BACKGROUND: Health care providers' perceptions regarding appropriateness in end-of-life treatments have been widely studied. While nurses and physicians believe that rationing and other cost-related practices sometimes occur in the intensive care unit (ICU), they allege that treatment is often excessive. OBJECTIVE: To prospectively determine the incidence and causes of health care providers' perceptions regarding appropriateness of end-of-life treatments. METHODS: The present prospective study collected data from patients admitted to the medical-surgical trauma ICU of a 30-bed, Canadian teaching hospital over a three-month period. Daily surveys were completed independently by bedside nurses, charge nurses and attending physician. RESULTS: In total, 5224 of 6558 expected surveys (representing 294 patients) were analyzed, yielding a response rate of 79.7%. The incidence of perceived inappropriate care in the present study was 6.5% (19 of 294 patients), with ongoing treatment for >2 days after this determination occurring in 1% (three of 294 patients). However, at least one caregiver perceived inappropriate care at some point in 110 of 294 (37.5%) patients. In these cases, in which processes to address care were not already underway, respondents believed that important issues resulting in provision of inappropriate treatments included patient-family issues and communication before or in the ICU. Caregivers did not know their patients' wishes 22% (1129 of 5224) of the time. CONCLUSIONS: Although ongoing inappropriate care appeared to be a rare occurrence, the issue was a concern to at least one caregiver in one-third of cases. Public awareness for end-of-life issues, adequate communication, and up-to-date knowledge and practice in determining the wishes of critically ill patients are potential target areas to improve end-of-life care and reduce inappropriate care in the ICU. A daily, prospective survey of multidisciplinary caregivers, such as the survey used in the present study, is a viable and valuable means of determining the scope and causes of inappropriate care in the ICU.
BACKGROUND: Health care providers' perceptions regarding appropriateness in end-of-life treatments have been widely studied. While nurses and physicians believe that rationing and other cost-related practices sometimes occur in the intensive care unit (ICU), they allege that treatment is often excessive. OBJECTIVE: To prospectively determine the incidence and causes of health care providers' perceptions regarding appropriateness of end-of-life treatments. METHODS: The present prospective study collected data from patients admitted to the medical-surgical trauma ICU of a 30-bed, Canadian teaching hospital over a three-month period. Daily surveys were completed independently by bedside nurses, charge nurses and attending physician. RESULTS: In total, 5224 of 6558 expected surveys (representing 294 patients) were analyzed, yielding a response rate of 79.7%. The incidence of perceived inappropriate care in the present study was 6.5% (19 of 294 patients), with ongoing treatment for >2 days after this determination occurring in 1% (three of 294 patients). However, at least one caregiver perceived inappropriate care at some point in 110 of 294 (37.5%) patients. In these cases, in which processes to address care were not already underway, respondents believed that important issues resulting in provision of inappropriate treatments included patient-family issues and communication before or in the ICU. Caregivers did not know their patients' wishes 22% (1129 of 5224) of the time. CONCLUSIONS: Although ongoing inappropriate care appeared to be a rare occurrence, the issue was a concern to at least one caregiver in one-third of cases. Public awareness for end-of-life issues, adequate communication, and up-to-date knowledge and practice in determining the wishes of critically illpatients are potential target areas to improve end-of-life care and reduce inappropriate care in the ICU. A daily, prospective survey of multidisciplinary caregivers, such as the survey used in the present study, is a viable and valuable means of determining the scope and causes of inappropriate care in the ICU.
Authors: J P Quenot; J P Rigaud; S Prin; S Barbar; A Pavon; M Hamet; N Jacquiot; B Blettery; C Hervé; P E Charles; G Moutel Journal: Intensive Care Med Date: 2011-11-30 Impact factor: 17.440
Authors: Karen E A Burns; Mark Duffett; Michelle E Kho; Maureen O Meade; Neill K J Adhikari; Tasnim Sinuff; Deborah J Cook Journal: CMAJ Date: 2008-07-29 Impact factor: 8.262
Authors: Christiane S Hartog; F Hoffmann; A Mikolajetz; S Schröder; A Michalsen; K Dey; R Riessen; U Jaschinski; M Weiss; M Ragaller; S Bercker; J Briegel; C Spies; D Schwarzkopf Journal: Anaesthesist Date: 2018-09-12 Impact factor: 1.041
Authors: D D Benoit; H I Jensen; J Malmgren; V Metaxa; A K Reyners; M Darmon; K Rusinova; D Talmor; A P Meert; L Cancelliere; L Zubek; P Maia; A Michalsen; S Vanheule; E J O Kompanje; J Decruyenaere; S Vandenberghe; S Vansteelandt; B Gadeyne; B Van den Bulcke; E Azoulay; R D Piers Journal: Intensive Care Med Date: 2018-05-28 Impact factor: 17.440