The prevalence of perceptions of mismatch between treatment intensity and achievable goals of care in the intensive care unit: a cross-sectional study
To describe the prevalence of perceptions of patients receiving a mismatch in treatment intensity, as perceived by intensive care unit (ICU) healthcare providers, and to assess the congruence of perceptions between providers.
In this cross-sectional, observational study conducted in 21 ICUs in Australia and New Zealand, patient prevalence data was linked to an ICU staff survey to describe the extent to which patient treatment intensity was matched to the perceived prognosis and patient wishes.
Of the 307 study patients, 62 (20.2%) were reported to be receiving a mismatch in treatment intensity by at least one ICU healthcare professional. For reported mismatch, there was consensus amongst staff members for 52/62 (84%) of patients. Patients were significantly more likely to receive mismatched treatments if they were more severely unwell (APACHE II score > 20 vs. ≤ 20), odds ratio OR 2.35, 95% confidence interval (CI) 1.63–3.37, p < 0.0001, if they were an emergency admission (OR 3.05, CI 1.18–7.89, p = 0.0212) or if they had an advance care directive (OR 3.68, 95% CI 1.66–8.16, p = 0.0013).
Being more severely unwell, being an emergency admission or having an advance care directive made patients more likely to be perceived as having a mismatch between the intensity of treatments provided and either the achievable goals of care, expected prognosis or patient’s wishes.
KeywordsDecision-making Patient outcomes Treatment intensity
The authors appreciate and wish to acknowledge the work of ANZICS and the George Institute in carrying out the annual Point Prevalence Program. Finally, thank you to the doctors, nurses and allied health staff who were willing to provide their thoughtful opinions in completing the survey. Participating sites and investigators are Frank van Haren, Helen Rodgers at Canberra Hospital, ACT; Dr Peter Harrigan, Miranda Hardie at John Hunter Hospital, NSW; Dr David Milliss, Helen Wong at Concord Hospital, NSW; Dr David Gattas, Heidi Buhr at Royal Prince Alfred Hospital, NSW; Professor Simon Finfer, Frances Bass at Royal North Shore Hospital, NSW; Dr Ian Seppelt, Rebecca Gresham at Nepean Hospital, NSW; Dr Priya Nair, Serena Knowles at St Vincents Hospital, NSW; Dr Craig French, Samantha Bates at Western Hospital, VIC; Dr Neeraj Bhadange at Mackay Base Hospital, QLD; Dr Sandra Peake, Jo-Anne McIntyre at Queen Elizabeth Hospital SA; Dr Marianne Chapman, Stephanie O’Connor at Royal Adelaide Hospital SA; Dr Brad Wibrow, Brigit Roberts at Sir Charles Gairdner Hospital, WA; Dr Ed Litton, Elizabeth Jenkinson at Royal Perth Hospital, WA; Dr Adrian Regli and Anne Marie Palermo at Fremantle Hospital, WA; Dr Seton Henderson, Jan Mehrtens at Christchurch Hospital, NZ; Dr Colin McArthur, Lynette Newby at Auckland Hospital, NZ; Dr Tony Williams, Anna Tilsley at Middlemore Hospital, NZ; Dr Dick Dinsdale, Diane Mackle at Wellington Hospital, NZ; Robyn Hutchinson at Dunedin Hospital, NZ; Nelson Hospital, NZ; Jill Norton at Nelson Hospital NZ; Dr Troy Browne, Jennifer Goodson at Tauranga Hospital, NZ.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
Institutional approval was obtained from all participating sites prior to study commencement, with additional approval for the sites surveying their ICU staff.
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