Intensive care unit admission in chronic obstructive pulmonary disease: patient information and the physician’s decision-making process View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-06-04

AUTHORS

Matthieu Schmidt, Alexandre Demoule, Emmanuelle Deslandes-Boutmy, Marine Chaize, Sandra de Miranda, Nicolas Bèle, Nicolas Roche, Elie Azoulay, Thomas Similowski

ABSTRACT

IntroductionICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission.MethodsCOPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD patients to the ICU and to propose invasive mechanical ventilation.ResultsSelf-report questionnaires were filled in by 126 COPD patients and 102 relatives, and 173 pulmonologists and 135 ICU physicians were interviewed. For 41% (n = 39) of patients and 54% (n = 51) of relatives, ICU admission had never been expected prior to admission. One half of patients were not routinely informed by their pulmonologist about possible ICU admission at some time during the course of COPD. Moreover, treatment options (that is, non-invasive ventilation, intubation and mechanical ventilation or tracheotomy) were not explained to COPD patients during regular pulmonologist visits. Pulmonologists and ICU physician have different perceptions of the decision-making process pertaining to ICU admission and intubation.ConclusionsThe information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient’s personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed. More... »

PAGES

r115

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/cc13906

DOI

http://dx.doi.org/10.1186/cc13906

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1039987657

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24898342


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72 patients
73 patients' personal values
74 perception
75 personal values
76 physician's decision-making process
77 physicians
78 possible ICU admission
79 practice
80 preferences
81 process
82 prognosis
83 prognosis of COPD
84 pulmonary disease
85 pulmonologist visits
86 pulmonologists
87 questionnaire
88 relatives
89 risk
90 specific care
91 time
92 transfer
93 treatment options
94 treatment preferences
95 unit admission
96 values
97 ventilation
98 visits
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