ICU sedation, delirium & recovery
Patient versus surrogate decision making for life sustaining treatment and terminal care intensity
Authors' conclusion
Surrogate-led decisions were associated with paradoxically higher care intensity and costs, potentially overriding prior patient wishes.
Study context
- Population
- Adult Intensive Care Unit (ICU) admissions, South Korean National Health Insurance Service database, 2020–2023
- Participants
- 1,189,042 admissions · 417 hospitals
- Exposure
- Patient-determined vs surrogate-determined Physician Orders for Life-Sustaining Treatment (POLST) vs no documentation
- Outcome
- Invasive terminal care (among 90-day decedents)
Methodological detailshigh-dimensional fixed-effects models, 417 hospitals
- High-dimensional fixed-effects models
- 417 hospitals
Main finding
As reported in the abstract
Invasive terminal care, 90-day decedents
Each group vs no documentationOdds ratio (95% CI)
PD-POLST
0.43(0.43–0.54)
SD-POLST
2.16(1.98–2.35)
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Invasive terminal care, patients with proactive ADs (subgroup)SD-POLST vs No documentation | 1.69 (1.51–1.89) | |
| 0.512Odds ratio (log scale) |
| Outcome | Cost ratio (95% CI) |
|---|---|
| Daily hospitalization costsSD-POLST vs No documentation | 1.04 (1.02–1.06) |
- Invasive terminal care, patients with proactive Advance Directives (ADs) (subgroup): patients with proactive ADs once a surrogate signed the final order
- Invasive terminal care, patients with proactive ADs (subgroup): 90-day decedents
Invasive terminal care, patients with proactive ADs (subgroup)
- Increased care intensity once a surrogate signed the final order ("AD erosion")
Original publication
Patient versus surrogate decision making for life sustaining treatment and terminal care intensity. Am J Respir Crit Care Med. Published 12 June 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →