Ann C Long1,2, Lyndia C Brumback2,3, J Randall Curtis1,2, Alexander Avidan4, Mario Baras5, Edoardo De Robertis6, Linda Efferen7, Ruth A Engelberg1,2, Erin K Kross1,2, Andrej Michalsen8, Richard A Mularski9, Charles L Sprung4. 1. Harborview Medical Center, Division of Pulmonary, Critical Care and Sleep. 2. Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA. 3. Department of Biostatistics, University of Washington, Seattle, WA. 4. Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel. 5. The Hebrew University, Hadassah School of Public Health, Jerusalem, Israel. 6. Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy. 7. Office of Population Health, Clinical Medicine, Stony Brook Medicine, Hauppauge, NY. 8. Department of Anesthesiology and Critical Care, Tettnang Hospital, Tettnang, Germany. 9. Kaiser Permanente, The Center for Health Research, Portland, OR.
Abstract
OBJECTIVES: To develop an enhanced understanding of factors that influence providers' views about end-of-life care, we examined the contributions of provider, hospital, and country to variability in agreement with consensus statements about end-of-life care. DESIGN AND SETTING: Data were drawn from a survey of providers' views on principles of end-of-life care obtained during the consensus process for the Worldwide End-of-Life Practice for Patients in ICUs study. SUBJECTS: Participants in Worldwide End-of-Life Practice for Patients in ICUs included physicians, nurses, and other providers. Our sample included 1,068 providers from 178 hospitals and 31 countries. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We examined views on cardiopulmonary resuscitation and withholding/withdrawing life-sustaining treatments, using a three-level linear mixed model of responses from providers within hospitals within countries. Of 1,068 providers from 178 hospitals and 31 countries, 1% strongly disagreed, 7% disagreed, 11% were neutral, 44% agreed, and 36% strongly agreed with declining to offer cardiopulmonary resuscitation when not indicated. Of the total variability in those responses, 98%, 0%, and 2% were explained by differences among providers, hospitals, and countries, respectively. After accounting for provider characteristics and hospital size, the variance partition was similar. Results were similar for withholding/withdrawing life-sustaining treatments. CONCLUSIONS: Variability in agreement with consensus statements about end-of-life care is related primarily to differences among providers. Acknowledging the primary source of variability may facilitate efforts to achieve consensus and improve decision-making for critically ill patients and their family members at the end of life.
OBJECTIVES: To develop an enhanced understanding of factors that influence providers' views about end-of-life care, we examined the contributions of provider, hospital, and country to variability in agreement with consensus statements about end-of-life care. DESIGN AND SETTING: Data were drawn from a survey of providers' views on principles of end-of-life care obtained during the consensus process for the Worldwide End-of-Life Practice for Patients in ICUs study. SUBJECTS:Participants in Worldwide End-of-Life Practice for Patients in ICUs included physicians, nurses, and other providers. Our sample included 1,068 providers from 178 hospitals and 31 countries. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We examined views on cardiopulmonary resuscitation and withholding/withdrawing life-sustaining treatments, using a three-level linear mixed model of responses from providers within hospitals within countries. Of 1,068 providers from 178 hospitals and 31 countries, 1% strongly disagreed, 7% disagreed, 11% were neutral, 44% agreed, and 36% strongly agreed with declining to offer cardiopulmonary resuscitation when not indicated. Of the total variability in those responses, 98%, 0%, and 2% were explained by differences among providers, hospitals, and countries, respectively. After accounting for provider characteristics and hospital size, the variance partition was similar. Results were similar for withholding/withdrawing life-sustaining treatments. CONCLUSIONS: Variability in agreement with consensus statements about end-of-life care is related primarily to differences among providers. Acknowledging the primary source of variability may facilitate efforts to achieve consensus and improve decision-making for critically illpatients and their family members at the end of life.
Authors: Timur Sellmann; Muhammad Abu Alneaj; Dietmar Wetzchewald; Heidrun Schwager; Christian Burisch; Serge C Thal; Tienush Rassaf; Manfred Weiss; Stephan Marsch; Frank Breuckmann Journal: BMC Anesthesiol Date: 2022-05-18 Impact factor: 2.376
Authors: Spyros D Mentzelopoulos; Keith Couper; Patrick Van de Voorde; Patrick Druwé; Marieke Blom; Gavin D Perkins; Ileana Lulic; Jana Djakow; Violetta Raffay; Gisela Lilja; Leo Bossaert Journal: Notf Rett Med Date: 2021-06-02 Impact factor: 0.826
Authors: Michael E Wilson; Aniket Mittal; Bibek Karki; Claudia C Dobler; Abdul Wahab; J Randall Curtis; Patricia J Erwin; Abdul M Majzoub; Victor M Montori; Ognjen Gajic; M Hassan Murad Journal: Intensive Care Med Date: 2019-10-28 Impact factor: 41.787