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Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients

BACKGROUND: Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without canc...

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Autores principales: Benoit, Dominique D., van der Zee, Esther N., Darmon, Michael, Reyners, An K. L., Metaxa, Victoria, Mokart, Djamel, Wilmer, Alexander, Depuydt, Pieter, Hvarfner, Andreas, Rusinova, Katerina, Zijlstra, Jan G., Vincent, François, Lathyris, Dimitrios, Meert, Anne-Pascale, Devriendt, Jacques, Uyttersprot, Emma, Kompanje, Erwin J. O., Piers, Ruth, Azoulay, Elie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325749/
https://www.ncbi.nlm.nih.gov/pubmed/34331626
http://dx.doi.org/10.1186/s13613-021-00895-5
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author Benoit, Dominique D.
van der Zee, Esther N.
Darmon, Michael
Reyners, An K. L.
Metaxa, Victoria
Mokart, Djamel
Wilmer, Alexander
Depuydt, Pieter
Hvarfner, Andreas
Rusinova, Katerina
Zijlstra, Jan G.
Vincent, François
Lathyris, Dimitrios
Meert, Anne-Pascale
Devriendt, Jacques
Uyttersprot, Emma
Kompanje, Erwin J. O.
Piers, Ruth
Azoulay, Elie
author_facet Benoit, Dominique D.
van der Zee, Esther N.
Darmon, Michael
Reyners, An K. L.
Metaxa, Victoria
Mokart, Djamel
Wilmer, Alexander
Depuydt, Pieter
Hvarfner, Andreas
Rusinova, Katerina
Zijlstra, Jan G.
Vincent, François
Lathyris, Dimitrios
Meert, Anne-Pascale
Devriendt, Jacques
Uyttersprot, Emma
Kompanje, Erwin J. O.
Piers, Ruth
Azoulay, Elie
author_sort Benoit, Dominique D.
collection PubMed
description BACKGROUND: Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. METHODS: This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. RESULTS: Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60–1.72 and HR 0.87, 95% CI 0.49–1.54) and TLDs (HR 0.81, 95% CI 0.33–1.99 and HR 0.70, 95% CI 0.27–1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58–3.15 and 1.66, 95% CI 1.28–2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. CONCLUSIONS: The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-021-00895-5.
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spelling pubmed-83257492021-08-02 Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients Benoit, Dominique D. van der Zee, Esther N. Darmon, Michael Reyners, An K. L. Metaxa, Victoria Mokart, Djamel Wilmer, Alexander Depuydt, Pieter Hvarfner, Andreas Rusinova, Katerina Zijlstra, Jan G. Vincent, François Lathyris, Dimitrios Meert, Anne-Pascale Devriendt, Jacques Uyttersprot, Emma Kompanje, Erwin J. O. Piers, Ruth Azoulay, Elie Ann Intensive Care Research BACKGROUND: Whether Intensive Care Unit (ICU) clinicians display unconscious bias towards cancer patients is unknown. The aim of this study was to compare the outcomes of critically ill patients with and without perceptions of excessive care (PECs) by ICU clinicians in patients with and without cancer. METHODS: This study is a sub-analysis of the large multicentre DISPROPRICUS study. Clinicians of 56 ICUs in Europe and the United States completed a daily questionnaire about the appropriateness of care during a 28-day period. We compared the cumulative incidence of patients with concordant PECs, treatment limitation decisions (TLDs) and death between patients with uncontrolled and controlled cancer, and patients without cancer. RESULTS: Of the 1641 patients, 117 (7.1%) had uncontrolled cancer and 270 (16.4%) had controlled cancer. The cumulative incidence of concordant PECs in patients with uncontrolled and controlled cancer versus patients without cancer was 20.5%, 8.1%, and 9.1% (p < 0.001 and p = 0.62, respectively). In patients with concordant PECs, we found no evidence for a difference in time from admission until death (HR 1.02, 95% CI 0.60–1.72 and HR 0.87, 95% CI 0.49–1.54) and TLDs (HR 0.81, 95% CI 0.33–1.99 and HR 0.70, 95% CI 0.27–1.81) across subgroups. In patients without concordant PECs, we found differences between the time from admission until death (HR 2.23, 95% CI 1.58–3.15 and 1.66, 95% CI 1.28–2.15), without a corresponding increase in time until TLDs (NA, p = 0.3 and 0.7) across subgroups. CONCLUSIONS: The absence of a difference in time from admission until TLDs and death in patients with concordant PECs makes bias by ICU clinicians towards cancer patients unlikely. However, the differences between the time from admission until death, without a corresponding increase in time until TLDs, suggest prognostic unawareness, uncertainty or optimism in ICU clinicians who did not provide PECs, more specifically in patients with uncontrolled cancer. This study highlights the need to improve intra- and interdisciplinary ethical reflection and subsequent decision-making at the ICU. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-021-00895-5. Springer International Publishing 2021-07-31 /pmc/articles/PMC8325749/ /pubmed/34331626 http://dx.doi.org/10.1186/s13613-021-00895-5 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Benoit, Dominique D.
van der Zee, Esther N.
Darmon, Michael
Reyners, An K. L.
Metaxa, Victoria
Mokart, Djamel
Wilmer, Alexander
Depuydt, Pieter
Hvarfner, Andreas
Rusinova, Katerina
Zijlstra, Jan G.
Vincent, François
Lathyris, Dimitrios
Meert, Anne-Pascale
Devriendt, Jacques
Uyttersprot, Emma
Kompanje, Erwin J. O.
Piers, Ruth
Azoulay, Elie
Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients
title Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients
title_full Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients
title_fullStr Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients
title_full_unstemmed Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients
title_short Outcomes of ICU patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients
title_sort outcomes of icu patients with and without perceptions of excessive care: a comparison between cancer and non-cancer patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325749/
https://www.ncbi.nlm.nih.gov/pubmed/34331626
http://dx.doi.org/10.1186/s13613-021-00895-5
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