학술논문
Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians.
Document Type
Academic Journal
Author
Wilson ME; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN. Electronic address: wilson.michael1@mayo.edu.; Dobler CC; Evidence-Based Practice Center, Mayo Clinic, Rochester, MN.; Zubek L; Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.; Gajic O; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.; Talmor D; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.; Curtis JR; Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA.; Hinds RF; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.; Banner-Goodspeed VM; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.; Mueller A; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.; Rickett DM; Department of Critical Care and Palliative Care, Henry Mayo Hospital, Valencia, CA.; Elo G; Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary.; Filipe M; Department of Anesthesiology and Intensive Therapy, St. Stephen and St. Ladislaus Combined Hospital, Budapest, Hungary.; Szucs O; Department of Surgery, Semmelweis University, Budapest, Hungary.; Novotny PJ; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.; Piers RD; Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.; Benoit DD; Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 0231335 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1931-3543 (Electronic) Linking ISSN: 00123692 NLM ISO Abbreviation: Chest Subsets: MEDLINE
Subject
Language
English
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.
(Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
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.
(Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)