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Outcomes of ICU patients with and without perceptions of excessive care : a comparison between cancer and non-cancer patients

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Abstract
Background Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. Methods This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. Results Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60-1.72 and HR 0.87, 95% CI 0.49-1.54) and TLDs (HR 0.81, 95% CI 0.33-1.99 and HR 0.70, 95% CI 0.27-1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58-3.15 and 1.66, 95% CI 1.28-2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. Conclusions The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU.
Keywords
Critical Care and Intensive Care Medicine, Cancer, Critical care, ICU, Bias, Perception of care, Prognostication, Treatment limitation, INAPPROPRIATE CARE, END, PHYSICIANS, ADMISSION, SURVIVAL, NURSES, JUNIOR

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MLA
Benoit, Dominique, et al. “Outcomes of ICU Patients with and without Perceptions of Excessive Care : A Comparison between Cancer and Non-Cancer Patients.” ANNALS OF INTENSIVE CARE, vol. 11, no. 1, 2021, doi:10.1186/s13613-021-00895-5.
APA
Benoit, D., van der Zee, E. N., Darmon, M., Reyners, A. K. L., Metaxa, V., Mokart, D., … Azoulay, E. (2021). Outcomes of ICU patients with and without perceptions of excessive care : a comparison between cancer and non-cancer patients. ANNALS OF INTENSIVE CARE, 11(1). https://doi.org/10.1186/s13613-021-00895-5
Chicago author-date
Benoit, Dominique, Esther N. van der Zee, Michael Darmon, An K. L. Reyners, Victoria Metaxa, Djamel Mokart, Alexander Wilmer, et al. 2021. “Outcomes of ICU Patients with and without Perceptions of Excessive Care : A Comparison between Cancer and Non-Cancer Patients.” ANNALS OF INTENSIVE CARE 11 (1). https://doi.org/10.1186/s13613-021-00895-5.
Chicago author-date (all authors)
Benoit, Dominique, Esther N. van der Zee, Michael Darmon, An K. L. Reyners, Victoria Metaxa, Djamel Mokart, Alexander Wilmer, Pieter Depuydt, Andreas Hvarfner, Katerina Rusinova, Jan G.Zijlstra, François Vincent, Dimitrios Lathyris, Anne-Pascale Meert, Jacques Devriendt, Emma Uyttersprot, Erwin J. O. Kompanje, Ruth Piers, and Elie Azoulay. 2021. “Outcomes of ICU Patients with and without Perceptions of Excessive Care : A Comparison between Cancer and Non-Cancer Patients.” ANNALS OF INTENSIVE CARE 11 (1). doi:10.1186/s13613-021-00895-5.
Vancouver
1.
Benoit D, van der Zee EN, Darmon M, Reyners AKL, Metaxa V, Mokart D, et al. Outcomes of ICU patients with and without perceptions of excessive care : a comparison between cancer and non-cancer patients. ANNALS OF INTENSIVE CARE. 2021;11(1).
IEEE
[1]
D. Benoit et al., “Outcomes of ICU patients with and without perceptions of excessive care : a comparison between cancer and non-cancer patients,” ANNALS OF INTENSIVE CARE, vol. 11, no. 1, 2021.
@article{8717322,
  abstract     = {{Background Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. Methods This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. Results Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60-1.72 and HR 0.87, 95% CI 0.49-1.54) and TLDs (HR 0.81, 95% CI 0.33-1.99 and HR 0.70, 95% CI 0.27-1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58-3.15 and 1.66, 95% CI 1.28-2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. Conclusions The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU.}},
  articleno    = {{120}},
  author       = {{Benoit, Dominique and van der Zee, Esther N. and Darmon, Michael and Reyners, An K. L. and Metaxa, Victoria and Mokart, Djamel and Wilmer, Alexander and Depuydt, Pieter and Hvarfner, Andreas and Rusinova, Katerina and G.Zijlstra, Jan and Vincent, François and Lathyris, Dimitrios and Meert, Anne-Pascale and Devriendt, Jacques and Uyttersprot, Emma and Kompanje, Erwin J. O. and Piers, Ruth and Azoulay, Elie}},
  issn         = {{2110-5820}},
  journal      = {{ANNALS OF INTENSIVE CARE}},
  keywords     = {{Critical Care and Intensive Care Medicine,Cancer,Critical care,ICU,Bias,Perception of care,Prognostication,Treatment limitation,INAPPROPRIATE CARE,END,PHYSICIANS,ADMISSION,SURVIVAL,NURSES,JUNIOR}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{11}},
  title        = {{Outcomes of ICU patients with and without perceptions of excessive care : a comparison between cancer and non-cancer patients}},
  url          = {{http://doi.org/10.1186/s13613-021-00895-5}},
  volume       = {{11}},
  year         = {{2021}},
}

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