Nurse and Physician Preferences for End-of-Life Care for Trauma Patients

Background: End-of-life care for trauma patients requires unique practice guidelines because it is fraught with difficulties not encountered in end-of-life care for terminally ill patients. The purpose of this project was to analyze survey information from nurses and physicians regarding preferences for end-of-life care in trauma that would inform best-practice guidelines. Methods: A survey was sent via the US Postal Service to a convenience sample of trauma professionals, including physicians, nurses, and emergency medical technicians. Questions were designed to provide information on difficult issues related to death and dying from trauma. The general public was also surveyed, and all results were used to develop a best-practice model for end-of-life care. Results: Seven hundred seventy-four trauma professionals returned the survey for a response rate of 51%. This included 460 nurses and 181 physicians. Some salient findings include: (1) If a loved one required resuscitation in the emergency department, more nurses (78.4%) than physicians (38.7%) prefer to be in the treatment room rather than in the waiting room; (2) similar percentages of nurses (97.7%) and physicians (99.4%) agree that life-sustaining treatment should be withdrawn in cases in whom there is no hope of recovery; and (3) a larger percentage of nurses (58.8%) than physicians (20.6%) believe that patients have the right to demand care that physicians think is medically futile. Conclusions: Nurses and physicians agree on some issues about end-of-life care in trauma but disagree on others. Education and discourse among trauma professionals are needed to bring understanding to the issues.