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.
| Original language | English |
|---|---|
| Pages (from-to) | 1140-1147 |
| Number of pages | 8 |
| Journal | Chest |
| Volume | 155 |
| Issue number | 6 |
| Early online date | 26 Mar 2019 |
| DOIs | |
| Publication status | Published - 1 Jun 2019 |
| Externally published | Yes |
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Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians. / Wilson, Michael E; Dobler, Claudia C; Zubek, Laszlo; Gajic, Ognjen; Talmor, Daniel; Curtis, J Randall; Hinds, Richard F; Banner-Goodspeed, Valerie M; Mueller, Ariel; Rickett, Dee M; Elo, Gabor; Filipe, Mario; Szucs, Orsolya; Novotny, Paul J; Piers, Ruth D; Benoit, Dominique D.
In: Chest, Vol. 155, No. 6, 01.06.2019, p. 1140-1147.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians
AU - Wilson, Michael E
AU - Dobler, Claudia C
AU - Zubek, Laszlo
AU - Gajic, Ognjen
AU - Talmor, Daniel
AU - Curtis, J Randall
AU - Hinds, Richard F
AU - Banner-Goodspeed, Valerie M
AU - Mueller, Ariel
AU - Rickett, Dee M
AU - Elo, Gabor
AU - Filipe, Mario
AU - Szucs, Orsolya
AU - Novotny, Paul J
AU - Piers, Ruth D
AU - Benoit, Dominique D
N1 - Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85065991448&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2019.02.404
DO - 10.1016/j.chest.2019.02.404
M3 - Article
VL - 155
SP - 1140
EP - 1147
JO - Diseases of the chest
JF - Diseases of the chest
SN - 0012-3692
IS - 6
ER -