Contribution of information about acute and geriatric characteristics to decisions about life-sustaining treatment for old patients in intensive care

Michael Beil, P. Vernon van Heerden, Dylan W. de Lange, Wojciech Szczeklik, Susannah Leaver, Bertrand Guidet, Hans Flaatten, Christian Jung*, Sigal Sviri, Leo Joskowicz

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Life-sustaining treatment (LST) in the intensive care unit (ICU) is withheld or withdrawn when there is no reasonable expectation of beneficial outcome. This is especially relevant in old patients where further functional decline might be detrimental for the self-perceived quality of life. However, there still is substantial uncertainty involved in decisions about LST. We used the framework of information theory to assess that uncertainty by measuring information processed during decision-making. Methods: Datasets from two multicentre studies (VIP1, VIP2) with a total of 7488 ICU patients aged 80 years or older were analysed concerning the contribution of information about the acute illness, age, gender, frailty and other geriatric characteristics to decisions about LST. The role of these characteristics in the decision-making process was quantified by the entropy of likelihood distributions and the Kullback–Leibler divergence with regard to withholding or withdrawing decisions. Results: Decisions to withhold or withdraw LST were made in 2186 and 1110 patients, respectively. Both in VIP1 and VIP2, information about the acute illness had the lowest entropy and largest Kullback–Leibler divergence with respect to decisions about withdrawing LST. Age, gender and geriatric characteristics contributed to that decision only to a smaller degree. Conclusions: Information about the severity of the acute illness and, thereby, short-term prognosis dominated decisions about LST in old ICU patients. The smaller contribution of geriatric features suggests persistent uncertainty about the importance of functional outcome. There still remains a gap to fully explain decision-making about LST and further research involving contextual information is required. Trial registration: VIP1 study: NCT03134807 (1 May 2017), VIP2 study: NCT03370692 (12 December 2017).

Original languageAmerican English
Article number1
JournalBMC Medical Informatics and Decision Making
Volume23
Issue number1
DOIs
StatePublished - 6 Jan 2023

Bibliographical note

Publisher Copyright:
© 2023, The Author(s).

Keywords

  • Decision-making
  • Information theory
  • Intensive care
  • Life-sustaining treatment
  • Uncertainty

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