Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians

Michael E. Wilson; Claudia C. Dobler; Laszlo Zubek; Ognjen Gajic; Daniel Talmor; J. Randall Curtis; Richard F. Hinds; Valerie M. Banner-Goodspeed; Ariel Mueller; Dee M. Rickett; Gabor Elo; Mario Filipe; Orsolya Szucs; Paul J. Novotny; Ruth D. Piers; Dominique D. Benoit

doi:10.1016/j.chest.2019.02.404

Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians

Michael E. Wilson, Claudia C. Dobler, Laszlo Zubek, Ognjen Gajic, Daniel Talmor, J. Randall Curtis, Richard F. Hinds, Valerie M. Banner-Goodspeed, Ariel Mueller, Dee M. Rickett, Gabor Elo, Mario Filipe, Orsolya Szucs, Paul J. Novotny, Ruth D. Piers, Dominique D. Benoit

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Background: ICU patients/surrogates may experience adverse outcomes related to perceived inappropriate treatment. The objective was to determine the prevalence of patient/surrogate-reported perceived inappropriate treatment, its impact on adverse outcomes, and discordance with clinicians. Methods: We conducted a multicenter, prospective, observational study of adult ICU patients. Results: For 151 patients, 1,332 patient, surrogate, nurse, and physician surveys were collected. Disagreement between patients/surrogates and clinicians regarding “too much” treatment being administered occurred in 26% of patients. Disagreement regarding “too little” treatment occurred in 10% of patients. Disagreement about perceived inappropriate treatment was associated with prognostic discordance (P = .02) and lower patient/surrogate satisfaction (Likert scale 1-5 of 4 vs 5; P = .02). Patient/surrogate respondents reported “too much” treatment in 8% of patients and “too little” treatment in 6% of patients. Perceived inappropriate treatment was associated with moderate or high respondent distress for 55% of patient/surrogate respondents and 35% of physician/nurse respondents (P = .30). Patient/surrogate perception of inappropriate treatment was associated with lower satisfaction (Family Satisfaction in the ICU Questionnaire-24, 69.9 vs 86.6; P = .002) and lower trust in the clinical team (Likert scale 1-5 of 4 vs 5; P = .007), but no statistically significant differences in depression (Patient Health Questionnaire-2 of 2 vs 1; P = .06) or anxiety (Generalized Anxiety Disorder-7 Scale of 7 vs 4; P = .18). Conclusions: For approximately one-third of ICU patients, there is disagreement between clinicians and patients/surrogates about the appropriateness of treatment. Disagreement about appropriateness of treatment was associated with prognostic discordance and lower patient/surrogate satisfaction. Patients/surrogates who reported inappropriate treatment also reported lower satisfaction and trust in the ICU team.

Original language	English (US)
Pages (from-to)	1140-1147
Number of pages	8
Journal	Chest
Volume	155
Issue number	6
DOIs	https://doi.org/10.1016/j.chest.2019.02.404
State	Published - Jun 2019

Keywords

ICU
decision making
futility
professional-family relations

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine

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10.1016/j.chest.2019.02.404

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Wilson, M. E., Dobler, C. C., Zubek, L., Gajic, O., Talmor, D., Curtis, J. R., Hinds, R. F., Banner-Goodspeed, V. M., Mueller, A., Rickett, D. M., Elo, G., Filipe, M., Szucs, O., Novotny, P. J., Piers, R. D., & Benoit, D. D. (2019). Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians. Chest, 155(6), 1140-1147. https://doi.org/10.1016/j.chest.2019.02.404

Wilson, ME, Dobler, CC, Zubek, L, Gajic, O, Talmor, D, Curtis, JR, Hinds, RF, Banner-Goodspeed, VM, Mueller, A, Rickett, DM, Elo, G, Filipe, M, Szucs, O, Novotny, PJ, Piers, RD & Benoit, DD 2019, 'Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians', Chest, vol. 155, no. 6, pp. 1140-1147. https://doi.org/10.1016/j.chest.2019.02.404

@article{4c48ab342d3e4b0c99c1cb089306d829,

title = "Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians",

abstract = "Background: ICU patients/surrogates may experience adverse outcomes related to perceived inappropriate treatment. The objective was to determine the prevalence of patient/surrogate-reported perceived inappropriate treatment, its impact on adverse outcomes, and discordance with clinicians. Methods: We conducted a multicenter, prospective, observational study of adult ICU patients. Results: For 151 patients, 1,332 patient, surrogate, nurse, and physician surveys were collected. Disagreement between patients/surrogates and clinicians regarding “too much” treatment being administered occurred in 26% of patients. Disagreement regarding “too little” treatment occurred in 10% of patients. Disagreement about perceived inappropriate treatment was associated with prognostic discordance (P = .02) and lower patient/surrogate satisfaction (Likert scale 1-5 of 4 vs 5; P = .02). Patient/surrogate respondents reported “too much” treatment in 8% of patients and “too little” treatment in 6% of patients. Perceived inappropriate treatment was associated with moderate or high respondent distress for 55% of patient/surrogate respondents and 35% of physician/nurse respondents (P = .30). Patient/surrogate perception of inappropriate treatment was associated with lower satisfaction (Family Satisfaction in the ICU Questionnaire-24, 69.9 vs 86.6; P = .002) and lower trust in the clinical team (Likert scale 1-5 of 4 vs 5; P = .007), but no statistically significant differences in depression (Patient Health Questionnaire-2 of 2 vs 1; P = .06) or anxiety (Generalized Anxiety Disorder-7 Scale of 7 vs 4; P = .18). Conclusions: For approximately one-third of ICU patients, there is disagreement between clinicians and patients/surrogates about the appropriateness of treatment. Disagreement about appropriateness of treatment was associated with prognostic discordance and lower patient/surrogate satisfaction. Patients/surrogates who reported inappropriate treatment also reported lower satisfaction and trust in the ICU team.",

keywords = "ICU, decision making, futility, professional-family relations",

author = "Wilson, {Michael E.} and Dobler, {Claudia C.} and Laszlo Zubek and Ognjen Gajic and Daniel Talmor and Curtis, {J. Randall} and Hinds, {Richard F.} and Banner-Goodspeed, {Valerie M.} and Ariel Mueller and Rickett, {Dee M.} and Gabor Elo and Mario Filipe and Orsolya Szucs and Novotny, {Paul J.} and Piers, {Ruth D.} and Benoit, {Dominique D.}",

note = "Publisher Copyright: {\textcopyright} 2019 American College of Chest Physicians",

year = "2019",

month = jun,

doi = "10.1016/j.chest.2019.02.404",

language = "English (US)",

volume = "155",

pages = "1140--1147",

journal = "Chest",

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publisher = "American College of Chest Physicians",

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T1 - Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians

AU - Wilson, Michael E.

AU - Dobler, Claudia C.

AU - Zubek, Laszlo

AU - Gajic, Ognjen

AU - Talmor, Daniel

AU - Curtis, J. Randall

AU - Hinds, Richard F.

AU - Banner-Goodspeed, Valerie M.

AU - Mueller, Ariel

AU - Rickett, Dee M.

AU - Elo, Gabor

AU - Filipe, Mario

AU - Szucs, Orsolya

AU - Novotny, Paul J.

AU - Piers, Ruth D.

AU - Benoit, Dominique D.

PY - 2019/6

Y1 - 2019/6

N2 - Background: ICU patients/surrogates may experience adverse outcomes related to perceived inappropriate treatment. The objective was to determine the prevalence of patient/surrogate-reported perceived inappropriate treatment, its impact on adverse outcomes, and discordance with clinicians. Methods: We conducted a multicenter, prospective, observational study of adult ICU patients. Results: For 151 patients, 1,332 patient, surrogate, nurse, and physician surveys were collected. Disagreement between patients/surrogates and clinicians regarding “too much” treatment being administered occurred in 26% of patients. Disagreement regarding “too little” treatment occurred in 10% of patients. Disagreement about perceived inappropriate treatment was associated with prognostic discordance (P = .02) and lower patient/surrogate satisfaction (Likert scale 1-5 of 4 vs 5; P = .02). Patient/surrogate respondents reported “too much” treatment in 8% of patients and “too little” treatment in 6% of patients. Perceived inappropriate treatment was associated with moderate or high respondent distress for 55% of patient/surrogate respondents and 35% of physician/nurse respondents (P = .30). Patient/surrogate perception of inappropriate treatment was associated with lower satisfaction (Family Satisfaction in the ICU Questionnaire-24, 69.9 vs 86.6; P = .002) and lower trust in the clinical team (Likert scale 1-5 of 4 vs 5; P = .007), but no statistically significant differences in depression (Patient Health Questionnaire-2 of 2 vs 1; P = .06) or anxiety (Generalized Anxiety Disorder-7 Scale of 7 vs 4; P = .18). Conclusions: For approximately one-third of ICU patients, there is disagreement between clinicians and patients/surrogates about the appropriateness of treatment. Disagreement about appropriateness of treatment was associated with prognostic discordance and lower patient/surrogate satisfaction. Patients/surrogates who reported inappropriate treatment also reported lower satisfaction and trust in the ICU team.

AB - Background: ICU patients/surrogates may experience adverse outcomes related to perceived inappropriate treatment. The objective was to determine the prevalence of patient/surrogate-reported perceived inappropriate treatment, its impact on adverse outcomes, and discordance with clinicians. Methods: We conducted a multicenter, prospective, observational study of adult ICU patients. Results: For 151 patients, 1,332 patient, surrogate, nurse, and physician surveys were collected. Disagreement between patients/surrogates and clinicians regarding “too much” treatment being administered occurred in 26% of patients. Disagreement regarding “too little” treatment occurred in 10% of patients. Disagreement about perceived inappropriate treatment was associated with prognostic discordance (P = .02) and lower patient/surrogate satisfaction (Likert scale 1-5 of 4 vs 5; P = .02). Patient/surrogate respondents reported “too much” treatment in 8% of patients and “too little” treatment in 6% of patients. Perceived inappropriate treatment was associated with moderate or high respondent distress for 55% of patient/surrogate respondents and 35% of physician/nurse respondents (P = .30). Patient/surrogate perception of inappropriate treatment was associated with lower satisfaction (Family Satisfaction in the ICU Questionnaire-24, 69.9 vs 86.6; P = .002) and lower trust in the clinical team (Likert scale 1-5 of 4 vs 5; P = .007), but no statistically significant differences in depression (Patient Health Questionnaire-2 of 2 vs 1; P = .06) or anxiety (Generalized Anxiety Disorder-7 Scale of 7 vs 4; P = .18). Conclusions: For approximately one-third of ICU patients, there is disagreement between clinicians and patients/surrogates about the appropriateness of treatment. Disagreement about appropriateness of treatment was associated with prognostic discordance and lower patient/surrogate satisfaction. Patients/surrogates who reported inappropriate treatment also reported lower satisfaction and trust in the ICU team.

KW - ICU

KW - decision making

KW - futility

KW - professional-family relations

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JO - Chest

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Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians

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