FACTORS EXPLAINING VARIABILITY AMONG CAREGIVERS IN THE INTENT TO RESTRICT LIFE-SUPPORT INTERVENTIONS IN A PEDIATRIC INTENSIVE-CARE UNIT

Objective: To explore patient-related factors which influence the deci sions of pediatric intensive care unit (ICU) caregivers to restrict li fe-support interventions. Design: Cross sectional survey. Setting: A u niversity affiliated pediatric ICU. Subjects: All physicians and nurse s caring for oncology or cardiology ICU patients. Interventions: Seven patient characteristics were systematically presented in 16 theoretic al case scenarios. Measurements and Main Results: Individual linear re gression models were constructed for each participant by calculating t he importance caregivers placed on seven patient characteristics when deciding about starting intravenous vasopressors, performing chest com pressions, 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 f actors influencing decisions were family preferences (76% of decisions ), followed by probability of survival (50%), and functional status (4 7%). There was marked variability among respondents in 38 (79%)/48 of the questions; 20% to 50% of caregivers chose opposing directions of p atient management when they were asked to indicate the likelihood that they would perform a specific life support intervention. The same ter m was never used by all respondents to describe the probability of sur vival for a scenario. Conclusion: Critically ill children and their fa milies could face markedly different attitudes about the restriction o f life-support interventions, depending on which nurses and physicians are involved in their care.