Communication of end-of-life decisions in European intensive care units

Cohen, Simon; Sprung, Charles L.; Sjökvist, Peter; Lippert, Anne; Ricou, Bara; Baras, Mario; Hovilehto, Seppo; Maia, Paulo; Phelan, Dermot; Reinhart, Konrad; Werdan, Karl; Bülow, Hans-Henrik; Woodcock, Tom

doi:10.1007/s00134-005-2742-x

Cited by 152 publications

(114 citation statements)

References 28 publications

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“…[39][40][41][42][43][44] What our study adds is the insight that parents appreciated receiving this detailed information, as evidenced by their reactions and their questions in return. It may be postulated that the provision of relevant information helps parents to grasp what is happening to their child and regain some feeling of control.…”

Section: Discussionmentioning

confidence: 82%

Talking With Parents About End-of-Life Decisions for Their Children

et al. 2015

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Section: Discussionmentioning

confidence: 82%

Talking With Parents About End-of-Life Decisions for Their Children

et al. 2015

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“…A recent French study in competent VOPs reported that only 13% had been asked about their treatment preferences and willingness to be admitted to the ICU prior to ICU admission [37]. Data from the North American SUP-PORT and European Ethicus studies also documented that information about a patient's wishes regarding EOL decisions was available in only 20% of competent patients [38,39]. This was, again, confirmed in more recent studies [40,41], in which only 57% of families were involved in providing information related to EOL decisions in VOPs.…”

Section: Patients' Wishes and Directivesmentioning

confidence: 99%

“…Vice versa, the outcome of non-ICU care must also be known if we want to make the proper comparison. As discussed, there is ample evidence that age is associated with decisions to refuse ICU admission [36][37][38][39]. Yet, there currently is no robust or validated clinical prediction tool that is able to reliably indicate the VOP who will substantially benefit from ICU care.…”

Section: Costs-benefits For Elderly Patientsmentioning

confidence: 99%

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Flaatten¹,

Lange²,

Artigas³

et al. 2017

Intensive Care Med

210

196

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The "very old intensive care patients" (abbreviated to VOPs; greater than 80 years old) are probably the fastest expanding subgroup of all intensive care unit (ICU) patients. Up until recently most ICU physicians have been reluctant to admit these VOPs. The general consensus was that there was little survival to gain and the incremental life expectancy of ICU admission was considered too small. Several publications have questioned this belief, but others have confirmed the poor long-term mortality rates in VOPs. More appropriate triage (resource limitation enforced decisions), admission decisions based on shared decision-making and improved prediction models are also needed for this particular patient group. Here, an expert panel proposes a research agenda for VOPs for the coming years.

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“…(12) Surrogates often lack knowledge of patients' wishes for life support and have poor comprehension of their medical problems. (13,14) Additionally, others have reported potential contributing deficiencies in ICU-based surrogate-physician communication. (12,13,15,16) However, the physician-surrogate interaction has been infrequently described in the unique setting of PMV consideration, in which a patient has survived an acute illness but yet failed to improve sufficiently to be independent of life support.…”

Section: Introductionmentioning

confidence: 99%

Expectations and outcomes of prolonged mechanical ventilation

Cox¹

2010

Critical Care Medicine

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Objective: Prolonged mechanical ventilation (PMV) provision is increasing markedly despite poor patient outcomes. Misunderstanding prognosis in the PMV decision making process could provide an explanation to this phenomenon. Therefore, we aimed to compare PMV decision makers' expectations for long-term patient outcomes with prospectively observed outcomes.Design, Setting, and Patients: 126 patients undergoing PMV, their surrogates, and their intensive care unit physicians were enrolled consecutively (total n=378) at an academic medical center between April 2006 and April 2007 and followed prospectively for one year. Measurements:Participants were interviewed at the time of tracheostomy placement about their expectations for one-year patient survival, functional status, and quality of life. These expectations were then compared to observed one-year outcomes measured with validated questionnaires.Results: One-year follow up was 100%, with the exception of patient death or cognitive inability to complete interviews. At one year, only 11 (9%) patients were alive and independent of major functional status limitations. Most surrogates reported high baseline expectations for one-year patient survival (117 [93%]), functional status (90 [71%]), and quality of life (105 [83%]). In contrast, fewer physicians described high expectations for survival (54 [43%]), functional status (7 [6%]), and quality of life (5 [4%]). Surrogate-physician pair concordance in expectations was poor (all κ<0.08), as was their accuracy in outcome prediction (range 23-44%). Just 33 (26%) surrogates reported that physicians discussed what to expect for patients' likely future survival, general health, and caregiving needs. Conclusions:One-year patient outcomes for PMV patients were significantly worse than expected by patients' surrogates and physicians. Lack of prognostication about outcomes, discordance between

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Communication of end-of-life decisions in European intensive care units

Abstract: ICU patients typically lack decision-making capacity, and physicians know patients' wishes in only 20% of EOL decisions. There were regional differences in discussions of EOL decisions with families and other physicians. In European ICUs there seems to be a need to improve communication.

Cited by 152 publications

References 28 publications

Talking With Parents About End-of-Life Decisions for Their Children

Talking With Parents About End-of-Life Decisions for Their Children

The status of intensive care medicine research and a future agenda for very old patients in the ICU

Expectations and outcomes of prolonged mechanical ventilation

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