443 The Shadowy Boundary Between Life and Death: How Physicians Manage Non-Survivable Head Trauma

INTRODUCTION: Caring for patients with a terminal prognosis after a non-survivable head injury is fraught with ethical and moral challenges. METHODS: A web-based, 25-question survey was distributed to fifty academic hospitals. Conventional descriptive statistics and inferential analyses were employed. RESULTS: 133 physicians completed the survey (29% neurosurgery, 25% trauma surgery, 45% critical care). Medical literacy (25%), patient religious/moral views (23%) and trust (17%) were identified as the most significant communication barriers. When broadly asked what outside forces influenced what interventions were offered, physicians cited organ procurement organizations (OPO; 12%) and medical malpractice concerns (10%). Critical care physicians (73.3%) and trauma surgeons (73.5%) were more likely to provide further life-prolonging care to patients with an unknown organ donor status than neurosurgeons (48.7%, p value = 0.023). However, no significant difference was observed between specialties when considering non-organ donors (neurosurgery = 61.5%, critical care = 50%, trauma surgery = 58.5%, p value = 0.481). Physicians reported that disclosing non-survivability to families (43%) and providing futile care (61%) were detrimental to their own mental health. However, 60% percent of respondents felt fulfilled by caring for patients and families after this type of injury. CONCLUSIONS: Overall, our findings show variation in how physicians manage patients after non-survivable head trauma. Clear guidelines delineating reasonable and futile interventions would allow for standardization of care and opportunity for organ donation where appropriate. Additionally, this study revealed a potential impact of non-medical influences such as organ-procurement organizations and medicolegal fears when determining interventions offered. While this study shows that the burden of communicating with families and providing futile medical care takes a toll on mental health to providers, many clinicians continue to derive meaning from their role in the care of these patients.