Clinician gender and agreement with intensive care unit recommendations for patients aged 80 and over

Patients aged 80 and over are among the fastest-growing groups admitted to intensive care units worldwide, and the decisions surrounding their treatment are rarely made in isolation. Frailty, polypharmacy, and uncertain trajectories of recovery mean that choices about admission, treatment intensity, and rehabilitation are inherently shared across disciplines, drawing in intensivists, geriatricians, emergency physicians, nurses, pharmacists, and allied health professionals. A new analysis of an international expert panel suggests that when these specialists are asked to weigh formal recommendations for the very old critically ill, they largely agree with one another regardless of gender, with only a narrow band of divergence emerging around multidisciplinary input.

Outside critical care, a growing body of evidence has linked clinician gender to differences in how care is delivered. Studies have found that patients treated by female physicians show better chronic disease control and, in hospital medicine, lower mortality and readmission rates. Consensus recommendations, meanwhile, are only as robust as the panel that drafts them, and research on such panels has shown that seniority, professional role, and gender can all shape how much an individual contributes to the final document. Against this backdrop, researchers led by Dr. Nastaran Sharifian and assisted by medical student Aoife Bates at University of Galway, working with international collaborators, set out to determine whether a panelist’s gender influenced how they rated proposed recommendations for the management of very old patients in the intensive care unit.

The underlying material came from a recent international Delphi process convened by the European Society of Intensive Care Medicine. A steering group of 28 specialists drafted 59 candidate statements covering goals of care, ICU admission, treatment decisions, and post-discharge management. A further 82 experts then rated their agreement across two anonymous rounds, and consensus was ultimately reached on 48 of the statements. The full panel was predominantly medical, with roughly 85 percent of members being doctors, drawn mainly from intensive care, though geriatric and emergency medicine, clinical pharmacy, and allied health professions were also represented, reflecting the multidisciplinary reality of caring for very old patients.

The secondary analysis, published online on August 8, 2026, in the Journal of Intensive Medicine, focused on the 128 panelists who reported both their gender and clinical background, comprising 53 female and 75 male respondents. The investigators concentrated on the 26 statements that reached only moderate consensus, where opinion had diverged most during the Delphi process, and compared agreement scores on a scale from zero to 100. Importantly, what was measured throughout was how strongly panelists endorsed a proposed recommendation, an expression of opinion rather than a record of what any clinician actually does at the bedside.

The dominant finding was agreement. Across the great majority of the proposed recommendations, there was no significant difference between female and male respondents, and in analyses adjusted for provider category and age, independent effects of gender were limited. Interactions between gender and specialty were almost all non-significant, indicating a pattern that held consistently across intensivists, emergency physicians, and geriatricians. Where differences did emerge, they clustered in a single domain: multidisciplinary input. Female respondents recorded higher agreement on five statements concerning non-physician involvement, including medication review by a pharmacist, geriatrician, or other specialist, scoring 91.9 compared with 81.0 for male respondents, a statistically significant gap. Female panelists also rated clinical pharmacist involvement more highly, at 90.4 versus 81.8, as well as dietitian input to optimize nutrition, at 93.0 versus 85.6, speech and language therapy advice, at 88.9 versus 80.6, and transfer from the ICU to a geriatric ward where available, at 86.9 versus 78.7.

Male respondents recorded higher agreement on just one statement: that decisions to limit life-sustaining therapy should be based on expected functional outcome, scoring 87.8 compared with 81.2 for female respondents. The gender gaps widened further when the researchers examined who agreed emphatically rather than simply agreed. Two-thirds of female respondents strongly endorsed dietitian involvement, against 37.8 percent of male respondents, and for clinical pharmacist involvement the figures were 54.7 percent and 27 percent respectively. Other domains showed no separation at all, including ethics consultation, quality of life as a long-term outcome, and hospital readmissions.

The authors are careful to frame the work as an exploratory secondary analysis intended to generate hypotheses rather than settle questions. Twenty-six statements were compared without correction for multiple testing, so while six significant results exceed what chance alone would predict, most individual differences would not withstand a conservative statistical correction. The comparison groups are also small, with roughly 51 female and 71 male respondents rating each statement, meaning the estimates carry wide margins of uncertainty. Furthermore, the recommendations showing gender differences are those concerning non-physician disciplines, and nursing and allied health professions are predominantly female. Because the analysis adjusted for medical specialty rather than professional role, it cannot fully separate a genuine gender effect from the simple tendency of practitioners to endorse their own discipline. These are ratings of proposed recommendations, not observations of care actually delivered to patients.

What the analysis does suggest is that stated support for recommendations on collaborative care varied modestly with who was asked, while the broad architecture of the recommendations commanded consensus regardless of the respondent’s gender. For those convening guideline panels, the finding underscores the need for broad representation, since the composition of an expert group may subtly shape which aspects of care receive the strongest endorsement. Whether these attitudinal differences translate into measurable differences in patient outcomes remains an open question that will require direct observational and interventional research.

As very old patients continue to make up a growing share of intensive care admissions worldwide, understanding how expert consensus forms, and where it frays, becomes increasingly consequential. This study offers reassurance that on the fundamentals of caring for patients over 80 in the ICU, female and male specialists across specialties are largely reading from the same page, while highlighting that the value placed on pharmacists, dietitians, therapists, and geriatric wards is where perspectives most often diverge.

The Delphi technique used to generate the underlying recommendations deserves some explanation, because its design shapes what the secondary analysis could detect. In a Delphi process, experts rate statements anonymously and iteratively, with feedback between rounds, so that consensus emerges without the pressure of face-to-face debate or hierarchy. Anonymity is intended to equalize contributions, yet prior research on expert panels suggests that demographic characteristics, including gender, can still influence how individuals rate proposals. That makes the near-universal agreement observed here across female and male panelists noteworthy, even if the divergence on multidisciplinary statements was the exception rather than the rule.

The specific statements that divided respondents map closely onto well-documented vulnerabilities of the very old intensive care population. Polypharmacy is common among patients over 80, many of whom arrive in intensive care already taking multiple medications that may be inappropriate, duplicative, or poorly tolerated in the setting of acute organ dysfunction. Structured medication review by a pharmacist or geriatrician is one of the most consistently recommended interventions in geriatric care, and malnutrition and swallowing difficulties are similarly prevalent in this age group, which helps explain why dietitian and speech and language therapy input featured among the candidate statements at all. The placement of these services within intensive care varies widely between institutions, so attitudes toward them may reflect professional experience with how well, or how poorly, such support is currently delivered.

The single statement on which male respondents agreed more strongly, that decisions to limit life-sustaining therapy should rest on expected functional outcome, touches on one of the most contested questions in geriatric critical care. Functional outcome as a criterion for withholding or withdrawing treatment raises difficult issues about how recovery is predicted, whose definition of acceptable function prevails, and how such judgments weigh against patient values and family perspectives. Prior studies of end-of-life decision-making in intensive care have reported varied findings on clinician gender and attitudes toward treatment limitation, and the modest difference observed here, on a single statement with a small gap, should be interpreted with corresponding caution.

The statistical structure of the analysis also merits emphasis for readers weighing its conclusions. When many comparisons are made simultaneously, a handful will reach conventional significance thresholds by chance alone. The researchers note that six significant results out of twenty-six comparisons exceed what random variation would be expected to produce, which lends the overall pattern some credibility, but the individual estimates remain imprecise given the modest number of respondents per statement. The adjustment for provider category and age, while useful, could not account for every characteristic that might shape a panelist’s response, such as years of experience, country of practice, or the intensity of their exposure to allied health services.

Looking forward, the most productive extension of this work would move from stated opinions to observed practice. Linking panelist characteristics or, more feasibly, clinician characteristics in routine practice to objective measures such as medication review completion, dietitian referral rates, rehabilitation uptake, and ultimately survival and functional recovery would test whether the attitudinal signal detected here has any clinical footprint. Studies of physician gender and patient outcomes suggest such links are possible, though the mechanisms remain debated. Until then, the practical takeaway for guideline developers is procedural rather than clinical: assembling panels that genuinely represent the multidisciplinary teams who care for very old patients may be the surest way to ensure that recommendations about collaborative care reflect the full range of expertise that such care depends upon.

Subject of Research: The influence of clinician gender on agreement with intensive care recommendations for patients aged 80 and over

Article Title: Clinician gender and agreement with intensive care unit recommendations for patients aged 80 and over

Article References: Clinician gender and agreement with intensive care unit recommendations for patients aged 80 and over. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: intensive care, clinician gender, Delphi consensus, geriatrics, ESICM, very old patients, multidisciplinary care, critical care, Journal of Intensive Medicine, agreement ratings, frailty, guideline panels