Sex differences in advance directives and their clinical translation among critically ill adults: results from the ADVISE study.

IF 5.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Simon A Amacher, Sira M Baumann, Paulina S C Kliem, Dominik Vock, Yasmin Erne, Pascale Grzonka, Sebastian Berger, Martin Lohri, Sabina Hunziker, Caroline E Gebhard, Mathias Nebiker, Luca Cioccari, Raoul Sutter
{"title":"Sex differences in advance directives and their clinical translation among critically ill adults: results from the ADVISE study.","authors":"Simon A Amacher, Sira M Baumann, Paulina S C Kliem, Dominik Vock, Yasmin Erne, Pascale Grzonka, Sebastian Berger, Martin Lohri, Sabina Hunziker, Caroline E Gebhard, Mathias Nebiker, Luca Cioccari, Raoul Sutter","doi":"10.1186/s13613-025-01518-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Advance directives (ADs) are legally binding documents outlining individual preferences for medical care in the event of incapacitation. Evidence regarding their significance and implementation in critical care is scarce. Thus, this retrospective cohort study assesses sex differences in ADs' frequency, content, clinical translation, and associated outcomes in critically ill adults. The study was performed in two interdisciplinary tertiary Swiss intensive care units (ICUs). It included patients with ADs treated in the ICUs for > 48 h. The primary endpoint was the frequency of ADs. Secondary endpoints included the content of ADs, sex differences in baseline and treatment characteristics, the clinical implementation of ADs, and in-hospital outcomes.</p><p><strong>Results: </strong>5242 patients were treated for > 48 h in the ICUs, of which 313 (6.0%) had ADs (124 females [6.8% of 1813 females] and 189 males [5.5% of 3429 males], p = 0.054). No sex-related differences were observed regarding baseline characteristics except that females with ADs were more frequently single, divorced, or widowed (57% vs. 37%, p = 0.001), more frequently had acute stroke as main diagnosis (13% vs. 3%, p = 0.001), and more often refused cardiopulmonary resuscitation (CPR) (42% vs. 25%, p = 0.002) than males with ADs. In multivariable analyses, female sex was associated with refusing CPR independent of relationship status. Compared to males, females' ADs were more frequently violated (24% vs. 10%, p < 0.001), primarily by receiving unwanted treatments (24% vs. 8%, p < 0.001) and/or undesired ICU admission (10.5% vs 2.1%, p = 0.002). Despite these differences, treatment adaptations during intensive care, in-hospital outcomes, and discharge destinations did not differ between sexes.</p><p><strong>Conclusions: </strong>This study revealed sex disparities in the content and translation of ADs between females and males admitted to ICUs. Females' ADs were more frequently violated, indicating a potential sex bias in the interpretation and translation of ADs in critical care. Clinicians must remain vigilant against violations of ADs and strive to deliver equitable care. Further prospective research is needed to investigate the causes of disparities in ICU end-of-life decision-making, integrating both qualitative and quantitative measures, to ensure equal treatment for all patients, regardless of sex or gender.</p>","PeriodicalId":7966,"journal":{"name":"Annals of Intensive Care","volume":"15 1","pages":"94"},"PeriodicalIF":5.5000,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12259517/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Intensive Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13613-025-01518-z","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Advance directives (ADs) are legally binding documents outlining individual preferences for medical care in the event of incapacitation. Evidence regarding their significance and implementation in critical care is scarce. Thus, this retrospective cohort study assesses sex differences in ADs' frequency, content, clinical translation, and associated outcomes in critically ill adults. The study was performed in two interdisciplinary tertiary Swiss intensive care units (ICUs). It included patients with ADs treated in the ICUs for > 48 h. The primary endpoint was the frequency of ADs. Secondary endpoints included the content of ADs, sex differences in baseline and treatment characteristics, the clinical implementation of ADs, and in-hospital outcomes.

Results: 5242 patients were treated for > 48 h in the ICUs, of which 313 (6.0%) had ADs (124 females [6.8% of 1813 females] and 189 males [5.5% of 3429 males], p = 0.054). No sex-related differences were observed regarding baseline characteristics except that females with ADs were more frequently single, divorced, or widowed (57% vs. 37%, p = 0.001), more frequently had acute stroke as main diagnosis (13% vs. 3%, p = 0.001), and more often refused cardiopulmonary resuscitation (CPR) (42% vs. 25%, p = 0.002) than males with ADs. In multivariable analyses, female sex was associated with refusing CPR independent of relationship status. Compared to males, females' ADs were more frequently violated (24% vs. 10%, p < 0.001), primarily by receiving unwanted treatments (24% vs. 8%, p < 0.001) and/or undesired ICU admission (10.5% vs 2.1%, p = 0.002). Despite these differences, treatment adaptations during intensive care, in-hospital outcomes, and discharge destinations did not differ between sexes.

Conclusions: This study revealed sex disparities in the content and translation of ADs between females and males admitted to ICUs. Females' ADs were more frequently violated, indicating a potential sex bias in the interpretation and translation of ADs in critical care. Clinicians must remain vigilant against violations of ADs and strive to deliver equitable care. Further prospective research is needed to investigate the causes of disparities in ICU end-of-life decision-making, integrating both qualitative and quantitative measures, to ensure equal treatment for all patients, regardless of sex or gender.

Abstract Image

Abstract Image

Abstract Image

危重症成人预先指示及其临床翻译的性别差异:来自ADVISE研究的结果。
背景:预先指示(ADs)是具有法律约束力的文件,概述了在丧失行为能力的情况下个人对医疗护理的偏好。关于它们在重症监护中的重要性和实施的证据很少。因此,本回顾性队列研究评估了危重成人中ad发生频率、内容、临床转化和相关结果的性别差异。该研究在两个跨学科的瑞士三级重症监护病房(icu)进行。该研究纳入了在icu中治疗48小时的ADs患者。主要终点是ADs的发生频率。次要终点包括ADs的含量、基线和治疗特征的性别差异、ADs的临床实施情况和住院结果。结果:5242例患者在icu内治疗bbb48 h,其中发生ad的患者313例(6.0%),其中女性124例(占1813例女性的6.8%),男性189例(占3429例男性的5.5%),p = 0.054。在基线特征方面,没有观察到性别相关的差异,除了女性ad患者比男性ad患者更频繁地单身、离婚或丧偶(57%对37%,p = 0.001),更频繁地以急性卒中为主要诊断(13%对3%,p = 0.001),更频繁地拒绝心肺复苏(CPR)(42%对25%,p = 0.002)。在多变量分析中,女性性别与拒绝心肺复苏相关,独立于关系状态。与男性相比,女性的ADs被违反的频率更高(24%比10%),p结论:本研究揭示了icu女性和男性在ADs内容和翻译上的性别差异。女性的ADs更容易被违反,这表明在重症监护ADs的解释和翻译中存在潜在的性别偏见。临床医生必须对违反ADs的行为保持警惕,并努力提供公平的护理。需要进一步的前瞻性研究来调查ICU临终决策差异的原因,整合定性和定量措施,以确保所有患者的平等治疗,无论性别或性别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信