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Cited by 182Palliative Care and End-of-Life IssuesEthics in medical practiceFamily and Patient Care in Intensive Care Units

Decision‐Making and Outcomes of Prolonged ICU Stays in Seriously Ill Patients

Teno, Joan M., Fisher, Elliot, Hamel, Mary Beth, Wu, Albert W., Murphy, Donald J., Wenger, Neil S., Lynn, Joanne, Harrell, Frank E.·2000·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2000.tb03144.x
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Abstract

BACKGROUND: Despite concern about the high costs and the uncertain benefit of prolonged treatment in the intensive care unit (ICU), there has been little research examining decision‐making and outcomes for patients with prolonged ICU stays. OBJECTIVES: To evaluate decision‐making and outcomes for seriously ill patients with an ICU stay of at least 14 days. DESIGN: A prospective cohort study. SETTING: Five teaching hospitals. PARTICIPANTS: Seriously ill patients enrolled in the Study To Understand Prognoses and Preferences for Risks and Outcomes of Treatments (SUPPORT). MEASUREMENT: Patients, their surrogate decision‐makers, and their physicians were interviewed about prognosis, communication, and goals of medical care. Based on age, diagnoses, comorbid illnesses, and acute physiology data, the SUPPORT Prognostic Model provided estimates of 6‐month survival on study days 1, 3, 7, and 14. Hospital costs were estimated from hospital billing data. RESULTS: Of the 9105 patients enrolled in SUPPORT, 1494 (16%) had ICU stays of 14 days or longer. The median length of stay in an ICU was 4 days for the entire SUPPORT cohort and 35 days for patients who were treated in an ICU for 14 days or longer. Median hospital costs were $76,501 for patients who had ICU stays 14 days or longer and $10,916 for patients who did not have long ICU stays. Fifty‐five percent of patients with long ICU stays had died by 6 months, and an additional 19% had substantial functional impairment. Among patients with ICU stays of at least 14 days, only 20% had estimates of 6‐month survival that fell below 10% at any time during their hospitalization. For patients with long ICU stays, the mean predicted probability of 6‐month survival was 0.46 on study Day 3 and 0.47 on study Day 14. Fewer than 40% of patients (or their surrogates) reported that their physicians had talked with them about their prognoses or preferences for life‐sustaining treatment. Among the patients who preferred a palliative approach to care, only 29% thought that their care was consistent with that aim. Those who discussed their preferences for care with a physician were 1.9 times more likely to believe that treatment was in accord with their preferences for palliation (95% CI, 1.4–2.5) CONCLUSIONS: Prolonged ICU stays were expensive and were often followed by death or disability. Patients reported low rates of discussions with their physicians about their prognoses and preferences for life‐sustaining treatments. Many preferred that care focus on palliation and believed that care was inconsistent with their preferences. Patients were more likely to receive care consistent with their preferences if they had discussed their care preferences with their physicians.

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Authors
Teno, J. M., Fisher, E., Hamel, M. B., Wu, A. W., Murphy, D. J., Wenger, N. S., Lynn, J., & Harrell, F. E.
Affiliations
  • Brown University (US)
  • Dartmouth College (US)
  • Beth Israel Deaconess Medical Center (US)
  • Johns Hopkins University (US)
  • Presbyterian St. Luke's Medical Center (US)
  • University of California, Los Angeles (US)
  • George Washington University (US)
  • University of Virginia (US)
Corresponding author
Teno, Joan M.
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2000-05
Volume
48
Issue
S1
Pages
S70-4
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2000.tb03144.x
OpenAlex
W2004792235
Cited by
182
References
31
Citations by year
2025: 3 · 2024: 4 · 2023: 7 · 2022: 3 · 2021: 2 · 2020: 4 · 2019: 14 · 2018: 7 · 2017: 9 · 2016: 9 · 2015: 7 · 2014: 4 · 2013: 5 · 2012: 10
FWCI
7.83
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 5474 d)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Agency for Healthcare Research and Quality (R01 HS 08158-01)
  • National Institute on Aging (K08-AG0075-02)
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 › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
Keywords
prolonged ICU stay, ICU length of stay, seriously ill patients, prognosis communication, surrogate decision-making, 6-month survival, hospital costs, life-sustaining treatment, functional disability, physician-patient communication, end-of-life care
MeSH terms
Activities of Daily Living, Aged, Communication, Critical Care, Decision Making, Female, Health Status, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Physician-Patient Relations, Prognosis, Prospective Studies, Quality of Life, Terminal Care, Critical Illness, Treatment Outcome, Patient Satisfaction

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