• David R Brush, Kenneth A Rasinski, Jesse B Hall, and G Caleb Alexander.
• Johns Hopkins School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA. galexand@jhsph.edu
• Am. J. Respir. Crit. Care Med. 2012 Oct 1; 186 (7): 633639633-9.

RationaleThere is debate about whether physicians should routinely provide patient surrogates with recommendations about limiting life support.ObjectivesTo explore physicians' self-reported practices and attitudes.MethodsA cross-sectional, stratified survey of 1,000 randomly selected US critical care physicians was mailed. We included a vignette to experimentally examine how surrogate desire for a recommendation and physician agreement with the surrogate modified whether physicians would provide a recommendation.Measurements And Main ResultsProportion of respondents reporting they routinely provide surrogates with a recommendation and how responses varied based on vignette characteristics. A total of 608 (66%) of 922 eligible physicians participated. Approximately one (22%) in five reported always providing surrogates with a recommendation, whereas 1 (11%) in 10 reported rarely or never doing so. Almost all respondents reported comfort making recommendations (92%) and viewed them as appropriate (93%). Most also viewed recommendations as a critical care physician's duty (87%) and did not view them as unduly influential (80%). Approximately two-fifths (41%) believed recommendations were only appropriate if sought by surrogates. In response to the vignettes, nearly all respondents (91%) provided a recommendation when the surrogate requested a recommendation and the physician agreed with the surrogate's likely decision. Physicians were less likely to provide an unwanted recommendation, both when physicians agreed (29%) and disagreed with the surrogate's likely decision (44%).ConclusionsThere is substantial variation among physicians' self-reported use of recommendations to surrogates of critically ill adults. Surrogates' desires for recommendations and physicians' agreement with surrogates' likely decisions may have important influence on whether recommendations are provided.

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