National questionnaire survey on what influences doctors' decisions about admission to intensive care

doi:10.1136/bmj.329.7463.425

BMJ 2004;329:425 (21 August), doi:10.1136/bmj.329.7463.425

Paper

National questionnaire survey on what influences doctors' decisions about admission to intensive care

Monica Escher, senior registrar¹, Thomas V Perneger, professor², Jean-Claude Chevrolet, professor³

¹ Pain and Palliative Care Consultation, Division of Clinical Pharmacology and Toxicology, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland, ² Quality of Care Unit, Geneva University Hospitals, ³ Medical Intensive Care Division, Geneva University Hospitals

Correspondence to: M Escher monica.escher{at}hcuge.ch

Objective To determine what influences doctors' decisions aboutadmission of patients to intensive care.

Design National questionnaire survey using eight clinical vignettesinvolving hypothetical patients.

Setting Switzerland.

Participants 402 Swiss doctors specialising in intensive care.

Main outcome measures Rating of factors influencing decisionson admission and response to eight hypothetical clinical scenarios.

Results Of 381 doctors agreeing to participate, 232 (61%) returnedquestionnaires. Most rated as important or very important theprognosis of the underlying disease (82%) and of the acute illness(81%) and the patients' wishes (71%). Few considered importantthe socioeconomic circumstances of the patient (2%), religiousbeliefs (3%), and emotional state (6%). In the vignettes, underlyingdisease (cancer versus non-cancerous disease) was not associatedwith admission to intensive care, but four other factors were:patients' wishes (odds ratio 3.0, 95% confidence interval 2.0to 4.6), "upbeat" personality (2.9, 1.9 to 4.4), younger age(1.5, 1.1 to 2.2), and a greater number of beds available inintensive care (1.8, 1.2 to 2.5).

Conclusions Doctors' decisions to admit patients to intensivecare are influenced by patients' wishes and ethically problematicnon-medical factors such as a patient's personality or availabilityof beds. Patients with cancer are not discriminated against.

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Rapid Responses:

Read all Rapid Responses

Why the surprise?: Richard D Colman
bmj.com, 22 Aug 2004 [Full text]
Why not test impact of gender, or at least control for it?: Judith M Dwyer
bmj.com, 26 Aug 2004 [Full text]
Uncovering "unconscious processes" in medical decision making: Clare Harries, et al.
bmj.com, 2 Sep 2004 [Full text]
Re: Why not test impact of gender, or at least control for it?: Thomas V Perneger
bmj.com, 8 Sep 2004 [Full text]
Re: Uncovering "unconscious processes" in medical decision making: Thomas V Perneger
bmj.com, 8 Sep 2004 [Full text]
ICU admission and non clinical factors: Alberto Giannini
bmj.com, 16 Sep 2004 [Full text]