The prevalence of perceptions of mismatch between treatment intensity and achievable goals of care in the intensive care unit: a cross-sectional study

Matthew H. Anstey, Edward Litton, Michelle L. Trevenen, Kelly Thompson, Steve Webb, Ian Seppelt, Imogen A. Mitchell

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Abstract

Purpose: To describe the prevalence of perceptions of patients receiving a mismatch in treatment intensity, as perceived by intensive care unit (ICU) healthcare providers, and to assess the congruence of perceptions between providers. Methods: In this cross-sectional, observational study conducted in 21 ICUs in Australia and New Zealand, patient prevalence data was linked to an ICU staff survey to describe the extent to which patient treatment intensity was matched to the perceived prognosis and patient wishes. Results: Of the 307 study patients, 62 (20.2%) were reported to be receiving a mismatch in treatment intensity by at least one ICU healthcare professional. For reported mismatch, there was consensus amongst staff members for 52/62 (84%) of patients. Patients were significantly more likely to receive mismatched treatments if they were more severely unwell (APACHE II score > 20 vs. ≤ 20), odds ratio OR 2.35, 95% confidence interval (CI) 1.63–3.37, p < 0.0001, if they were an emergency admission (OR 3.05, CI 1.18–7.89, p = 0.0212) or if they had an advance care directive (OR 3.68, 95% CI 1.66–8.16, p = 0.0013). Conclusions: Being more severely unwell, being an emergency admission or having an advance care directive made patients more likely to be perceived as having a mismatch between the intensity of treatments provided and either the achievable goals of care, expected prognosis or patient’s wishes.

Original languageEnglish
Pages (from-to)459-467
Number of pages9
JournalIntensive Care Medicine
Volume45
Issue number4
DOIs
Publication statusPublished - 1 Apr 2019

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Patient Care Planning
Intensive Care Units
Cross-Sectional Studies
Advance Directives
Therapeutics
Confidence Intervals
Emergencies
APACHE
New Zealand
Health Personnel
Observational Studies
Odds Ratio
Delivery of Health Care

Cite this

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title = "The prevalence of perceptions of mismatch between treatment intensity and achievable goals of care in the intensive care unit: a cross-sectional study",
abstract = "Purpose: To describe the prevalence of perceptions of patients receiving a mismatch in treatment intensity, as perceived by intensive care unit (ICU) healthcare providers, and to assess the congruence of perceptions between providers. Methods: In this cross-sectional, observational study conducted in 21 ICUs in Australia and New Zealand, patient prevalence data was linked to an ICU staff survey to describe the extent to which patient treatment intensity was matched to the perceived prognosis and patient wishes. Results: Of the 307 study patients, 62 (20.2{\%}) were reported to be receiving a mismatch in treatment intensity by at least one ICU healthcare professional. For reported mismatch, there was consensus amongst staff members for 52/62 (84{\%}) of patients. Patients were significantly more likely to receive mismatched treatments if they were more severely unwell (APACHE II score > 20 vs. ≤ 20), odds ratio OR 2.35, 95{\%} confidence interval (CI) 1.63–3.37, p < 0.0001, if they were an emergency admission (OR 3.05, CI 1.18–7.89, p = 0.0212) or if they had an advance care directive (OR 3.68, 95{\%} CI 1.66–8.16, p = 0.0013). Conclusions: Being more severely unwell, being an emergency admission or having an advance care directive made patients more likely to be perceived as having a mismatch between the intensity of treatments provided and either the achievable goals of care, expected prognosis or patient’s wishes.",
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AU - Litton, Edward

AU - Trevenen, Michelle L.

AU - Thompson, Kelly

AU - Webb, Steve

AU - Seppelt, Ian

AU - Mitchell, Imogen A.

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AB - Purpose: To describe the prevalence of perceptions of patients receiving a mismatch in treatment intensity, as perceived by intensive care unit (ICU) healthcare providers, and to assess the congruence of perceptions between providers. Methods: In this cross-sectional, observational study conducted in 21 ICUs in Australia and New Zealand, patient prevalence data was linked to an ICU staff survey to describe the extent to which patient treatment intensity was matched to the perceived prognosis and patient wishes. Results: Of the 307 study patients, 62 (20.2%) were reported to be receiving a mismatch in treatment intensity by at least one ICU healthcare professional. For reported mismatch, there was consensus amongst staff members for 52/62 (84%) of patients. Patients were significantly more likely to receive mismatched treatments if they were more severely unwell (APACHE II score > 20 vs. ≤ 20), odds ratio OR 2.35, 95% confidence interval (CI) 1.63–3.37, p < 0.0001, if they were an emergency admission (OR 3.05, CI 1.18–7.89, p = 0.0212) or if they had an advance care directive (OR 3.68, 95% CI 1.66–8.16, p = 0.0013). Conclusions: Being more severely unwell, being an emergency admission or having an advance care directive made patients more likely to be perceived as having a mismatch between the intensity of treatments provided and either the achievable goals of care, expected prognosis or patient’s wishes.

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