ArticleCritical care (London, England)2020
Impact of advance directives on the variability between intensivists in the decisions to forgo life-sustaining treatment.
Article in Critical care (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03013530 (Assessment of Factors Involved in the Decision-making for ICU Patients' Care), which is not on this map. Cited by 4 papers.
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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 Factors Involved in the Decision-making for ICU Patients' Care
Who cites it
4 citing papers in PubMed.
- CARE-ATLANTIC: understanding cross cultural differences in goals of care; a transatlantic study in critical care medicine.BMC medical ethics · 2026Article
- The impact of age on intensive care.Ageing research reviews · 2023Review
- Team-family conflicts over end-of-life decisions in ICU: A survey of French physicians' beliefs.PloS one · 2023Article
- Impact of the Coronavirus Disease Pandemic on Patients with Head Injuries in South Korea.Journal of Korean Neurosurgical Society · 2022Article
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Authors and funding
30 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is wide variability between intensivists in the decisions to forgo life-sustaining treatment (DFLST). Advance directives (ADs) allow patients to communicate their end-of-life wishes to physicians. We assessed whether ADs reduced variability in DFLSTs between intensivists.
methodsWe conducted a multicenter, prospective, simulation study. Eight patients expressed their wishes in ADs after being informed about DFLSTs by an intensivist-investigator. The participating intensivists answered ten questions about the DFLSTs of each patient in two scenarios, referring to patients' characteristics without ADs (round 1) and then with (round 2). DFLST score ranged from 0 (no-DFLST) to 10 (DFLST for all questions). The main outcome was variability in DFLSTs between intensivists, expressed as relative standard deviation (RSD).
resultsA total of 19,680 decisions made by 123 intensivists from 27 ICUs were analyzed. The DFLST score was higher with ADs than without (6.02 95% CI [5.85; 6.19] vs 4.92 95% CI [4.75; 5.10], p < 0.001). High inter-intensivist variability did not change with ADs (RSD: 0.56 (round 1) vs 0.46 (round 2), p = 0.84). Inter-intensivist agreement on DFLSTs was weak with ADs (intra-class correlation coefficient: 0.28). No factor associated with DFLSTs was identified. A qualitative analysis of ADs showed focus on end-of-life wills, unwanted things and fear of pain.
conclusionsADs increased the DFLST rate but did not reduce variability between the intensivists. In the decision-making process using ADs, the intensivist's decision took priority. Further research is needed to improve the matching of the physicians' decision with the patient's wishes. Trial registration ClinicalTrials.gov Identifier: NCT03013530. Registered 6 January 2017; https://clinicaltrials.gov/ct2/show/NCT03013530 .
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