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Changes in Physician Attitudes Toward Limiting Care of Critically Ill Patients

Changes in Physician Attitudes Toward Limiting Care of Critically Ill Patients Abstract To determine whether physician attitudes toward decision making in the care of critically ill patients have changed, a survey of physicians was conducted in 1981 and repeated in 1988. physicians in 1988 were more comfortable discussing "do-not-resuscitate" options with patients and were more likely to allow a critically ill patient to die if the patient so requested. Most physicians in both surveys believe that treatment costs should not play a role in medical decisions. Trainees in 1988 were more aggressive in their management of case studies than were faculty in 1988 or trainees in 1981. While in both years the most important factors in the decision to treat aggressively were a patient's expressed desire to live or die and the amount of patient suffering, physicians in 1988 ranked malpractice concerns as a more important determinant in their decision process compared with physicians in 1981. Significant changes in physician attitudes toward the care of critically ill patients have occurred during this decade. (Arch Intern Med. 1991;151:1537-1540) References 1. Cassileth BR, Zupkis RV, Sutton-Smith K, March V. Information and participation preferences among cancer patients . Ann Intern Med . 1980;92:832-836.Crossref 2. Faden RR, Becker C, Lewis C, Freeman J, Faden A. Disclosure of information to patients in medical care . Med Care . 1981;19:718-733.Crossref 3. Harris L, Boyle JM, Braunstein PJ. Informed consent and the structure of medical care. In: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Provider Relationship. Washington, DC: Government Printing Office; 1982;2:217-316. 4. Haug MR, Lavin B. Practitioner or patient: who's in charge? J Health Soc Behav . 1981;22:212-219.Crossref 5. Callahan D. Setting Limits: Medical Goals in an Aging Society . New York, NY: Simon & Schuster Inc Publishers; 1987. 6. Mayer-Oakes SA, Oye RK, Leake B, Brook RH. The early effect of Medicare's prospective payment system on the use of medical intensive care services in three community hospitals . JAMA . 1988;260:3146-3149.Crossref 7. Linn BS, Robinson DS. The possible impact of DRGs on nutritional status of patients having surgery for cancer of the head and neck . JAMA . 1988;260:514-518.Crossref 8. Annas GJ. Judging Medicine . Clifton, NJ: Humana Press; 1988:183-195. 9. Weisman CS, Morlock LL, Teitelbaum MA, Klassen AC, Celentano DD. Practice changes in response to the malpractice litigation climate . Med Care . 1989;27:16-24.Crossref 10. Optimum care for hopelessly ill patients: a report of the Clinical Care Committee of the Massachusetts General Hospital . N Engl J Med . 1976;295:362-364.Crossref 11. Rabkin MT, Gillerman G, Rice NR. Orders not to resuscitate . N Engl J Med . 1976;295:364-366.Crossref 12. Miles SH, Cranford R, Schultz AL. The do-not-resuscitate order in a teaching hospital: considerations and a suggested policy . Ann Intern Med . 1982;96:660-664.Crossref 13. Lipton HL. Do-not-resuscitate decisions in a community hospital: incidence, implications, and outcomes . JAMA . 1986;256:1164-1169.Crossref 14. Youngner SJ, Lewandowski W, McClish DK, et al. Do not resuscitate orders: incidence and implications in a medical intensive care unit . JAMA . 1985;253:54-57.Crossref 15. Bedell SE, Pelle D, Maher P, Cleary PD. Do-not-resuscitate orders for critically ill patients in the hospital: how are they used and what is their impact? JAMA . 1986;256:233-237.Crossref 16. Charlson ML, Sax FL, Mackenzie CR, et al. Resuscitation: how do we decide? a prospective study of physicians' preferences and the clinical course of hospitalized patients . JAMA . 1986;255:1316-1322.Crossref 17. Evans AL, Brody BA. The do-not-resuscitate order in teaching hospitals . JAMA . 1985;253:2236-2239.Crossref 18. Taffet GE, Teasdale TA, Luchi RJ. In-hospital cardiopulmonary resuscitation . JAMA . 1988;260:2069-2072.Crossref 19. Murphy DJ, Murray AM, Robinson BE, Campion EW. Outcomes of cardiopulmonary resuscitation in the elderly . Ann Intern Med . 1989;111:199-205.Crossref 20. Schneiderman SJ, Spragg RG. Ethical decisions in discontinuing mechanical ventilation . N Engl J Med . 1988;318:984-988.Crossref 21. Daniels N. Why saying no to patients in the United States is so hard: cost containment, justice and provider autonomy . N Engl J Med . 1986;314:1380-1383.Crossref 22. Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? N Engl J Med . 1989;321:86-92.Crossref 23. Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ. Physicians'responses to financial incentives . N Engl J Med . 1990;322:1059-1063.Crossref 24. Salem-Schatz SR, Avorn J, Soumerai SB. Influence of clinical knowledge, organizational context and practice style in transfusion decision making . JAMA . 1990;264;476-483.Crossref 25. Bedell SE, Delbanco TL. Choices about cardiopulmonary resuscitation in the hospital: when do physicians talk with patients? N Engl J Med . 1984;310:1089-1093.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Changes in Physician Attitudes Toward Limiting Care of Critically Ill Patients

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References (29)

Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400080049008
Publisher site
See Article on Publisher Site

Abstract

Abstract To determine whether physician attitudes toward decision making in the care of critically ill patients have changed, a survey of physicians was conducted in 1981 and repeated in 1988. physicians in 1988 were more comfortable discussing "do-not-resuscitate" options with patients and were more likely to allow a critically ill patient to die if the patient so requested. Most physicians in both surveys believe that treatment costs should not play a role in medical decisions. Trainees in 1988 were more aggressive in their management of case studies than were faculty in 1988 or trainees in 1981. While in both years the most important factors in the decision to treat aggressively were a patient's expressed desire to live or die and the amount of patient suffering, physicians in 1988 ranked malpractice concerns as a more important determinant in their decision process compared with physicians in 1981. Significant changes in physician attitudes toward the care of critically ill patients have occurred during this decade. (Arch Intern Med. 1991;151:1537-1540) References 1. Cassileth BR, Zupkis RV, Sutton-Smith K, March V. Information and participation preferences among cancer patients . Ann Intern Med . 1980;92:832-836.Crossref 2. Faden RR, Becker C, Lewis C, Freeman J, Faden A. Disclosure of information to patients in medical care . Med Care . 1981;19:718-733.Crossref 3. Harris L, Boyle JM, Braunstein PJ. Informed consent and the structure of medical care. In: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions: The Ethical and Legal Implications of Informed Consent in the Patient-Provider Relationship. Washington, DC: Government Printing Office; 1982;2:217-316. 4. Haug MR, Lavin B. Practitioner or patient: who's in charge? J Health Soc Behav . 1981;22:212-219.Crossref 5. Callahan D. Setting Limits: Medical Goals in an Aging Society . New York, NY: Simon & Schuster Inc Publishers; 1987. 6. Mayer-Oakes SA, Oye RK, Leake B, Brook RH. The early effect of Medicare's prospective payment system on the use of medical intensive care services in three community hospitals . JAMA . 1988;260:3146-3149.Crossref 7. Linn BS, Robinson DS. The possible impact of DRGs on nutritional status of patients having surgery for cancer of the head and neck . JAMA . 1988;260:514-518.Crossref 8. Annas GJ. Judging Medicine . Clifton, NJ: Humana Press; 1988:183-195. 9. Weisman CS, Morlock LL, Teitelbaum MA, Klassen AC, Celentano DD. Practice changes in response to the malpractice litigation climate . Med Care . 1989;27:16-24.Crossref 10. Optimum care for hopelessly ill patients: a report of the Clinical Care Committee of the Massachusetts General Hospital . N Engl J Med . 1976;295:362-364.Crossref 11. Rabkin MT, Gillerman G, Rice NR. Orders not to resuscitate . N Engl J Med . 1976;295:364-366.Crossref 12. Miles SH, Cranford R, Schultz AL. The do-not-resuscitate order in a teaching hospital: considerations and a suggested policy . Ann Intern Med . 1982;96:660-664.Crossref 13. Lipton HL. Do-not-resuscitate decisions in a community hospital: incidence, implications, and outcomes . JAMA . 1986;256:1164-1169.Crossref 14. Youngner SJ, Lewandowski W, McClish DK, et al. Do not resuscitate orders: incidence and implications in a medical intensive care unit . JAMA . 1985;253:54-57.Crossref 15. Bedell SE, Pelle D, Maher P, Cleary PD. Do-not-resuscitate orders for critically ill patients in the hospital: how are they used and what is their impact? JAMA . 1986;256:233-237.Crossref 16. Charlson ML, Sax FL, Mackenzie CR, et al. Resuscitation: how do we decide? a prospective study of physicians' preferences and the clinical course of hospitalized patients . JAMA . 1986;255:1316-1322.Crossref 17. Evans AL, Brody BA. The do-not-resuscitate order in teaching hospitals . JAMA . 1985;253:2236-2239.Crossref 18. Taffet GE, Teasdale TA, Luchi RJ. In-hospital cardiopulmonary resuscitation . JAMA . 1988;260:2069-2072.Crossref 19. Murphy DJ, Murray AM, Robinson BE, Campion EW. Outcomes of cardiopulmonary resuscitation in the elderly . Ann Intern Med . 1989;111:199-205.Crossref 20. Schneiderman SJ, Spragg RG. Ethical decisions in discontinuing mechanical ventilation . N Engl J Med . 1988;318:984-988.Crossref 21. Daniels N. Why saying no to patients in the United States is so hard: cost containment, justice and provider autonomy . N Engl J Med . 1986;314:1380-1383.Crossref 22. Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? N Engl J Med . 1989;321:86-92.Crossref 23. Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ. Physicians'responses to financial incentives . N Engl J Med . 1990;322:1059-1063.Crossref 24. Salem-Schatz SR, Avorn J, Soumerai SB. Influence of clinical knowledge, organizational context and practice style in transfusion decision making . JAMA . 1990;264;476-483.Crossref 25. Bedell SE, Delbanco TL. Choices about cardiopulmonary resuscitation in the hospital: when do physicians talk with patients? N Engl J Med . 1984;310:1089-1093.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Aug 1, 1991

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