Why is it so hard to stop doing things that are unwanted, non-beneficial, or unsustainable?

摘要

We recognise that critical care is sometimes provided in situations that are unwanted, non-beneficial, or unsustainably resource intense. In this issue of The Lancet Respiratory Medicine, a Series of three articles1"3 review the published literature on avoiding unwanted intensive care unit (ICU) care, and identify the drivers of non-beneficial or cost-ineffective ICU use. Although to stop doing something that is unwanted, ineffective, and expensive should be easy, previous attempts to reduce the use of critical care in these situations have not always been met with success. Observational studies have routinely shown that advance care planning documents and palliative care consultation are associated with low rates of ICU use near the end of life.