Medical Professionals' Treatment Decisions for Critical Patients With Ambiguous Treatment Wishes: A Cross‐Sectional Study

TL;DR

This study explores how medical professionals in Japan make treatment decisions for ICU patients with unclear end-of-life wishes, finding that family preferences often override patient preferences.

Contribution

The study reveals how medical professionals' decision-making varies by expertise and highlights the role of family preferences in ambiguous end-of-life care scenarios.

Findings

More than half of intensivists and ICU nurses prioritize family requests over ambiguous patient wishes.

Nurses have higher survival probability thresholds for emergency surgery compared to intensivists and surgeons.

Shared decision-making is recommended to align patient autonomy with family and medical professionals' decisions.

Abstract

Many patients do not want life‐prolonging treatments at critical stages of their illnesses, and are able to communicate their wishes to their families or surrogates. However, few among them have clarity on what such life‐prolonging treatments mean or entail. This study clarifies differences in the perspectives of medical professionals based on levels of expertise with respect to treatment decisions for intensive care unit (ICU) patients whose wishes for end‐of‐life care are ambiguous.

The cross‐sectional study included intensivists, surgeons, and ICU nurses working in 171 Japanese hospitals with ICUs. A total of 837 participants were mailed questionnaires which included questions on the current status and approaches to decision‐making with end‐of‐life care for ICU patients. Additionally, a simulated case study was conducted to investigate the decision‐making process for treating patients with uncertain survival rates.

Responses were obtained from 489 participants from 151 hospitals. More than half of the intensivists and ICU nurses reported that family members' requests were respected when the patient had ambiguous treatment preferences. Participants considered the patients' survival probability when deciding to perform emergency surgery, with nurses having significantly higher thresholds than intensivists and surgeons (intensivists: 20.8 ± 20.6, surgeons: 26.6 ± 25.2, ICU nurses: 36.4 ± 26.4; p < 0.001).

Family preferences take precedence over patient preferences when deciding on end‐of‐life treatments for ICU patients. Shared decision‐making should be promoted to correctly share patients' end‐of‐life medical wishes with surrogate decision‐makers and medical practitioners.

Life‐saving treatments may be considered in the intensive care unit (ICU), even if the patient advises their family of their desire not to receive life‐prolonging treatments.The methods and perceptions of decision support for patients and their families differ according to the expertise of the medical professionals, even for the same patient; this may lead to differences in setting treatment goals.In the ICU, where decision‐making time is short, medical professionals should make shared decisions while including families' information about patients' autonomy.

Life‐saving treatments may be considered in the intensive care unit (ICU), even if the patient advises their family of their desire not to receive life‐prolonging treatments.

The methods and perceptions of decision support for patients and their families differ according to the expertise of the medical professionals, even for the same patient; this may lead to differences in setting treatment goals.

In the ICU, where decision‐making time is short, medical professionals should make shared decisions while including families' information about patients' autonomy.

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