Attitudes of health care workers towards waking a terminally ill patient in the intensive care unit for treatment decisions

Abstract

Objective: We examined whether health care workers would wake an intubated patient whose preferences are not known, and whether attitudes are influenced by how health care workers themselves would like to be treated if they were in the patient's place.

Design, setting, and subjects: Convenience sample of 90 participants at a postgraduate lecture to anesthesiologists and related professions. Participants filled out questionnaires after a case presentation followed by two commentaries, one arguing against, the other for waking a 49-year-old intubated patient suffering from a large, intratracheal, poorly differentiated metastatic squamous cell carcinoma of the lungs. The patient was not aware of the diagnosis and poor prognosis and had not expressed any preferences.

Results: Participants were almost equally divided between the two alternatives. Significant differences were found between professions concerning the willingness not to wake the patient (19.8% of nurses vs. 45% of physicians and others). There was a strong correlation between the preferences of the health care worker for her-/himself and what he/she would do if in charge of the patient.

Conclusions: Our study shows that attitudes of health care workers towards waking and informing an intubated patient in the intensive care unit about a hopeless situation differ. Educational programs should ensure that physicians and nurses, especially when discussing and deciding withdrawal of vital support, are aware of theses differences and realize that their own behavior can be influenced by their own preferences if themselves in the patient's situation.