Featured Research

from universities, journals, and other organizations

Decisions to forgo life support may depend heavily on the icu where patients are treated

Date:
May 21, 2013
Source:
Perelman School of Medicine at the University of Pennsylvania
Summary:
The decision to limit life support in patients in the intensive care unit (ICU) appears to be significantly influenced by physician practices and/or the culture of the hospital, suggests new findings.

The decision to limit life support in patients in the intensive care unit (ICU) appears to be significantly influenced by physician practices and/or the culture of the hospital, suggests new findings from researchers at the Perelman School of Medicine at the University of Pennsylvania presented at the American Thoracic Society International Conference on May 21.

A retrospective analysis of over 269,000 ICU patients from the Project IMPACT database revealed a substantial variation in decisions to forgo life-sustaining therapies rates among 153 ICUs in the United States -- which suggests many factors unrelated to the patient or family may be affecting such decisions, particularly for patients who are unable to participate in decision making.

"Patient factors such as severity of illness, age, race, and functional status explain a significant amount of the variability in decisions to forgo life-sustaining therapies, but it is likely that ICU culture and physician practices also play a major role," said Caroline M. Quill, MD, a fellow in the department of Pulmonary, Allergy, and Critical Care at Penn Medicine. "My sense is because patients in the ICU are often unable to participate in decision-making, the influence of providers and the ICU culture may be even greater than the patient or family preference."

One in five Americans die during or shortly after an ICU stay, with many them dying following a decision to forgo life support. Though these decisions are common, the influences on these decisions are not well understood.

Limitations on care include do-not-resuscitate orders, withholding or withdrawing mechanical ventilation, withholding CPR, or an order for comfort measures or hospice care.

In order to study better understand these influences, the researchers wanted to quantify the variation among ICUs after adjusting for patient factors -- gender, condition, age, and race, for example. The thought is that if a host of patient characteristics can be identified that reliably predict who will and who will not have a decision to forgo life-sustaining therapy, then after adjustment for such characteristics among large samples of ICU patients, rates should be relatively consistent among ICUs.

Here, that was not the case. Overall, 11.7 percent of patients had a decision to forgo life-sustaining therapies among 153 ICUs in the US between 2001 and 2009. Of those, 58.8 percent died in the ICU and 41.2 percent survived to ICU discharge. After researchers adjusted for patient factors in their model, the study still revealed a six-fold variation among ICUs in the probability of a decision to forgo life-sustaining therapy. This suggests that the ICU to which a given patient is admitted influences his or her odds of having a DFLST, regardless of personal or clinical characteristics.

The team also looked at which patient characteristics are associated with these decisions. Older patients, women, and patients with more functional limitations at the time of admission to an ICU were more likely to limit life support, the researchers found. Conversely, black race and other non-white races were less likely to make the decisions to forgo life-sustaining therapies.

"This high variability among ICUs highlights an opportunity to improve upon 'patient-centeredness' in end of life decisions," said Dr. Quill. "Knowing how certain physicians reach and convey prognostic judgments, and how an ICU culture, their organizational factors, like nighttime staffing, influences these decision may help us devise targeted interventions to improve the quality of end-of-life care."

Sarah J. Ratcliffe, PhD, Michael O. Harhay, MPH and Scott D. Halpern, MD, PhD are co-authors on the study.


Story Source:

The above story is based on materials provided by Perelman School of Medicine at the University of Pennsylvania. Note: Materials may be edited for content and length.


Cite This Page:

Perelman School of Medicine at the University of Pennsylvania. "Decisions to forgo life support may depend heavily on the icu where patients are treated." ScienceDaily. ScienceDaily, 21 May 2013. <www.sciencedaily.com/releases/2013/05/130521152427.htm>.
Perelman School of Medicine at the University of Pennsylvania. (2013, May 21). Decisions to forgo life support may depend heavily on the icu where patients are treated. ScienceDaily. Retrieved April 23, 2014 from www.sciencedaily.com/releases/2013/05/130521152427.htm
Perelman School of Medicine at the University of Pennsylvania. "Decisions to forgo life support may depend heavily on the icu where patients are treated." ScienceDaily. www.sciencedaily.com/releases/2013/05/130521152427.htm (accessed April 23, 2014).

Share This



More Health & Medicine News

Wednesday, April 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Big Pharma Braces for M&A Wave

Big Pharma Braces for M&A Wave

Reuters - Business Video Online (Apr. 22, 2014) Big pharma on the move as Novartis boss, Joe Jimenez, tells Reuters about plans to transform his company via an asset exchange with GSK, and Astra Zeneca shares surge on speculation that Pfizer is looking for a takeover. Joanna Partridge reports. Video provided by Reuters
Powered by NewsLook.com
How Smaller Plates And Cutlery Could Make You Feel Fuller

How Smaller Plates And Cutlery Could Make You Feel Fuller

Newsy (Apr. 22, 2014) NBC's "Today" conducted an experiment to see if changing the size of plates and utensils affects the amount individuals eat. Video provided by Newsy
Powered by NewsLook.com
How to Master Motherhood With the Best Work/Life Balance

How to Master Motherhood With the Best Work/Life Balance

TheStreet (Apr. 22, 2014) In the U.S., there are more than 11 million couples trying to conceive at any given time. From helping celebrity moms like Bethanny Frankel to ordinary soon-to-be-moms, TV personality and parenting expert, Rosie Pope, gives you the inside scoop on mastering motherhood. London-born entrepreneur Pope is the creative force behind Rosie Pope Maternity and MomPrep. She explains why being an entrepreneur offers the best life balance for her and tips for all types of moms. Video provided by TheStreet
Powered by NewsLook.com
Catching More Than Fish: Ugandan Town Crippled by AIDS

Catching More Than Fish: Ugandan Town Crippled by AIDS

AFP (Apr. 22, 2014) The village of Kasensero on the shores of Lake Victoria was where HIV-AIDS was first discovered in Uganda. Its transient population of fishermen and sex workers means the nationwide programme to combat the virus has had little impact. Duration: 02:30 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins