Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients
Abstract Background Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and with...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2021-07-01
|
| Series: | Annals of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13613-021-00895-5 |
| _version_ | 1819073560206901248 |
|---|---|
| author | Dominique D. Benoit Esther N. van der Zee Michael Darmon An K. L. Reyners Victoria Metaxa Djamel Mokart Alexander Wilmer Pieter Depuydt Andreas Hvarfner Katerina Rusinova Jan G.Zijlstra François Vincent Dimitrios Lathyris Anne-Pascale Meert Jacques Devriendt Emma Uyttersprot Erwin J. O. Kompanje Ruth Piers Elie Azoulay |
| author_facet | Dominique D. Benoit Esther N. van der Zee Michael Darmon An K. L. Reyners Victoria Metaxa Djamel Mokart Alexander Wilmer Pieter Depuydt Andreas Hvarfner Katerina Rusinova Jan G.Zijlstra François Vincent Dimitrios Lathyris Anne-Pascale Meert Jacques Devriendt Emma Uyttersprot Erwin J. O. Kompanje Ruth Piers Elie Azoulay |
| author_sort | Dominique D. Benoit |
| collection | DOAJ |
| description | Abstract Background Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. Methods This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. Results Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60–1.72 and HR 0.87, 95% CI 0.49–1.54) and TLDs (HR 0.81, 95% CI 0.33–1.99 and HR 0.70, 95% CI 0.27–1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58–3.15 and 1.66, 95% CI 1.28–2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. Conclusions The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU. |
| first_indexed | 2024-12-21T17:55:34Z |
| format | Article |
| id | doaj.art-da59897d16dc495ebbf35a7f7966af07 |
| institution | Directory Open Access Journal |
| issn | 2110-5820 |
| language | English |
| last_indexed | 2024-12-21T17:55:34Z |
| publishDate | 2021-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj.art-da59897d16dc495ebbf35a7f7966af072022-12-21T18:55:14ZengSpringerOpenAnnals of Intensive Care2110-58202021-07-0111111110.1186/s13613-021-00895-5Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patientsDominique D. Benoit0Esther N. van der Zee1Michael Darmon2An K. L. Reyners3Victoria Metaxa4Djamel Mokart5Alexander Wilmer6Pieter Depuydt7Andreas Hvarfner8Katerina Rusinova9Jan G.Zijlstra10François Vincent11Dimitrios Lathyris12Anne-Pascale Meert13Jacques Devriendt14Emma Uyttersprot15Erwin J. O. Kompanje16Ruth Piers17Elie Azoulay18Department of Intensive Care Medicine, Ghent University HospitalDepartment of Intensive Care Medicine, Erasmus MC University Medical Center RotterdamHôpital Saint-Louis and UniversityDepartment of Medical Oncology, University Medical Center GroningenDepartment of Critical Care, King’s College HospitalCritical Care and Anesthesiology, Institut Paoli CalmettesDepartment of General Internal Medicine, University Hospital LouvainDepartment of Intensive Care Medicine, Ghent University HospitalDepartment of Perioperative Medicine and Intensive Care, Karolinska University HospitalDepartment of Palliative Care, 1St Faculty of Medicine, Charles University of MedicineDepartment of Critical Care, University Medical Center Groningen, University of GroningenMedical Surgical ICU, GHIC Le Raincy-MontfermeilDepartment of Intensive Care Medicine, General Hospital G. GennimatasService de Médecine Interne, Université Libre de Bruxelles (ULB)Intensive Care Unit, Brugmann University HospitalDepartment of Applied Mathematics and Computer Sciences, Ghent UniversityDepartment of Intensive Care Medicine, Erasmus MC University Medical Center RotterdamDepartment of Geriatric Medicine, Ghent University HospitalHôpital Saint-Louis and UniversityAbstract Background Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. Methods This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. Results Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60–1.72 and HR 0.87, 95% CI 0.49–1.54) and TLDs (HR 0.81, 95% CI 0.33–1.99 and HR 0.70, 95% CI 0.27–1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58–3.15 and 1.66, 95% CI 1.28–2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. Conclusions The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU.https://doi.org/10.1186/s13613-021-00895-5CancerCritical careICUBiasPerception of carePrognostication |
| spellingShingle | Dominique D. Benoit Esther N. van der Zee Michael Darmon An K. L. Reyners Victoria Metaxa Djamel Mokart Alexander Wilmer Pieter Depuydt Andreas Hvarfner Katerina Rusinova Jan G.Zijlstra François Vincent Dimitrios Lathyris Anne-Pascale Meert Jacques Devriendt Emma Uyttersprot Erwin J. O. Kompanje Ruth Piers Elie Azoulay Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients Annals of Intensive Care Cancer Critical care ICU Bias Perception of care Prognostication |
| title | Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients |
| title_full | Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients |
| title_fullStr | Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients |
| title_full_unstemmed | Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients |
| title_short | Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients |
| title_sort | outcomes of icu patients with and without perceptions of excessive care a comparison between cancer and non cancer patients |
| topic | Cancer Critical care ICU Bias Perception of care Prognostication |
| url | https://doi.org/10.1186/s13613-021-00895-5 |
| work_keys_str_mv | AT dominiquedbenoit outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT esthernvanderzee outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT michaeldarmon outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT anklreyners outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT victoriametaxa outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT djamelmokart outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT alexanderwilmer outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT pieterdepuydt outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT andreashvarfner outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT katerinarusinova outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT jangzijlstra outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT francoisvincent outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT dimitrioslathyris outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT annepascalemeert outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT jacquesdevriendt outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT emmauyttersprot outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT erwinjokompanje outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT ruthpiers outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients AT elieazoulay outcomesoficupatientswithandwithoutperceptionsofexcessivecareacomparisonbetweencancerandnoncancerpatients |