Key Factors in Decision Making for ECLS: A Binational Factorial Survey
| Autor: | Peter Steiger, Philipp K. Buehler, Tanja Krones, Niels Hagenbuch, Ana Rosca, Daniel Drewniak, Giovanna Brandi, Liane Schenk, Sabine Stamm-Balderjahn |
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| Přispěvatelé: | University of Zurich |
| Rok vydání: | 2022 |
| Předmět: |
endocrine system
medicine.medical_specialty 610 Medicine & health 030204 cardiovascular system & hematology extracorporeal life support decision making 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Germany Surveys and Questionnaires medicine Humans Intensive care medicine Health policy Retrospective Studies business.industry Neurological status Health Policy Factorial survey 3. Good health factorial survey Treatment Outcome Key factors 030228 respiratory system age neurological status Life support 10222 Institute of Biomedical Ethics and History of Medicine 10023 Institute of Intensive Care Medicine business |
| DOI: | 10.5167/uzh-208047 |
| Popis: | BackgroundExtracorporeal life support (ECLS) provides support to patients with cardiopulmonary failure refractory to conventional therapy. While ECLS is potentially life-saving, it is associated with severe complications; decision making to initiate ECLS must, therefore, carefully consider which patients ECLS potentially benefits despite its consequences.ObjectiveTo answer 2 questions: First, which medically relevant patient factors influence decisions to initiate ECLS? Second, what are factors relevant to decisions to withdraw a running ECLS treatment?MethodsWe conducted a factorial survey among 420 physicians from 111 hospitals in Switzerland and Germany. The study included 2 scenarios: 1 explored willingness to initiate ECLS, and 1 explored willingness to withdraw a running ECLS treatment. Each participant responded to 5 different vignettes for each scenario. Vignettes were analyzed using mixed-effects regression models with random intercepts.ResultsFactors in the vignettes such as patients’ age, treatment costs, therapeutic goal, comorbidities, and neurological outcome significantly influenced the decision to initiate ECLS. When it came to the decision to withdraw ECLS, patients’ age, days on ECLS, criteria for discontinuation, condition of the patient, comorbidities, and neurological outcome were significant factors. In both scenarios, patients’ age and neurological outcome were the most influential factors.ConclusionsThis study provided insights into physicians’ decision making processes about ECLS initiation and withdrawal. Patients’ age and neurological status were the strongest factors influencing decisions regarding initiation of ECLS as well as for ECLS withdrawal. The findings may contribute to a more refined understanding of complex decision making for ECLS. |
| Databáze: | OpenAIRE |
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