Evidence map›Paper›PMID 31095596›Full record

ArticlePloS one2019

What's behind the white coat: Potential mechanisms of physician-attributable variation in critical care.

Kuldeep N Yadav, Michael Josephs, Nicole B Gabler, Michael E Detsky, Scott D Halpern, Joanna L Hart

Abstract read
In one paragraph

Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–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

4 citing papers in PubMed.

  1. Article
  2. Article
  3. A model for occupational stress amongst paediatric and adult critical care staff during COVID-19 pandemic.International archives of occupational and environmental health · 2021
    Observational
  4. Article
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.

Kuldeep N YadavPalliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.ORCID 0000-0002-7661-6229
Michael JosephsPalliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Nicole B GablerPalliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Michael E DetskyPalliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Scott D HalpernPalliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Joanna L HartPalliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.ORCID 0000-0001-5617-741X

Funding

Enabling Medical Research Growth in Emergency MedicineK12HL109009 · NHLBI · UNIVERSITY OF PENNSYLVANIA · PI KIMMEL, STEPHEN E. · 2011 to 2015
$3.4M
NHLBI NIH HHS K12 HL109009
6 · The paper itself

Abstract

backgroundCritical care intensity is known to vary across regions and centers, yet the mechanisms remain unidentified. Physician behaviors have been implicated in the variability of intensive care near the end of life, but physician characteristics that may underlie this association have not been determined. PURPOSE: We sought to identify behavioral attributes that vary among intensivists to generate hypotheses for mechanisms of intensivist-attributable variation in critical care delivery.

methodsWe administered a questionnaire to intensivists who participated in a prior cohort study in which intensivists made prognostic estimates. We evaluated the degree to which scores on six attribute measures varied across intensivists. Measures were selected for their relevance to preference-sensitive critical care: a modified End-of-Life Preferences (EOLP) scale, Life Orientation Test-Revised (LOT-R), Jefferson Scale of Empathy (JSE), Physicians' Reactions to Uncertainty (PRU) scale, Collett-Lester Fear of Death (CLFOD) scale, and a test of omission bias. We conducted regression analyses assessing relationships between intensivists' attribute scores and their prognostic accuracy, as physicians' prognostic accuracy may influence preference-sensitive decisions.

results20 of 25 eligible intensivists (80%) completed the questionnaire. Intensivists' scores on the EOLP, LOT-R, PRU, CLFOD, and omission bias measures varied considerably, while their responses on the JSE scale did not. There were no consistent associations between attribute scores and prognostic accuracy.

conclusionsIntensivists vary in feasibly measurable attributes relevant to preference-sensitive critical care delivery. These attributes represent candidates for future research aimed at identifying mechanisms of clinician-attributable variation in critical care and developing effective interventions to reduce undue variation.

Indexed as

Attitude of Health PersonnelCritical CareDecision MakingEmpathyIntensive Care UnitsPhysiciansAdultAgedFemaleHumansMaleMiddle Aged

Identifiers

PMID31095596
PMCPMC6522043

What OpenQuestion holds

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Registered trials

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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.