Treatment preferences of hospitalized medical patients for life-sustaining interventions and intensive care unit admission

Messer, Marcia; Huber, W. G.; Allmann, Jakob; Eckes, Jeanne; Schuster, T; Schmid, RM; Saugel, Bernd

doi:10.1093/bja/aev237

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…In old age the need is greater for patients to be involved in decisions about the nature and extent of medical interventions (15,16). However, it is not possible to infer wishes about lifesustaining interventions on the basis of age alone-doctors frequently draw false conclusions in this regard (15)(16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 99%

Advance Directives and Powers of Attorney in Intensive Care Patients

Heer¹,

Saugel²,

Sensen³

et al. 2017

Deutsches Ärzteblatt International

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For patients hospitalized in intensive care units, there should be early discussion about the presence or absence of documents of these kinds and early evaluation of the patient's concrete wishes in critical situations. Future studies are needed to determine how best to assure that these documents will be correctly prepared and then given over to hospital staff so that they can take their place in the patient's record.

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Section: Discussionmentioning

confidence: 99%

Advance Directives and Powers of Attorney in Intensive Care Patients

Heer¹,

Saugel²,

Sensen³

et al. 2017

Deutsches Ärzteblatt International

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“…Such a poor prognosis could lead to therapeutic nihilism, which limits access to critical care medicine [6]. Moreover, some patients may be hesitant to undergo invasive treatment or ICU admission due to vague fears and anxieties for their ending up with undesirable life-sustaining treatments [15,16]. Therefore, there is a pressing need for reliable clinical prediction models that take into account the patient values, preferences, and care goals to make better-shared decisions [17].…”

Section: Introductionmentioning

confidence: 99%

Predictive performance of the sequential organ failure assessment score for in‐hospital mortality in patients with end‐stage kidney disease in intensive care units: A multicenter registry in Japan

Shimada,

Matsuoka,

Miyakoshi

et al. 2023

Ther Apher Dial

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IntroductionThere is limited evidence regarding whether the performance of the Sequential Organ Failure Assessment (SOFA) score differs between patients with and without end‐stage kidney disease (ESKD) in intensive care units (ICUs).MethodsWe used a multicenter registry (Japanese Intensive care Patient Database) to enroll adult ICU patients between April 2018 and March 2021. We recalibrated the SOFA score using a logistic regression model and evaluated its predictive ability in both ESKD and non‐ESKD groups. The primary outcome was in‐hospital mortality.Results128 134 patients were enrolled. The AUROC of the SOFA score was lower in the ESKD group than in the non‐ESKD group [0.789 (95% CI, 0.774–0.804) vs. 0.846 (95% CI, 0.841–0.850)]. The calibration plot revealed good performance in both groups. However, it overestimated in‐hospital mortality in ESKD groups.ConclusionThe SOFA score demonstrated good predictive ability in patients with and without ESKD, but it overestimated the in‐hospital mortality in ESKD patients.

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“…9 When properly executed, a written TLD is a useful method to ensure that patient's preferences regarding CPR or other invasive lifesaving treatments are honored. [14][15][16] However, ICU patients often lack decision-making capacity 17,18 and advanced directives are often lacking or unclear. [19][20][21] Cheveaux et al showed that "having a malignancy" is associated with more do-not-resuscitate decisions at the ward, of which more than half were made by the medical team.…”

Section: Introductionmentioning

confidence: 99%

“…9 When properly executed, a written TLD is a useful method to ensure that patient’s preferences regarding CPR or other invasive life-saving treatments are honored. 14 –16…”

Section: Introductionmentioning

confidence: 99%

Treatment Limitation Decisions in Critically Ill Patients With a Malignancy on the Intensive Care Unit

Zee

Epker

Bakker

et al. 2020

J Intensive Care Med

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Background: Treatment limitation decisions (TLDs) on the ICU can be challenging, especially in patients with a malignancy. Up-to-date literature regarding TLDs in critically ill patients with a malignancy admitted to the ICU is scarce. The aim was to compare the incidence of written TLDs between patients with an active malignancy, patients with a malignancy in their medical history (complete remission, CR) and patients without a malignancy admitted unplanned to the ICU. Methods: We conducted a retrospective cohort study in a large university hospital in the Netherlands. We identified all unplanned admissions to the ICU in 2017 and categorized the patients in 3 groups: patients with an active malignancy (study population), with CR and without a malignancy. A TLD was defined as a written instruction not to perform life-saving treatments, such as CPR in case of cardiac arrest. A multivariate binary logistic regression analysis was used to identify whether having a malignancy was associated with TLDs. Results: Of the 1046 unplanned admissions, 125 patients (12%) had an active malignancy and 76 (7.3%) patients had CR. The incidence of written TLDs in these subgroups were 37 (29.6%) and 20 (26.3%). Age (OR 1.03; 95% CI 1.01 -1.04), SOFA score at ICU admission (OR 1.11; 95% CI 1.05 -1.18) and having an active malignancy (OR 1.75; 95% CI 1.04-2.96) compared to no malignancy were independently associated with written TLDs. SOFA scores on the day of the TLD were not significantly different in patients with and without a malignancy. Conclusions: This study shows that the presence of an underlying malignancy is independently associated with written TLDs during ICU stay. Patients with CR were not at risk of more written TLDs. Whether this higher incidence of TLDs in patients with a malignancy is justified, is at least questionable and should be evaluated in future research.

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Treatment preferences of hospitalized medical patients for life-sustaining interventions and intensive care unit admission

Cited by 4 publications

References 7 publications

Advance Directives and Powers of Attorney in Intensive Care Patients

Advance Directives and Powers of Attorney in Intensive Care Patients

Predictive performance of the sequential organ failure assessment score for in‐hospital mortality in patients with end‐stage kidney disease in intensive care units: A multicenter registry in Japan

Treatment Limitation Decisions in Critically Ill Patients With a Malignancy on the Intensive Care Unit

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