Should docs recommend to limit life support?
Multiple pulmonary and critical care professional societies recently have recommended that physicians should routinely provide recommendations to surrogate decision makers about whether to limit life support. However, there is a lack of empirical data on the perspective of surrogates.
Researchers set out to understand the attitudes of surrogates toward receiving a physician's recommendation during deliberations about whether to limit life support for an incapacitated patient. They conducted a prospective, mixed methods study among 169 surrogate decision makers for critically ill patients.1 Surrogates sequentially viewed two videos of simulated physician-surrogate discussions about whether to limit life support, which varied only by whether the physician gave a recommendation.
The main quantitative outcome was whether surrogates preferred to receive a physicians' recommendation. Surrogates also participated in an in-depth, semistructured interview to explore the reasons for their preference. Fifty-six percent (95/169) of surrogates preferred to receive a recommendation, 42% (70/169) preferred not to receive a recommendation, and 2% (4/169) felt that both approaches were equally acceptable.
Researchers identified four primary themes that explained surrogates' preferences, including surrogates' perceptions of physicians' appropriate role in life-or-death decisions and their perceptions of the positive or negative consequences of a recommendation on the physician-surrogate relationship, on the decision making process, and on long-term regret for the family.
There is no consensus among surrogates about whether physicians should routinely provide a recommendation regarding life support decisions for incapacitated patients, the researchers said. These findings suggest that physicians should ask surrogates whether they wish to receive a recommendation regarding life support decisions and should be flexible in their approach to decision making, they said.
Reference
1. White DB, Evans LR, Bautista CA, et al. Are physicians' recommendations to limit life support beneficial or burdensome? Bringing empirical data to the debate. Am J Respir Crit Care Med 2009; 80:320-325. DOI: 10.1164/rccm.200811-1776OC.
Multiple pulmonary and critical care professional societies recently have recommended that physicians should routinely provide recommendations to surrogate decision makers about whether to limit life support. However, there is a lack of empirical data on the perspective of surrogates.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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