Conflict in the care of patients with prolonged stay in the ICU: types, sources, and predictors
- 19 July 2003
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 29 (9), 1489-1497
- https://doi.org/10.1007/s00134-003-1853-5
Abstract
To determine types, sources, and predictors of conflicts among patients with prolonged stay in the ICU. We prospectively identified conflicts by interviewing treating physicians and nurses at two stages during the patients' stays. We then classified conflicts by type and source and used a case-control design to identify predictors of team-family conflicts. Seven medical and surgical ICUs at four teaching hospitals in Boston, USA. All patients admitted to the participating ICUs over an 11-month period whose stay exceeded the 85th percentile length of stay for their respective unit (n=656). Clinicians identified 248 conflicts involving 209 patients; hence, nearly one-third of patients had conflict associated with their care: 142 conflicts (57%) were team-family disputes, 76 (31%) were intrateam disputes, and 30 (12%) occurred among family members. Disagreements over life-sustaining treatment led to 63 team-family conflicts (44%). Other leading sources were poor communication (44%), the unavailability of family decision makers (15%), and the surrogates' (perceived) inability to make decisions (16%). Nurses detected all types of conflict more frequently than physicians, especially intrateam conflicts. The presence of a spouse reduced the probability of team-family conflict generally (odds ratio 0.64) and team-family disputes over life-sustaining treatment specifically (odds ratio 0.49). Conflict is common in the care of patients with prolonged stays in the ICU. However, efforts to improve the quality of care for critically ill patients that focus on team-family disagreements over life-sustaining treatment miss significant discord in a variety of other areas.Keywords
This publication has 34 references indexed in Scilit:
- Results of a clinical trial on care improvement for the critically illCritical Care Medicine, 2003
- A study of proactive ethics consultation for critically and terminally ill patients with extended lengths of stayCritical Care Medicine, 1998
- Nurses' reflections on problems associated with decision‐making in critical care settingsJournal of Advanced Nursing, 1997
- The Role of Critical Care Nurses in Euthanasia and Assisted SuicideNew England Journal of Medicine, 1996
- The inaccessibility of advance directives on transfer from ambulatory to acute care settingsJAMA, 1995
- A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter studyJama-Journal Of The American Medical Association, 1993
- Validity and reliability testing of the FAMCARE scale: Measuring family satisfaction with advanced cancer careSocial Science & Medicine (1982), 1993
- A Prospective Study of Advance Directives for Life-Sustaining CareNew England Journal of Medicine, 1991
- Withholding and Withdrawal of Life Support from the Critically IllNew England Journal of Medicine, 1990
- Therapeutic intervention scoring systemCritical Care Medicine, 1974