en
Scientific article
English

Admission of incompetent patients to intensive care: doctors' responsiveness to family wishes

Published inCritical care medicine, vol. 37, no. 2, p. 528-532
Publication date2009
Abstract

OBJECTIVE: When a patient is incompetent, the family is often considered to be a natural surrogate. The doctors' responsiveness to family wishes may vary. We explored if doctors' personal characteristics were associated with responsiveness to the relatives' wishes when admission to the intensive care unit (ICU) is considered. METHODS: In a mail survey, we asked all Swiss ICU doctors to decide on the admission of a hypothetical incompetent patient presenting with hemolytic uremic syndrome. Each participant was randomly allocated to a version of the scenario in which the family asked either that "everything be done" or that the patient be "spared useless suffering." MAIN RESULTS: Overall, 232 (60.9%) questionnaires were returned. When the family asked that "everything be done," 60% of doctors chose to admit the hypothetical patient, but when the family asked that she be spared useless suffering, only 39% did so (odds ratio [OR] 2.6, confidence interval 1.5-4.6). This OR captures responsiveness to family wishes. It varied across subgroups of ICU doctors. Characteristics associated with greater responsiveness to family wishes were older age (OR 6.0 vs. 1.2, p = 0.002), nonuniversity work setting (OR 4.2 vs. 1.0, p = 0.012), less time devoted to intensive care practice (OR 4.0 vs. 1.5, p = 0.036), and greater self-confidence in ethical knowledge (OR 3.4 vs. 1.7, p = 0.044). CONCLUSIONS: Older doctors and those working in regional hospitals were more responsive to family wishes when assessing an incompetent patient for ICU admission. These findings emphasize the need for effective advance care planning.

Keywords
  • Adult
  • *Decision Making
  • Female
  • Health Care Surveys
  • Humans
  • *Intensive Care Units
  • Male
  • *Mental Competency
  • Middle Aged
  • *Patient Admission
  • *Physicians
  • *Professional-Family Relations
  • Questionnaires
  • Switzerland
  • Triage
Citation (ISO format)
ESCHER, Monica et al. Admission of incompetent patients to intensive care: doctors” responsiveness to family wishes. In: Critical care medicine, 2009, vol. 37, n° 2, p. 528–532. doi: 10.1097/CCM.0b013e3181958409
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