Management of potentially inappropriate life-sustaining therapies: a survey of Quebec intensivists.

PURPOSE: Potentially inappropriate treatments (PITs) are a common issue in the intensive care unit (ICU) with substantial economic and human impacts. Previous studies about PITs in Canada lacked representation of physicians practicing in the province of Quebec and were conducted before the 2023 updated reference document on consent to care from the Collège des Médecins du Québec and the Barreau du Québec. We sought to evaluate the approaches and perspectives of adult ICU physicians in Quebec regarding demands for potentially inappropriate life-sustaining therapies (LSTs) and cardiopulmonary resuscitation.

METHODS

We conducted an electronic survey of academic and regional ICU physicians in Quebec. It assessed decision-making in fictional scenarios and opinions through Likert-like scales and free-text statements. Our main analysis was the level of agreement for each question. We also evaluated subjective appropriateness of care, conducted subgroup analyses according to demographic factors, and performed a qualitative thematic analysis.

RESULTS

We received 124/319 responses (response rate, 39%). There was no consensus among respondents in the four scenarios about withholding LSTs. The only consensus was to avoid withdrawing an active LST. In the scenarios, 78% (314/405) of the provided LSTs were deemed inappropriate by the provider. Most respondents identified PITs as a frequent problem (71%; 84/118) and thought that guidelines (69%; 82/118) and institutional support (59%; 70/118) were inadequate. Medico-legal risk was highlighted as the most significant issue.

CONCLUSIONS

Demands for PITs present a significant challenge for ICU physicians in Quebec, contributing to heterogeneous approaches and high levels of self-assessed inappropriate treatments.