ArticleAnnals of the American Thoracic Society2017
Clinical Momentum in the Intensive Care Unit. A Latent Contributor to Unwanted Care.
Article in Annals of the American Thoracic Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 1 of them a synthesis that pooled it.
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The influence of POLST on treatment intensity at the end of life: A systematic review.Journal of the American Geriatrics Society · 2021Pooled it
- Efficacy of a Communication-Priming Intervention on Documented Goals-of-Care Discussions in Hospitalized Patients With Serious Illness: A Randomized Clinical Trial.JAMA network open · 2022Trial
- A psychometric evaluation of the Family Decision-Making Self-Efficacy Scale among surrogate decision-makers of the critically ill.Palliative & supportive care · 2020Trial
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Time-limited trials for acute dialysis decision-making for critically ill older patients: rationale, communication strategies, and future research.Current opinion in nephrology and hypertension · 2026Review
- The Challenges of Prognosticating Persistent Critical Illness: A Qualitative Study.CHEST critical care · 2026Article
- Decision-Making Approaches Used to Limit Potentially Nonbeneficial Life-Prolonging Interventions.JAMA network open · 2026Article
- Evaluation of a Tablet-Based Emotion Regulation Intervention for Surrogate Decision-Makers of Patients With Critical Illness: Pilot Nonrandomized Trial.JMIR formative research · 2026Article
- Clinician perspectives on utilizing time-limited trials among patients with an out-of-hospital cardiac arrest: A qualitative study.Resuscitation plus · 2026Article
- Patterns and outcomes of real-world high-flow nasal cannula use: a multi-hospital retrospective cohort study.Critical care science · 2026Observational
- Managing the Uncertainty of "Precision" While Navigating Goals of Care: A Framework for Collaborative Interpretation of Complex Genomic Testing Results in Critically-Ill Neonates.Children (Basel, Switzerland) · 2025Article
- Families' Experiences Making Decisions across Time and Settings in Chronic Critical Illness.Annals of the American Thoracic Society · 2025Article
- Clinical Momentum: An Observational Study Identifying Latent Forces Driving Surgical Interventions for Older Adults Near the End of Life.Annals of surgery · 2025Article
- Systemic Strategies to Prevent Nonbeneficial Treatments Near the End of Life.JAMA network open · 2025Article
- The Surgical Pause: The Importance of Measuring Frailty and Taking Action to Address Identified Frailty.Joint Commission journal on quality and patient safety · 2025Article
- Clinical momentum in the care of older adults with advanced dementia: What evidence is there in the medical record?Journal of the American Geriatrics Society · 2025Article
- Racial, Ethnic, and Socioeconomic Differences in Critical Care Near the End of Life: A Narrative Review.Critical care clinics · 2024Review
- Leveraging the electronic health record to identify delivery of goal-concordant care.medRxiv : the preprint server for health sciences · 2024Article
- Article
- Clinician perspectives on integrating neuro-oncology and palliative care for patients with high-grade glioma.Neuro-oncology practice · 2024Article
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
Many older adults in the United States receive invasive medical care near the end of life, often in an intensive care unit (ICU). However, most older adults report preferences to avoid this type of medical care and to prioritize comfort and quality of life near death. We propose a novel term, "clinical momentum," to describe a system-level, latent, previously unrecognized property of clinical care that may contribute to the provision of unwanted care in the ICU. The example of chronic critical illness illustrates how clinical momentum is generated and propagated during the care of patients with prolonged illness. The ICU is an environment that is generally permissive of intervention, and clinical practice norms and patterns of usual care can promote the accumulation of multiple interventions over time. Existing models of medical decision-making in the ICU describe how individual signs, symptoms, or diagnoses automatically lead to intervention, bypassing opportunities to deliberate about the value of an intervention in the context of a patient's likely outcome or treatment preferences. We hypothesize that clinical momentum influences patients, families, and physicians to accept or tolerate ongoing interventions without consideration of likely outcomes, eventually leading to the delivery of unwanted care near the end of life. In the future, a mixed-methods research program could refine the conceptual model of clinical momentum, measure its impact on clinical practice, and interrupt its influence on unwanted care near the end of life.
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