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

Michael 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 journalArticle

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 languageEnglish (US)
Pages (from-to)1140-1147
Number of pages8
JournalChest
Volume155
Issue number6
DOIs
StatePublished - Jun 1 2019

Fingerprint

Therapeutics
Patient Satisfaction
Nurses
Physicians
Surveys and Questionnaires
Anxiety Disorders
Observational Studies
Anxiety
Prospective Studies
Depression
Health

Keywords

  • decision making
  • futility
  • ICU
  • professional-family relations

ASJC Scopus subject areas

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

Cite this

Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians. / Wilson, Michael; Dobler, Claudia C.; Zubek, Laszlo; Gajic, Ognjen; Talmor, Daniel; Curtis, J. Randall; Hinds, Richard F.; Banner-Goodspeed, Valerie M.; Mueller, Ariel; Rickett, Dee M.; Elo, Gabor; Filipe, Mario; Szucs, Orsolya; Novotny, Paul J.; Piers, Ruth D.; Benoit, Dominique D.

In: Chest, Vol. 155, No. 6, 01.06.2019, p. 1140-1147.

Research output: Contribution to journalArticle

Wilson, M, 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
Wilson, Michael ; Dobler, Claudia C. ; Zubek, Laszlo ; Gajic, Ognjen ; Talmor, Daniel ; Curtis, J. Randall ; Hinds, Richard F. ; Banner-Goodspeed, Valerie M. ; Mueller, Ariel ; Rickett, Dee M. ; Elo, Gabor ; Filipe, Mario ; Szucs, Orsolya ; Novotny, Paul J. ; Piers, Ruth D. ; Benoit, Dominique D. / Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians. In: Chest. 2019 ; Vol. 155, No. 6. pp. 1140-1147.
@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 = "decision making, futility, ICU, professional-family relations",
author = "Michael Wilson 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.}",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.chest.2019.02.404",
language = "English (US)",
volume = "155",
pages = "1140--1147",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "6",

}

TY - JOUR

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

AU - Wilson, Michael

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 - 2019/6/1

Y1 - 2019/6/1

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 - decision making

KW - futility

KW - ICU

KW - professional-family relations

UR - http://www.scopus.com/inward/record.url?scp=85065991448&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065991448&partnerID=8YFLogxK

U2 - 10.1016/j.chest.2019.02.404

DO - 10.1016/j.chest.2019.02.404

M3 - Article

C2 - 30922949

AN - SCOPUS:85065991448

VL - 155

SP - 1140

EP - 1147

JO - Chest

JF - Chest

SN - 0012-3692

IS - 6

ER -