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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000227
Clinical Investigations

A Scenario-Based, Randomized Trial of Patient Values and Functional Prognosis on Intensivist Intent to Discuss Withdrawing Life Support*

Turnbull, Alison E. DVM, MPH, PhD1,2,3; Krall, Jenna R. BA4; Ruhl, A. Parker MD2,3,5; Curtis, J. Randall MD, MPH6,7; Halpern, Scott D. MD, PhD8,9,10; Lau, Bryan M. ScM, MHS, PhD1; Needham, Dale M. FCA, MD, PhD2,3,11

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Abstract

Objectives:

To evaluate the effect of 1) patient values as expressed by family members and 2) a requirement to document patients’ functional prognosis on intensivists’ intention to discuss withdrawal of life support in a hypothetical family meeting.

Design:

A three-armed, randomized trial.

Setting:

One hundred seventy-nine U.S. hospitals with training programs in critical care accredited by the Accreditation Council for Graduate Medical Education.

Subjects:

Six hundred thirty intensivists recruited via e-mail invitation from a database of 1,850 eligible academic intensivists.

Interventions:

Each intensivist was randomized to review 10, online, clinical scenarios with a range of illness severities involving a hypothetical patient (Mrs. X). In control-group scenarios, the patient did not want continued life support without a reasonable chance of independent living. In the first experimental arm, the patient wanted life support regardless of functional outcome. In the second experimental arm, patient values were identical to the control group, but intensivists were required to record the patient’s estimated 3-month functional prognosis.

Measurements and Main Results:

Response to the question: “Would you bring up the possibility of withdrawing life support with Mrs. X’s family?” answered using a five-point Likert scale. There was no effect of patient values on whether intensivists intended to discuss withdrawal of life support (p = 0.81), but intensivists randomized to record functional prognosis were 49% more likely (95% CI, 20–85%) to discuss withdrawal.

Conclusions:

In this national, scenario-based, randomized trial, patient values had no effect on intensivists’ decisions to discuss withdrawal of life support with family. However, requiring intensivists to record patients’ estimated 3-month functional outcome substantially increased their intention to discuss withdrawal.

Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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