Association between physicians’ beliefs and the option of comfort care for critically ill patients

Schenker, Yael; Tiver, Greer A.; Hong, Seo Yeon; White, Douglas B.

doi:10.1007/s00134-012-2671-4

Cited by 79Palliative Care and End-of-Life IssuesFamily and Patient Care in Intensive Care UnitsEthics in medical practice

Association between physicians’ beliefs and the option of comfort care for critically ill patients

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Schenker, Yael, Tiver, Greer A., Hong, Seo Yeon, White, Douglas B.·2012·Intensive Care Medicine

DOI 10.1007/s00134-012-2671-4PMC PMC3470837

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Abstract

Purpose For critically ill patients at high risk of death, reasonable treatment options include attempts at life prolongation and treatment focused on comfort. Little is known about whether and how physicians present the option of comfort care to surrogates. This study assessed how comfort care is presented to surrogates and whether physicians' beliefs are associated with whether comfort care is presented as an option.Methods Mixed-methods study of 72 audio-recorded family conferences about treatment decisions in five ICUs at two hospitals in San Francisco, California. One hundred sixty-nine family members and 54 physicians participated. Patients were at high risk of death or severe functional impairment. Transcripts of audio-recorded conferences were coded to identify whether physicians offered comfort care as an alternative to life-sustaining treatment and to characterize the stated risks and benefits. Physicians completed a questionnaire indicating the strength of their belief that life support should be foregone.Results The inpatient mortality rate was 72 %. Using a broad definition of comfort-oriented treatment, this option was presented in 56 % (95 % CI, 44-67 %) of conferences. In clustered multivariate models, the only independent predictor of offering comfort care as an option was the strength of the physician's belief that life support should be foregone [OR 1.38 (1.14-1.66), p = 0.01].Conclusions Clinicians did not explicitly inform surrogates about the option of comfort-oriented treatment in roughly half of clinician-family meetings. Physicians who more strongly believe that the appropriate goal of care is life prolongation are less likely to inform surrogates about the option of comfort care.

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Clinicians often fail to adequately elicit patient treatment preferences, provide guidance about the surrogate's role, disclose likely long-term outcomes, and discuss the option of comfort-focused care.
“clinicians often fail to adequately elicit patient treatment preferences, provide guidance about the surrogate’s role, disclose likely long-term outcomes, and discuss the option of comfort-focused care (7–13).”
From Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation (2019) · cites this paper as [9]
The Discussion reports that clinicians did not explicitly present comfort-oriented treatment in roughly half of the clinician-family conferences studied. The paper does not establish the other attributed failures: inadequately eliciting patient preferences, guiding surrogates about their role, or disclosing likely long-term outcomes. Page numbers are not supplied in our copy. (LLM, conf=0.88)
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Additional file 1 of Impact of a family support intervention on hospitalization costs and hospital readmissions among ICU patients at high risk of death or severe functional impairment
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This editorial refers to the article available at: doi:10.1007/s00134-012-2671-4.
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Authors: Schenker, Y., Tiver, G. A., Hong, S. Y., & White, D. B.
Affiliations: University of Pittsburgh (US)
Corresponding author: Schenker, Yael
ORCID: Schenker, Yael
Hong, Seo Yeon
White, Douglas B.
Venue: Intensive Care Medicine
Publisher: Springer Science and Business Media LLC
Published: 2012-08-11
Volume: 38
Issue: 10
Pages: 1607-1615
ISSN: 0342-4642 (ISSN-L)
1432-1238
DOI: 10.1007/s00134-012-2671-4
PMC: PMC3470837
OpenAlex: W1965038222
Cited by: 79
References: 50
Citations by year: 2026: 3 · 2025: 3 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 4 · 2019: 9 · 2018: 10 · 2017: 2 · 2016: 5 · 2015: 5 · 2014: 9 · 2013: 8 · 2012: 1
FWCI: 7.10
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
Locations: Intensive Care Medicine (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (UL1TR000005, KL2TR000146)
National Institute on Aging (AG032875, K23AG032875)
National Heart, Lung, and Blood Institute (R01HL094553)
National Center for Research Resources (UL1RR024153, KL2RR024154)
National Center for Advancing Translational Sciences
National Institute on Minority Health and Health Disparities (L60 MD003332)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
Keywords: comfort care, physician beliefs, family meetings, surrogate decision-making, life-sustaining treatment, end-of-life care, intensive care unit, physician-family communication, treatment decision-making
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, California, Decision Making, Female, Humans, Intensive Care Units, Life Support Care, Male, Middle Aged, Palliative Care, Physicians, Professional-Family Relations, Surveys and Questionnaires, San Francisco, Critical Illness, Patient-Centered Care, Young Adult

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Association between physicians’ beliefs and the option of comfort care for critically ill patients

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