Post by Jason Adam Wasserman, PhD, HEC-C

New in Chest: a study finding only limited association between patients' stated ICU goals and the care they actually receive, with Gina Piscatello's commentary worrying about the discordance (https://buff.ly/sAdxla2). But I'm not sure the data points clearly to failures in treatment decision making. The goal sets — maximal survival, maximal comfort, or a liminal category — are too vague to map discretely onto interventions like tracheostomy, which can serve survival or comfort depending on what's going on with the patient. Where you'd expect an intervention to run higher in the survival group, it usually did, just not to significance in a small subsample (invasive ventilation, artificial nutrition at discharge, and so on). Even the exceptions don't obviously signal discordance between patient goals and care delivered. More likely, the maximal-survival patients are on a different trajectory: pushed to the end on maximal therapy, they reach a point where those interventions can no longer contribute to survival and so stop being goal-appropriate, whereas the same treatments were still appropriate for the middle group until later. In other words, goal concordance itself may be producing the differences. https://buff.ly/rNEWZuw #Bioethics #EndOfLifeCare #ClinicalEthics #PatientCare #Healthcare