To Intubate or Not to Intubate: Emergency Medicine Physicians' Perspective on Intubating Critically Ill, Terminal Cancer Patients.

Abstract

Emergency physicians (EPs) often need to make a decision whether or not to intubate a terminal cancer patient. The objective of this study was to explore EPs' attitudes about intubating critically ill, terminal cancer patients. Fifty EPs at three emergency departments (one university based, one community, and one Health Maintenance Organization) in Southern California participated in an anonymous survey that presented a hypothetical case of an end-stage lung cancer patient in pending respiratory failure. Fourteen questions along a five-point Likert scale asked EPs about prognosis and factors that influence their decision to intubate or not. A convenience sampling of 50 EPs yielded a 100% survey response rate. Ninety-four percent believed intubation would not provide an overall survival benefit. If the family insisted, 26% would intubate the patient even with a do-not-intubate (DNI) status. Ninety-four percent would postpone intubation if palliative consultation were available in the ED. Sixty-eight percent believed that a discussion about goals of care was more time consuming than intubation. Only 16% believed they had sufficient training in palliative care. Although 29% who felt they had inadequate palliative care training would intubate the patient with a DNI, only 13% of EPs with self-perceived adequate palliative care training would intubate that patient. EPs vary in their attitudes about intubating dying cancer patients when families demanded it, even when they believed it was nonbeneficial and against the patient's wishes. Palliative care education has the potential to influence that decision making. Intubation could be mitigated by the availability of palliative consultation in the ED.