Biases in how physicians choose to withdraw life support.
We have investigated biases in physicians' decisions regarding the form of life support to withdraw from critically ill patients in whom the decision to withdraw has already been made. Using a specially designed instrument that solicited both self-reported preferences and also responses to experimen...
| Publicado en: | Lancet Vol. 342; no. 8872; pp. 642 - 647 |
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| Autores principales: | , , , |
| Formato: | clinical trial research randomized controlled trial Journal Article |
| Publicado: |
Lancet
9/11/1993
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=1721863&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 1721863 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 9/11/1993 vid: 342 iid: 8872 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 1721863 1721863 NLM8103146 1721863 10.1016/0140-6736(93)91759-F NLM8103146 1721863 ppf: 642 ppct: 5 formats: fmt: @attributes: type: T tig: atl: Biases in how physicians choose to withdraw life support. aug: au: Christakis, Nicholas A Asch, David A Christakis, N A Asch, D A affil: Division of General Internal Medicine, School of Medicine, University of Pennsylvania, Philadelphia sug: subj: Decision Making Physicians Psychosocial Factors Euthanasia, Passive Prejudice Time Factors Uncertainty Human Internal Medicine Life Support Care Methods Critical Care Attitude of Health Personnel Clinical Trials Validation Studies Comparative Studies Evaluation Research Multicenter Studies Randomized Controlled Trials Critical Care Family Needs Inventory ab: We have investigated biases in physicians' decisions regarding the form of life support to withdraw from critically ill patients in whom the decision to withdraw has already been made. Using a specially designed instrument that solicited both self-reported preferences and also responses to experimentally varied clinical vignettes, we surveyed 862 American internists, of whom 481 (56%) responded. Physicians do have preferences about the form of life support withdrawn. From most likely to least likely the order is: blood products, haemodialysis, intravenous vasopressors, total parenteral nutrition, antibiotics, mechanical ventilation, tube feedings, and intravenous fluids. Four biases in decision making were also identified. Physicians prefer to withdraw forms of therapy supporting organs that failed for natural rather than iatrogenic reasons, to withdraw recently instituted rather than longstanding interventions, to withdraw forms of therapy resulting in immediate death rather than delayed death, and to withdraw forms of therapy resulting in delayed death when confronted with diagnostic uncertainty. Because these biases may have clinical, social, and ethical consequences counter to patient goals, and because they may affect the underlying decision whether to withdraw life support at all, they may represent impediments to rational and compassionate decision making in critical care. pubtype: Academic Journal doctype: clinical trial research randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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