authors.initials: A
authors.lastname: Spanier
authors.forename: R
authors.initials: R
authors.lastname: Jaeschke
authors.forename: T R
authors.initials: TR
authors.lastname: Todd
authors.forename: D L
authors.initials: DL
authors.lastname: Streiner
mesh_terms: D000368:Aged; D002170:Canada; D003430:Cross-Sectional Studies; D003657:Decision Making; D006282:Health Personnel / Q000706:statistics & numerical data*; D006306:Health Surveys; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008020:Life Support Care / Q000706:statistics & numerical data*; D008875:Middle Aged; D018579:Patient Selection; D019555:Physician-Nurse Relations; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D035501:Uncertainty; D028761:Withholding Treatment