Intensive care decision making in the seriously ill and elderly*
Abstract
Objective To determine the influence of self-reported preadmission quality of life, hypothetical quality of life and mortality prognosis, and length and intensity of intensive care on decision making in the seriously ill and elderly. Design Prospective cohort study. Setting Medical university. Subjects Adult inpatients with chronic illness and an estimated 50% 6-month mortality along with patients > or =80 yrs old with an acute illness. Interventions Patients were presented with two scenarios: a) mechanical ventilation for 14 days; and 2) mechanical ventilation for 1 month with tracheostomy and feeding tube placement. A modified time trade-off was used to vary survival and quality of life over plausible ranges. Patients could consent to intensive care or choose care directed at comfort measures. Measurements and main results Fifty patients were interviewed. As projected intensive care unit mortality rate or postintensive care unit quality of life decreased, patients were less likely to consent to intensive care. Postintensive care quality of life was as important to patients as intensive care survival estimates. However, prehospitalization quality of life did not significantly influence decision making regarding life-extending treatment. When progressing from the acute intensive care scenario to chronic mechanical ventilation with associated interventions, patients demanded a significant increase in survival and quality of life. Neither race nor previous intensive care unit a…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The clinical importance of a 9-percentage point change is supported by a study of seriously ill patients whose potential willingness to receive prolonged mechanical ventilation declined substantially when prognosis worsened from 50% to 40%.
“The clinical importance of a 9–percentage point change is supported by a study of seriously ill patients whose potential willingness to receive prolonged mechanical ventilation declined substantially when prognosis worsened from 50% to 40% (30).”
From Effects of a Personalized Web-Based Decision Aid for Surrogate Decision Makers of Patients With Prolonged Mechanical Ventilation (2019) · cites this paper as [30]
Cites
Decision‐Making and Outcomes of Prolonged ICU Stays in Seriously Ill Patients
Teno, J. M., Fisher, E., Hamel, M. B., Wu, A. W., Murphy, D. J., Wenger, N. S., Lynn, J., & Harrell, F. E. (2000) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2000.tb03144.x · Cited by 182 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Failure to engage hospitalized elderly patients and their families in advance care planning
Heyland, D. K. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.180 · Cited by 496 · see citing works
White, D. B., Ernecoff, N., Buddadhumaruk, P., Hong, S., Weissfeld, L., Curtis, J. R., Luce, J. M., & Lo, B. (2016) · JAMA · doi:10.1001/jama.2016.5351 · Cited by 232 · see citing works
Surrogate Decision Makers' Interpretation of Prognostic Information: A Mixed-Methods Study
Zier, L. S., Sottile, P. D., Hong, S. Y., Weissfield, L. A., & White, D. B. (2012) · Annals of Internal Medicine · doi:10.7326/0003-4819-156-5-201203060-00008 · Cited by 171 · see citing works
Cox, C. E., White, D. B., Hough, C. L., Jones, D. M., Kahn, J. M., Olsen, M. K., Lewis, C. L., Hanson, L. C., & Carson, S. S. (2019) · Annals of Internal Medicine · doi:10.7326/m18-2335 · Cited by 152 · see citing works
“The clinical importance of a 9–percentage point change is supported by a study of seriously ill patients whose potential willingness to receive prolonged mechanical ventilation declined substantially when prognosis worsened from 50% to 40% (30).”
Hough, C. L., Caldwell, E. S., Cox, C. E., Douglas, I. S., Kahn, J. M., White, D. B., Seeley, E. J., Bangdiwala, S. I., Rubenfeld, G. D., Angus, D. C., et al. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000001205 · Cited by 79 · see citing works
- Authors
- Lloyd, C. B., Nietert, P. J., & Silvestri, G. A.
- Affiliations
- Medical University of South Carolina (US)
- Venue
- Critical Care Medicine
- Published
- 2004-03
- Volume
- 32
- Issue
- 3
- Pages
- 649-654
- ISSN
- 0090-3493 (ISSN-L)
- OpenAlex
- W2035577909
- Cited by
- 87
- References
- 1
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 5 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 3 · 2013: 5 · 2012: 8
- FWCI
- 5.16
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- end-of-life decisions, quality of life, mortality prediction, mechanical ventilation, elderly patients, seriously ill patients, time trade-off, tracheostomy, feeding tube, comfort care, patient preferences, chronic disease
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Attitude to Health, Critical Care, Decision Making, Female, Humans, Intubation, Intratracheal, Male, Middle Aged, Palliative Care, Prognosis, Prospective Studies, Quality of Life, Respiration, Artificial, Terminal Care, United States, Logistic Models
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
