Table 2

Physician and nurse attitudes towards specific end-of-life questions

Regarding end-of-life questions, participants stated:Physicians
(n=149)
Nurses
(n=320)
p Values*
Satisfaction with current DFLST79 (53.4%)109 (34.6%)0.011
ICU commitment to high ethical standards112 (75.7%)180 (57.1%)0.001
This commitment involves the nursing staff89 (80.2%)134 (74.9%)NS
The decision to limit treatment is:
(more than one answer)
 indispensable124 (84.9%)208 (65.0%)<0.001
 useful71 (48.6%)119 (37.2%)0.020
 dangerous, criminal or illegal2 (1.4%)24 (7.5%)0.047
DFLSTs are taken by all the physicians as a group without the nursing staff113 (75.8%)257 (80.3%)NS
DFLSTs should ideally be taken collaboratively by the nursing staff and physicians96 (64.4%)176 (55.5%)NS
The family should be informed about DFLST99 (66.9%)257 (81.1%)<0.001
The family should not be properly informed because of its inability to understand the medical details77 (77.8%)118 (73.8%)NS
The family is actually informed about DFLST26 (17.7%)62 (19.9%)NS
The main reason that the families are not fully informed is fear of litigation25 (17.4%)46 (14.9%)NS
When you make a DFLST, you worry that this might lead to litigation80 (54.4%)NANA
Withholding tracheal intubation can be considered if the patient will not benefit from intubation112 (75.2%)214 (67.5%)NS
Extubation can be considered because intubation prolongs the dying process unnecessarily42 (28.4%)74 (23.2%)NS
Decreasing the FiO2 is different from extubating113 (75.8%)229 (71.6%)NS
Withdrawal of artificial ventilation represents a different approach from withdrawing other treatments (breath=life)76 (51.4%)198 (63.5%) 0.004
Withholding or withdrawal of inotropic medications can be considered because inotropic medications prolong the dying process unnecessarily122 (81.9%)209 (65.3%)<0.001
In favour of using a scale for gradual treatment limitation, recorded clearly in the patient’s medical record†89 (68.5%)205 (84.4%)<0.001
Increasing sedation is limited because it can hasten death14 (9.5%)66 (20.8%)<0.001
The appropriate term is ‘refusal of futile care’ instead of ‘passive euthanasia’104 (71.7%)140 (44.7%)<0.001
Personal experience with dying patients has influenced your approach100 (67.1%)149 (47.3%)0.002
Discussions about ethics in the ICU should be given more attention or should be approached in a different way110 (74.8%)254 (80.4%)NS
  • *Statistical comparisons were performed with χ2 test for categorical variables.

  • †A substantial percentage of participants (19.6%) declined to express an opinion in this question. Statistical analysis was performed between participants who gave a ‘yes’ or ‘no’ answer.

  • DFLST, decisions to forego life sustaining treatments; FiO2, fraction of inspired oxygen; ICU, intensive care unit; NS, non-significant.