Abstract:
OBJECTIVE:Most studies have assessed conflict between clinicians and surrogate decision makers in ICUs from only clinicians' perspectives. It is unknown if surrogates' perceptions differ from clinicians'. We sought to determine the degree of agreement between physicians and surrogates about conflict and to identify predictors of physician-surrogate conflict. DESIGN:Prospective cohort study. SETTING:Four ICUs of two hospitals in San Francisco, California. PATIENTS:Two hundred and thirty surrogate decision makers and 100 physicians of 175 critically ill patients. MEASUREMENTS:Questionnaires addressing participants' perceptions of whether there was physician-surrogate conflict, as well as attitudes and preferences about clinician-surrogate communication; κ scores to quantify physician-surrogate concordance about the presence of conflict; and hierarchical multivariate modeling to determine predictors of conflict. MAIN RESULTS:Either the physician or surrogate identified conflict in 63% of cases. Physicians were less likely to perceive conflict than surrogates (27.8% vs 42.3%; p = 0.007). Agreement between physicians and surrogates about conflict was poor (κ = 0.14). Multivariable analysis with surrogate-assessed conflict as the outcome revealed that higher levels of surrogates' satisfaction with physicians' bedside manner were associated with lower odds of conflict (odds ratio, 0.75 per 1 point increase in satisfaction; 95% CI, 0.59-0.96). Multivariable analysis with physician-assessed conflict as the outcome revealed that the surrogate having felt discriminated against in the healthcare setting was associated with higher odds of conflict (odds ratio, 17.5; 95% CI, 1.6-190.1) while surrogates' satisfaction with physicians' bedside manner was associated with lower odds of conflict (0-10 scale; odds ratio, 0.76 per 1 point increase; 95% CI, 0.58-0.99). CONCLUSIONS:Conflict between physicians and surrogates is common in ICUs. There is little agreement between physicians and surrogates about whether physician-surrogate conflict has occurred. Further work is needed to develop reliable and valid methods to assess conflict. In the interim, future studies should assess conflict from the perspective of both clinicians and surrogates.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Schuster RA,Hong SY,Arnold RM,White DBdoi
10.1097/CCM.0b013e3182a27598subject
Has Abstractpub_date
2014-02-01 00:00:00pages
328-35issue
2eissn
0090-3493issn
1530-0293pii
00003246-201402000-00012journal_volume
42pub_type
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journal_title:Critical care medicine
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doi:10.1097/00003246-198205000-00001
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journal_title:Critical care medicine
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更新日期:2010-06-01 00:00:00
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更新日期:2004-11-01 00:00:00
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更新日期:2007-04-01 00:00:00
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journal_title:Critical care medicine
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更新日期:2008-04-01 00:00:00
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更新日期:2002-10-01 00:00:00
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pub_type: 评论,杂志文章,多中心研究
doi:10.1097/01.ccm.0000150026.85210.13
更新日期:2005-02-01 00:00:00
abstract::Clonidine may be a source of serious toxicity when ingested by toddlers. We describe 11 cases of clonidine ingestion by toddlers (mean dose 0.15 mg/kg; range 0.01 to 0.57). The source of the clonidine was a grand-parent in six of 11 cases. Symptoms included altered level of consciousness (n = 11), miosis (n = 5), brad...
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更新日期:2015-07-01 00:00:00
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更新日期:2011-05-01 00:00:00
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更新日期:2007-10-01 00:00:00
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journal_title:Critical care medicine
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更新日期:1984-12-01 00:00:00
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更新日期:1982-06-01 00:00:00
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更新日期:2014-02-01 00:00:00
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更新日期:2006-10-01 00:00:00
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更新日期:2015-10-01 00:00:00