TY - JOUR
T1 - The prevalence of perceptions of mismatch between treatment intensity and achievable goals of care in the intensive care unit
T2 - a cross-sectional study
AU - Anstey, Matthew H.
AU - Litton, Edward
AU - Trevenen, Michelle L.
AU - Thompson, Kelly
AU - Webb, Steve
AU - Seppelt, Ian
AU - Mitchell, Imogen A.
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Purpose: To describe the prevalence of perceptions of patients receiving a mismatch in treatment intensity, as perceived by intensive care unit (ICU) healthcare providers, and to assess the congruence of perceptions between providers. Methods: In this cross-sectional, observational study conducted in 21 ICUs in Australia and New Zealand, patient prevalence data was linked to an ICU staff survey to describe the extent to which patient treatment intensity was matched to the perceived prognosis and patient wishes. Results: Of the 307 study patients, 62 (20.2%) were reported to be receiving a mismatch in treatment intensity by at least one ICU healthcare professional. For reported mismatch, there was consensus amongst staff members for 52/62 (84%) of patients. Patients were significantly more likely to receive mismatched treatments if they were more severely unwell (APACHE II score > 20 vs. ≤ 20), odds ratio OR 2.35, 95% confidence interval (CI) 1.63–3.37, p < 0.0001, if they were an emergency admission (OR 3.05, CI 1.18–7.89, p = 0.0212) or if they had an advance care directive (OR 3.68, 95% CI 1.66–8.16, p = 0.0013). Conclusions: Being more severely unwell, being an emergency admission or having an advance care directive made patients more likely to be perceived as having a mismatch between the intensity of treatments provided and either the achievable goals of care, expected prognosis or patient’s wishes.
AB - Purpose: To describe the prevalence of perceptions of patients receiving a mismatch in treatment intensity, as perceived by intensive care unit (ICU) healthcare providers, and to assess the congruence of perceptions between providers. Methods: In this cross-sectional, observational study conducted in 21 ICUs in Australia and New Zealand, patient prevalence data was linked to an ICU staff survey to describe the extent to which patient treatment intensity was matched to the perceived prognosis and patient wishes. Results: Of the 307 study patients, 62 (20.2%) were reported to be receiving a mismatch in treatment intensity by at least one ICU healthcare professional. For reported mismatch, there was consensus amongst staff members for 52/62 (84%) of patients. Patients were significantly more likely to receive mismatched treatments if they were more severely unwell (APACHE II score > 20 vs. ≤ 20), odds ratio OR 2.35, 95% confidence interval (CI) 1.63–3.37, p < 0.0001, if they were an emergency admission (OR 3.05, CI 1.18–7.89, p = 0.0212) or if they had an advance care directive (OR 3.68, 95% CI 1.66–8.16, p = 0.0013). Conclusions: Being more severely unwell, being an emergency admission or having an advance care directive made patients more likely to be perceived as having a mismatch between the intensity of treatments provided and either the achievable goals of care, expected prognosis or patient’s wishes.
KW - Decision-making
KW - Patient outcomes
KW - Treatment intensity
UR - http://www.scopus.com/inward/record.url?scp=85061184710&partnerID=8YFLogxK
U2 - 10.1007/s00134-019-05543-y
DO - 10.1007/s00134-019-05543-y
M3 - Article
SN - 0342-4642
VL - 45
SP - 459
EP - 467
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 4
ER -