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Determining ICU Staff's Conceptions, Opinions, Views, Experiences, and Reflection (DISCOVER) of Brain Death-Results
Pascale Grzonka1, Sebastian Berger1, Kai Tisljar1
1Clinic for Intensive Care Medicine, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland.
Objectives:
To assess perceptions, beliefs, and conceptual understanding of brain death among ICU professionals at three Swiss hospitals and to examine their associations with personal, educational, and professional experiences.
Design:
Cross-sectional questionnaire-based survey.
Setting:
Multicenter survey at three Swiss care centers.
Subjects:
ICU healthcare professionals (i.e., physicians and nurses).
Interventions:
None.
Measurements And Main Results:
Questionnaires assessed demographics, religious beliefs, professional experience, exposure to brain death cases, knowledge of diagnostic criteria, and emotional and ethical attitudes using closed-ended and semi-open questions, Likert scales (1 = "very unsure," "absolutely not" to 10 = "very sure," "absolutely"), and checklists. Endpoints were (primary) perceptions, beliefs, conceptual understanding of brain death, and (secondary) interprofessional differences and associations/correlations with personal, educational, social, and professional factors. Among 338 ICU professionals (78.1% nurses, 74% women), key diagnostic brain death criteria were well recognized, although misconceptions about nonessential tests persisted. Self-perceived understanding and approval were high (both median Likert scores, 9; interquartile range [IQR], 8-10), while agreement that a brain-dead patient is not a patient but a corpse was much lower (median, 1; IQR, 1-4). Physicians showed greater approval than nurses (p = 0.003) and were more likely to equate brain death with circulatory death (p < 0.001). Understanding increased with ICU experience (ρ = 0.194) and age (ρ = 0.213; both p < 0.001) and was higher among those with prior exposure to brain death or its diagnostics (both p < 0.001). No significant associations were found for sex, religious beliefs, parenthood, or bereavement.
Conclusions:
Although Swiss ICU professionals generally endorse and understand the brain death concept, our data indicate specific areas for improvement in conceptual clarity, particularly among nurses and less experienced professionals. In contrast to personal/philosophical influences, clinical exposure increases understanding and alignment with definitions, underscoring the need for targeted interdisciplinary education.
