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Prevalence, clinical impact and associated patient-centred outcomes of advance directives in Swiss intensive care units: Results from the retrospective ADVISE Study

Year: 2025

Type: article

Abstract: STUDY AIMS: Data on the usefulness of advance directives for end-of-life decision-making in intensive care units (ICUs) are scarce. The primary aim of the present study was to investigate the prevalence of advance directives in patients of two Swiss ICUs. To contextualise how advance directives are created, interpreted and translated into clinical practice and which patient profiles influence whether and how patients choose to formulate advance directives, secondary objectives included analysing their content, clinical translation, and associated patient characteristics and outcomes. METHODS: The retrospective cohort study was carried out at two tertiary Swiss ICUs.Data were collected from patients with advance directives treated in ICUs >48 hours from 2020 to 2022.The primary endpoint was the prevalence of advance directives and their content regarding life-prolonging measures, including cardiopulmonary resuscitation (CPR). RESULTS: Of the 5242 patients included, 313 (6.0%) had advance directives. While 290/313 (92.7%) consented to life-prolonging measures other than CPR, CPR was less frequently desired (217/313 [69.3%]). 14.0% (18/129) requested CPR despite declining life-prolonging measures. Fewer women consented to life-prolonging measures and/or CPR than men, whereas prior ICU stays were associated with higher consent rates. Of 104 treatment adaptations, 53 (51.0%) aligned with advance directives, while 33/104 adaptations (31.7%) were based on presumed poor prognosis and 4/104 (3.9%) on surrogate decisions. While patients declining life-prolonging measures experienced faster treatment changes, survival and functional outcomes did not differ based on consent status. CONCLUSIONS: The prevalence of patients with advance directives admitted to Swiss ICUs is low, and substantial obstacles must be overcome in clinical practice. Inconsistent or contradictory contenthighlightsa need for better preemptive communication and documentation of patients' wishes. Respecting patient autonomy in choosing to forgo life-prolonging measures might not be associated with a lower likelihood of survival or functional outcomes. TRIAL REGISTRATION: https://clinicaltrials.gov NCT04348318.

Source: Swiss Medical Weekly

DOI: 10.57187/s.4625