title: Education, ethics, and end-of-life decisions in the intensive care unit.
abstract: OBJECTIVE
  To examine the influence of education and clinical experience on residents' attitudes toward withdrawal of life support.
  
  
  METHODS
  Self-administered survey.
  
  
  METHODS
  Four Canadian teaching hospitals.
  
  
  METHODS
  Residents rotating through four intensive care units.
  
  
  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.
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Lesley
authors.initials: L
authors.lastname: Stevens
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
authors.forename: Lauren
authors.initials: L
authors.lastname: Griffith
authors.forename: Steven
authors.initials: S
authors.lastname: Walter
authors.forename: Joseph
authors.initials: J
authors.lastname: McMullin
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003657:Decision Making; D004992:Ethics, Medical / Q000193:education*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D008020:Life Support Care; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D009864:Ontario