National questionnaire survey on what influences doctors' decisions about admission to intensive care

Abstract

OBJECTIVE: To determine what influences doctors' decisions about admission of patients to intensive care. DESIGN: National questionnaire survey using eight clinical vignettes involving hypothetical patients. SETTING: Switzerland. PARTICIPANTS: 402 Swiss doctors specialising in intensive care. MAIN OUTCOME MEASURES: Rating of factors influencing decisions on admission and response to eight hypothetical clinical scenarios. RESULTS: Of 381 doctors agreeing to participate, 232 (61%) returned questionnaires. Most rated as important or very important the prognosis of the underlying disease (82%) and of the acute illness (81%) and the patients' wishes (71%). Few considered important the socioeconomic circumstances of the patient (2%), religious beliefs (3%), and emotional state (6%). In the vignettes, underlying disease (cancer versus non-cancerous disease) was not associated with admission to intensive care, but four other factors were: patients' wishes (odds ratio 3.0, 95% confidence interval 2.0 to 4.6), "upbeat" personality (2.9, 1.9 to 4.4), younger age (1.5, 1.1 to 2.2), and a greater number of beds available in intensive care (1.8, 1.2 to 2.5). CONCLUSIONS: Doctors' decisions to admit patients to intensive care are influenced by patients' wishes and ethically problematic non-medical factors such as a patient's personality or availability of beds. Patients with cancer are not discriminated against.