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The impact of country and culture on end-of-life care for injured patients: results from an international survey.

Publication ,  Journal Article
Ball, CG; Navsaria, P; Kirkpatrick, AW; Vercler, C; Dixon, E; Zink, J; Laupland, KB; Lowe, M; Salomone, JP; Dente, CJ; Wyrzykowski, AD ...
Published in: J Trauma
December 2010

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 (<30%). End-of-life decision making for patients with traumatic brain injuries varied extensively across regions with regard to the impact of patient age, Glasgow Coma Scale score, and clinician philosophy. Similar differences were observed for spinal cord injuries (age and functional level). The availability and use of "donation after cardiac death" also varied substantially between countries. CONCLUSIONS: In this unique study, geographic differences in religion, practice composition, decision-maker viewpoint, and institutional resources resulted in significant variation in end-of-life care after injury. These disparities reflect competing concepts (patient autonomy, distributive justice, and religion).

Duke Scholars

Published In

J Trauma

DOI

EISSN

1529-8809

Publication Date

December 2010

Volume

69

Issue

6

Start / End Page

1323 / 1333

Location

United States

Related Subject Headings

  • United States
  • Tissue and Organ Procurement
  • Terminal Care
  • Surveys and Questionnaires
  • South Africa
  • Religion
  • Physician-Patient Relations
  • Medical Futility
  • Intensive Care Units
  • Humans
 

Citation

APA
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Ball, C. G., Navsaria, P., Kirkpatrick, A. W., Vercler, C., Dixon, E., Zink, J., … Feliciano, D. V. (2010). The impact of country and culture on end-of-life care for injured patients: results from an international survey. J Trauma, 69(6), 1323–1333. https://doi.org/10.1097/TA.0b013e3181f66878
Ball, Chad G., Pradeep Navsaria, Andrew W. Kirkpatrick, Christian Vercler, Elijah Dixon, John Zink, Kevin B. Laupland, et al. “The impact of country and culture on end-of-life care for injured patients: results from an international survey.J Trauma 69, no. 6 (December 2010): 1323–33. https://doi.org/10.1097/TA.0b013e3181f66878.
Ball CG, Navsaria P, Kirkpatrick AW, Vercler C, Dixon E, Zink J, et al. The impact of country and culture on end-of-life care for injured patients: results from an international survey. J Trauma. 2010 Dec;69(6):1323–33.
Ball, Chad G., et al. “The impact of country and culture on end-of-life care for injured patients: results from an international survey.J Trauma, vol. 69, no. 6, Dec. 2010, pp. 1323–33. Pubmed, doi:10.1097/TA.0b013e3181f66878.
Ball CG, Navsaria P, Kirkpatrick AW, Vercler C, Dixon E, Zink J, Laupland KB, Lowe M, Salomone JP, Dente CJ, Wyrzykowski AD, Hameed SM, Widder S, Inaba K, Ball JE, Rozycki GS, Montgomery SP, Hayward T, Feliciano DV. The impact of country and culture on end-of-life care for injured patients: results from an international survey. J Trauma. 2010 Dec;69(6):1323–1333.

Published In

J Trauma

DOI

EISSN

1529-8809

Publication Date

December 2010

Volume

69

Issue

6

Start / End Page

1323 / 1333

Location

United States

Related Subject Headings

  • United States
  • Tissue and Organ Procurement
  • Terminal Care
  • Surveys and Questionnaires
  • South Africa
  • Religion
  • Physician-Patient Relations
  • Medical Futility
  • Intensive Care Units
  • Humans