Association between education in EOL care and variability in EOL practice: a survey of ICU physicians.
OBJECTIVE
This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU.


METHODS
Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics.


RESULTS
The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns were the leading cause for this dichotomy.


CONCLUSIONS
Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.
Intensive Care Unit, Emergency Department, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, Brazil. dnforte@yahoo.com.br
Daniel Neves
DN
Forte
Jean Louis
JL
Vincent
Irineu Tadeu
IT
Velasco
Marcelo
M
Park
D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D001938:Brazil; D003422:Critical Care / Q000941:ethics / Q000379:methods / Q000592:standards*; D003657:Decision Making; D004501:Education, Medical / Q000592:standards / Q000706:statistics & numerical data; D028741:Ethics Committees, Clinical; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D019555:Physician-Nurse Relations; D010818:Practice Patterns, Physicians'; D016414:Resuscitation Orders / Q000941:ethics; D013727:Terminal Care / Q000941:ethics / Q000379:methods / Q000592:standards*; D000078329:Workforce