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

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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Therapeutics
Patient Satisfaction
Nurses
Physicians
Surveys and Questionnaires
Anxiety Disorders
Observational Studies
Anxiety
Prospective Studies
Depression
Health

Cite this

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. / Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians. In: Chest. 2019 ; Vol. 155, No. 6. pp. 1140-1147.
@article{26232e37088a4d0d937987e674aa7f41,
title = "Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians",
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.",
author = "Wilson, {Michael E} and Dobler, {Claudia C} and Laszlo Zubek and Ognjen Gajic and Daniel Talmor and Curtis, {J Randall} and Hinds, {Richard F} and Banner-Goodspeed, {Valerie M} and Ariel Mueller and Rickett, {Dee M} and Gabor Elo and Mario Filipe and Orsolya Szucs and Novotny, {Paul J} and Piers, {Ruth D} and Benoit, {Dominique D}",
note = "Copyright {\circledC} 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.",
year = "2019",
month = "6",
day = "1",
doi = "10.1016/j.chest.2019.02.404",
language = "English",
volume = "155",
pages = "1140--1147",
journal = "Diseases of the chest",
issn = "0012-3692",
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}

Wilson, ME, Dobler, CC, Zubek, L, Gajic, O, Talmor, D, Curtis, JR, Hinds, RF, Banner-Goodspeed, VM, Mueller, A, Rickett, DM, Elo, G, Filipe, M, Szucs, O, Novotny, PJ, Piers, RD & Benoit, DD 2019, 'Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians' Chest, vol. 155, no. 6, pp. 1140-1147. https://doi.org/10.1016/j.chest.2019.02.404

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 journalArticleResearchpeer-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.

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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 -