Behaviour artificial intelligence technology to support the decision-making process of continuation or withdrawal of life-sustaining therapy
Patrick J. Thoral (Onze Lieve Vrouwe Gasthuis, Vrije Universiteit Amsterdam)
Jesse de Metz (Onze Lieve Vrouwe Gasthuis)
Stella Mulia (Councyl)
Annebel ten Broeke (Councyl)
Nicolaas Heyning (Councyl)
Birkitt L. ten Tusscher (Vrije Universiteit Amsterdam)
Rolf K. Gigengack (Vrije Universiteit Amsterdam)
Hilde M. Feijen (Onze Lieve Vrouwe Gasthuis)
Caspar G. Chorus (TU Delft - Industrial Design Engineering)
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Abstract
Background
Withholding and withdrawing life-sustaining therapy (LST) is common in European ICUs but significant variations exist. Behaviour artificial intelligence technology (BAIT) may help standardize the ethical dilemma to continue or withdraw LST for patients already admitted to the ICU.
Methods
Several sessions with intensivists of an academic medical centre and a large urban teaching hospital were held to determine the criteria influencing the process. A discrete choice experiment was conducted during which 25 hypothetical cases were presented to the participants. For each case the participants had to decide whether they would continue, continue with a time limited trial of one week, or withdraw LST. The results of the experiment were used to develop a multinomial logistic regression model that was incorporated in a web-based decision-support system.
Results
Thirty-six participants (intensivists and fellows in intensive care medicine) completed the experiment. The estimated model consisted of twelve covariates and showed good model fit (McFadden’s ρ2 0.25). The most important covariates were age, patient values, expected cardiovascular and pulmonary impairment after ICU discharge and frailty at admission. The BAIT system lets intensivists view expected decisions based on documented criteria and uses color-coding to show the magnitude of the effect and its direction (i.e. to continue or withdraw LST).
Conclusions
We developed a BAIT system that may support clinicians facing the dilemma of continuing or withdrawing LST by elucidating the key criteria involved in assessing medical futility.
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