title: Admission of incompetent patients to intensive care: doctors' responsiveness to family wishes.
abstract: OBJECTIVE
  When a patient is incompetent, the family is often considered to be a natural surrogate. The doctors' responsiveness to family wishes may vary. We explored if doctors' personal characteristics were associated with responsiveness to the relatives' wishes when admission to the intensive care unit (ICU) is considered.
  
  
  METHODS
  In a mail survey, we asked all Swiss ICU doctors to decide on the admission of a hypothetical incompetent patient presenting with hemolytic uremic syndrome. Each participant was randomly allocated to a version of the scenario in which the family asked either that "everything be done" or that the patient be "spared useless suffering."
  
  
  RESULTS
  Overall, 232 (60.9%) questionnaires were returned. When the family asked that "everything be done," 60% of doctors chose to admit the hypothetical patient, but when the family asked that she be spared useless suffering, only 39% did so (odds ratio [OR] 2.6, confidence interval 1.5-4.6). This OR captures responsiveness to family wishes. It varied across subgroups of ICU doctors. Characteristics associated with greater responsiveness to family wishes were older age (OR 6.0 vs. 1.2, p = 0.002), nonuniversity work setting (OR 4.2 vs. 1.0, p = 0.012), less time devoted to intensive care practice (OR 4.0 vs. 1.5, p = 0.036), and greater self-confidence in ethical knowledge (OR 3.4 vs. 1.7, p = 0.044).
  
  
  CONCLUSIONS
  Older doctors and those working in regional hospitals were more responsive to family wishes when assessing an incompetent patient for ICU admission. These findings emphasize the need for effective advance care planning.
authors.affiliation: Division of Clinical Pharmacology and Toxicology, Pain and Palliative Care Consultation, Geneva University Hospitals, Geneva, Switzerland. monica.escher@hcuge.ch
authors.forename: M
authors.initials: M
authors.lastname: Escher
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Perneger
authors.forename: Claudia P
authors.initials: CP
authors.lastname: Heidegger
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Chevrolet
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010343:Patient Admission; D010820:Physicians; D011368:Professional-Family Relations; D011795:Surveys and Questionnaires; D013557:Switzerland; D014218:Triage