When is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study

Abstract Background Health care professionals have to judge the appropriateness of treatment in critical care on a daily basis. There is general consensus that critical care interventions should not be performed when they are inappropriate. It is not yet clear which chances of survival are considere...

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Autores principales:	M. Zink, A. Horvath, V. Stadlbauer
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Inappropriate treatment Futility Critical care Decision making Sex Demographic Medical philosophy. Medical ethics R723-726
Acceso en línea:	https://doaj.org/article/86819881301f4032ab8797c3187cc4cd
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spelling	oai:doaj.org-article:86819881301f4032ab8797c3187cc4cd2021-11-07T12:03:17ZWhen is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study10.1186/s12910-021-00705-41472-6939https://doaj.org/article/86819881301f4032ab8797c3187cc4cd2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12910-021-00705-4https://doaj.org/toc/1472-6939Abstract Background Health care professionals have to judge the appropriateness of treatment in critical care on a daily basis. There is general consensus that critical care interventions should not be performed when they are inappropriate. It is not yet clear which chances of survival are considered necessary or which risk for serious disabilities is acceptable in quantitative terms for different stakeholders to start intensive care treatment. Methods We performed an anonymous online survey in a random sample of 1,052 participants recruited via email invitation and social media. Age, sex, nationality, education, professional involvement in health care, critical care medicine and treatment decisions in critical care medicine as well as personal experience with critical illness were assessed as potential influencing variables. Participants provided their opinion on the necessary chances of survival and the acceptable risk for serious disabilities to start a high-risk or uncomfortable therapy for themselves, relatives or for their patients on a scale of 0–100%. Results Answers ranged from 0 to 100% for all questions. A three-peak pattern with different distributions of the peaks was observed. Sex, education, being a health care professional, being involved in treatment decisions and religiosity influence these opinions. Male respondents and those with a university education would agree that a risky and uncomfortable treatment should be started even with a low chance of survival for themselves, relatives and patients. More respondents would choose a lower necessary chance of survival (0–33% survival) when deciding for patients compared to themselves or relatives to start a risky and uncomfortable treatment. On the other hand, the majority of respondents would accept only a low risk of severe disability for both themselves and their patients. Conclusion No cut-off can be identified for the necessary chances of survival or the acceptable risk of disability to help quantify the “inappropriateness” of critical care treatment. Sex and education are the strongest influencing factors on this opinion. The large variation in personal opinions, depending on demographic and personality variables and education needs to be considered in the communication between health care professionals and patients or surrogates.M. ZinkA. HorvathV. StadlbauerBMCarticleInappropriate treatmentFutilityCritical careDecision makingSexDemographicMedical philosophy. Medical ethicsR723-726ENBMC Medical Ethics, Vol 22, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Inappropriate treatment Futility Critical care Decision making Sex Demographic Medical philosophy. Medical ethics R723-726
spellingShingle	Inappropriate treatment Futility Critical care Decision making Sex Demographic Medical philosophy. Medical ethics R723-726 M. Zink A. Horvath V. Stadlbauer When is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study
description	Abstract Background Health care professionals have to judge the appropriateness of treatment in critical care on a daily basis. There is general consensus that critical care interventions should not be performed when they are inappropriate. It is not yet clear which chances of survival are considered necessary or which risk for serious disabilities is acceptable in quantitative terms for different stakeholders to start intensive care treatment. Methods We performed an anonymous online survey in a random sample of 1,052 participants recruited via email invitation and social media. Age, sex, nationality, education, professional involvement in health care, critical care medicine and treatment decisions in critical care medicine as well as personal experience with critical illness were assessed as potential influencing variables. Participants provided their opinion on the necessary chances of survival and the acceptable risk for serious disabilities to start a high-risk or uncomfortable therapy for themselves, relatives or for their patients on a scale of 0–100%. Results Answers ranged from 0 to 100% for all questions. A three-peak pattern with different distributions of the peaks was observed. Sex, education, being a health care professional, being involved in treatment decisions and religiosity influence these opinions. Male respondents and those with a university education would agree that a risky and uncomfortable treatment should be started even with a low chance of survival for themselves, relatives and patients. More respondents would choose a lower necessary chance of survival (0–33% survival) when deciding for patients compared to themselves or relatives to start a risky and uncomfortable treatment. On the other hand, the majority of respondents would accept only a low risk of severe disability for both themselves and their patients. Conclusion No cut-off can be identified for the necessary chances of survival or the acceptable risk of disability to help quantify the “inappropriateness” of critical care treatment. Sex and education are the strongest influencing factors on this opinion. The large variation in personal opinions, depending on demographic and personality variables and education needs to be considered in the communication between health care professionals and patients or surrogates.
format	article
author	M. Zink A. Horvath V. Stadlbauer
author_facet	M. Zink A. Horvath V. Stadlbauer
author_sort	M. Zink
title	When is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study
title_short	When is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study
title_full	When is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study
title_fullStr	When is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study
title_full_unstemmed	When is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study
title_sort	when is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? a random sample online questionnaire study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/86819881301f4032ab8797c3187cc4cd
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When is it considered reasonable to start a risky and uncomfortable treatment in critically ill patients? A random sample online questionnaire study

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