Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 28;20(5):e0324482.
doi: 10.1371/journal.pone.0324482. eCollection 2025.

Goals of care discussions among critically Ill patients on vasopressor treatment

Walid A Alkeridy  1   2   3 , Khalid M Alayed  1 , Shadan AlMuhaidib  4 , Mohammed Khalid Alageel  5   6 , Sarah Ahmed Alqahtani  7 , Shatha Bin Dher  7 , Abdulaziz M Almotairi  7 , Claire Ann Lim  8 , Musa F Alzahrani  1   9
Affiliations

Goals of care discussions among critically Ill patients on vasopressor treatment

Walid A Alkeridy et al. PLoS One. .

Abstract

Background: Goals of care (GOC) discussions are essential for aligning medical management with the values of critically ill patients, particularly those requiring vasopressors, such as dopamine. To evaluate GOC discussions in terms of prevalence, factors associated with documentation, and impact on survival among critically ill patients requiring vasopressors for hemodynamic support.

Methods: We conducted a retrospective cohort study at a tertiary healthcare facility in Riyadh, Saudi Arabia, focusing on patients admitted to intensive care units (ICUs) and internal medicine (IM) wards. The study included adult in patients who received dopamine during their hospital stay. Factors associated with GOC documentation were identified using logistic regression analysis. The 30-day and 1-year survival rates according to GOC discussions were analyzed using Kaplan-Meier survival curves, which were compared using the log-rank test.

Results: Of 301 patients, 56.8% were men and 64.8% were aged ≥60 years. GOC discussions were documented in 61.8% of patients and were more frequent among older patients (≥60 years) than among younger patients (73.1% vs. 51.3%, p < 0.001) and in those with higher APACHE II scores (median 21.0 vs. 18.0, p = 0.001). Multivariable analysis identified age ≥ 60 years as independent precipitating factor of GOC discussions (odds ratio 2.41, 95% confidence interval 1.34-4.32, p = 0.003). The study found significantly lower survival rates at both 30 days and 1 year among patients who had documented GOC discussions.

Conclusions: GOCs were more prevalent among critically ill older patients. The study found significantly higher mortality rates at both 30 days and 1 year among patients who had documented GOC discussions. These findings highlight the need for institutional strategies to integrate GOC discussions into routine care and address their potential implications on patient outcomes.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparison of patient goals of care discussion (“No” vs. “Yes”), overall and by care setting: internal medicine (IM) and intensive care unit (ICU).
Fig 2
Fig 2. Kaplan–Meier survival curve for 30-day mortality adjusted by patient goals of care.
Fig 3
Fig 3. Kaplan–Meier survival curve for 1-year mortality adjusted by patient goals of care.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Belanger E. Shared decision-making in palliative care: Research priorities to align care with patients’ values. Palliat Med. 2017;31(7):585–6. doi: 10.1177/0269216317713864 - DOI - PubMed
    1. Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. Med Decis Making. 2015;35(1):114–31. doi: 10.1177/0272989X14551638 - DOI - PMC - PubMed
    1. Brabers AEM, van Dijk L, Groenewegen PP, van Peperstraten AM, de Jong JD. Does a strategy to promote shared decision-making reduce medical practice variation in the choice of either single or double embryo transfer after in vitro fertilisation? A secondary analysis of a randomised controlled trial. BMJ Open. 2016;6(5):e010894. doi: 10.1136/bmjopen-2015-010894 - DOI - PMC - PubMed
    1. Gross J, Koffman J. Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review. PLoS One. 2024;19(3):e0299933. doi: 10.1371/journal.pone.0299933 - DOI - PMC - PubMed
    1. Mack JW, Cernik C, Uno H, Xu L, Laurent CA, Fisher L, et al.. Discussions about goals of care and advance care planning among adolescents and young adults with cancer approaching the end of life. J Clin Oncol. 2023;41(30):4739–46. doi: 10.1200/JCO.23.00641 - DOI - PMC - PubMed

Substances

LinkOut - more resources