Medical Professionals' Treatment Decisions for Critical Patients With Ambiguous Treatment Wishes: A Cross-Sectional Study.

Background and Aims: Many patients do not want life-prolonging treatments at critical stages of their illnesses, and are able to communicate their wishes to their families or surrogates. However, few among them have clarity on what such life-prolonging treatments mean or entail. This study clarifies differences in the perspectives of medical professionals based on levels of expertise with respect to treatment decisions for intensive care unit (ICU) patients whose wishes for end-of-life care are ambiguous. Methods: The cross-sectional study included intensivists, surgeons, and ICU nurses working in 171 Japanese hospitals with ICUs. A total of 837 participants were mailed questionnaires which included questions on the current status and approaches to decision-making with end-of-life care for ICU patients. Additionally, a simulated case study was conducted to investigate the decision-making process for treating patients with uncertain survival rates. Results: Responses were obtained from 489 participants from 151 hospitals. More than half of the intensivists and ICU nurses reported that family members' requests were respected when the patient had ambiguous treatment preferences. Participants considered the patients' survival probability when deciding to perform emergency surgery, with nurses having significantly higher thresholds than intensivists and surgeons (intensivists: 20.8 ± 20.6, surgeons: 26.6 ± 25.2, ICU nurses: 36.4 ± 26.4; Conclusions: Family preferences take precedence over patient preferences when deciding on end-of-life treatments for ICU patients. Shared decision-making should be promoted to correctly share patients' end-of-life medical wishes with surrogate decision-makers and medical practitioners.