The ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over

Garrouste-Orgeas, M., Tabah, A., Vesin, A., Philippart, F., Kpodji, A., Bruel, C., Gregoire, C., Max, A., Timsit, J. F. and Misset, B. (2013) The ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over. Intensive Care Medicine, 39 9: 1574-1583. doi:10.1007/s00134-013-2977-x


Author Garrouste-Orgeas, M.
Tabah, A.
Vesin, A.
Philippart, F.
Kpodji, A.
Bruel, C.
Gregoire, C.
Max, A.
Timsit, J. F.
Misset, B.
Title The ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 0342-4642
1432-1238
Publication date 2013-09
Sub-type Article (original research)
DOI 10.1007/s00134-013-2977-x
Open Access Status Not Open Access
Volume 39
Issue 9
Start page 1574
End page 1583
Total pages 10
Place of publication Heidelberg, Germany
Publisher Springer
Language eng
Formatted abstract
Purpose

To assess physician decisions about ICU admission for life-sustaining treatments (LSTs).

Methods

Observational simulation study of physician decisions for patients aged ≥80 years. Each patient was allocated at random to four physicians who made decisions based on actual bed availability and existence of an additional bed before and after obtaining information on patient preferences. The simulations involved non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of IMV (RRT after IMV).

Results

The physician participation rate was 100/217 (46 %); males without religious beliefs predominated, and median ICU experience was 9 years. Among participants, 85.7, 78, and 62 % felt that NIV, IMV, or RRT (after IMV) was warranted, respectively. By logistic regression analysis, factors associated with admission were age <85 years, self-sufficiency, and bed availability for NIV and IMV. Factors associated with IMV were previous ICU stay (OR 0.29, 95 % CI 0.13–0.65, p = 0.01) and cancer (OR 0.23, 95 % CI 0.10–0.52, p = 0.003), and factors associated with RRT (after IMV) were living spouse (OR 2.03, 95 % CI 1.04–3.97, p = 0.038) and respiratory disease (OR 0.42, 95 % CI 0.23–0.76, p = 0.004). Agreement among physicians was low for all LSTs. Knowledge of patient preferences changed physician decisions for 39.9, 56, and 57 % of patients who disagreed with the initial physician decisions for NIV, IMV, and RRT (after IMV) respectively. An additional bed increased admissions for NIV and IMV by 38.6 and 13.6 %, respectively.

Conclusions

Physician decisions for elderly patients had low agreement and varied greatly with bed availability and knowledge of patient preferences.
Keyword Aged
Decision making
Intensive care unit
Triage
Therapy
ETHICA
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Mon, 20 Jun 2016, 17:17:03 EST by Alexs Tabah on behalf of School of Medicine