Respiratory Therapists' Experiences and Attitudes Regarding Terminal Extubations and End-of-Life Care.
BACKGROUND
Respiratory therapists (RTs) routinely care for patients with life-limiting illnesses and in some hospitals are responsible for terminal extubations. Data on how such experiences affect RTs are scarce. The objective of this work was to survey RTs at 2 academic medical centers about their experiences caring for patients with terminal extubations.


METHODS
An online survey was distributed to the hospitals' RTs. Survey data included demographics and experiences with end-of-life care and terminal extubations. The survey was derived from previously published questionnaires plus input from hospital RT leaders.


RESULTS
Sixty-five of 173 RTs (37.6%) responded. Of these, 42.4% were ≥50 y old, and 62.7% were female. 20.3% had ≤5 y experience; 52.5% had ≥16 y. 93.8% self-reported being involved in at least one terminal extubation; of those, 36.1% reported performing ≥20. Nearly half (47.5%) wanted to be involved in family meetings discussing terminal extubations, but just 6.6% were frequently involved. Only 32.3% felt that they received adequate education regarding terminal illness in RT school; 32.3% reported gathering this knowledge while working. 60.0% wanted more formal education around terminal patient care. 27.9% reported sometimes being uncomfortable with performing a terminal extubation; most of these rarely felt that they had the option not to perform the extubation.


CONCLUSIONS
RTs are rarely involved in end-of-life discussions despite a desire to be, and they experience situations that generate discomfort. There is demand for more formal RT training around care for terminal patients. Clinical protocols that involve RTs in meetings before ventilator withdrawal should be considered.
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Emory Palliative Care Center, Emory University, Atlanta, Georgia. anjali.grandhige@emory.edu.
Anjali P
AP
Grandhige
Department of Respiratory Care, Emory University Hospital, Atlanta, Georgia.
Marjorie
M
Timmer
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Emory Palliative Care Center, Emory University, Atlanta, Georgia.
Michael J
MJ
O'Neill
Emory Palliative Care Center, Emory University, Atlanta, Georgia. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Zachary O
ZO
Binney
Emory Palliative Care Center, Emory University, Atlanta, Georgia. United States Department of Veterans Affairs Medical Center and Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
Tammie E
TE
Quest
D000293:Adolescent; D000328:Adult; D060666:Airway Extubation / Q000523:psychology*; D001291:Attitude of Health Personnel; D002985:Clinical Protocols; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012138:Respiratory Therapy / Q000523:psychology*; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000523:psychology*; D055815:Young Adult
end of life; palliative care; respiratory therapist; ventilator