TY - JOUR
T1 - End-of-life decision-making and quality of ICU performance
T2 - An observational study in 84 Italian units
AU - Bertolini, Guido
AU - Boffelli, Simona
AU - Malacarne, Paolo
AU - Peta, Mario
AU - Marchesi, Mariano
AU - Barbisan, Camillo
AU - Tomelleri, Stefano
AU - Spada, Simonetta
AU - Satolli, Roberto
AU - Gridelli, Bruno
AU - Lizzola, Ivo
AU - Mazzon, Davide
PY - 2010/9
Y1 - 2010/9
N2 - Purpose: To appraise the end-of-life decision-making in several intensive care units (ICUs) and to evaluate the association between the average inclination to limit treatment and overall survival at ICU level. Design: Prospective, multicenter, observational study, lasting 12 months. Setting: Eighty-four Italian, adult ICUs. Patients: Consecutive patients (3,793) who died in ICU or were discharged in terminal condition, in 2005. Measurements: Data collection included patient description, treatment limitation and decision-makers, involvement of patients and relatives in the decision, and organ donation. A logistic regression model was used to identify predictors of treatment limitation and develop a measure of the inclination to limit treatment for each ICU. This was compared with the standardized mortality ratio, an index of the overall performance of the unit. Results: Treatment limitation preceded 62% of deaths. In 25% of cases, nurses were involved in the decision. Half the limitations were do-not-resuscitate orders, with the remaining half almost equally split between withholding and withdrawing treatment. Units less inclined to limit treatments (odds ratio
AB - Purpose: To appraise the end-of-life decision-making in several intensive care units (ICUs) and to evaluate the association between the average inclination to limit treatment and overall survival at ICU level. Design: Prospective, multicenter, observational study, lasting 12 months. Setting: Eighty-four Italian, adult ICUs. Patients: Consecutive patients (3,793) who died in ICU or were discharged in terminal condition, in 2005. Measurements: Data collection included patient description, treatment limitation and decision-makers, involvement of patients and relatives in the decision, and organ donation. A logistic regression model was used to identify predictors of treatment limitation and develop a measure of the inclination to limit treatment for each ICU. This was compared with the standardized mortality ratio, an index of the overall performance of the unit. Results: Treatment limitation preceded 62% of deaths. In 25% of cases, nurses were involved in the decision. Half the limitations were do-not-resuscitate orders, with the remaining half almost equally split between withholding and withdrawing treatment. Units less inclined to limit treatments (odds ratio
KW - Critically ill
KW - Decision-making
KW - End-of-life
KW - Ethics
KW - Intensive care units
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U2 - 10.1007/s00134-010-1910-9
DO - 10.1007/s00134-010-1910-9
M3 - Article
C2 - 20464541
AN - SCOPUS:77955925220
VL - 36
SP - 1495
EP - 1504
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 9
ER -