Critical Care volume 24 , Article number: Cite this article. Metrics details. There is wide variability between intensivists in the decisions to forgo life-sustaining treatment DFLST. Advance directives ADs allow patients to communicate their end-of-life wishes to physicians. We conducted a multicenter, prospective, simulation study. A total of 19, decisions made by intensivists from 27 ICUs were analyzed. A qualitative analysis of ADs showed focus on end-of-life wills, unwanted things and fear of pain.
Trial registration ClinicalTrials. The DFLST includes decisions about no-escalation or withholding or withdrawal of treatment that lead to differences in mortality [ 2 ].
These decisions are made by the patient, the physician or close relatives, or result from a shared decision-making process. However, there are numerous limitations to this process. When making a DFLST, physicians are greatly influenced by their personal characteristics including religion and culture [ 7 , 8 ], which results in considerable variability in their decisions [ 7 , 9 ].
This variability is constant within the same specialty or structure [ 10 , 11 , 12 , 13 , 14 ]. Patients want physicians to follow their wishes [ 15 ], but most ICU patients are not able to properly communicate these wishes because they lack decision-making capacity.
Advance directives ADs give incapacitated patients the opportunity to indicate what treatment they wish to have [ 16 ]. However, there is no discussion between the patient and the physician to explain the wishes expressed in ADs. We conducted a multicenter, prospective, simulation study, in France from September to March A consent form was collected from all participants patients and intensivists after they had been informed orally and received a written information form.
