End-of-life decision disparities according to the gross national income in critically ill patients : a secondary analysis of the ETHICUS-2 study

Article

MARTIN-LOECHES, Ignacio | SPRUNG, Charles L. | WOLSZTYNSKI, Eric | CUSACK, Rachael | LOBO, Suzana Margareth | PROTTI, Alessandro | AVIDAN, Alexander

AIM: This study aimed to evaluate the association of end-of-life decisions and time to death in a global cohort of critically ill patients who participated in the international study on end-of-life practices in intensive care units (ICU) (Ethicus-2 study). METHODS: A post hoc analysis was conducted on data from a worldwide observational study that prospectively recruited adult ICU patients who died between September 1, 2015, and September 30, 2016, from 199 ICUs in 36 countries. RESULTS: The end-of-life pathways of 10,547 ICU non-survivors were s analysed. Patients in high-income countries exhibited a significantly shorter time to death compared to those from middle-income countries. Additionally, therapeutic decisions were found to have a significant but varied association with the length of ICU stay across gross national income (GNI) groups. Specifically, patients in high-income countries with no decision had the shortest length of stay (LOS) overall. However, withdrawing or withholding life-sustaining treatment led to longer LOS in both middle and high GNI countries. CONCLUSION: This study's findings highlight the need for uniformity in global end-of-life decision-making. Outcomes are significantly associated with gross national income (GNI). Moreover, patients in high-income nations tend to have shorter ICU stays before death.

http://dx.doi.org/10.1186/s13613-025-01419-1

Voir la revue «Annals of intensive care, 15»

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