Influence of personal preferences for life-sustaining treatment on medical decision making among pediatric intensivists.
OBJECTIVE
Withholding and withdrawal of life-sustaining treatment by physicians is influenced by a variety of factors; the role of physicians' personal preferences for life-sustaining treatments has not previously been explored. We sought to examine the relationship between personal preferences for life-sustaining treatment and medical decision making among pediatric intensivists.


METHODS
Cross-sectional national anonymous mail survey.


METHODS
All board-certified/eligible pediatric intensivists identified by the American Medical Association Masterfile.


METHODS
None.


RESULTS
A total of 471 (30%) surveys were returned. A Personal Preference Score was calculated from responses to personal-preference questions for life-sustaining treatments adapted from "Your Life, Your Choices," by Pearlman et al. Physicians were asked to consider the "acceptability" of offering and recommending treatment options involving life-sustaining treatments in a hypothetical scenario of a 2-yr old with a high cervical spinal-cord transection. Logistic regression controlling for sociodemographic characteristics found significant relationships (p<.01) between physicians' own preferences modeled as a one standard deviation change in their own Personal Preference Score (preference for life-sustaining treatment) and whether they offered more or less aggressive care (OR [95%CI]). Physicians who had a higher Personal Preference Score (higher preference for their own life-sustaining treatment) were more likely to recommend a tracheostomy (1.38 [1.35-1.41]) and reintubation if the patient failed extubation (1.87 [1.81-1.94]). Pediatric intensivists who had a lower Personal Preference Score (lower preference for life-sustaining treatment) were more likely to recommend that the patient not be reintubated if extubation failed (1.42 [1.39-1.46]) and to recommend Do Not Resuscitate status (1.34 [1.31-1.37]).


CONCLUSIONS
Among pediatric intensivists, personal preferences for life-sustaining treatment were significantly associated with scenario-based responses to acceptability of withholding and withdrawal of life-sustaining treatment. Physicians should be aware of the potential for personal preferences to influence practice recommendations, and endeavor to elicit and respect family preferences in collaborative decision making.
Division of Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA. needlej@ohsu.edu
Jennifer S
JS
Needle
Richard A
RA
Mularski
Thuan
T
Nguyen
Erik K
EK
Fromme
D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D010372:Pediatrics; D010820:Physicians / Q000523:psychology; D012737:Sex Factors; D014481:United States; D028761:Withholding Treatment