CARE-ATLANTIC: understanding cross cultural differences in goals of care; a transatlantic study in critical care medicine

Medical paternalism, where physicians decide based on perceived patient interests, contrasts with the value of patient autonomy, which emphasizes patients' rights to make informed choices about their medical care. This study explores how trainees from cultures emphasizing these contrasting values interpret limitations on life-sustaining treatments, focusing on potential differences in decision-making.

A survey was designed with two clinical vignettes and trainees rated their agreement or disagreement with 21 different treatment choices on a 5-point Likert scale. Surveys were distributed via Fellowship Program Directors in the U.S. and the ANJMIR in France. Statistical analysis used the Mann-Whitney U test to compare responses across countries and code status groups.

A total of 217 trainees responded. Both American and French critical care trainees made different decisions based on patient code status alone, with the Americans being very polarized in their decisions and the French less so. Significant variations across interventions reflected cultural influences on medical decision-making.

This study reveals significant cultural differences in decision-making between French and American critical care trainees. Americans align more closely with patient preferences, while French trainees show greater variability, highlighting the impact of cultural norms on medical practices and patient care.