The Impact of Country and Culture on End-of-Life Care for Injured Patients: Results From an International Survey

BACKGROUND:Up to 20% of all trauma patients admitted to an intensive care unit die from their injuries. End-of-life decision making is a variable process that involves prognosis, predicted functional outcomes, personal beliefs, institutional resources, societal norms, and clinician experience. The goal of this study was to better understand end-of-life processes after major injury by comparing clinician viewpoints from various countries and cultures. METHODS:A clinician-based, 38-question international survey was used to characterize the impacts of medical, religious, social, and system factors on end-of-life care after trauma. RESULTS:A total of 419 clinicians from the United States (49%), Canada (19%), South Africa (11%), Europe (9%), Asia (8%), and Australasia (4%) completed the survey. In America, the admitting surgeon guided most end-of-life decisions (51%), when compared with all other countries (0–27%). The practice structure of American respondents also varied from other regions. Formal medical futility laws are rarely available (14–38%). Ethical consultation services are often accessible (29–98%), but rarely used (0–29%), and typically unhelpful (