Abstract
BackgroundTo test the hypothesis that Intensive Care Unit (ICU) doctors and nurses differ in their personal preferences for treatment from the general population, and whether doctors and nurses make different choices when thinking about themselves, as compared to when they are treating a patient.MethodsCross sectional, observational study conducted in 13 ICUs in Australia in 2017 using a discrete choice experiment survey. Respondents completed a series of choice sets, based on hypothetical situations which varied in the severity or likelihood of: death, cognitive impairment, need for prolonged treatment, need for assistance with care or requiring residential care.ResultsA total of 980 ICU staff (233 doctors and 747 nurses) participated in the study. ICU staff place the highest value on avoiding ending up in a dependent state. The ICU staff were more likely to choose to discontinue therapy when the prognosis was worse, compared with the general population. There was consensus between ICU staff personal views and the treatment pathway likely to be followed in 69% of the choices considered by nurses and 70% of those faced by doctors. In 27% (1614/5945 responses) of the nurses and 23% of the doctors (435/1870 responses), they felt that aggressive treatment would be continued for the hypothetical patient but they would not want that for themselves.ConclusionThe likelihood of returning to independence (or not requiring care assistance) was reported as the most important factor for ICU staff (and the general population) in deciding whether to receive ongoing treatments. Goals of care discussions should focus on this, over likelihood of survival.
Highlights
Shared decision making in the Intensive Care Unit (ICU) for treatment decisions and limitations of care is complicated: most patients are too sick to take part in the decision-making process and many patients have never documented or discussed their wishes with family members [1, 2]
Characteristics of the ICU sample are outlined in Table 1; 13 hospitals contributed to the study, all metropolitan tertiary teaching hospitals, except for one private hospital and two large regional centers
Any of the choice on treatment options. 5.7% (45/785) of staff had previously been admitted to ICU themselves, whereas 41.8% (328/784, 263/598 nurses, 65/186 doctors) had family members previously admitted to ICU
Summary
Shared decision making in the Intensive Care Unit (ICU) for treatment decisions and limitations of care is complicated: most patients are too sick to take part in the decision-making process and many patients have never documented or discussed their wishes with family members [1, 2]. There is evidence that when faced with a critical illness, some doctors chose less aggressive treatments for themselves, than they would for their patients Collaborative family meetings, those which involve the direct care nurse, have been shown to improve the quality of communication [4, 6, 7]. This raises the question: do the attitudes of doctors and nurses towards end of life decisions in the intensive care reflect those of patients or their families whom they are guiding? To test the hypothesis that Intensive Care Unit (ICU) doctors and nurses differ in their personal preferences for treatment from the general population, and whether doctors and nurses make different choices when thinking about themselves, as compared to when they are treating a patient
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