Observational Study

. 2021 Aug 10;25(1):287.

doi: 10.1186/s13054-021-03712-4.

Intensive care doctors and nurses personal preferences for Intensive Care, as compared to the general population: a discrete choice experiment

Matthew H Anstey^{1

2

3}, Imogen A Mitchell^{4

5}, Charlie Corke⁶, Lauren Murray⁷, Marion Mitchell^{8

9}, Andrew Udy¹⁰, Vineet Sarode^{11

12}, Nhi Nguyen¹³, Oliver Flower¹⁴, Kwok M Ho^{15

16

17}, Edward Litton^{15

18}, Bradley Wibrow^{19

15}, Richard Norman²⁰

Affiliations

¹ Intensive Care Department, Sir Charles Gairdner Hospital, Level 4 G Block, Hospital Ave, Nedlands, Perth, WA, 6009, Australia. matthew.anstey@health.wa.gov.au.
² School of Population Health, Curtin University, Bentley, Australia. matthew.anstey@health.wa.gov.au.
³ School of Medicine, University of Western Australia, Crawley, Australia. matthew.anstey@health.wa.gov.au.
⁴ Australian National University, Canberra, Australia.
⁵ Canberra Hospital, Canberra, Australia.
⁶ University Hospital Geelong, Geelong, Australia.
⁷ Sunshine Coast University Hospital, Birtinya, QLD, Australia.
⁸ Griffith University, Griffith, QLD, Australia.
⁹ Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
¹⁰ Alfred Hospital, Melbourne, Australia.
¹¹ Monash University, Melbourne, Australia.
¹² Cabrini Hospital, Melbourne, Australia.
¹³ Nepean Hospital, Kingswood, NSW, Australia.
¹⁴ Royal North Shore Hospital, Sydney, Australia.
¹⁵ School of Medicine, University of Western Australia, Crawley, Australia.
¹⁶ Royal Perth Hospital, Perth, Australia.
¹⁷ School of Veterinary and Life Sciences, Murdoch University, Perth, Australia.
¹⁸ Fiona Stanley Hospital, Perth, Australia.
¹⁹ Intensive Care Department, Sir Charles Gairdner Hospital, Level 4 G Block, Hospital Ave, Nedlands, Perth, WA, 6009, Australia.
²⁰ School of Population Health, Curtin University, Bentley, Australia.

PMID: 34376239
PMCID: PMC8353726
DOI: 10.1186/s13054-021-03712-4

Observational Study

Intensive care doctors and nurses personal preferences for Intensive Care, as compared to the general population: a discrete choice experiment

Matthew H Anstey et al. Crit Care. 2021.

. 2021 Aug 10;25(1):287.

doi: 10.1186/s13054-021-03712-4.

Authors

Affiliations

¹ Intensive Care Department, Sir Charles Gairdner Hospital, Level 4 G Block, Hospital Ave, Nedlands, Perth, WA, 6009, Australia. matthew.anstey@health.wa.gov.au.
² School of Population Health, Curtin University, Bentley, Australia. matthew.anstey@health.wa.gov.au.
³ School of Medicine, University of Western Australia, Crawley, Australia. matthew.anstey@health.wa.gov.au.
⁴ Australian National University, Canberra, Australia.
⁵ Canberra Hospital, Canberra, Australia.
⁶ University Hospital Geelong, Geelong, Australia.
⁷ Sunshine Coast University Hospital, Birtinya, QLD, Australia.
⁸ Griffith University, Griffith, QLD, Australia.
⁹ Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
¹⁰ Alfred Hospital, Melbourne, Australia.
¹¹ Monash University, Melbourne, Australia.
¹² Cabrini Hospital, Melbourne, Australia.
¹³ Nepean Hospital, Kingswood, NSW, Australia.
¹⁴ Royal North Shore Hospital, Sydney, Australia.
¹⁵ School of Medicine, University of Western Australia, Crawley, Australia.
¹⁶ Royal Perth Hospital, Perth, Australia.
¹⁷ School of Veterinary and Life Sciences, Murdoch University, Perth, Australia.
¹⁸ Fiona Stanley Hospital, Perth, Australia.
¹⁹ Intensive Care Department, Sir Charles Gairdner Hospital, Level 4 G Block, Hospital Ave, Nedlands, Perth, WA, 6009, Australia.
²⁰ School of Population Health, Curtin University, Bentley, Australia.

PMID: 34376239
PMCID: PMC8353726
DOI: 10.1186/s13054-021-03712-4

Abstract

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.

Keywords: Attitude to death; Decision making; Discrete choice experiment; Intensive care units.

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Conflict of interest statement

The authors have no competing interests to declare.

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Intensive care doctors and nurses personal preferences for Intensive Care, as compared to the general population: a discrete choice experiment

Affiliations

Intensive care doctors and nurses personal preferences for Intensive Care, as compared to the general population: a discrete choice experiment

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Abstract

Conflict of interest statement

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