ArticleBMJ open2021
Physicians' perspective on potentially non-beneficial treatment when assessing patients with advanced disease for ICU admission: a qualitative study.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 9 citations in OpenAlex.
- Timing matters: sex differences in treatment limitation decisions in intensive care.Critical care (London, England) · 2026Article
- The ICUPASS Study: Variability, Influencing Factors, and Clinician Stress in ICU Admission Decisions.Cureus · 2026Article
- Shared decision-making with older people on TReatment Escalation planning for Acute deterioration in the emergency Medical Setting - Observed (STREAMS-O): an ethnographic study.BMC geriatrics · 2025Article
- An Explanatory Mixed-Methods Study of Intensive Care Unit Net Benefit: Triage and Trajectory for Sepsis and Acute Respiratory Failure.Annals of the American Thoracic Society · 2025Article
- Context factors in clinical decision-making: a scoping review.BMC medical informatics and decision making · 2025Article
- Article
- Perspectives of healthcare professionals and older patients on shared decision-making for treatment escalation planning in the acute hospital setting: a systematic review and qualitative thematic synthesis.EClinicalMedicine · 2023Article
- The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review.Indian journal of palliative careArticle
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe use of intensive care at the end of life can be high, leading to inappropriate healthcare utilisation, and prolonged suffering for patients and families. The objective of the study was to determine which factors influence physicians' admission decisions in situations of potentially non-beneficial intensive care.
designThis is a secondary analysis of a qualitative study exploring the triage process. In-depth interviews were analysed using an inductive approach to thematic content analysis.
settingData were collected in a Swiss tertiary care centre between March and June 2013.
participants12 intensive care unit (ICU) physicians and 12 internists routinely involved in ICU admission decisions.
resultsPhysicians struggled to understand the request for intensive care for patients with advanced disease and full code status. Physicians considered patients' long-term vital and functional prognosis, but they also resorted to shortcuts, that is, a priori consensus about reasons for admitting a patient. Family pressure and unexpected critical events were determinants of admission to the ICU. Patient preferences, ICU physician's expertise and collaborative decision making facilitated refusal. Physicians were willing to admit a patient with advanced disease for a limited amount of time to fulfil a personal need.
conclusionsIn situations of potentially non-beneficial intensive care, the influence of shortcuts or context-related factors suggests that practice variations and inappropriate admission decisions are likely to occur. Institutional guidelines and timely goals of care discussions with patients with advanced disease and their families could contribute to ensuring appropriate levels of care.
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