Clinicians, patients clash over treatment in one-third of ICU cases

In about one-third of intensive care unit cases, there are disagreements between the clinicians and patients, or their surrogates, about the appropriateness of treatment, according to a study published in Chest.

For the study, led by researchers from Rochester, Minn.-based Mayo Clinic, 151 ICU patient cases from multiple centers were examined. The researchers collected 1,332 patient, surrogate, nurse and physician surveys.

They found disagreement between patients or surrogates and clinicians regarding:

• Too much treatment being administered in 26 percent of cases
• Too little treatment being administered in 10 percent of cases

Patient or surrogate respondents complained about "too much" treatment in 8 percent of cases and "too little" treatment in 6 percent of cases. Fifty-five percent of patients/surrogates who perceived inappropriate treatment experienced high or moderate distress, compared to 35 percent of physicians and nurses.

Patient/surrogate perception of inappropriate treatment was associated with lower satisfaction and lower trust in the clinical team.

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