{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T19:57:11Z","timestamp":1792439831376,"version":"4.5.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To evaluate the prevalence and reasons for perceived inappropriateness of care (PIC) among ICU clinicians, to identify organizational, clinician, and work-related characteristics associated with PIC, and to determine if PIC is associated with adverse patient outcomes within 6 months post-ICU.<\/jats:p>\n <\/jats:sec>\n \n DESIGN:<\/jats:title>\n Single-day cross-sectional survey, supplemented with follow-up data.<\/jats:p>\n <\/jats:sec>\n \n SETTING AND PATIENTS:<\/jats:title>\n Physicians and nurses from 47 Dutch ICUs and 525 patients who were treated in the ICU on the survey day.<\/jats:p>\n <\/jats:sec>\n \n INTERVENTIONS:<\/jats:title>\n None.<\/jats:p>\n <\/jats:sec>\n \n MEASUREMENTS AND MAIN RESULTS:<\/jats:title>\n \n PIC (i.e., a patient situation in which care provision conflicts with a clinician\u2019s personal values or professional judgment) and other relevant variables were collected through questionnaires and the National Intensive Care Evaluation registry. A total of 1058 physicians and nurses (response rate, 72%) and 215 of the 397 eligible patients (54.2%) completed the survey. Among clinicians, 276 (26%) reported PIC for at least one patient. Clinicians mostly referred to distributive injustice (\n n<\/jats:italic>\n = 181; 70%) and disproportionality of care (66%). Being a nurse (adjusted odds ratio [aOR], 1.78; 95% CI, 1.37\u20132.33;\n p<\/jats:italic>\n < 0.001) and working in a culture that avoids end-of-life decisions (aOR, 1.92; 95% CI, 1.51\u20132.45;\n p<\/jats:italic>\n < 0.001) were associated with higher PIC risk. Larger ICU bed capacity (aOR, 0.97; 95% CI, 0.94\u20130.99;\n p<\/jats:italic>\n = 0.004) and mutual respect within interdisciplinary teams (aOR, 0.84; 95% CI, 0.70\u20131.00;\n p<\/jats:italic>\n = 0.045) were protective. PIC reported by multiple clinicians was independently associated with increased risk of death (aOR, 3.86; 95% CI, 1.23\u201312.16;\n p<\/jats:italic>\n = 0.02) and the combined outcome (i.e., death, severely frail, or not living at home anymore; aOR, 2.91; 95% CI, 1.14\u20137.42;\n p<\/jats:italic>\n = 0.03).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n PIC is common in the ICU, inversely associated with a supportive ethical work environment, and should be regarded as a legitimate concern that warrants team reflection, as it is a prognostic marker of poor patient outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007241","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T14:00:25Z","timestamp":1781272825000},"page":"2373-2385","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Perceived Inappropriateness of Intensive Care Treatment Among Clinicians: A Cross-Sectional Nationwide Survey on the Prevalence, Associated Factors, and Outcomes"],"prefix":"10.1097","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2532-0724","authenticated-orcid":false,"given":"Gijs","family":"Hesselink","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Ramakers","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard G.","family":"Fikkers","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renze","family":"Jongstra","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diederik","family":"van Dijk","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian","family":"Vloet","sequence":"additional","affiliation":[{"name":"Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands."},{"name":"Foundation Family and patient Centered Intensive Care, Alkmaar, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferishta","family":"Bakhshi-Raiez","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands."},{"name":"Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique D.","family":"Benoit","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Ghent University Hospital, Gent, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"Zegers","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Perceived Inappropriateness of Care Netherlands-Intensive Care Unit (PICNL-ICU) Study 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