ArticleIntensive care medicine2012
Association between physicians' beliefs and the option of comfort care for critically ill patients.
Article in Intensive 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 NCT02955563 (CSDM), which is not on this map. Cited by 33 papers, 2 of them syntheses that pooled it.
What it found
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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.
CSDM: A Trial to Improve Communication and Shared Decision Making Using a Web-Based Tool
Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 78 citations in OpenAlex.
- Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement.Critical care medicine · 2016Guideline
- Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review.Critical care (London, England) · 2014Pooled it
- Randomized Clinical Trial of the Four Supports Intervention for Surrogate Decision-Makers in Intensive Care Units.American journal of respiratory and critical care medicine · 2025Trial
- Effect of Documenting Prognosis on the Information Provided to ICU Proxies: A Randomized Trial.Critical care medicine · 2019Trial
- Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation: A Randomized Clinical Trial.Annals of internal medicine · 2019Trial
- Rationale and Design of the Randomized Evaluation of Default Access to Palliative Services (REDAPS) Trial.Annals of the American Thoracic Society · 2016Trial
- A scenario-based, randomized trial of patient values and functional prognosis on intensivist intent to discuss withdrawing life support.Critical care medicine · 2014Trial
- Article
- Values Frameworks as Ideal Types: Navigating Ethics Conflicts with Normative Minorities : Values Frameworks as Ideal Types: Response to Critics of "Surrogate Wars".HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues · 2025Article
- Impact of a family support intervention on hospitalization costs and hospital readmissions among ICU patients at high risk of death or severe functional impairment.Annals of intensive care · 2024Article
- Don't Throw the Baby Out With the Bathwater: Meta-Analysis of Advance Care Planning and End-of-life Cancer Care.Journal of pain and symptom management · 2023Review
- Time-limited trials in the ICU: a mixed-methods sequential explanatory study of intensivists at two academic centres.BMJ open · 2022Article
- [Ad hoc ethical decision-making in clinical acute and emergency medicine : Position paper of the Ethics Section of the German Interdisciplinary Association of Critical Care and Emergency Medicine (DIVI) in collaboration with the Ethics Section of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN)].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2022Review
- Spanish Medical Interpreters' Management of Challenges in End of Life Discussions.Patient education and counseling · 2021Article
- Impact of a Visual Support Dedicated to Prognosis on Symptoms of Stress of ICU Family Members: A Before-and-After Implementation Study.Critical care explorations · 2021Article
- Racial Disparities in Utilization of Palliative Care Among Patients Admitted With Advanced Solid Organ Malignancies.The American journal of hospice & palliative care · 2021Article
- Prognosticating Outcomes and Nudging Decisions with Electronic Records in the Intensive Care Unit Trial Protocol.Annals of the American Thoracic Society · 2021Article
- Lung Transplant Pulmonologists' Views of Specialty Palliative Care for Lung Transplant Recipients.Journal of palliative medicine · 2020Article
- Conceptualizing and Counting Discretionary Utilization in the Final 100 Days of Life: A Scoping Review.Journal of pain and symptom management · 2020Article
- Association of Family Ratings of Quality of End-of-Life Care With Stopping Dialysis Treatment and Receipt of Hospice Services.JAMA network open · 2019Observational
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
purposeFor critically ill patients at high risk of death, reasonable treatment options include attempts at life prolongation and treatment focused on comfort. Little is known about whether and how physicians present the option of comfort care to surrogates. This study assessed how comfort care is presented to surrogates and whether physicians' beliefs are associated with whether comfort care is presented as an option.
methodsMixed-methods study of 72 audio-recorded family conferences about treatment decisions in five ICUs at two hospitals in San Francisco, California. One hundred sixty-nine family members and 54 physicians participated. Patients were at high risk of death or severe functional impairment. Transcripts of audio-recorded conferences were coded to identify whether physicians offered comfort care as an alternative to life-sustaining treatment and to characterize the stated risks and benefits. Physicians completed a questionnaire indicating the strength of their belief that life support should be foregone.
resultsThe inpatient mortality rate was 72 %. Using a broad definition of comfort-oriented treatment, this option was presented in 56 % (95 % CI, 44-67 %) of conferences. In clustered multivariate models, the only independent predictor of offering comfort care as an option was the strength of the physician's belief that life support should be foregone [OR 1.38 (1.14-1.66), p = 0.01].
conclusionsClinicians did not explicitly inform surrogates about the option of comfort-oriented treatment in roughly half of clinician-family meetings. Physicians who more strongly believe that the appropriate goal of care is life prolongation are less likely to inform surrogates about the option of comfort care.
Indexed as
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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.