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Biomedical subjects

L I Southerland

Publications and source records attributed to L I Southerland.

6 recordsLinked to original sources
PubMed1991

A prospective study of advance directives for life-sustaining care.

BACKGROUND: The use of advance directives is recommended so that people can determine the medical care they will receive when they are no longer competent, but the effectiveness of such directives is not clear. METHODS: In a prospective study conducted over a two-year period, 126 competent residents of a nursing home and 49 family members of incompetent patients were interviewed to determine their preferences with respect to hospitalization, intensive care, cardiopulmonary resuscitation, artificial ventilation, surgery, and tube feeding in the event of critical illness, terminal illness, or permanent unconsciousness. Advance directives, consisting of signed statements of treatment preferences, were placed in the medical record to assist in care in the nursing home and to be forwarded to the hospital if necessary. RESULTS: In an analysis of 96 outcome events (hospitalization or death in the nursing home), care was consistent with previously expressed wishes 75 percent of the time; however, the presence of the written advance directive in the medical record did not facilitate consistency. Among the 24 events in which inconsistencies occurred, care was provided more aggressively than had been requested in 6 cases, largely because of unanticipated surgery or artificial ventilation, and less aggressively than requested in 18, largely because hospitalization or cardiopulmonary resuscitation was withheld. Inconsistencies were more likely in the nursing home than in the hospital. CONCLUSIONS. The effectiveness of written advance directives is limited by inattention to them and by decisions to place priority on considerations other than the patient's autonomy. Since our study was performed in only one nursing home and one hospital, other studies are necessary to determine the generalizability of our findings.

Adult↗
PubMed1988

Patients' and families' preferences for medical intensive care.

Medical ethics suggest that life-sustaining treatment decisions should be made with consideration for patients' preferences and quality of life. Patients were interviewed who were at least 55 years old and had experienced medical intensive care at a university hospital during a one-year period to determine their preferences regarding intensive care; family members were interviewed if the patient had died (n = 160). Seventy percent of patients and families were 100% willing to undergo intensive care again to achieve even one month of survival; 8% were completely unwilling to undergo intensive care to achieve any prolongation of survival. Preferences were poorly correlated with functional status or quality of life and were not altered by life expectancy for 82% of respondents. Age, severity of critical illness, length of stay, and charges for intensive care did not influence willingness to undergo intensive care. These data suggest that personal preferences may conflict with any health policy that limits the allocation of intensive care based on age, function, or quality of life.

Age Factors↗
PubMed1988

A comparison of patient, family, and physician assessments of the value of medical intensive care.

Medical ethics suggest that physicians incorporate patient preferences when making life-sustaining treatment decisions. This study therefore examines how closely physicians' assessments of the usefulness of intensive care agree with their patients' willingness to receive intensive care. Former intensive care patients, at least 55 yr old (or family members of nonsurviving patients), and their physicians were interviewed (n = 76 pairs of interviews) to determine how valuable each believe intensive care would be to the patient (on a scale of 0 to 100%) under actual and ideal life circumstances. Little correlation was found between individual patient or family member and physician responses (Kendall's Tau ranged from -.14 to .22 depending on how long life was prolonged). Physicians' evaluations of intensive care for patients under ideal life circumstances were strongly correlated with physicians' personal preferences for intensive care (Kendall's Tau, .41 to .65, p less than .02). Because physicians and patients may not agree regarding the value of intensive care, physicians must explicitly discuss patients' preferences in order to reconcile wishes and justifiable needs for critical care.

Aged↗
PubMed1987

A comparison of patient, family, and nurse evaluations of the usefulness of intensive care.

As patient advocates, critical care nurses need to be cognizant of which treatments the patients and their families prefer. Therefore, we conducted a study to compare how nurses, their critically ill patients, and their families evaluate the usefulness of intensive care. A group of former medical intensive care patients (n = 72), or their family members if the patient had died, were asked how willing they would be to undergo (or to subject their relative to) intensive care again, if necessary. All nurses (n = 15) caring for these patients were asked a parallel, hypothetical question about the usefulness of intensive care to these patients and to themselves, were they to become sick. Analysis of matched pairs of patient (or family member) and nurse questionnaires (n = 38) revealed that: nurses underestimate the usefulness of intensive care as evaluated by their patients and families; and patients believe that quality of life is a less important factor in judging the usefulness of intensive care than do their nurses.

Attitude↗
PubMedDate not supplied

Quality of life following intensive care.

Evaluations of intensive care have largely focused on survival, cost, or functional status; however, these may not be the only outcomes of interest to patients, families, and health care providers. Quality of life is an important consideration in evaluating intensive care because it influences decisions about the use of life-sustaining treatment. A study was conducted to assess the quality of life of survivors of intensive care to determine the relationship of perceived quality of life to other outcomes of intensive care. Patients at least 55 years old who received medical intensive care during 1983 (n = 69) were interviewed to determine social characteristics, functional status, psychological well-being, and their perceived quality of life using a new 11-item Perceived Quality of Life scale. Functional status correlated only moderately with perceived quality of life (r = 0.49, p = 0.0001). Objective measures of patients' material and social resources did not predict satisfaction. To evaluate outcome adequately, it is necessary to assess perceptions of life quality from patients who have received life-sustaining treatment.

Adaptation, Psychological↗