The online version of this article (https://doi.org/10.1007/s00134-018-5231-8) contains supplementary material, which is available to authorized users.
The full list of investigators of the DISPROPRICUS study group are listed in the Acknowledgements and in the ESM 3 file.
Whether the quality of the ethical climate in the intensive care unit (ICU) improves the identification of patients receiving excessive care and affects patient outcomes is unknown.
In this prospective observational study, perceptions of excessive care (PECs) by clinicians working in 68 ICUs in Europe and the USA were collected daily during a 28-day period. The quality of the ethical climate in the ICUs was assessed via a validated questionnaire. We compared the combined endpoint (death, not at home or poor quality of life at 1 year) of patients with PECs and the time from PECs until written treatment-limitation decisions (TLDs) and death across the four climates defined via cluster analysis.
Of the 4747 eligible clinicians, 2992 (63%) evaluated the ethical climate in their ICU. Of the 321 and 623 patients not admitted for monitoring only in ICUs with a good (n = 12, 18%) and poor (n = 24, 35%) climate, 36 (11%) and 74 (12%), respectively were identified with PECs by at least two clinicians. Of the 35 and 71 identified patients with an available combined endpoint, 100% (95% CI 90.0–1.00) and 85.9% (75.4–92.0) (P = 0.02) attained that endpoint. The risk of death (HR 1.88, 95% CI 1.20–2.92) or receiving a written TLD (HR 2.32, CI 1.11–4.85) in patients with PECs by at least two clinicians was higher in ICUs with a good climate than in those with a poor one. The differences between ICUs with an average climate, with (n = 12, 18%) or without (n = 20, 29%) nursing involvement at the end of life, and ICUs with a poor climate were less obvious but still in favour of the former.
Enhancing the quality of the ethical climate in the ICU may improve both the identification of patients receiving excessive care and the decision-making process at the end of life.
Kompanje EJ, Piers RD, Benoit DD (2013) Causes and consequences of disproportionate care in intensive care medicine. Curr Opin Crit Care 19:630–635 PubMed
Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, Curtis JR, ford DW, Osborne M, Misak C, Au DH, Azoulay E, Brody B, Fahy BG, Hall JB, Kesecioglu J, Kon AA, Lindell KO, White DB, on behalf of the American Thoracic Society ad hoc committee on Futile and Potentially Inappropriate Treatment (2015) An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med 191:1318–1330 CrossRefPubMed
Piers R, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, Michalsen A, Azevedo Maia P, Owczuk R, Rubulotta F, Depuydt P, Meert AP, Reyners A, Aquilina A, Bekaert M, Van den Noorgate N, Schrauwen W, Benoit D (2011) APPROPRICUS study group of the ESICM. Perception of appropriateness of care among European and Israeli intensive care unit nurses and doctors. JAMA 306:2694–2703 CrossRefPubMed
Vandenbulcke B, Piers R, Jenssen HI, Malmgrem J, Metaxa V, Reyners AK, Darmon M, Rusinova K, Talmor D, Meert AP, Cancellierre L, Zubek L, Maia P, Michalsen A, Decruyenaere J, Kompanje EJO, Azoulay E, Vlerick P, Van den Sompel A, Vansteelandt S, Vanheule S, Benoit DD (2018) On behalf the DISPROPRICUS study group of the Ethics Section of the ESICM. Ethical decision-making climate in the ICU: theoretical framework and validation of self-assessment tool. BMJ Qual Saf. https://doi.org/10.1136/bmjqs-2017-007390 ([Epub ahead of print]) CrossRef
Detsky ME, Harhay MO, Bayard DF, Delman AM, Buehler AE, Kent SA, Cuiffetelli IV, Cooney E, Gabler NB, Ratcliffe SJ, Mikkelsen ME, Halpern SD (2017) Discriminative accuracy of physician and nurse predictions for survival and functional outcomes 6 months after ICU admission. JAMA 317:2187–2195 CrossRefPubMedPubMedCentral
Brislin RW (1976) Translation: application and research. Gardner Press Inc, New York
Oeyen SG, Vandijck D, Benoit DD, Annemans L, Decruyenaere J (2010) Quality of life after intensive care: a systematic review of the literature. Crit Care Med 38:386–400 CrossRef
Everitt BS, Landau S, Leese M, Stahl D (2011) Cluster analyis, 5th edition. Wiley. ISBN: 978-0-470-74991-3
Putter H, Fiocco M, Geskus RB (2007) Tutorial in biostatistics: competing risks and multi-state models. Statist Med 26:2389–2430 CrossRef
Zollo L, Pellegrini MM, Ciappei C (2017) What sparks ethical decision making? The interplay between moral intuition and moral reasoning: lessons from the scholastic doctrine. J Bus Ethics 145:681–700 CrossRef
Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Michell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300:1665–1673 CrossRefPubMedPubMedCentral
Curtis JR, Vincent JL (2010) Ethics and end-of-life care for adults in the intensive care unit. The Lancet 376:1347–1353 CrossRef
Dzeng E, Curtis JR (2018) Understanding ethical climate, moral distress, and burnout: a novel tool and a conceptual framework. BMJ Qual Saf:1–5. https://doi.org/10.1136/bmjqs-2018-007905 ( Epub ahead of print)
De Angelis R, Sant M, Coleman MP, Francisci S, Baili P, Pierannunzio D, Trama A, Visser O, Brenner H, Ardanaz E, Bielska-Lasota M, Engholm G, Nennecke A, Siesling S, Berrino F, Capocaccia R, Eurocare-5 Working Groups (2014) Cancer survival in Europe 1999–2007 by country and age: results of the Eurocare-5. A population-based study. Lancet Oncol 15:23–34 CrossRefPubMed
- Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA
D. D. Benoit
H. I. Jensen
A. K. Reyners
A. P. Meert
E. J. O. Kompanje
B. Van den Bulcke
R. D. Piers
the DISPROPRICUS study group of the Ethics Section of the European Society of Intensive Care Medicine
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