Most trauma professionals and members of the general public say they would prefer palliative care following a severe injury if physicians determined aggressive critical care would not save their lives, according to a report in the August issue of Archives of Surgery, one of the JAMA/Archives journals. However, trauma care professionals and other individuals differ in their opinions regarding patients' rights to demand care and the role of divine intervention in recovery from an injury.
Trauma has been the third or fourth leading cause of death in the United States for the past 17 years, according to background information in the article. "Trauma poses unique issues to clinicians," the authors write. "Victims are unknown to them prior to the injury event and the clinicians frequently need to make rapid life and death decisions with little time to determine victims' values and preferences for care."
Lenworth M. Jacobs, M.D., M.P.H., of Hartford Hospital, Hartford, and the University of Connecticut School of Medicine, Farmington, and colleagues analyzed the results of two surveys conducted in 2005. One was a telephone survey of 1,006 members of the general public age 18 and older, and the other was a written survey mailed to medical directors at trauma centers, trauma nurses and emergency medical services personnel.
The researchers found that:
Similar percentages of the general public (46.2 percent) and trauma professionals (47.4 percent) had received emergency medical care in the past 10 years
- 51.9 percent of the public and 62.7 percent of the professionals would prefer to be in the emergency department treatment area while an injured loved one was resuscitated
- Most of the public (72.4 percent) and less than half (44.3 percent) of the professionals believe trauma patients have a right to demand care not ordered by a physician; however, most of both groups trust a physician's decision to withdraw treatment when it would be futile
- Professionals were more likely to be organ donors than the general public (78.9 percent vs. 50.6 percent), and slightly more professionals report having a living will (40.4 percent vs. 35.7 percent)
- Religious beliefs would be important to 41 percent of the public and 30.6 percent of the professionals when making decisions about their own medical care; more of the public (61.3 percent) than the professionals (20.2 percent) believe that a person in a persistent vegetative state could be saved by a miracle or that divine intervention could save a person when physicians believe treatment is futile (57.4 percent vs. 19.5 percent)
"The findings of the surveys pose challenges for trauma professionals, hospital administrators, insurers and society as a whole," the authors conclude. "Issues need to be discussed in the clinical and public arenas and within the curricula of health professional education. Rich and sensitive dialogue is needed so that all dying trauma patients and their families receive quality end-of-life care."
(Arch Surg. 2008;143:730-735. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: The survey of the public was supported by funds from the Aetna Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.