Disagreement Between Clinicians and Score in Decision-Making Capacity of Critically Ill Patients*

被引：13

作者：

Bertrand, Pierre-Marie ^{[1
]}

Pereira, Bruno ^{[2
]}

Adda, Mireille ^{[1
]}

Timsit, Jean-Francois ^{[3
]}

Wolff, Michel ^{[4
]}

Hilbert, Gilles ^{[5
]}

Gruson, Didier ^{[5
]}

Garrouste-Orgeas, Maite ^{[6
]}

Argaud, Laurent ^{[7
]}

Constantin, Jean-Michel ^{[8
]}

Chabanne, Russel ^{[8
]}

Quenot, Jean-Pierre ^{[9
]}

Bohe, Julien ^{[10
]}

Guerin, Claude ^{[11
]}

Papazian, Laurent ^{[12
]}

Jonquet, Olivier ^{[13
]}

Klouche, Kada ^{[13
]}

Delahaye, Arnaud ^{[14
]}

Riu, Beatrice ^{[15
]}

Zieleskiewicz, Laurent ^{[16
]}

Darmon, Michael ^{[17
]}

Azoulay, Elie ^{[18
]}

Souweine, Bertrand ^{[1
,19
]}

Lautrette, Alexandre ^{[1
,19
]}

机构：

[1] Univ Hosp Clermont Ferrand, Intens Care Unit, Gabriel Montpied Hosp, Clermont Ferrand, France

[2] Univ Hosp Clermont Ferrand, Biostat Unit, Delegat Rech Clin DRCI, Clermont Ferrand, France

[3] Univ Hosp Grenoble, Albert Michallon Hosp, Intens Care Unit, Grenoble, France

[4] Bichat Claude Bernard Hosp, AP HP, Intens Care Unit, Paris, France

[5] Univ Hosp Bordeaux, Pellegrin Tripode Hosp, Intens Care Unit, Bordeaux, France

[6] St Joseph Hosp, Intens Care Unit, Paris, France

[7] Univ Hosp Lyon, Edouard Herriot Hosp, Intens Care Unit, Lyon, France

[8] Univ Hosp Clermont Ferrand, Estaing Hosp, Dept Anaesthesiol, Intens Care Unit, Clermont Ferrand, France

[9] Univ Hosp Dijon, Intens Care Unit, Bocage Cent Hosp, Dijon, France

[10] Univ Hosp Lyon, Hosp Civils Hosp, Intens Care Unit, Lyon, France

[11] Univ Hosp Lyon, Croix Rousse Hosp, Intens Care Unit, Lyon, France

[12] Univ Hosp Aix Marseille, Nord Teaching Hosp, Intens Care Unit, Marseille, France

[13] Univ Hosp Montpellier, Lapeyronie Hosp, Intens Care Unit, Montpellier, France

[14] Rodez Hosp, Intens Care Unit, Rodez, France

[15] Univ Hosp Toulouse, Purpan Hosp, Intens Care Unit, Toulouse, France

[16] Univ Hosp Aix Marseille, Nord Teaching Hosp, Dept Anaesthesiol, Intens Care Unit, Marseille, France

[17] Univ Hosp St Etienne, Nord Teaching Hosp, Intens Care Unit, St Etienne, France

[18] St Louis Hosp, AP HP, Intens Care Unit, Paris, France

[19] Clermont Auvergne Univ, LMGE, UMR CNRS 6023, Clermont Ferrand, France

来源：

CRITICAL CARE MEDICINE | 2019年 / 47卷 / 03期

关键词：

capacity assessment; critical care; decision-making capacity; ethic; MENTAL INCAPACITY; HEALTH-CARE; CONSENT; PREFERENCES; SURROGATES; VALUES; COMA; END;

D O I：

10.1097/CCM.0000000000003550

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: To compare the assessment of decision-making capacity of ICU patients by attending clinicians (physicians, nurses, and residents) with a capacity score measured by the Mini-Mental Status Examination, completed by Aid to Capacity Evaluation if necessary. The primary outcome was agreement between physicians' assessments and the score. Secondary outcomes were agreement between nurses' or residents' assessments and the score and identification of factors associated with disagreement. Design: A 1-day prevalence study. Setting: Nineteen ICUs in France. Subjects: All patients hospitalized in the ICU on the study day and the attending clinicians. Interventions: The decision-making capacity of patients was assessed by the attending clinicians and independently by an observer using the score. Measurements and Main Results: A total of 206 patients were assessed by 213 attending clinicians (57 physicians, 97 nurses, and 59 residents). Physicians designated more patients as having decision-making capacity (n = 92/ 206 [ 45%]) than score (n = 34/206 [17%]; absolute difference 28% [95% CI, 20-37%]; p = 0.001). There was a high disagreement between assessments of all clinicians and score (Kappa coefficient 0.39 [95% CI, 0.29-0.50] for physicians; 0.39 [95% CI, 0.27-0.52] for nurses; and 0.46 [95% CI, 0.35-0.58] for residents). The main factor associated with disagreement was a Glasgow Coma Scale score between 10 and 15 (odds ratio, 2.92 [1.18-7.19], p = 0.02 for physicians; 4.97 [1.50-16.45], p = 0.01 for nurses; and 3.39 [1.12-10.29], p = 0.03 for residents) without differentiating between the Glasgow Coma Scale scores from 10 to 15. Conclusions: The decision-making capacity of ICU patients was largely overestimated by all attending clinicians as compared with a score. The main factor associated with disagreement was a Glasgow Coma Scale score between 10 and 15, suggesting that clinicians confused consciousness with decision-making capacity.

引用

页码：337 / 344

页数：8

共 38 条

[1] Assessment of patients' competence to consent to treatment [J].

Appelbaum, Paul S. .

NEW ENGLAND JOURNAL OF MEDICINE, 2007, 357 (18) :1834-1840

[2] An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units [J].

Bosslet, Gabriel T. ;

Pope, Thaddeus M. ;

Rubenfeld, Gordon D. ;

Lo, Bernard ;

Truog, Robert D. ;

Rushton, Cynda H. ;

Curtis, J. Randall ;

Ford, Dee W. ;

Osborne, Molly ;

Misak, Cheryl ;

Au, David H. ;

Azoulay, Elie ;

Brady, Baruch ;

Fahy, Brenda G. ;

Hall, Jesse B. ;

Kesecioglu, Jozef ;

Kon, Alexander A. ;

Lindell, Kathleen O. ;

White, Douglas B. .

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2015, 191 (11) :1318-1330

[3] Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units [J].

Cai, Xuemei ;

Robinson, Jennifer ;

Muehlschlegel, Susanne ;

White, Douglas B. ;

Holloway, Robert G. ;

Sheth, Kevin N. ;

Fraenkel, Liana ;

Hwang, David Y. .

NEUROCRITICAL CARE, 2015, 23 (01) :131-141

[4] CURVES: A Mnemonic for Determining Medical Decision-Making Capacity and Providing Emergency Treatment in the Acute Setting [J].

Chow, Grant V. ;

Czarny, Matthew J. ;

Hughes, Mark T. ;

Carrese, Joseph A. .

CHEST, 2010, 137 (02) :421-427

[5] Ability of family members to predict patient's consent to critical care research [J].

Ciroldi, Magali ;

Cariou, Alain ;

Adrie, Christophe ;

Annane, Djilali ;

Castelain, Vincent ;

Cohen, Yves ;

Delahaye, Arnaud ;

Joly, Luc Marie ;

Galliot, Richard ;

Garrouste-Orgeas, Maite ;

Papazian, Laurent ;

Michel, Fabrice ;

Barnes, Nancy Kenstish ;

Schlemmer, Benoit ;

Pochard, Frederic ;

Azoulay, Elie .

INTENSIVE CARE MEDICINE, 2007, 33 (05) :807-813

[6] Supporting Patient Autonomy: The Importance of Clinician-patient Relationships [J].

Entwistle, Vikki A. ;

Carter, Stacy M. ;

Cribb, Alan ;

McCaffery, Kirsten .

JOURNAL OF GENERAL INTERNAL MEDICINE, 2010, 25 (07) :741-745

[7] Assessment of patient capacity to consent to treatment [J].

Etchells, E ;

Darzins, P ;

Silberfeld, M ;

Singer, PA ;

McKenny, J ;

Naglie, G ;

Katz, M ;

Guyatt, GH ;

Molloy, DW ;

Strang, D .

JOURNAL OF GENERAL INTERNAL MEDICINE, 1999, 14 (01) :27-34

[8] Decision-making capacity and surrogate designation in French ICU patients [J].

Ferrand, E ;

Bachoud-Levi, AC ;

Rodrigues, M ;

Maggiore, S ;

Brun-Buisson, C ;

Lemaire, F .

INTENSIVE CARE MEDICINE, 2001, 27 (08) :1360-1364

[9] MINI-MENTAL STATE - PRACTICAL METHOD FOR GRADING COGNITIVE STATE OF PATIENTS FOR CLINICIAN [J].

FOLSTEIN, MF ;

FOLSTEIN, SE ;

MCHUGH, PR .

JOURNAL OF PSYCHIATRIC RESEARCH, 1975, 12 (03) :189-198

[10] Development and Validation of a Brief Cognitive Assessment Tool The Sweet 16 [J].

Fong, Tamara G. ;

Jones, Richard N. ;

Rudolph, James L. ;

Yang, Frances M. ;

Tommet, Douglas ;

Habtemariam, Daniel ;

Marcantonio, Edward R. ;

Langa, Kenneth M. ;

Inouye, Sharon K. .

ARCHIVES OF INTERNAL MEDICINE, 2011, 171 (05) :432-437

← 1 2 3 4 →