Factors influencing decisions to withdraw or continue life support and attitudes towards treatment of the critically ill: A survey of registered nurses in intensive care units

Abstract

Introduction: To examine the major determinants influencing the decision to withdraw or continue life support and the attitudes of registered nurses towards the treatments for the critically ill patients in intensive care units (ICUs). Methods: A self-administered questionnaire was distributed to a convenience sample of registered nurses working in 4 ICUs of a large teaching hospital in Singapore. The questionnaire consisted of 3 sections. The first section gathered details about the respondent's demographics; the second section required respondents to rate the importance of 18 different factors influencing the decision to withdraw or continue life support (1 = least important, 5 = most important) while the third section elicited responses about management strategy to 2 clinical scenarios from a possible pool of 6 different scenarios. Results: Eighty-three nurses responded (response rate: 70%). Patient advance directives (μ =3.63), likelihood of surviving current episode (μ = 3.52) and premorbid cognitive function (μ = 3.49) were the most important consideration factors for the withdrawal of life support. Across various clinical scenarios, the majority (82.6%) reported that "continue with current management" was most likely to be in the patients' best interests. Level of agreement between what the respondents believed to be in the patient's best interest and their responses on what they would do if they encountered a similar case was good (Kappa=0.78). Conclusion: Respondents regarded "Patient advanced directives" to be the most important factor in influencing decisions to withdraw or continue life support. In general, nurses were uncomfortable with complete withdrawal of life support. One way to minimise the impact of clinician's social, ethical, moral and religious values on medical decision making is to encourage more Singaporeans to make an Advance Medical Directive.