A comparison of the opinions of intensive care unit staff and family members of the treatment intensity received by patients admitted to an intensive care unit: A multicentre survey

Matthew H Anstey; Edward Litton; Nihar Jha; Michelle L Trevenen; Steve Webb; Imogen A Mitchell

doi:10.1016/j.aucc.2018.08.008

A comparison of the opinions of intensive care unit staff and family members of the treatment intensity received by patients admitted to an intensive care unit: A multicentre survey

Aust Crit Care. 2019 Sep;32(5):378-382. doi: 10.1016/j.aucc.2018.08.008. Epub 2018 Nov 13.

Authors

Matthew H Anstey¹, Edward Litton², Nihar Jha³, Michelle L Trevenen⁴, Steve Webb⁵, Imogen A Mitchell⁶

Affiliations

¹ Sir Charles Gairdner Hospital, Perth, Australia; Curtin University, School of Public Health, Australia. Electronic address: matthew.anstey@health.wa.gov.au.
² Fiona Stanley Hospital, Australia; St John of God Hospital, Subiaco, Western Australia 6009, Australia.
³ Sir Charles Gairdner Hospital, Perth, Australia.
⁴ Centre for Applied Statistics, University of Western Australia, Australia.
⁵ St John of God Hospital, Subiaco, Western Australia 6009, Australia; Monash University, Australia.
⁶ The Canberra Hospital, Australia; Australian National University Medical School, Australia.

PMID: 30446268
DOI: 10.1016/j.aucc.2018.08.008

Abstract

Background: Achieving shared decision-making in the intensive care unit (ICU) is challenging because of limited patient capacity, leading to a reliance on surrogate decision-makers. Prior research shows that ICU staff members often perceive that patients receive inappropriate or futile treatments while some surrogate decision-makers of patients admitted to the ICU report inadequate communication with physicians. Therefore, understanding the perceptions of both ICU staff and surrogate decision-makers around wishes for ICU treatments is an essential component to improve these situations.

Objectives: The objectives of this study were to compare perceptions of ICU staff with surrogate decision-makers about the intensity and appropriateness of treatments received by patients and analyse the causes of any incongruence.

Methods: A multicentred, single-day survey of staff and surrogate decision-makers of ICU inpatients was conducted across four Australian ICUs in 2014. Patients were linked to a larger prospective observational study, allowing comparison of patient outcomes.

Results: Twelve of 32 patients were identified as having a mismatch between staff and surrogate decision-maker perceptions. For these 12 patients, all 12 surrogate decision-makers believed that the treatment intensity the patient was receiving was of the appropriate intensity and duration. Mismatched patients were more likely to be emergency admissions to ICU compared with nonmismatched patients (0.0% vs 42.1%, p = 0.012) and have longer ICU admissions (7.5 vs 3, p = 0.022). There were no significant differences in perceived communication (p = 0.61).

Conclusions: Family members did not share the same perceptions of treatment with ICU staff. This may result from difficulty in prognostication; challenges in conveying poor prognoses to surrogate decision-makers; and the accuracy of surrogate decision-makers.

Keywords: Communication; Decision making; Family; Intensive care units; Medical futility; Surveys and questionnaires.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Aged
Australia
Decision Making*
Family / psychology*
Female
Humans
Intensive Care Units / organization & administration*
Male
Personnel, Hospital / psychology*
Professional Role*
Prospective Studies
Surveys and Questionnaires