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Prevalence of disagreement about appropriateness of treatment between ICU patients/surrogates and clinicians

(2019) CHEST. 155(6). p.1140-1147
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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, INTENSIVE-CARE, PERCEPTIONS, SATISFACTION, NURSES

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MLA
Wilson, Michael E., et al. “Prevalence of Disagreement about Appropriateness of Treatment between ICU Patients/Surrogates and Clinicians.” CHEST, vol. 155, no. 6, 2019, pp. 1140–47.
APA
Wilson, M. E., Dobler, C. C., Zubek, L., Gajic, O., Talmor, D., Curtis, J. R., … Benoit, D. (2019). Prevalence of disagreement about appropriateness of treatment between ICU patients/surrogates and clinicians. CHEST, 155(6), 1140–1147.
Chicago author-date
Wilson, Michael E, Claudia C Dobler, Laszlo Zubek, Ognjen Gajic, Daniel Talmor, J Randall Curtis, Richard F Hinds, et al. 2019. “Prevalence of Disagreement about Appropriateness of Treatment between ICU Patients/Surrogates and Clinicians.” CHEST 155 (6): 1140–47.
Chicago author-date (all authors)
Wilson, Michael E, 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 Piers, and Dominique Benoit. 2019. “Prevalence of Disagreement about Appropriateness of Treatment between ICU Patients/Surrogates and Clinicians.” CHEST 155 (6): 1140–1147.
Vancouver
1.
Wilson ME, Dobler CC, Zubek L, Gajic O, Talmor D, Curtis JR, et al. Prevalence of disagreement about appropriateness of treatment between ICU patients/surrogates and clinicians. CHEST. 2019;155(6):1140–7.
IEEE
[1]
M. E. Wilson et al., “Prevalence of disagreement about appropriateness of treatment between ICU patients/surrogates and clinicians,” CHEST, vol. 155, no. 6, pp. 1140–1147, 2019.
@article{8610417,
  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.},
  author       = {Wilson, Michael E and Dobler, Claudia C and Zubek, Laszlo and Gajic, Ognjen and Talmor, Daniel and Curtis, J Randall and Hinds, Richard F and Banner-Goodspeed, Valerie M and Mueller, Ariel and Rickett, Dee M and Elo, Gabor and Filipe, Mario and Szucs, Orsolya and Novotny, Paul J and Piers, Ruth and Benoit, Dominique},
  issn         = {0012-3692},
  journal      = {CHEST},
  keywords     = {decision making,futility,ICU,professional-family relations,INTENSIVE-CARE,PERCEPTIONS,SATISFACTION,NURSES},
  language     = {eng},
  number       = {6},
  pages        = {1140--1147},
  title        = {Prevalence of disagreement about appropriateness of treatment between ICU patients/surrogates and clinicians},
  url          = {http://dx.doi.org/10.1016/j.chest.2019.02.404},
  volume       = {155},
  year         = {2019},
}

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