Dataset Information

Are physicians' recommendations to limit life support beneficial or burdensome? Bringing empirical data to the debate.

ABSTRACT:

Rationale

Although there is a growing belief that physicians should routinely provide a recommendation to surrogates during deliberations about withdrawing life support, there is a paucity of empirical data on surrogates' perspectives on this topic.

Objectives

To understand the attitudes of surrogate decision-makers toward receiving a physician's recommendation during deliberations about whether to limit life support for an incapacitated patient.

Methods

We conducted a prospective, mixed methods study among 169 surrogate decision-makers for critically ill patients. Surrogates sequentially viewed two videos of simulated physician-surrogate discussions about whether to limit life support, which varied only by whether the physician gave a recommendation.

Measurements and main results

The main quantitative outcome was whether surrogates preferred to receive a physicians' recommendation. Surrogates also participated in an in-depth, semistructured interview to explore the reasons for their preference. Fifty-six percent (95/169) of surrogates preferred to receive a recommendation, 42% (70/169) preferred not to receive a recommendation, and 2% (4/169) felt that both approaches were equally acceptable. We identified four main themes that explained surrogates' preferences, including surrogates' perceptions of physicians' appropriate role in life or death decisions and their perceptions of the positive or negative consequences of a recommendation on the physician-surrogate relationship, on the decision-making process, and on long-term regret for the family.

Conclusions

There is no consensus among surrogates about whether physicians should routinely provide a recommendation regarding life support decisions for incapacitated patients. These findings suggest that physicians should ask surrogates whether they wish to receive a recommendation regarding life support decisions and should be flexible in their approach to decision-making.

SUBMITTER: White DB

PROVIDER: S-EPMC2731809 | biostudies-literature | 2009 Aug

REPOSITORIES: biostudies-literature

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Publications

Are physicians' recommendations to limit life support beneficial or burdensome? Bringing empirical data to the debate.

White Douglas B DB Evans Leah R LR Bautista Christopher A CA Luce John M JM Lo Bernard B

American journal of respiratory and critical care medicine 20090604 4

<h4>Rationale</h4>Although there is a growing belief that physicians should routinely provide a recommendation to surrogates during deliberations about withdrawing life support, there is a paucity of empirical data on surrogates' perspectives on this topic.<h4>Objectives</h4>To understand the attitudes of surrogate decision-makers toward receiving a physician's recommendation during deliberations about whether to limit life support for an incapacitated patient.<h4>Methods</h4>We conducted a pros ...[more]

PMID: 19498057

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Project description:BackgroundRecognizing that alert fatigue poses risks to patient safety and clinician wellness, there is a growing emphasis on evaluation and governance of electronic health record clinical decision support (CDS). This is particularly critical for interruptive alerts to ensure that they achieve desired clinical outcomes while minimizing the burden on clinicians. This study describes an improvement effort to address a problematic interruptive alert intended to notify clinicians about patients needing coronavirus disease 2019 (COVID) precautions and how we collaborated with operational leaders to develop an alternative passive CDS system in acute care areas.ObjectivesOur dual aim was to reduce the alert burden by redesigning the CDS to adhere to best practices for decision support while also improving the percent of admitted patients with symptoms of possible COVID who had appropriate and timely infection precautions orders.MethodsIterative changes to CDS design included adjustment to alert triggers and acknowledgment reasons and development of a noninterruptive rule-based order panel for acute care areas. Data on alert burden and appropriate precautions orders on symptomatic admitted patients were followed over time on run and attribute (p) and individuals-moving range control charts.ResultsAt baseline, the COVID alert fired on average 8,206 times per week with an alert per encounter rate of 0.36. After our interventions, the alerts per week decreased to 1,449 and alerts per encounter to 0.07 equating to an 80% reduction for both metrics. Concurrently, the percentage of symptomatic admitted patients with COVID precautions ordered increased from 23 to 61% with a reduction in the mean time between COVID test and precautions orders from 19.7 to -1.3 minutes.ConclusionCDS governance, partnering with operational stakeholders, and iterative design led to successful replacement of a frequently firing interruptive alert with less burdensome passive CDS that improved timely ordering of COVID precautions.

Dataset Information

Are physicians' recommendations to limit life support beneficial or burdensome? Bringing empirical data to the debate.

Rationale

Objectives

Methods

Measurements and main results

Conclusions

Publications

Are physicians' recommendations to limit life support beneficial or burdensome? Bringing empirical data to the debate.

Similar Datasets

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