title: Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios.
abstract: BACKGROUND
  Evidence suggests that dying patients' physical and emotional suffering is inadequately treated in intensive care units. Although there are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is also difficult to decide who should participate in this decision.
  
  
  METHODS
  We distributed a self-administered questionnaire in 13 adult intensive care units (ICUs) assessing the attitudes of physicians and nurses regarding end-of-life decisions. Family members from a medical-surgical ICU in a tertiary cancer hospital were also invited to participate. Questions were related to two hypothetical clinical scenarios, one with a competent patient and the other with an incompetent patient, asking whether the ventilator treatment should be withdrawn and about who should make this decision.
  
  
  RESULTS
  Physicians (155) and nurses (204) of 12 ICUs agreed to take part in this study, along with 300 family members. The vast majority of families (78.6%), physicians (74.8%) and nurses (75%) want to discuss end-of-life decisions with competent patients. Most of the physicians and nurses desire family involvement in end-of-life decisions. Physicians are more likely to propose withdrawal of the ventilator with competent patients than with incompetent patients (74.8% × 60.7%, P = 0.028). When the patient was incompetent, physicians (34.8%) were significantly less prone than nurses (23.0%) and families (14.7%) to propose decisions regarding withdrawal of the ventilator support (P < 0.001).
  
  
  CONCLUSIONS
  Physicians, nurses and families recommended limiting life-support therapy with terminally ill patients and favored family participation. In decisions concerning an incompetent patient, physicians were more likely to maintain the therapy.
authors.affiliation: Unidade de Terapia Intensiva, Centro de Tratamento e Pesquisa Hospital AC Camargo, Rua Prof, Antônio Prudente, 211 - São Paulo, SP, Brazil CEP 01509-900. regolins@uol.com.br
authors.forename: Renata R L
authors.initials: RR
authors.lastname: Fumis
authors.forename: Daniel
authors.initials: D
authors.lastname: Deheinzelin
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000639:trends; D008020:Life Support Care / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D010820:Physicians / Q000523:psychology*; D012121:Respiration, Artificial / Q000523:psychology*; D012138:Respiratory Therapy / Q000523:psychology; D011795:Surveys and Questionnaires