TY - JOUR
T1 - Prognostication of patients in coma after cardiac arrest
T2 - Public perspectives
AU - van Til, Janine
AU - Bouwers-Beens, Eline
AU - Mertens, Mayli
AU - Boenink, Marianne
AU - Groothuis-Oudshoorn, Catherina
AU - Hofmeijer, Jeannette
N1 - Funding Information:
This research was conducted with financial support from the Netherlands Organisation of Scientific Research, Program Responsible Innovation (grant number 313-99-309), with contributions from the Hersenstichting (Brain Foundation), Twente Medical Systems international, and Clinical Science Systems.
Funding Information:
We thank our study participants for their time and willingness to participate in this survey. We thank our funders, the Netherlands Organisation of Scientific Research and the Nederlandse Hersenstichting (Brain Foundation) for the financial support.
Publisher Copyright:
© 2021 The Authors
PY - 2021/12
Y1 - 2021/12
N2 - Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for differences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37–54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests.
AB - Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for differences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37–54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests.
KW - End-of-life decisions
KW - Post-anoxic coma
KW - Prognostic tests
KW - Public perspective
KW - Quality of life
KW - Withdrawal of life support
KW - UT-Hybrid-D
UR - http://www.scopus.com/inward/record.url?scp=85117367797&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2021.10.002
DO - 10.1016/j.resuscitation.2021.10.002
M3 - Article
AN - SCOPUS:85117367797
SN - 0300-9572
VL - 169
SP - 4
EP - 10
JO - Resuscitation
JF - Resuscitation
ER -