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Factors explaining variability among caregivers in the intent to restrict life-support interventions in a pediatric
A G Randolph1, M B Zollo, R S Wigton
1Department of Pediatrics, University of California at San Francisco, USA.
Objective:
To explore patient-related factors which influence the decisions of pediatric intensive care unit (ICU) caregivers to restrict life-support interventions.
Design:
Cross-sectional survey.
Setting:
A university-affiliated pediatric ICU.
Subjects:
All physicians and nurses caring for oncology or cardiology ICU patients.
Interventions:
Seven patient characteristics were systematically presented in 16 theoretical case scenarios.
Measurements And Main Results:
Individual linear regression models were constructed for each participant by calculating the importance caregivers placed on seven patient characteristics when deciding about starting intravenous vasopressors, performing chest compressions, and withdrawing life support. We compared the numerical and descriptive (very low, low, moderate, high) probability of survival. We surveyed 86 caregivers and 56 (65%) responded. The most important factors influencing decisions were family preferences (76% of decisions), followed by probability of survival (50%), and functional status (47%). There was marked variability among respondents in 38 (79%)/48 of the questions; 20% to 50% of caregivers chose opposing directions of patient management when they were asked to indicate the likelihood that they would perform a specific life-support intervention. The same term was never used by all respondents to describe the probability of survival for a scenario.
Conclusion:
Critically ill children and their families could face markedly different attitudes about the restriction of life-support interventions, depending on which nurses and physicians are involved in their care.