Family Physicians' Decision-making in Mechanical Ventilation Withdrawal: A Cross-sectional Study

In Thailand, family physicians play a central role in palliative care, which often includes the withdrawal of mechanical ventilation (WMV) as part of life-sustaining treatment cessation. However, the rationale behind these decisions varies significantly among practitioners. This study examines key factors that influence Thai family physicians' decisions to discontinue mechanical ventilation for terminally ill patients.

We conducted an online survey from December 2021 to January 2022, employing a customised questionnaire. Its content validity and reliability were affirmed, achieving Cronbach's alpha scores of 0.81 and 0.88 in separate sections.

Among 164 respondents, 123 (75%) had previously participated in WMV decisions. Key influencing factors included the involvement of family or surrogate decision-makers (SDMs), physicians' experience with end-of-life care and patients' explicit opposition to ventilator support. Urgent requests from families or SDMs and the imminence of patient mortality were also pivotal. A consensus on the ethical appropriateness of WMV was observed. Notably, physicians with over 3 years of experience in palliative care were significantly more likely to discontinue ventilation (odds ratio [OR] = 5.30; P = 0.001), a likelihood further increased by formal training in this area (OR = 8.97; P < 0.001).

The decisions of Thai family physicians to cease mechanical ventilation in terminally ill patients are strongly influenced by family or SDMs' input, their own experiential background and the expressed wishes of the patients regarding ventilator assistance.