WHO DECIDES - PHYSICIANS WILLINGNESS TO USE LIFE-SUSTAINING TREATMENT

Background: Physician specialty training is associated with variations in the use of medical treatment for specific diseases. Objective: To examine whether physicians' specialties predict differences in willing ness to use life-sustaining treatments. Methods: One hundred fifty-eig ht physicians (response rate, 85%) who cared for 378 hospitalized pati ents with endstage congestive heart failure, chronic obstructive pulmo nary disease, malignant: neoplasms, or hepatic cirrhosis were intervie wed to assess their thresholds for use of specific life-sustaining tre atments. Their patients were then followed up to determine whether dec isions were made to use or withhold cardiopulmonary resuscitation, ven tilator support, or intensive care. Physicians' attitudes, their state d thresholds for treatment use, and their use of these treat ments in daily practice were compared by specialty group. Results: Physicians r ecommended cardiopulmonary resuscitation and ventilator support for pa tients with endstage congestive heart failure or chronic obstructive p ulmonary-disease if the chance for survival was at least 48%, but they required a predicted survival of at least 74% for patients with cance r. For a patient with end-stage congestive heart failure or chronic ob structive pulmonary disease, cardiologists were consistently more will ing than other physicians to use life-sustaining treatments. In practi ce, decisions to use or withhold such treatments were made for 151 pat ients with end-stage diseases. Compared with other physicians, cardiol ogists were least likely to issue orders to withhold treatment and mos t likely to use life-sustaining treatments for patients they treated. Oncologists rarely used such treatments and issued orders to withhold these treatments much more often. Conclusion: Physician specialty is a ssociated with differences in willingness to use, and in actual use of , life-sustaining treatments.