title: Intensive care unit admission in chronic obstructive pulmonary disease: patient information and the physician's decision-making process.
abstract: BACKGROUND
  ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission.
  
  
  METHODS
  COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD patients to the ICU and to propose invasive mechanical ventilation.
  
  
  RESULTS
  Self-report questionnaires were filled in by 126 COPD patients and 102 relatives, and 173 pulmonologists and 135 ICU physicians were interviewed. For 41% (n = 39) of patients and 54% (n = 51) of relatives, ICU admission had never been expected prior to admission. One half of patients were not routinely informed by their pulmonologist about possible ICU admission at some time during the course of COPD. Moreover, treatment options (that is, non-invasive ventilation, intubation and mechanical ventilation or tracheotomy) were not explained to COPD patients during regular pulmonologist visits. Pulmonologists and ICU physician have different perceptions of the decision-making process pertaining to ICU admission and intubation.
  
  
  CONCLUSIONS
  The information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient's personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Schmidt
authors.forename: Alexandre
authors.initials: A
authors.lastname: Demoule
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Deslandes-Boutmy
authors.forename: Marine
authors.initials: M
authors.lastname: Chaize
authors.forename: Sandra
authors.initials: S
authors.lastname: de Miranda
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bèle
authors.forename: Nicolas
authors.initials: N
authors.lastname: Roche
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Thomas
authors.initials: T
authors.lastname: Similowski
mesh_terms: D003142:Communication; D003422:Critical Care; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D011368:Professional-Family Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D015272:Pulmonary Medicine; D012121:Respiration, Artificial