Characteristics associated with decision-making regarding withholding or withdrawing life-sustaining treatments: a 5-year retrospective analysis at an intensive care unit in a tertiary hospital in southern China

Abstract

Background: The decision to withhold or withdraw life-sustaining treatments is a pivotal facet of end-of-life care for patients. Previous research has revealed substantial global disparities in this issue, with limited investigations conducted in China.

Methods: A retrospective study investigating the prevalence of withholding or withdrawing life-sustaining treatments at an intensive care unit in a tertiary hospital from January 2013 to May 2018 was conducted to elucidate the associated characteristics. The primary outcome measure was the prevalence of withholding or withdrawing life-sustaining treatments. The secondary measures were the demographic and clinical data. Univariate and multivariate logistic regression analyses were performed to determine associations between the clinical characteristics and the decision-making.

Results: This analysis included 437 patients, of which 372 (85.1%) experienced withholding or withdrawal of life-sustaining treatments. Older age (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.05), rural residence (OR: 2.92; 95% CI: 1.17-7.32), belonging to the local province (OR: 1.38; 95% CI: 1.22-1.57), lower per capita income group (OR: 3.59; 95% CI: 2.52-5.09), and a primary diagnosis of trauma (OR: 4.95; 95% CI: 1.19-20.64), neurosurgical disorder (OR: 4.42; 95% CI: 1.76-11.06), or neurological disorder (OR: 12.33; 95% CI: 1.56-97.52) were significantly associated with the decision to withhold or withdraw life-sustaining treatments.

Conclusion: Withholding or withdrawing life-sustaining treatments may vary based on factors such as age, residential location, per capita income, and the primary diagnosis. It is imperative that healthcare policymakers acknowledge these variations and consider the local ethical norms and cultural practices when facing this issue.

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Zhao Y and Xing Q collected data and draft the manuscript; Quan X reviewed the draft and statistics; Wang T contributed to project administration and supervision. All authors have read and approved the final manuscript.

Funding

This study was funded by Clinical Medical Center Construction Project of Hainan Province (HNCM202201) and the Major Science and Technology Program of Hainan Province (ZDKJ202004).

Ethical approval of studies and informed consent

The study followed the principles of the Declaration of Helsinki as revised in 2013. This study was approved and written informed consent was waived by the Ethics Committee of Hainan Hospital of Chinese PLA General Hospital (no. 301hn112017563, 2017.05), owing to the anonymized retrospective nature of the analysis.

Acknowledgments

None.

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