Variability in the pediatric intensivists' threshold for withdrawal/limitation of life support as perceived by bedside nurses: a multicenter survey study

BACKGROUND We hypothesized that bedside nurses perceive significant variability in the pediatric intensivist thresholds for approaching a family about withdrawal/limitation of life-sustaining therapy. METHODS All nurses working in four university-affiliated medical-surgical pediatric intensive care units staffed by 11, 7, 6, and 5 intensivists with 36, 18, 10, and 8 beds were sent three mailings of a survey asking questions about intensivist decisions for withdrawal/limitation of life-sustaining therapy. Responses were tabulated; chi-square compared results among centers; a p < 0.05 after Bonferroni correction was significant. RESULTS The response rate was 205 of 415 (49%); 152 of 205 (74%) disagreed with the statement that each of the intensivists had the same threshold for approaching a family to suggest withdrawal/limitation of life-sustaining therapy, with no significant difference between centers. Also, 110 of 205 (54%) and 119 of 205 (58%) disagreed with the statement that each intensivist has the same threshold of the patient's chance for survival or projected quality of life when making a decision to withdraw/limit life-sustaining therapy with no significant difference between centers. The threshold to suggest withdraw/limit life-sustaining therapy based on chance of survival or projected quality of life differs between intensivists by at least 10% according to 113 of 184 (61%) and 121 of 184 (66%) nurses; the two larger centers had significantly higher difference among intensivists for projected quality of life. Fifty-five of 200 (27%) disagreed with the statement that they would have equal confidence in each intensivist accepting a recommendation for withdrawal/limitation of life-sustaining therapy for their own child, with no difference between centers. CONCLUSIONS Bedside pediatric intensive care unit nurses in this multicenter Canadian study perceive wide variability in intensivist thresholds for approaching a family to suggest withdrawal/limitation of life-sustaining therapy.