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Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care
BACKGROUND: Life-sustaining treatment (LST) in the intensive care unit (ICU) is withheld or withdrawn when there is no reasonable expectation of beneficial outcome. This is especially relevant in old patients where further functional decline might be detrimental for the self-perceived quality of lif...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9818057/ https://www.ncbi.nlm.nih.gov/pubmed/36609257 http://dx.doi.org/10.1186/s12911-022-02094-z |
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author | Beil, Michael van Heerden, P. Vernon de Lange, Dylan W. Szczeklik, Wojciech Leaver, Susannah Guidet, Bertrand Flaatten, Hans Jung, Christian Sviri, Sigal Joskowicz, Leo |
author_facet | Beil, Michael van Heerden, P. Vernon de Lange, Dylan W. Szczeklik, Wojciech Leaver, Susannah Guidet, Bertrand Flaatten, Hans Jung, Christian Sviri, Sigal Joskowicz, Leo |
author_sort | Beil, Michael |
collection | PubMed |
description | BACKGROUND: Life-sustaining treatment (LST) in the intensive care unit (ICU) is withheld or withdrawn when there is no reasonable expectation of beneficial outcome. This is especially relevant in old patients where further functional decline might be detrimental for the self-perceived quality of life. However, there still is substantial uncertainty involved in decisions about LST. We used the framework of information theory to assess that uncertainty by measuring information processed during decision-making. METHODS: Datasets from two multicentre studies (VIP1, VIP2) with a total of 7488 ICU patients aged 80 years or older were analysed concerning the contribution of information about the acute illness, age, gender, frailty and other geriatric characteristics to decisions about LST. The role of these characteristics in the decision-making process was quantified by the entropy of likelihood distributions and the Kullback–Leibler divergence with regard to withholding or withdrawing decisions. RESULTS: Decisions to withhold or withdraw LST were made in 2186 and 1110 patients, respectively. Both in VIP1 and VIP2, information about the acute illness had the lowest entropy and largest Kullback–Leibler divergence with respect to decisions about withdrawing LST. Age, gender and geriatric characteristics contributed to that decision only to a smaller degree. CONCLUSIONS: Information about the severity of the acute illness and, thereby, short-term prognosis dominated decisions about LST in old ICU patients. The smaller contribution of geriatric features suggests persistent uncertainty about the importance of functional outcome. There still remains a gap to fully explain decision-making about LST and further research involving contextual information is required. Trial registration: VIP1 study: NCT03134807 (1 May 2017), VIP2 study: NCT03370692 (12 December 2017). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12911-022-02094-z. |
format | Online Article Text |
id | pubmed-9818057 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-98180572023-01-06 Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care Beil, Michael van Heerden, P. Vernon de Lange, Dylan W. Szczeklik, Wojciech Leaver, Susannah Guidet, Bertrand Flaatten, Hans Jung, Christian Sviri, Sigal Joskowicz, Leo BMC Med Inform Decis Mak Article BACKGROUND: Life-sustaining treatment (LST) in the intensive care unit (ICU) is withheld or withdrawn when there is no reasonable expectation of beneficial outcome. This is especially relevant in old patients where further functional decline might be detrimental for the self-perceived quality of life. However, there still is substantial uncertainty involved in decisions about LST. We used the framework of information theory to assess that uncertainty by measuring information processed during decision-making. METHODS: Datasets from two multicentre studies (VIP1, VIP2) with a total of 7488 ICU patients aged 80 years or older were analysed concerning the contribution of information about the acute illness, age, gender, frailty and other geriatric characteristics to decisions about LST. The role of these characteristics in the decision-making process was quantified by the entropy of likelihood distributions and the Kullback–Leibler divergence with regard to withholding or withdrawing decisions. RESULTS: Decisions to withhold or withdraw LST were made in 2186 and 1110 patients, respectively. Both in VIP1 and VIP2, information about the acute illness had the lowest entropy and largest Kullback–Leibler divergence with respect to decisions about withdrawing LST. Age, gender and geriatric characteristics contributed to that decision only to a smaller degree. CONCLUSIONS: Information about the severity of the acute illness and, thereby, short-term prognosis dominated decisions about LST in old ICU patients. The smaller contribution of geriatric features suggests persistent uncertainty about the importance of functional outcome. There still remains a gap to fully explain decision-making about LST and further research involving contextual information is required. Trial registration: VIP1 study: NCT03134807 (1 May 2017), VIP2 study: NCT03370692 (12 December 2017). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12911-022-02094-z. BioMed Central 2023-01-06 /pmc/articles/PMC9818057/ /pubmed/36609257 http://dx.doi.org/10.1186/s12911-022-02094-z Text en © The Author(s) 2023 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/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Article Beil, Michael van Heerden, P. Vernon de Lange, Dylan W. Szczeklik, Wojciech Leaver, Susannah Guidet, Bertrand Flaatten, Hans Jung, Christian Sviri, Sigal Joskowicz, Leo Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care |
title | Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care |
title_full | Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care |
title_fullStr | Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care |
title_full_unstemmed | Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care |
title_short | Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care |
title_sort | contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9818057/ https://www.ncbi.nlm.nih.gov/pubmed/36609257 http://dx.doi.org/10.1186/s12911-022-02094-z |
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