This was the topic of my diploma theses in Vienna. While it was entirely a statistical analysis of numerous variables, I tried to think about a different approach to the topic in the form of a structural interview for this seminar.
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Statistically, slightly more than half of the population in the developed world is female. However, those numbers do not reflect the sex distribution on intensive care units in developed countries. A study conducted by Valentin et al. showed that men were significantly more likely to be transferred to an intensive care unit (ICU) than women. As a matter of fact, during the study period 60% of all patients on Austrian ICUs were male.
Additionally, women were significantly older when being transferred to the ICU than men (66.0 years vs. 59.3 years; p<0.001), had a higher severity of illness – as measured by the SAPS II score –, had a lower overall level of care – as measured by the TISS 28 score –, and a lower chance to receive invasive treatment.
In another study conducted by Dorner et al. length of stay on the ICU was on average significantly shorter for women than for men.
There were, however, numerous limitations that formed an obstacle for giving explanations for gender disparities in those studies. Besides differences in clinical presentation, ethnicity, DNR orders and hospital refunding policy, personal opinions and differences in decision making among the medical staff might have influenced outcome, length of stay or treatment strategies.
Valentin, A., et al., Gender-related differences in intensive care: a multiple-center cohort study of therapeutic interventions and outcome in critically ill patients. Crit Care Med, 2003. 31(7): p. 1901-7.
Dorner, T., et al., [Gender specific differences in the frequency of admission to intensive care units, duration of stay and the application of intensive medical care measures in men and women aged 75 years and above in an Austrian region]. Gesundheitswesen, 2010. 72(2): p. e72-5.
Objective: It is the aim of this study to further investigate whether the medical staff is partially responsible for the above mentioned gender disparities due to personal opinion and making different decisions for treatment between men and women.
Study design: this is a structured qualitative and quantitative interview conducted at an ICU in Vienna.
Research question: Are personal opinions and differences in making a decision among doctors between men and women responsible for gender disparities in survival, quality of care and length of stay on Austrian ICUs?
The following questions are supposed to show whether the existence of gender disparities is known and whether doctors make different decisions for men and women in certain situations based on their knowledge and experience.
Questions:
Do you think there are gender disparities in clinical presentation of symptoms?
Do gender and/or sex influence your decision making?
To what extent do gender disparities exist in the rate of DNRs?
Have you read any publications on gender disparities in intensive care?
Do you know of any other areas of medicine where severe gender disparities exist?
On average how many patients on your ICU are female?
In your opinion, could there be any differences in treatment of an 80 year-old man compared to an 80 year old woman with similar APACHE II values?
Are there any differences between men and women in causes for admission?
Are there any treatments you would not consider for female patients or male patients in certain situations?
Based on your experience which group of patients has the highest chance of full recovery (including age and sex)?