Population Preferences for Treatments When Critically Ill: A Discrete Choice Experiment

Area of Science:

• Medical Ethics
• Critical Care Medicine
• Health Economics

Background:

• Many intensive care unit (ICU) patients are unable to participate in shared decision-making.
• Patient values are often not previously documented, complicating surrogate decision-making.
• General population values can guide clinicians in providing appropriate recommendations to surrogates.

Purpose of the Study:

• To explore the general population's preferences regarding intensive care unit (ICU) treatments.
• To understand factors influencing decisions about continuing or stopping active treatment.
• To inform clinical guidance for surrogate decision-makers when patient wishes are unknown.

Main Methods:

• A discrete choice experiment was used in an online survey of an Australian panel.
• Participants evaluated willingness to accept treatments based on outcomes (functional autonomy, pain, cognitive disability, burden on others) and probabilities.
• Logistic regression analyzed data, predicting treatment continuation based on demographic and health factors.

Main Results:

• Higher likelihood of negative intensive care unit sequelae increased preference to stop treatment, especially concerning need for care assistance and residential care.
• Younger individuals, those identifying as very religious, and those with young children were more likely to continue active treatment.
• Functional autonomy was the most valued factor in treatment decisions.

Conclusions:

• Patient independence is paramount when deciding on intensive care unit (ICU) treatments.
• Clinicians should prioritize functional independence over mere survival when guiding surrogates for incapacitated patients.
• Understanding population values enhances patient-centered care in critical situations.