Evidence map›Paper›PMID 37812228›Full record

ArticleIntensive care medicine2023

The impact of religion on changes in end-of-life practices in European intensive care units: a comparative analysis over 16 years.

Joerg C Schefold, Livio Ruzzante, Charles L Sprung, Anastasiia Gruber, Eldar Soreide, Joseph Cosgrove, Sudakshina Mullick, Georgios Papathanakos, Vasilios Koulouras, Paulo Azevedo Maia and 6 more

Open access · hybridAbstract read
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In one paragraph

Article in Intensive care medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
2.3field-weighted citation impact, top 12% of its field
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

6 citing papers in PubMed, 8 citations in OpenAlex.

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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

16 authors at 10 institutions in 9 countries.

Joerg C Schefold *Department of Intensive Care Medicine, Inselspital, University of Bern, Bern, Switzerland. joerg.schefold@insel.ch.ORCID http://orcid.org/0000-0001-9162-5724
Livio Ruzzante *Department of Intensive Care Medicine, Inselspital, University of Bern, Bern, Switzerland. livio.ruzzante@gmail.com.ORCID http://orcid.org/0000-0002-8693-8678
Charles L SprungDepartment of Anesthesiology, Critical Care and Pain Medicine, Hadassah Ein Karem Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Anastasiia GruberCenter for Medical Data Science, Institute for Statistics, Medical University of Vienna, Vienna, Austria.
Eldar SoreideSection for Quality and Patient Safety, Stavanger University Hospital, Stavanger and Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Joseph CosgroveInstitute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, NE7 7RG, UK.
Sudakshina MullickNarayana Hrudayalaya Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India.
Georgios PapathanakosDepartment of Intensive Care Medicine, University Hospital of Ioannina, Ioannina, Greece.
Vasilios KoulourasDepartment of Intensive Care Medicine, University Hospital of Ioannina, Ioannina, Greece.
Paulo Azevedo MaiaIntensive Care Department, Hospital Santo António (CHUdSA) and Instituto Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
Bara RicouIntensive Care. Department of Acute Medicine, Hospital of Geneva and University of Geneva, Geneva, Switzerland.
Martin PoschCenter for Medical Data Science, Institute for Statistics, Medical University of Vienna, Vienna, Austria.
Philipp MetnitzCenter for Medical Data Science, Institute for Statistics, Medical University of Vienna, Vienna, Austria.
Hans-Henrik BülowDepartment of Anaesthesiology and Intensive Care, Holbæk Hospital, Holbæk, Denmark.
Alexander AvidanDepartment of Anesthesiology, Critical Care and Pain Medicine, Hadassah Ein Karem Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
ETHICUS II Study Group
Hebrew University of Jerusalem · ILUniversidade do Porto · PTUniversity of Geneva · CHUniversity Hospital of Ioannina · GRUniversity of Bern · CHStatistics Austria · ATFreeman Hospital · GBHolbæk Sygehus · DKRabindranath Tagore International Institute of Cardiac Sciences · INStavanger University Hospital · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeReligious beliefs affect end-of-life practices in intensive care units (ICUs). Changes over time in end-of-life practices were not investigated regarding religions.

methodsTwenty-two European ICUs (3 regions: Northern, Central, and Southern Europe) participated in both Ethicus-1 (years 1999-2000) and Ethicus-2 studies (years 2015-2016). Data of ICU patients who died or had limitations of life-sustaining therapy were analysed regarding changes in end-of-life practices and patient/physician religious affiliations. Frequencies, timing of decision-making, and religious affiliations of physicians/patients were compared using the same definitions.

resultsIn total, 4592 adult ICU patients (n = 2807 Ethicus-1, n = 1785 Ethicus-2) were analysed. In both studies, patient and physician religious affiliations were mostly Catholic, Greek Orthodox, Jewish, Protestant, or unknown. Treating physicians (but not patients) commonly reported no religious affiliation (18%). Distribution of end-of-life practices with respect to religion and geographical regions were comparable between the two studies. Withholding [n = 1143 (40.7%) Ethicus-1 and n = 892 (50%) Ethicus-2] and withdrawing [n = 695 (24.8%) Ethicus-1 and n = 692 (38.8%) Ethicus-2] were most commonly decided. No significant changes in end-of-life practices were observed for any religion over 16 years. The number of end-of-life discussions with patients/ families/ physicians increased, while mortality and time until first decision decreased.

conclusionsChanges in end-of-life practices observed over 16 years appear unrelated to religious affiliations of ICU patients or their treating physicians, but the effects of religiosity and/or culture could not be assessed. Shorter time until decision in the ICU and increased numbers of patient and family discussions may indicate increased awareness of the importance of end-of-life decision-making in the ICU.

Indexed as

Terminal CareAdultDeathDecision MakingHumansIntensive Care UnitsReligionWithholding TreatmentActive shortening of the dying processEnd of lifeIntensive care unitsReligionWithdrawing life-sustaining treatmentsWithholding life-sustaining treatments

Identifiers

PMID37812228
PMCPMC10622347
OpenAlexW4387440056

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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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.