Clinical trial NCT03520270: Prevalence of Potentially Inappropriate Treatments
Official title: Potentially Inappropriate Treatments in Turkish ICUs: Point Prevalence Study
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Critical Illness
Terminal Illness
Potentially Inappropriate Medication List
Lead sponsor: Istanbul University
Sponsor class: OTHER
First posted: 2018-05-09
Enrollment: 1128
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All intensive care patients fulfilling eligibility criteria

Brief summary: A multicenter point prevalence study in Turkish intensive care units.

Detailed description: Intensive care units (ICU) are life-saving units for critical patients with using advanced technology. In some cases, it becomes a unit where treatment is not possible, the fatal patients are admitted and the death process is extended. Most patients with end-stage cancer, advanced-stage chronic obstructive pulmonary disease (COPD) and advanced-stage Alzheimer's disease prefer to die at home, although many often refer to emergency services at the end of their life and are then transferred to the ICU. Intensive care treatments are often very invasive and painful interventions. The patient who lives in intensive care unit is faced with many psychological distresses such as communication, isolation and fear besides physical ache. For this reason, it is necessary to make decisions (end-of-life decisions) such as forbearing intensive care treatments applied to the patients in the death process or cutting out the ones started. In the world, the goal for the end of life patients is, improving the last phase of their lives with the application of these decisions and symptom therapy, living in a peace without pain and respiratory distress. However, there is an uncertanity in these issues in our country and intensive care physicians are hesitant to make decisions about the end of life with concern about legal problems. Although it is known that these patients will not benefit most from the treatment of ICU, they are getting treatments for saving their lives in ICUs. The fact that intensive care beds are not available due to the patients who are not get beneficial treatment, brings the result of difficult finding of the beds which will benefit from the intensive care, and in fact it is a waste of intensive care resources which is very expensive. The size of the problem is not known as there is no data on the frequency of patients in our country who are in intensive care and require end-of-life care.

In this multicenter point prevalence study our aims are;

* to find out the incidence of patients in intensive care units in Turkey in the last period of life,
* to compare the resource use of end-of-life and non-end-of-life patients.

Eligibility criteria: Inclusion Criteria:

All patients who are over 18 years old, more than 48 hours in the intensive care unit, or expected to be hospitalized

Exclusion Criteria:

Patients under 18 years of age, less than 48 hours in the intensive care unit stay, or who are monitorized for post-operative care

Primary outcomes:
measure: Prevalence of terminal patients in the ICU
timeFrame: 1 day
Secondary outcomes:
measure: Resource use
timeFrame: 1 day
Other outcomes:
Locations:
city: Istanbul
country: Turkey
facility: Istanbul University Cerrahpasa Medical School
Study officials:
References:
citation: Nelson JE, Bassett R, Boss RD, Brasel KJ, Campbell ML, Cortez TB, Curtis JR, Lustbader DR, Mulkerin C, Puntillo KA, Ray DE, Weissman DE; Improve Palliative Care in the Intensive Care Unit Project. Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med. 2010 Sep;38(9):1765-72. doi: 10.1097/CCM.0b013e3181e8ad23.
citation: Shreves A, Marcolini E. End of life/palliative care/ethics. Emerg Med Clin North Am. 2014 Nov;32(4):955-74. doi: 10.1016/j.emc.2014.07.010. Epub 2014 Sep 16.