Disagreement Between Clinicians and Score in Decision-Making Capacity of Critically Ill Patients
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 b...
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| Veröffentlicht in: | Crit Care Med 2019-03, Vol.47 (3), p.337-344 |
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| creator | Bertrand, Pierre-Marie Pereira, Bruno Adda, Mireille Timsit, Jean-François Wolff, Michel Hilbert, Gilles Gruson, Didier Garrouste-Orgeas, Maïté Argaud, Laurent Constantin, Jean-Michel Chabanne, Russel Quenot, Jean-Pierre Bohe, Julien Guerin, Claude Papazian, Laurent Jonquet, Olivier Klouche, Kada Delahaye, Arnaud Riu, Beatrice Zieleskiewicz, Laurent Darmon, Michaël Azoulay, Elie Souweine, Bertrand Lautrette, Alexandre |
| description | 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. |
| doi_str_mv | 10.1097/CCM.0000000000003550 |
| format | Article |
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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.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0000000000003550</identifier><identifier>PMID: 30418220</identifier><language>eng</language><publisher>United States: by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</publisher><subject>Critical Illness - psychology ; Decision Making ; Female ; Glasgow Coma Scale ; Humans ; Intensive Care Units ; Life Sciences ; Male ; Mental Competency ; Mental Status and Dementia Tests - statistics & numerical data ; Middle Aged ; Physicians - psychology ; Physicians - statistics & numerical data ; Prospective Studies</subject><ispartof>Crit Care Med, 2019-03, Vol.47 (3), p.337-344</ispartof><rights>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>Copyright © by 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4350-62f85ffebb0f4a45ea68f749ce819fe057fa7f3761b2419a7842949278703ee83</citedby><cites>FETCH-LOGICAL-c4350-62f85ffebb0f4a45ea68f749ce819fe057fa7f3761b2419a7842949278703ee83</cites><orcidid>0000-0002-0788-4967 ; 0000-0003-1633-7700 ; 0000-0003-4545-7461 ; 0000-0003-2351-682X ; 0000-0002-8162-1508</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30418220$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-02195304$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Bertrand, Pierre-Marie</creatorcontrib><creatorcontrib>Pereira, Bruno</creatorcontrib><creatorcontrib>Adda, Mireille</creatorcontrib><creatorcontrib>Timsit, Jean-François</creatorcontrib><creatorcontrib>Wolff, Michel</creatorcontrib><creatorcontrib>Hilbert, Gilles</creatorcontrib><creatorcontrib>Gruson, Didier</creatorcontrib><creatorcontrib>Garrouste-Orgeas, Maïté</creatorcontrib><creatorcontrib>Argaud, Laurent</creatorcontrib><creatorcontrib>Constantin, Jean-Michel</creatorcontrib><creatorcontrib>Chabanne, Russel</creatorcontrib><creatorcontrib>Quenot, Jean-Pierre</creatorcontrib><creatorcontrib>Bohe, Julien</creatorcontrib><creatorcontrib>Guerin, Claude</creatorcontrib><creatorcontrib>Papazian, Laurent</creatorcontrib><creatorcontrib>Jonquet, Olivier</creatorcontrib><creatorcontrib>Klouche, Kada</creatorcontrib><creatorcontrib>Delahaye, Arnaud</creatorcontrib><creatorcontrib>Riu, Beatrice</creatorcontrib><creatorcontrib>Zieleskiewicz, Laurent</creatorcontrib><creatorcontrib>Darmon, Michaël</creatorcontrib><creatorcontrib>Azoulay, Elie</creatorcontrib><creatorcontrib>Souweine, Bertrand</creatorcontrib><creatorcontrib>Lautrette, Alexandre</creatorcontrib><title>Disagreement Between Clinicians and Score in Decision-Making Capacity of Critically Ill Patients</title><title>Crit Care Med</title><addtitle>Crit Care Med</addtitle><description>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.</description><subject>Critical Illness - psychology</subject><subject>Decision Making</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Life Sciences</subject><subject>Male</subject><subject>Mental Competency</subject><subject>Mental Status and Dementia Tests - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Physicians - psychology</subject><subject>Physicians - statistics & numerical data</subject><subject>Prospective Studies</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9vEzEQxS0EomnhGyDkIxy2jP-t18eypbRSKpCAs3HccWPqeIO9Icq3Z0NKhTjAXEYz-r030jxCXjA4ZWD0m76_PoU_SigFj8iMKQENcCMekxmAgUZII47Ica3fAJhUWjwlRwIk6ziHGfl6Hqu7LYgrzCN9i-MWMdM-xRx9dLlSl2_oJz8UpDHTc_SxxiE31-4u5lvau7XzcdzRIdC-xDF6l9KOXqVEP7oxTpb1GXkSXKr4_L6fkC8X7z73l838w_ur_mzeeCkUNC0PnQoBFwsI0kmFru2ClsZjx0xAUDo4HYRu2YJLZpzuJDfScN1pEIidOCGvD75Ll-y6xJUrOzu4aC_P5na_A87M9Bv5g03sqwO7LsP3DdbRrmL1mJLLOGyq5Uxw3grD-ITKA-rLUGvB8ODNwO5zsFMO9u8cJtnL-wubxQpvHkS_Hz8B3QHYDmnEUu_SZovFLtGlcfk_b_kP6S-My7bhwAyIaWr2KyV-AgYGoag</recordid><startdate>201903</startdate><enddate>201903</enddate><creator>Bertrand, Pierre-Marie</creator><creator>Pereira, Bruno</creator><creator>Adda, Mireille</creator><creator>Timsit, Jean-François</creator><creator>Wolff, Michel</creator><creator>Hilbert, Gilles</creator><creator>Gruson, Didier</creator><creator>Garrouste-Orgeas, Maïté</creator><creator>Argaud, Laurent</creator><creator>Constantin, Jean-Michel</creator><creator>Chabanne, Russel</creator><creator>Quenot, Jean-Pierre</creator><creator>Bohe, Julien</creator><creator>Guerin, Claude</creator><creator>Papazian, Laurent</creator><creator>Jonquet, Olivier</creator><creator>Klouche, Kada</creator><creator>Delahaye, Arnaud</creator><creator>Riu, Beatrice</creator><creator>Zieleskiewicz, Laurent</creator><creator>Darmon, Michaël</creator><creator>Azoulay, Elie</creator><creator>Souweine, Bertrand</creator><creator>Lautrette, Alexandre</creator><general>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><general>Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-0788-4967</orcidid><orcidid>https://orcid.org/0000-0003-1633-7700</orcidid><orcidid>https://orcid.org/0000-0003-4545-7461</orcidid><orcidid>https://orcid.org/0000-0003-2351-682X</orcidid><orcidid>https://orcid.org/0000-0002-8162-1508</orcidid></search><sort><creationdate>201903</creationdate><title>Disagreement Between Clinicians and Score in Decision-Making Capacity of Critically Ill Patients</title><author>Bertrand, Pierre-Marie ; Pereira, Bruno ; Adda, Mireille ; Timsit, Jean-François ; Wolff, Michel ; Hilbert, Gilles ; Gruson, Didier ; Garrouste-Orgeas, Maïté ; Argaud, Laurent ; Constantin, Jean-Michel ; Chabanne, Russel ; Quenot, Jean-Pierre ; Bohe, Julien ; Guerin, Claude ; Papazian, Laurent ; Jonquet, Olivier ; Klouche, Kada ; Delahaye, Arnaud ; Riu, Beatrice ; Zieleskiewicz, Laurent ; Darmon, Michaël ; Azoulay, Elie ; Souweine, Bertrand ; Lautrette, Alexandre</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4350-62f85ffebb0f4a45ea68f749ce819fe057fa7f3761b2419a7842949278703ee83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Critical Illness - psychology</topic><topic>Decision Making</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Life Sciences</topic><topic>Male</topic><topic>Mental Competency</topic><topic>Mental Status and Dementia Tests - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Physicians - psychology</topic><topic>Physicians - statistics & numerical data</topic><topic>Prospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bertrand, Pierre-Marie</creatorcontrib><creatorcontrib>Pereira, Bruno</creatorcontrib><creatorcontrib>Adda, Mireille</creatorcontrib><creatorcontrib>Timsit, Jean-François</creatorcontrib><creatorcontrib>Wolff, Michel</creatorcontrib><creatorcontrib>Hilbert, Gilles</creatorcontrib><creatorcontrib>Gruson, Didier</creatorcontrib><creatorcontrib>Garrouste-Orgeas, Maïté</creatorcontrib><creatorcontrib>Argaud, Laurent</creatorcontrib><creatorcontrib>Constantin, Jean-Michel</creatorcontrib><creatorcontrib>Chabanne, Russel</creatorcontrib><creatorcontrib>Quenot, Jean-Pierre</creatorcontrib><creatorcontrib>Bohe, Julien</creatorcontrib><creatorcontrib>Guerin, Claude</creatorcontrib><creatorcontrib>Papazian, Laurent</creatorcontrib><creatorcontrib>Jonquet, Olivier</creatorcontrib><creatorcontrib>Klouche, Kada</creatorcontrib><creatorcontrib>Delahaye, Arnaud</creatorcontrib><creatorcontrib>Riu, Beatrice</creatorcontrib><creatorcontrib>Zieleskiewicz, Laurent</creatorcontrib><creatorcontrib>Darmon, Michaël</creatorcontrib><creatorcontrib>Azoulay, Elie</creatorcontrib><creatorcontrib>Souweine, Bertrand</creatorcontrib><creatorcontrib>Lautrette, Alexandre</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Crit Care Med</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bertrand, Pierre-Marie</au><au>Pereira, Bruno</au><au>Adda, Mireille</au><au>Timsit, Jean-François</au><au>Wolff, Michel</au><au>Hilbert, Gilles</au><au>Gruson, Didier</au><au>Garrouste-Orgeas, Maïté</au><au>Argaud, Laurent</au><au>Constantin, Jean-Michel</au><au>Chabanne, Russel</au><au>Quenot, Jean-Pierre</au><au>Bohe, Julien</au><au>Guerin, Claude</au><au>Papazian, Laurent</au><au>Jonquet, Olivier</au><au>Klouche, Kada</au><au>Delahaye, Arnaud</au><au>Riu, Beatrice</au><au>Zieleskiewicz, Laurent</au><au>Darmon, Michaël</au><au>Azoulay, Elie</au><au>Souweine, Bertrand</au><au>Lautrette, Alexandre</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Disagreement Between Clinicians and Score in Decision-Making Capacity of Critically Ill Patients</atitle><jtitle>Crit Care Med</jtitle><addtitle>Crit Care Med</addtitle><date>2019-03</date><risdate>2019</risdate><volume>47</volume><issue>3</issue><spage>337</spage><epage>344</epage><pages>337-344</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><abstract>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.</abstract><cop>United States</cop><pub>by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc</pub><pmid>30418220</pmid><doi>10.1097/CCM.0000000000003550</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-0788-4967</orcidid><orcidid>https://orcid.org/0000-0003-1633-7700</orcidid><orcidid>https://orcid.org/0000-0003-4545-7461</orcidid><orcidid>https://orcid.org/0000-0003-2351-682X</orcidid><orcidid>https://orcid.org/0000-0002-8162-1508</orcidid></addata></record> |
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| ispartof | Crit Care Med, 2019-03, Vol.47 (3), p.337-344 |
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| source | MEDLINE; Journals@Ovid Ovid Autoload |
| subjects | Critical Illness - psychology Decision Making Female Glasgow Coma Scale Humans Intensive Care Units Life Sciences Male Mental Competency Mental Status and Dementia Tests - statistics & numerical data Middle Aged Physicians - psychology Physicians - statistics & numerical data Prospective Studies |
| title | Disagreement Between Clinicians and Score in Decision-Making Capacity of Critically Ill Patients |
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