Evidence map›Paper›PMID 38184166›Full record

ArticleChest2024

Hospital Policy Variation in Addressing Decisions to Withhold and Withdraw Life-Sustaining Treatment.

Gina M Piscitello, Patrick G Lyons, Valerie Gutmann Koch, William F Parker, Michael T Huber

Abstract read
In one paragraph

Article in Chest, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing 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

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

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. 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

5 authors.

Gina M PiscitelloDivision of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA; Palliative Research Center, University of Pittsburgh, Pittsburgh, PA. Electronic address: ginapiscitello@pitt.edu.
Patrick G LyonsDepartment of Medicine, Oregon Health and Science University, Portland, OR; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR.
Valerie Gutmann KochHealth Law & Policy Institute, The University of Houston Law Center, Houston, TX; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL.
William F ParkerMacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL; Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL; Public Health Sciences, University of Chicago, Chicago, IL.
Michael T HuberDivision of Geriatrics and Palliative Medicine, University of Miami, Miami, FL; Institute of Bioethics and Health Policy, University of Miami, Miami, FL.

Funding

NRSA Training CoreTL1TR001858 · NCATS · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI RADOMSKI, THOMAS, RUBIO, DORIS M · 2016 to 2025
$11.1M
Improving the efficiency and equity of critical care allocation during a crisis with place-based disadvantage indicesR01LM014263 · NLM · UNIVERSITY OF CHICAGO · PI William F Parker · 2023 to 2026
$2.0M
Mending a Broken Heart Allocation System with Machine LearningK08HL150291 · NHLBI · UNIVERSITY OF CHICAGO · PI PARKER, WILLIAM F · 2020 to 2024
$713k
NCATS NIH HHS TL1 TR001858NHLBI NIH HHS K08 HL150291NLM NIH HHS R01 LM014263
6 · The paper itself

Abstract

backgroundSociodemographic disparities in physician decisions to withhold and withdraw life-sustaining treatment exist. Little is known about the content of hospital policies that guide physicians involved in these decisions. RESEARCH QUESTION: What is the prevalence of US hospitals with policies that address withholding and withdrawing life-sustaining treatment; how do these policies approach ethically controversial scenarios; and how do these policies address sociodemographic disparities in decisions to withhold and withdraw life-sustaining treatment? STUDY DESIGN AND

methodsThis national cross-sectional survey assessed the content of hospital policies addressing decisions to withhold or withdraw life-sustaining treatment. We distributed the survey electronically to American Society for Bioethics and Humanities members between July and August 2023 and descriptively analyzed responses.

resultsAmong 93 respondents from hospitals or hospital systems representing all 50 US states, Puerto Rico, and Washington, DC, 92% had policies addressing decisions to withhold or withdraw life-sustaining treatment. Hospitals varied in their stated guidance, permitting life-sustaining treatment to be withheld or withdrawn in cases of patient or surrogate request (82%), physiologic futility (81%), and potentially inappropriate treatment (64%). Of the 8% of hospitals with policies that addressed patient sociodemographic disparities in decisions to withhold or withdraw life-sustaining treatment, these policies provided opposing recommendations to either exclude sociodemographic factors in decision-making or actively acknowledge and incorporate these factors in decision-making. Only 3% of hospitals had policies that recommended collecting and maintaining information about patients for whom life-sustaining treatment was withheld or withdrawn that could be used to identify disparities in decision-making.

interpretationAlthough most surveyed US hospital policies addressed withholding or withdrawing life-sustaining treatment, these policies varied widely in criteria and processes. Surveyed policies also rarely addressed sociodemographic disparities in these decisions.

Indexed as

Life Support CareWithholding TreatmentCross-Sectional StudiesDecision MakingHospitalsHumansSurveys and Questionnairesclinical medical ethicshealth disparitieshospital policylife-sustaining treatment

Identifiers

PMID38184166
PMCPMC11026167

What OpenQuestion holds

Textmetadata
Read underepoch 390

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.