Evidence map›Paper›PMID 28865869›Full record

ArticleJournal of pain and symptom management2018

Homing in on the Social: System-Level Influences on Overly Aggressive Treatments at the End of Life.

Elizabeth Dzeng, Daniel Dohan, J Randall Curtis, Thomas J Smith, Alessandra Colaianni, Christine S Ritchie

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In one paragraph

Article in Journal of pain and symptom management, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  6. Review
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  10. Associations between perceived interpersonal support and aggressiveness of care in the last month of life among patients with advanced cancer.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2024
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  19. We Need a Paradigm Shift Around End-of-Life Decision Making.Journal of the American Geriatrics Society · 2021
    Article
  20. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Elizabeth DzengDivision of Hospital Medicine, University of California, San Francisco, San Francisco, California, USA. Electronic address: liz.dzeng@ucsf.edu.
Daniel DohanInstitute of Health Policy Studies, University of California San Francisco, San Francisco, California, USA.
J Randall CurtisDivision of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA.
Thomas J SmithDepartment of Oncology and Palliative Care, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Alessandra ColaianniMassachusetts Eye and Ear Institute, Boston, Massachusetts, USA.
Christine S RitchieDivision of Geriatrics, University of California, San Francisco, San Francisco, California, USA.

Funding

VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Louise C. Walter · 2013 to 2026
$19.9M
NIA NIH HHS P30 AG044281
6 · The paper itself

Abstract

contextThe American Medical System is programmed to a default setting of aggressive care for the terminally ill. Institutional norms of decision making have been shown to promote high-intensity care, regardless of consistency with patient preferences. There are myriad factors at a system, clinician, surrogate, and patient level that drive the culture of overly aggressive treatments in American hospitals.

objectiveThe objective of this study was to understand physician perspective of the ways systems-level factors influence patient, physician, and surrogate perceptions and consequent behavior.

methodsSemi-structured in-depth qualitative interviews with 42 internal medicine physicians across three American academic medical centers were conducted. This qualitative study was exploratory in nature, intended to enhance conceptual understanding of underlying phenomena that drive physician attitudes and behavior.

resultsThe interviews revealed many factors that contributed to overly aggressive treatments at the end of life. Systemic factors, which describe underlying cultures (including institutional, professional, or community-based cultures), typical practices of care, or systemic defaults that drive patterns of care, manifested its influence both directly and through its impact on patient, surrogate, and physician behaviors and attitudes.

conclusionInstitutional cultures, social norms, and systemic defaults influence both normative beliefs regarding standards of care and treatments plans that may not benefit seriously ill patients.

Indexed as

Attitude of Health PersonnelCaregiversCritical IllnessCultureFemaleHumansInterviews as TopicLife Support CareMalePhysiciansQualitative ResearchTerminal CareUnited Statesend-of-life caremedical cultureOverly aggressive treatmentsqualitative researchsocial science

Identifiers

PMID28865869
PMCPMC6329585

What OpenQuestion holds

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Registered trials

None linked

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.