BACKGROUND: The Case Management Conference (CMC) is a multi-disciplinary meeting that is widely used to achieve consensus about treatment (including end-of-life) decisions in complex, critically ill patients. However, little is known about the attitudes of health care providers and patients toward using CMC to make end-of-life treatment decisions, and about their perceptions concerning whether the process works well.

AIMS/METHODS: We therefore surveyed 26 physicians and 163 nurses at the tertiary level NICU at Children's & Women's (C&W) Health Centre of B.C. in December 1996, for their attitudes and perceptions about the use of CMC as a decision making process for withdrawing/witholding active treatment in the NICU. As part of another study, we also surveyed parents of 26 C&W NICU patients who had CMCs held in 1997.

RESULTS: Most nurses (55%) but few physicians (12%) believed that no infant should have treatment withdrawn/witheld without a CMC (p<0.05). Nurses and physicians also differed about whether CMCs were usually held too late (84% vs 38%), and about whether decisions to withdraw/withold active treatment were generally handled in a consistent manner (12% vs 23%)(p<0.05). Only 17% of physicians and 17% of nurses believed that parents should be present at a CMC, compared to 38% of parents. While 36% of parents did not think that parents have the right to withold active treatment if the infant has a high risk of severe handicap, only 4% of health care providers agreed with this.

CONCLUSIONS: Nurses, physicians and parents differ in attitudes and perceptions about the use of CMC as a decision making process for withdrawing/witholding active treatment in the NICU. These differences have important implications for end-of-life treatment decision making and demonstrate a need for review and improvement of the CMC as a process for this purpose.