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Recommendations Developed for Responding to ICU Tx Requests

Multisociety recommendations on responding to requests for potentially inappropriate tx in ICU

WEDNESDAY, May 20, 2015 (HealthDay News) -- Multisociety recommendations have been developed to help physicians respond to requests for potentially inappropriate treatments in intensive care units. The policy statement was published online May 15 in the American Journal of Respiratory and Critical Care Medicine.

Gabriel T. Bosslet, M.D., from the Indiana University School of Medicine in Indianapolis, and colleagues developed recommendations using an iterative consensus process, including expert committee development and peer review by committees from multiple professional societies.

According to the committee, institutions should implement strategies to prevent treatment conflicts, including communication and early involvement of consultants. The term "potentially inappropriate" should be used instead of "futile" to describe treatments that have at least some chance of accomplishing the effect sought by the patient. Physicians should explain and advocate for the treatment plan they feel is most appropriate. Conflicts regarding potentially inappropriate treatments should be managed by a process which includes hospital review and attempts to find a willing provider elsewhere. Use of "futile" should be limited to situations where surrogates request treatment that cannot achieve their intended goal. The medical profession should lead efforts to engage the public and advocate for policies and legislation about appropriate use of life-prolonging technologies.

"The multisociety statement on responding to requests for potentially inappropriate treatments in intensive care units provides guidance for clinicians to prevent and manage disputes in patients with advanced critical illness," the authors write.

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