Article Text

Download PDFPDF

The impact of healthcare professionals’ personality and religious beliefs on the decisions to forego life sustaining treatments: an observational, multicentre, cross-sectional study in Greek intensive care units
  1. Asimenia Ntantana1,
  2. Dimitrios Matamis1,
  3. Savvoula Savvidou1,
  4. Kyriaki Marmanidou1,
  5. Maria Giannakou2,
  6. Μary Gouva3,
  7. George Nakos4,
  8. Vasilios Koulouras4
  1. 1 ICU “Papageorgiou” General Hospital of Thessaloniki, Thessaloniki, Greece
  2. 2 ICU AHEPA University Hospital of Thessaloniki, Thessaloniki, Greece
  3. 3 Technological Educational Institutes of Ipeirus, Thanaseika, Greece
  4. 4 ICU University Hospital of Ioannina, Ioannina, Greece
  1. Correspondence to Dimitrios Matamis; dmatamis{at}


Objectives To assess the opinion of intensive care unit (ICU) personnel and the impact of their personality and religious beliefs on decisions to forego life-sustaining treatments (DFLSTs).

Setting Cross-sectional, observational, national study in 18 multidisciplinary Greek ICUs, with >6 beds, between June and December 2015.

Participants 149 doctors and 320 nurses who voluntarily and anonymously answered the End-of-Life (EoL) attitudes, Personality (EPQ) and Religion (SpREUK) questionnaires. Multivariate analysis was used to detect the impact of personality and religious beliefs on the DFLSTs.

Results The participation rate was 65.7%. Significant differences in DFLSTs between doctors and nurses were identified. 71.4% of doctors and 59.8% of nurses stated that the family was not properly informed about DFLST and the main reason was the family’s inability to understand medical details. 51% of doctors expressed fear of litigation and 47% of them declared that this concern influenced the information given to family and nursing staff. 7.5% of the nurses considered DFLSTs dangerous, criminal or illegal. Multivariate logistic regression identified that to be a nurse and to have a high neuroticism score were independent predictors for preferring the term ‘passive euthanasia’ over ‘futile care’ (OR 4.41, 95% CI 2.21 to 8.82, p<0.001, and OR 1.59, 95% CI 1.03 to 2.72, p<0.05, respectively). Furthermore, to be a nurse and to have a high-trust religious profile were related to unwillingness to withdraw mechanical ventilation. Fear of litigation and non-disclosure of the information to the family in case of DFLST were associated with a psychoticism personality trait (OR 2.45, 95% CI 1.25 to 4.80, p<0.05).

Conclusion We demonstrate that fear of litigation is a major barrier to properly informing a patient’s relatives and nursing staff. Furthermore, aspects of personality and religious beliefs influence the attitudes of ICU personnel when making decisions to forego life-sustaining treatments.

  • Decisions to foregolife sustaining treatment (DFLST)
  • End-of-Life (EoL)
  • personality
  • religiousness

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors VK, DM, AN, MG, MG, GN were responsible for the study design and conception.Data acquisition, analysis and interpretation were performed by AN, SS, KM, DM, VK and MG, DM, SS and AN had full access to all data of the study and take responsibility for the integrity of the data and accuracy of the data analysis. Manuscript writing: DM, SS, AN.

  • Competing interests None declared.

  • Patient consent The participation in the study was not compulsory but voluntary.

  • Ethics approval The study protocol was approved by the national health authority (Protocol No Δ3β/23441) and the ethics committees of all participating hospitals were informed of the study by the national authority.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data from the study are available to anyone who may have an interest in the research, by email from the correspondent author.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.