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Abstract

Introduction: With an aging population, End of Life decision making (EoLDM) during critical illness and injury is important in facilitating compassionate care that is congruent with patient, family, and societal expectations. Hypothesis: Herein, we evaluate factors that influence practitioner EoLDM, particularly years in practice, use of advanced directives and cost consideration. Methods: An anonymous, online survey was offered to trauma & surgical critical care practitioners via the active membership of the Eastern Association for the Surgery of Trauma (n=1359) in June of 2012. Both demographic information and a series of relevant questions dealing with common motivational factors were included. Responses were reported using a five-point Likert scale. Results: 375 responses were received (27.6%). Ninety-two percent of respondents were physicians, 70% were male; and 77% were from level 1 trauma centers. Sixty-six percent of respondents rely on family members for EoLDM most or all of the time, yet 80.7% feel family members are rarely or only sometimes in appropriate emotional states to make such decisions. Seventy percent of practitioners with more than 15 years in practice feel families look to them for direction most or all of the time as compared to only 59.6% of less experienced practitioners, p=0.05. A significant minority of practitioners felt comfortable making decisions without family input, more commonly with experienced (38.2%) compared to less experienced (24.1%) practitioners, p<0.01. Sixty percent of practitioners rely on advance directives (AD) most or all of the time, and agree that AD’s are useful. Only 56.3% of respondents feel that families follow their loved one’s ADs most or all of the time. A patient’s family support or ability to pay for aftercare was never or rarely considered important by 80.1% of practitioners despite 85.1% reporting quality of life post-illness/injury was important most or all of the time. Conclusions: Trauma practitioners have evolving comfort and influence in decision making with experience level. Advance directives are not uniformly helpful and cost is rarely considered. Societal and practitioner education and protocols should be implemented to guide future EoLDM practices.