title: Great variation between ICU physicians in the approach to making end-of-life decisions.
abstract: BACKGROUND
  End-of-life (EOL) decision-making in the intensive care unit (ICU) is difficult, but is rarely practiced in simulated settings. We wanted to explore different strategies ICU physicians use when making EOL decisions, and whether attitudes towards EOL decisions differ between a small-group simulation setting and a large-group plenary setting.
  
  
  METHODS
  The study took place during a Scandinavian anaesthesiology and intensive care conference. The simulated ICU patient had a cancer disease with a grave prognosis, had undergone surgery, suffered from severe co-morbidities and had a son present demanding all possible treatment. The participants were asked to make a decision regarding further ICU care. We presented the same case scenario in a plenary session with voting opportunities.
  
  
  RESULTS
  In the simulation group (n = 48), ICU physicians used various strategies to come to an EOL decision: patient-oriented, family-oriented, staff-oriented and regulatory-oriented. The simulation group was more willing than the plenary group (n = 47) to readmit the patient to the ICU if the patient again would need respiratory support (32% vs. 8%, P < 0.001). Still, fewer participants in the simulation group than in the plenary group (21% vs. 38%, P = 0.019) considered the patient's life expectancy of living an independent life to be over 10%.
  
  
  CONCLUSIONS
  There was great variation between ICU physicians in the approach to making EOL decisions, and large variations in their life expectancy estimates. Participants in the simulation group were more willing to admit and readmit the patient to the ICU, despite being more pessimistic towards life expectancies. We believe simulation can be used more extensively in EOL decision-making training.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.|Stavanger Acute Medicine Foundation for Education and Research, Stavanger University Hospital, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: C A
authors.initials: CA
authors.lastname: Bjørshol
authors.affiliation: Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.|Department of Health Care Sciences, University of Stavanger, Stavanger, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Sollid
authors.affiliation: Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Flaatten
authors.affiliation: Stavanger Acute Medicine Foundation for Education and Research, Stavanger University Hospital, Stavanger, Norway.
authors.forename: I
authors.initials: I
authors.lastname: Hetland
authors.affiliation: Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.
authors.forename: W T
authors.initials: WT
authors.lastname: Mathiesen
authors.affiliation: Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.|Stavanger Acute Medicine Foundation for Education and Research, Stavanger University Hospital, Stavanger, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.|Department of Health Care Sciences, University of Stavanger, Stavanger, Norway.
authors.forename: E
authors.initials: E
authors.lastname: Søreide
mesh_terms: D000368:Aged; D003198:Computer Simulation; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D010820:Physicians; D011795:Surveys and Questionnaires; D013727:Terminal Care