title: Association between physicians' beliefs and the option of comfort care for critically ill patients.
abstract: OBJECTIVE
  For critically ill patients at high risk of death, reasonable treatment options include attempts at life prolongation and treatment focused on comfort. Little is known about whether and how physicians present the option of comfort care to surrogates. This study assessed how comfort care is presented to surrogates and whether physicians' beliefs are associated with whether comfort care is presented as an option.
  
  
  METHODS
  Mixed-methods study of 72 audio-recorded family conferences about treatment decisions in five ICUs at two hospitals in San Francisco, California. One hundred sixty-nine family members and 54 physicians participated. Patients were at high risk of death or severe functional impairment. Transcripts of audio-recorded conferences were coded to identify whether physicians offered comfort care as an alternative to life-sustaining treatment and to characterize the stated risks and benefits. Physicians completed a questionnaire indicating the strength of their belief that life support should be foregone.
  
  
  RESULTS
  The inpatient mortality rate was 72 %. Using a broad definition of comfort-oriented treatment, this option was presented in 56 % (95 % CI, 44-67 %) of conferences. In clustered multivariate models, the only independent predictor of offering comfort care as an option was the strength of the physician's belief that life support should be foregone [OR 1.38 (1.14-1.66), p = 0.01].
  
  
  CONCLUSIONS
  Clinicians did not explicitly inform surrogates about the option of comfort-oriented treatment in roughly half of clinician-family meetings. Physicians who more strongly believe that the appropriate goal of care is life prolongation are less likely to inform surrogates about the option of comfort care.
authors.affiliation: Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, USA. schenkery@upmc.edu
authors.forename: Yael
authors.initials: Y
authors.lastname: Schenker
authors.forename: Greer A
authors.initials: GA
authors.lastname: Tiver
authors.forename: Seo Yeon
authors.initials: SY
authors.lastname: Hong
authors.forename: Douglas B
authors.initials: DB
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D016638:Critical Illness / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D018802:Patient-Centered Care / Q000379:methods*; D010820:Physicians / Q000523:psychology*; D011368:Professional-Family Relations; D012495:San Francisco; D011795:Surveys and Questionnaires; D055815:Young Adult