Attitudes of Swedish physicians and nurses towards the use of life-sustaining treatment

Background: Withdrawal or withholding of life-sustaining treatment have bec ome accepted clinical practice within the intensive care unit (ICU). One im portant factor influencing these decisions is the attitudes of physicians a nd nurses. Method: Questionnaire survey of physicians and nurses in ICUs in 12 Swedish university-affiliated and/or tertiary referral hospitals. Results: The response rate was 850 of 1081 (79%) potentially eligible healt h care workers. Respondents first rated the importance of 16 factors consid ered in the decision to withdraw life support. The most important factors w ere the patient's likelihood of surviving the current episode, patient adva nce directives, patient age and likelihood of long-time survival. Responden ts also chose between five levels of care, ranging from comfort measures to full intensive care, in two of 12 different scenarios. Respondent characte ristics affecting the level of care chosen were the number of years of ICU experience and the particular ICU in which the respondent worked. Conclusion: Advance directives are believed by Swedish intensive care perso nnel to be very important in the decision to withdraw life support, contrar y to several descriptive studies suggesting modest patient and family influ ence on these decisions. Attitudes towards the intensity of care vary betwe en different centers, raising the possibility that levels of care for simil ar patients may differ across the country