ArticleAmerican journal of respiratory and critical care medicine2012
End-of-life care in the intensive care unit: can we simultaneously increase quality and reduce costs?
Article in American journal of respiratory and critical care medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02445937 (Stepped Wedge Trial of an Intervention to Support Proxy Decision Makers in ICUs), which is not on this map. Cited by 47 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Stepped Wedge Trial of an Intervention to Support Proxy Decision Makers in ICUs
Who cites it
47 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- End-of-Life Decision Support in the ICU: Where Are We Now?Western journal of nursing research · 2018Pooled it
- Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review.Critical care medicine · 2015Pooled it
- Pooled it
- A Pilot Efficacy Trial to Educate Muslim Americans about the Islamic Bioethical Perspectives in End-of-Life Healthcare.Journal of immigrant and minority health · 2024Trial
- Review
- Goals of Care Discussions in Medical Training: Integrating Palliative Care for Holistic, Patient-Centered Care.Healthcare (Basel, Switzerland) · 2026Review
- Peaceful dying among Canada's elderly: An analysis of the Canadian Longitudinal Study on Aging.PloS one · 2025Article
- Predictors of medical cost and length of stay of motorcycle injury patients presenting to hospitals in Kisumu City, Kenya.African health sciences · 2024Article
- Study protocol for a randomized controlled trial: Integrating the 'Time-limited Trial' in the emergency department.PloS one · 2024Article
- Impact of an Interdisciplinary Goals-of-Care Program Among Medical Inpatients at a Comprehensive Cancer Center During the COVID-19 Pandemic: A Propensity Score Analysis.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023Article
- Comparative costs for critically ill patients with limited English proficiency versus English proficiency.PloS one · 2023Article
- Better Regulation of End-Of-Life Care: A Call For A Holistic Approach.Journal of bioethical inquiry · 2022Article
- Improving Outcomes Measurement in Palliative Care: The Lasting Impact of Randy Curtis and his Collaborators.Journal of pain and symptom management · 2022Article
- Assessment of an Instrument to Measure Interdisciplinary Staff Perceptions of Quality of Dying and Death in a Pediatric Cardiac Intensive Care Unit.JAMA network open · 2022Article
- Is this as good as it gets? Implications of an asymptotic mortality decline and approaching the nadir in pediatric intensive care.European journal of pediatrics · 2022Review
- Impact of non-cystic fibrosis bronchiectasis on critically ill patients in Korea: a retrospective observational study.Scientific reports · 2021Observational
- Evaluation of Time-Limited Trials Among Critically Ill Patients With Advanced Medical Illnesses and Reduction of Nonbeneficial ICU Treatments.JAMA internal medicine · 2021Article
- Impact of Intensivist and Nursing Staff on Critically Ill Patient Mortality: A Retrospective Analysis of the Korean NHIS Cohort Data, 2011-2015.Yonsei medical journal · 2021Article
- Article
- Appropriateness of intensive care treatments near the end of life during the COVID-19 pandemic.Breathe (Sheffield, England) · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
The incidence and costs of critical illness are increasing in the United States at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. More than 25% of healthcare costs are spent in the last year of life, and approximately 20% of deaths occur in the intensive care unit (ICU). Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.