A comparison of patient, family, and physician assessments of the value of medical intensive care.

Medical ethics suggest that physicians incorporate patient preferences when making life-sustaining treatment decisions. This study therefore examines how closely physicians' assessments of the usefulness of intensive care agree with their patients' willingness to receive intensive care. Former intensive care patients, at least 55 yr old (or family members of nonsurviving patients), and their physicians were interviewed (n = 76 pairs of interviews) to determine how valuable each believe intensive care would be to the patient (on a scale of 0 to 100%) under actual and ideal life circumstances. Little correlation was found between individual patient or family member and physician responses (Kendall's Tau ranged from -.14 to .22 depending on how long life was prolonged). Physicians' evaluations of intensive care for patients under ideal life circumstances were strongly correlated with physicians' personal preferences for intensive care (Kendall's Tau, .41 to .65, p less than .02). Because physicians and patients may not agree regarding the value of intensive care, physicians must explicitly discuss patients' preferences in order to reconcile wishes and justifiable needs for critical care.