Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians

Michael E Wilson, 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 D Piers, Dominique D Benoit

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

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 languageEnglish
Pages (from-to)1140-1147
Number of pages8
JournalChest
Volume155
Issue number6
Early online date26 Mar 2019
DOIs
Publication statusPublished - 1 Jun 2019
Externally publishedYes

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