Observational studyIntensive care medicine2013
The ETHICA study (part II): simulation study of determinants and variability of ICU physician decisions in patients aged 80 or over.
Observational study in Intensive care medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02852629 (Assessment of a Tool for Decision Making in Case of Worsening Condition of Cancer Patients), which is not on this map. Cited by 38 papers, 1 of them a synthesis 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.
Assessment of a Tool for Decision Making in Case of Worsening Condition of Cancer Patients
Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Practices in Triage and Transfer of Critically Ill Patients: A Qualitative Systematic Review of Selection Criteria.Critical care medicine · 2020Pooled it
- Improving racial disparities in unmet palliative care needs among intensive care unit family members with a needs-targeted app intervention: The ICUconnect randomized clinical trial.Contemporary clinical trials · 2021Trial
- Admission to intensive care: a matter of shared decision-making in the very old?European geriatric medicine · 2026Review
- Reliability and validity of a new postoperative track assessment tool (PoTra-tool) as a decision-making aid: A prospective observational study.European journal of anaesthesiology and intensive care · 2025Article
- ICU Admission Preferences in the Hypothetical Event of Acute Critical Illness: A Survey of Very Old Norwegians and Their Next-of-Kins.Critical care explorations · 2024Article
- Hematologists' perspective on advance directives, a French national cross-sectional survey - the ADORE-H study.BMC medical ethics · 2024Article
- Oncologists' perspective on advance directives, a French national prospective cross-sectional survey - the ADORE study.BMC medical ethics · 2024Article
- Effect of a multimodal training on the ability of medical students to administer the MMSE: a comparative study.BMC medical education · 2024Article
- Ableism in the intensive care unit.Intensive care medicine · 2023Article
- Prudence in end-of-life decision making: A virtue-based analysis of physician communication with patients and surrogates.SSM. Qualitative research in health · 2022Article
- Advance Directives in Oncology and Haematology: A Long Way to Go-A Narrative Review.Journal of clinical medicine · 2022Review
- Physicians' Views and Agreement about Patient- and Context-Related Factors Influencing ICU Admission Decisions: A Prospective Study.Journal of clinical medicine · 2021Article
- UK consultants' experiences of the decision-making process around referral to intensive care: an interview study.BMJ open · 2021Article
- Noninvasive ventilation in critically ill very old patients with pneumonia: A multicenter retrospective cohort study.PloS one · 2021Article
- Identifying ICU admission decision patterns in a '20-questions game' approach using network analysis.The Southern African journal of critical care : the official journal of the Critical Care Society · 2021Article
- ICU-Mortality in Old and Very Old Patients Suffering From Sepsis and Septic Shock.Frontiers in medicine · 2021Article
- Impact of advance directives on the variability between intensivists in the decisions to forgo life-sustaining treatment.Critical care (London, England) · 2020Article
- Simulation Training in Hemodynamic Monitoring and Mechanical Ventilation: An Assessment of Physician's Performance.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2020Article
- Implementing an intervention to improve decision making around referral and admission to intensive care: Results of feasibility testing in three NHS hospitals.Journal of evaluation in clinical practice · 2020Article
- U.K. Intensivists' Preferences for Patient Admission to ICU: Evidence From a Choice Experiment.Critical care medicine · 2019Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo assess physician decisions about ICU admission for life-sustaining treatments (LSTs).
methodsObservational simulation study of physician decisions for patients aged ≥80 years. Each patient was allocated at random to four physicians who made decisions based on actual bed availability and existence of an additional bed before and after obtaining information on patient preferences. The simulations involved non-invasive ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of IMV (RRT after IMV).
resultsThe physician participation rate was 100/217 (46 %); males without religious beliefs predominated, and median ICU experience was 9 years. Among participants, 85.7, 78, and 62 % felt that NIV, IMV, or RRT (after IMV) was warranted, respectively. By logistic regression analysis, factors associated with admission were age <85 years, self-sufficiency, and bed availability for NIV and IMV. Factors associated with IMV were previous ICU stay (OR 0.29, 95 % CI 0.13-0.65, p = 0.01) and cancer (OR 0.23, 95 % CI 0.10-0.52, p = 0.003), and factors associated with RRT (after IMV) were living spouse (OR 2.03, 95 % CI 1.04-3.97, p = 0.038) and respiratory disease (OR 0.42, 95 % CI 0.23-0.76, p = 0.004). Agreement among physicians was low for all LSTs. Knowledge of patient preferences changed physician decisions for 39.9, 56, and 57 % of patients who disagreed with the initial physician decisions for NIV, IMV, and RRT (after IMV) respectively. An additional bed increased admissions for NIV and IMV by 38.6 and 13.6 %, respectively.
conclusionsPhysician decisions for elderly patients had low agreement and varied greatly with bed availability and knowledge of patient preferences.
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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.