• P Sjokvist, L Berggren, and D J Cook.
• Department of Anesthesia and Intensive Care, Orebro Medical Center Hospital, Sweden.
• Acta Anaesthesiol Scand. 1999 Feb 1;43(2):167-72.

BackgroundWithdrawal or withholding of life-sustaining treatment have become accepted clinical practice within the intensive care unit (ICU). One important factor influencing these decisions is the attitudes of physicians and nurses.MethodQuestionnaire survey of physicians and nurses in ICUs in 12 Swedish university-affiliated and/or tertiary referral hospitals.ResultsThe response rate was 850 of 1081 (79%) potentially eligible health care workers. Respondents first rated the importance of 16 factors considered in the decision to withdraw life support. The most important factors were the patient's likelihood of surviving the current episode, patient advance directives, patient age and likelihood of long-time survival. Respondents also chose between five levels of care, ranging from comfort measures to full intensive care, in two of 12 different scenarios. Respondent characteristics affecting the level of care chosen were the number of years of ICU experience and the particular ICU in which the respondent worked.ConclusionAdvance directives are believed by Swedish intensive care personnel to be very important in the decision to withdraw life support, contrary to several descriptive studies suggesting modest patient and family influence on these decisions. Attitudes towards the intensity of care vary between different centers, raising the possibility that levels of care for similar patients may differ across the country.

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