title: Recommendations to limit life support: a national survey of critical care physicians.
abstract: BACKGROUND
  There is debate about whether physicians should routinely provide patient surrogates with recommendations about limiting life support.
  
  
  OBJECTIVE
  To explore physicians' self-reported practices and attitudes.
  
  
  METHODS
  A cross-sectional, stratified survey of 1,000 randomly selected US critical care physicians was mailed. We included a vignette to experimentally examine how surrogate desire for a recommendation and physician agreement with the surrogate modified whether physicians would provide a recommendation.
  
  
  RESULTS
  Proportion of respondents reporting they routinely provide surrogates with a recommendation and how responses varied based on vignette characteristics. A total of 608 (66%) of 922 eligible physicians participated. Approximately one (22%) in five reported always providing surrogates with a recommendation, whereas 1 (11%) in 10 reported rarely or never doing so. Almost all respondents reported comfort making recommendations (92%) and viewed them as appropriate (93%). Most also viewed recommendations as a critical care physician's duty (87%) and did not view them as unduly influential (80%). Approximately two-fifths (41%) believed recommendations were only appropriate if sought by surrogates. In response to the vignettes, nearly all respondents (91%) provided a recommendation when the surrogate requested a recommendation and the physician agreed with the surrogate's likely decision. Physicians were less likely to provide an unwanted recommendation, both when physicians agreed (29%) and disagreed with the surrogate's likely decision (44%).
  
  
  CONCLUSIONS
  There is substantial variation among physicians' self-reported use of recommendations to surrogates of critically ill adults. Surrogates' desires for recommendations and physicians' agreement with surrogates' likely decisions may have important influence on whether recommendations are provided.
authors: Johns Hopkins School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA. galexand@jhsph.edu
authors: David R
authors: DR
authors: Brush
authors: Kenneth A
authors: KA
authors: Rasinski
authors: Jesse B
authors: JB
authors: Hall
authors: G Caleb
authors: GC
authors: Alexander
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003422:Critical Care; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011368:Professional-Family Relations; D028761:Withholding Treatment