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Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians.
- Source :
-
CHEST . Jun2019, Vol. 155 Issue 6, p1140-1147. 8p. - Publication Year :
- 2019
-
Abstract
- <bold>Background: </bold>ICU patients/surrogates may experience adverse outcomes related to perceived inappropriate treatment. The objective was to determine the prevalence of patient/surrogate-reported perceived inappropriate treatment, its impact on adverse outcomes, and discordance with clinicians.<bold>Methods: </bold>We conducted a multicenter, prospective, observational study of adult ICU patients.<bold>Results: </bold>For 151 patients, 1,332 patient, surrogate, nurse, and physician surveys were collected. Disagreement between patients/surrogates and clinicians regarding "too much" treatment being administered occurred in 26% of patients. Disagreement regarding "too little" treatment occurred in 10% of patients. Disagreement about perceived inappropriate treatment was associated with prognostic discordance (P = .02) and lower patient/surrogate satisfaction (Likert scale 1-5 of 4 vs 5; P = .02). Patient/surrogate respondents reported "too much" treatment in 8% of patients and "too little" treatment in 6% of patients. Perceived inappropriate treatment was associated with moderate or high respondent distress for 55% of patient/surrogate respondents and 35% of physician/nurse respondents (P = .30). Patient/surrogate perception of inappropriate treatment was associated with lower satisfaction (Family Satisfaction in the ICU Questionnaire-24, 69.9 vs 86.6; P = .002) and lower trust in the clinical team (Likert scale 1-5 of 4 vs 5; P = .007), but no statistically significant differences in depression (Patient Health Questionnaire-2 of 2 vs 1; P = .06) or anxiety (Generalized Anxiety Disorder-7 Scale of 7 vs 4; P = .18).<bold>Conclusions: </bold>For approximately one-third of ICU patients, there is disagreement between clinicians and patients/surrogates about the appropriateness of treatment. Disagreement about appropriateness of treatment was associated with prognostic discordance and lower patient/surrogate satisfaction. Patients/surrogates who reported inappropriate treatment also reported lower satisfaction and trust in the ICU team. [ABSTRACT FROM AUTHOR]
- Subjects :
- *THERAPEUTICS
*LIKERT scale
*DISEASE prevalence
Subjects
Details
- Language :
- English
- ISSN :
- 00123692
- Volume :
- 155
- Issue :
- 6
- Database :
- Academic Search Index
- Journal :
- CHEST
- Publication Type :
- Academic Journal
- Accession number :
- 136614555
- Full Text :
- https://doi.org/10.1016/j.chest.2019.02.404