Intensive care doctors and nurses personal preferences for Intensive Care, as compared to the general population: a discrete choice experiment
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Mitchell, Imogen A
Corke, Charlie
Murray, Lauren
Mitchell, Marion
Udy, Andrew
Sarode, Vineet
Nguyen, Nhi
Flower, Oliver
Ho, Kwok M
Litton, Edward
Wibrow, Bradley
Norman, Richard
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BACKGROUND: To test the hypothesis that Intensive Care Unit (ICU) doctors and nurses differ in their personal preferences for treatment from the general population, and whether doctors and nurses make different choices when thinking about themselves, as compared to when they are treating a patient. METHODS: Cross sectional, observational study conducted in 13 ICUs in Australia in 2017 using a discrete choice experiment survey. Respondents completed a series of choice sets, based on hypothetical situations which varied in the severity or likelihood of: death, cognitive impairment, need for prolonged treatment, need for assistance with care or requiring residential care. RESULTS: A total of 980 ICU staff (233 doctors and 747 nurses) participated in the study. ICU staff place the highest value on avoiding ending up in a dependent state. The ICU staff were more likely to choose to discontinue therapy when the prognosis was worse, compared with the general population. There was consensus between ICU staff personal views and the treatment pathway likely to be followed in 69% of the choices considered by nurses and 70% of those faced by doctors. In 27% (1614/5945 responses) of the nurses and 23% of the doctors (435/1870 responses), they felt that aggressive treatment would be continued for the hypothetical patient but they would not want that for themselves. CONCLUSION: The likelihood of returning to independence (or not requiring care assistance) was reported as the most important factor for ICU staff (and the general population) in deciding whether to receive ongoing treatments. Goals of care discussions should focus on this, over likelihood of survival.
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Critical Care
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25
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1
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© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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Health sciences
Attitude to death
Decision making
Discrete choice experiment
Intensive care units
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Anstey, MH; Mitchell, IA; Corke, C; Murray, L; Mitchell, M; Udy, A; Sarode, V; Nguyen, N; Flower, O; Ho, KM; Litton, E; Wibrow, B; Norman, R, Intensive care doctors and nurses personal preferences for Intensive Care, as compared to the general population: a discrete choice experiment, Critical Care, 2021, 25 (1), pp. 287