PT  - JOURNAL ARTICLE
AU  - Gäbler, Martin
AU  - Ohrenberger, Gerald
AU  - Funk, Georg-Christian
TI  - Treatment decisions in end-stage COPD: who decides how? A cross-sectional survey of different medical specialties
AID  - 10.1183/23120541.00163-2018
DP  - 2019 Jul 01
TA  - ERJ Open Research
PG  - 00163-2018
VI  - 5
IP  - 3
4099  - http://openres.ersjournals.com/content/5/3/00163-2018.short
4100  - http://openres.ersjournals.com/content/5/3/00163-2018.full
SO  - erjor2019 Jul 01; 5
AB  - Introduction End-stage chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure are often treated by representatives from different medical specialties. This study investigates if the choice of treatment is influenced by the medical specialty.Methods An online cross-sectional survey among four Austrian medical societies was performed, accompanied by a case vignette of a geriatric end-stage COPD patient with acute respiratory failure. Respondents had to choose between noninvasive ventilation (NIV), a conservative treatment attempt (without NIV) and a palliative approach. Ethical considerations and their impact on decision making were also assessed.Results Responses of 162 physicians (67 from intensive care units (ICUs), 51 from pulmonology or internal departments and 44 from geriatric or palliative care) were included. The decision for NIV (instead of a conservative or palliative approach) was associated with working in an ICU (OR 14.9, 95% CI 1.87–118.8) and in a pulmonology or internal department (OR 9.4, 95% CI 1.14–78.42) compared with working in geriatric or palliative care (Model 1). The decision for palliative care was negatively associated with working in a pulmonology or internal department (OR 0.16, 95% CI 0.05–0.47) and (nonsignificantly) in an ICU (OR 0.41, 95% CI 0.15–1.12) (Model 2).Conclusions Department association was shown to be an independent predictor for treatment decisions in end-stage COPD with acute respiratory failure. Further research on these differences and influential factors is necessary.Physicians from different departments make different treatment decisions in end-stage COPD patients with acute exacerbations. This may lead to over- or undertreatment. Subsequent training efforts (including ethical decision making) may be beneficial. http://bit.ly/2xaw1MW