Life-sustaining treatment preferences at end of life: a comparison between ICU and non-ICU hospital professionals

We compared personal end-of-life preferences for life-sustaining treatments (LST) between intensive care unit (ICU) caregivers and other hospital professionals. In a cross-sectional survey of 743 French hospital professionals (ICU caregivers, n = 195; non-ICU caregivers, n = 349; non-clinical hospital professionals, n = 199), participants responded to nine validated clinical scenarios varying in mortality risk and long-term consequences, choosing whether to continue or withdraw LST for themselves and what they perceived as the collegial decision for a patient. Multivariate logistic regression and decision-pattern analyses were performed. Only 13.3% of ICU caregivers had written advance directives despite universal awareness. Long-term consequences influenced decisions more than mortality risk in all groups, particularly ICU caregivers. After adjustment, ICU caregivers were more likely than other professionals to withdraw LST in scenario 1 (prolonged hospitalisation and burden on others) and less likely in scenario 5 (high mortality risk). They also showed less rigid, more context-dependent decision-making. In seven of nine scenarios, ICU caregivers would withdraw LST for themselves more often than they perceived was done collegially for patients. These distinct preferences, with functional dependence outweighing mortality risk, raise questions about the influence of professional culture on clinical judgment and the need to align treatment decisions with patient values.