When is it Worth Starting a Risky and Uncomfortable Treatment in Critically Ill Patients? Gender, Education and Professional Involvement in Critical Care Impact on the Opinion

Abstract

Background: Health care professionals have to judge the appropriateness of treatment in critical care on a daily basis. While there is general consensus that critical care interventions should not be performed when they are futile, it is unclear in quantitative terms, which chances of survival are considered necessary and which risk for serious disabilities is acceptable for different stakeholder in the process of intensive care treatment. Methods: We performed an anonymous online survey in 1052 people. We considered age, gender, nationality, education, involvement in health care, critical care medicine and treatment decisions as well as personal experience with critical illness as potential influencing variables. On a scale from 0-100%, participants were asked to give their opinion on the necessary survival changes and the acceptable risk for serious disabilities in order to start a high-risk or unpleasant therapy for themselves, relatives and for their patients, if the respondents were health care professionals who are involved in treatment decisions. Results: For all questions, a maximum of individual variations was observed with answers ranging from 0-100% for necessary survival chances and acceptable risk of disability. A three-peak pattern with different distributions of the peaks was observed for all answers. More respondents would choose a lower necessary chance of survival (0-33% survival) when deciding for patients compared to themselves or relatives to start a risky and uncomfortable treatment. On the other hand, the majority of respondents would accept only a low risk of severe disability for both themselves and their patients. Gender, education, being a health care professional, being involved in treatment decisions and religiosity influence these opinions. Male respondents and those with university education accept a lower survival chance for themselves, relatives and patients.Conclusion: Our study shows that people have very diverging views on the necessary chances of survival as well as on the acceptable risks for starting a risky and uncomfortable treatment, close relatives and patients. No general cut-off can be identified for the necessary survival chances or acceptable risk to help to quantify “futility”. Individual communication between health care professionals, patients and relatives in each case seems necessary.