[Perspectives on advance directives among German intensive care physicians in leading positions]

Six years after introduction of a law for advance directives (AD) in 2009, AD are still discussed controversially. For the first time in Germany, this study investigates intensive care physicians' perspectives on implementation of AD, and corresponding experience of ethical issues.

A standardized questionnaire was sent to German hospitals with > 300 beds and anesthesiologist-led intensive care units. The questionnaire was based on results of a previous qualitative study and was intended to be answered by one leading intensive care physician per hospital.

N = 222/299 (74.2 % response) physicians answered the survey. Despite a number of reported problems regarding the implementation of AD, 70.6 % (n = 154/218) rated AD generally as helpful. 86.5 % (n = 185/214) would prefer a more goal-oriented approach to an intervention-oriented approach to formulate AD. Furthermore 95.9 % (n = 207/216) plead for qualified professional counseling for intensive care topics in AD. Acceptance for interventions that equal termination of treatment can be perceived. Terminal extubation in correspondence with the patient's will is done in 79.4 % (n = 173/218) of hospitals, however 54.8 % (n = 113/206) of the physicians experience terminal extubations as burdening.

Supporting concepts and measures will be necessary in order to prepare valid AD and to effectively improve implementation in intensive care practice.