Discrepancies Among Physicians Regarding Knowledge, Attitudes, and Practices in End-of-Life Care

Physicians often dominate end-of-life decisions, and findings vary on their personal and patient advance directive decisions. Little is known about the relationships among physician spirituality, expectations for patient survival and quality of life, and treatment intensity. A survey design examined the knowledge, attitudes, and decision-making practices of 187 physicians in Northeast Texas. Race, sex, specialty, age group, and spirituality did not differ among physicians with and without advance directive, nor were there significant relationships among spirituality, intensity of the treatment of a terminal patient, and age. Significant relationships were found between expectations for survival and the intensity of the treatment of the terminally ill patient and between expectations for meaningful patient life in 6 months and treatment intensity. Forty-one percent worried about the legal consequences with advance directives. Most (66%) viewed morphine as appropriate even if it hastened death, 41% viewed tube feedings as heroic, and 21% viewed physician-assisted suicide as acceptable for terminally ill patients in extreme pain or distress. Hope for the survival and quality of life of terminally ill patients was common. Nursing implications are derived from awareness of physician perspectives and in facilitating patient autonomy, dignity, and respect for individual wishes at end of life.