Changes in communication of end-of-life decisions in European ICUs from 1999 to 2016 (Ethicus-2) - a prospective observational study.

Autor: Hartog CS; Department of Anesthesiology and Operative Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany; Klinik Bavaria, Kreischa, Germany. Electronic address: Christiane.hartog@charite.de., Maia PA; Intensive Care Medicine, Centro Hospitalar e Universitário do Porto, ICBAP, Porto, Portugal., Ricou B; Department of Acute Care Medicine, University Hospitals of Geneva, Geneva, Switzerland., Danbury C; Intensive Care, Royal Berkshire Hospital, Reading, United Kingdom., Galarza L; Department of Intensive Care, Hospital General Universitario de Castellon, Castellon de la Plana, Spain., Schefold JC; Department of Intensive Care Medicine, Inselspital, University Hospital Bern, University of Bern, Switzerland., Soreide E; Critical Care and Anaesthesiology Research Group, Stavanger University Hospital, Norway and Department of Clinical Medicine, University of Bergen, Bergen, Norway., Bocci MG; Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Pohrt A; Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany., Sprung CL; Division of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel., Avidan A; Division of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2022 Apr; Vol. 68, pp. 83-88. Date of Electronic Publication: 2021 Dec 21.
DOI: 10.1016/j.jcrc.2021.12.006
Abstrakt: Purpose: We investigated changes in communication practice about end-of-life decisions in European ICUs over 16 years.
Materials and Methods: This prospectively planned secondary analysis of two observational studies in 22 European ICUs in 1999-2000 (Ethicus-1) and 2015-16 (Ethicus-2) included consecutive patients who died or with limitation of life-sustaining therapy. ICUs were grouped into North, Central and South European regions.
Results: A total 4592 patients were included in 1999-2000 (n = 2807) and 2015-16 (n = 1785). Information about patient wishes increased overall (from 25.4% [570] to 51.1% [840]) and in all regions (42% to 61% [North], 22% to 56% [Central] and 20% to 32% [South], all p < 0.001). Discussions of treatment limitations with patients or families increased overall (66.0% to 76.1%) and in Northern and Central Europe (87% to 94% and 75% to 82.2%, respectively, all p < 0.001) but not in the South. Strongest predictor for discussions was the region (North>Central>South) followed by patient decision-making capacity.
Conclusion: End-of-life decisions are increasingly discussed but communication practices vary by region and follow a North-South gradient. Despite increased availability of information, patient preferences still remain unknown in every second patient. This calls for increased efforts to assess patient preference in advance and make them known to ICU clinicians.
Competing Interests: Declaration of competing interest CSH reports funding grants paid to her institution from the Innovation Funds of the German Federal Joint Committee (FKZ 01VSF19020, FKZ 01VSF17010) and the European Society of Intensive Care Medicine (ESICM) (2018–2021). JCS (full departmental disclosure) reports grants from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd., Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Nycomed, and Phagenesis, outside of the submitted work. The money went into departmental funds, no personal financial gain applied. All other authors declare no potential conflict of interest.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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