A rapid review of patient and family perspectives on inappropriateness of intensive care treatments at the end of life

Aim: To understand patient/family perspective of inappropriate intensive care unit (ICU) admissions and treatment.
Methods: Rapid literature review of English language articles published between 2001 and 2017 in Medline or PsycInfo.
Results: Thirteen articles covering 6,194 elderly patients or surrogate decision-makers from four countries were eligible. Perceived inappropriateness of ICU treatments was mainly expressed as dissatisfaction with clinicians as surrogate decision-makers, inconsistency with patient/family values, family distrust of physicians predictions on poor prognosis, and inadequate communication on over-aggressive treatment causing suffering. Consultation on opinion before ICU admission varied from 1% to 53.6%, and treatment goals from 1.4 to 31.7%. Satisfaction with the decision-making process in ICU was higher for those who had certain level of control and involvement in the process.
Conclusions: The patient/family perspective on inappropriateness of ICU treatments involves preferences, values and social constructs beyond medical criteria. Earlier consultation with families before ICU admission, and patient education on outcomes of life-sustaining therapies may help reconcile these provider-patient disagreements.
Keywords: professional-patient relations, intensive care, end-of-life, review.

Take-home message The patient/family perspective on inappropriateness of ICU at the end of life often differs from the clinicians opinion due to the non-medical frame of mind. To improve satisfaction with communication on treatment goals, consultation on patient values and inclusion of social constructs in addition to clinical prediction are a good start to reconcile differences between physician and health service users viewpoint.