Prognostication during physician-family discussions about limiting life support in intensive care units*
Critical Care MedicinePublished 4 January 2007
Douglas B. White, Ruth A. Engelberg, Marjorie D. Wenrich, Bernard Lo, J. Randall Curtis
Citations176
SJR quartileQ1
SJR score2.12
SNIP2.15
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TL;DR
Prognostication occurred frequently during physician-family deliberations about whether to forego life support, but physicians did not discuss the patient’s prognosis for survival in more than one third of conferences.
Abstract
Prognostication occurred frequently during physician-family deliberations about whether to forego life support, but physicians did not discuss the patient's prognosis for survival in more than one third of conferences. Less educated families received less information about prognosis. Future studies should address whether these observations partially explain the high prevalence of family misunderstandings about prognosis in intensive care units.
Keywords
MedicineHealth Professions
CHEST JournalThe APACHE III Prognostic System
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American Journal of Respiratory and Critical Care MedicineA National Survey of End-of-life Care for Critically Ill Patients
646 Citations1998Thomas J. Prendergast, Michaël Claessens +1 more
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633 Citations1999Cathy Charles, Timothy J. Whelan +1 more
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New England Journal of MedicineThe Influence of the Probability of Survival on Patients' Preferences Regarding Cardiopulmonary Resuscitation
576 Citations1994Donald J. Murphy, David Burrows +5 more
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Archives of Internal MedicineAttitude and Self-reported Practice Regarding Prognostication in a National Sample of Internists
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Physicians commonly encounter situations that require prognostication, feel poorly prepared for prognOSTication, find it stressful and difficult to make predictions, believe that patients expect too much certainty and might judge them adversely for prognostic errors, and vary in how they regard the key concept of being "terminally ill.
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It is argued that physicians and the medical profession as a whole have the duty to prognosticate, and shirking the difficult questions - as most doctors tend to do - advances neither medical knowledge nor the care seriously ill patients receive.
Journal of General Internal MedicineConflict associated with decisions to limit life-sustaining treatment in intensive care units
378 Citations2001Catherine Breen, Amy P. Abernethy +2 more
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368 Citations1995Richard J. Cook
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Critical Care MedicineClinician predictions of intensive care unit mortality*
249 Citations2004Graeme Rocker, Deborah Cook +10 more
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JAMAComparison of Clinical Assessment With APACHE II for Predicting Mortality Risk in Patients Admitted to a Medical Intensive Care Unit
240 Citations1988James A. Kruse
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PubMedCommunicating with patients who have limited literacy skills. Report of the National Work Group on Literacy and Health.
240 Citations1998Barry D. Weiss
The current status of illiteracy in the United States is characterized, the relationship between poor literacy and poor health is described, and recommendations on how to deal with patients who have poor reading skills are made.
Critical Care MedicineChallenges in End-of-Life Care in the ICU: Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003: Executive Summary
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PubMedWhat are the needs of families of critically ill patients? A review of the literature since 1976.
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