To test the hypothesis that Intensive Care Unit (ICU)
doctors and nurses differ in their personal preferences for treatment from the
general population, and whether doctors and nurses make different choices when
thinking about themselves, as compared to when they are treating a patient.
Methods
Cross sectional, observational study conducted in 13 ICUs in
Australia in 2017 using a discrete choice experiment survey. Respondents
completed a series of choice sets, based on hypothetical situations which
varied in the severity or likelihood of: death, cognitive impairment, need for
prolonged treatment, need for assistance with care or requiring residential
care.
Results
A total of 980 ICU staff (233 doctors and 747 nurses)
participated in the study. ICU staff place the highest value on avoiding ending
up in a dependent state. The ICU staff were more likely to choose to discontinue
therapy when the prognosis was worse, compared with the general population.
There was consensus between ICU staff personal views and the treatment pathway
likely to be followed in 69% of the choices considered by nurses and 70% of
those faced by doctors. In 27% (1614/5945 responses) of the nurses and 23% of
the doctors (435/1870 responses), they felt that aggressive treatment would be
continued for the hypothetical patient but they would not want that for
themselves.
Conclusion
The likelihood of returning to independence (or not
requiring care assistance) was reported as the most important factor for ICU
staff (and the general population) in deciding whether to receive ongoing
treatments. Goals of care discussions should focus on this, over likelihood of
survival.
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