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Results for “Advance Directive Adherence”

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PubMed1999

Would physicians override a do-not-resuscitate order when a cardiac arrest is iatrogenic?

OBJECTIVE: To assess whether physicians would be more likely to override a do-not-resuscitate (DNR) order when a hypothetical cardiac arrest is iatrogenic. DESIGN: Mailed survey of 358 practicing physicians. SETTING: A university-affiliated community teaching hospital. PARTICIPANTS: Of 358 physicians surveyed, 285 (80%) responded. MEASUREMENTS AND MAIN RESULTS: Each survey included three case descriptions in which a patient negotiates a DNR order, and then suffers a cardiac arrest. The arrests were caused by the patient's underlying disease, by an unexpected complication of treatment, and by the physician's error. Physicians were asked to rate the likelihood that they would attempt cardiopulmonary resuscitation for each case description. Physicians indicated that they would be unlikely to override a DNR order when the arrest was caused by the patient's underlying disease (mean score 2.55 on a scale from 1 "certainly would not" to 7 "certainly would"). Physicians reported they would be much more likely to resuscitate when the arrest was due to a complication of treatment (5.24 vs 2. 55; difference 95% confidence interval [CI] 2.44, 2.91; p <.001), and that they would be even more likely to resuscitate when the arrest was due to physician error (6.32 vs 5.24; difference 95% CI 0. 88, 1.20; p <.001). Eight percent, 29%, and 69% of physicians, respectively, said that they "certainly would" resuscitate in these three vignettes (p <.001). CONCLUSIONS: Physicians may believe that DNR orders do not apply to iatrogenic cardiac arrests and that patients do not consider the possibility of an iatrogenic arrest when they negotiate a DNR order. Physicians may also believe that there is a greater obligation to treat when an illness is iatrogenic, and particularly when an illness results from the physician's error. This response to iatrogenic cardiac arrests, and its possible generalization to other iatrogenic complications, deserves further consideration and discussion.

Advance Directive Adherence↗
PubMed2001

Advance directive completion rates and end-of-life preferences in Hawaii.

To estimate rates of advance directive completion, preference for in-home death and hospice services at life's end, and support for physician assistance in dying, questions were added to two statewide, random-sample telephone surveys-the 1998 Behavioral Risk Factor Surveillance System (N=2,153) and the 1999 OmniTrak health survey (N=700). Data were compared across age, ethnic, and gender groups. Overall, 29% of Hawaii residents had a living will, 22% had a healthcare power of attorney, 65% said they would prefer a home death, 60% would want hospice services, 64% believed a person had a moral right to end his or her life when faced with an incurable illness, and 63% felt doctors should be allowed by law to end a patient's life if the patient and his or her family requested it. Advance directive completion rates increased with age, desire for an in-home death varied by gender and ethnicity, and support of assisted-death options varied by ethnicity. Despite a large minority population, end-of-life preferences among the general population in Hawaii are similar to those of U.S. mainlanders. However, age, gender, and ethnic differences exist. Clinicians are encouraged to ask patients directly about their preferences as a first step toward improving end-of-life care.

Adolescent↗
PubMed2002

The use of life-sustaining treatments in hospitalized persons aged 80 and older.

OBJECTIVES: To characterize the use of life-sustaining treatments in hospitalized patients aged 80 and older. DESIGN: A prospective cohort study. SETTING: Four teaching hospitals in the United States that participated in the Hospitalized Elderly Longitudinal Project (HELP). PARTICIPANTS: Hospitalized patients aged 80 and older. MEASUREMENTS: We report the rates of admissions to intensive and coronary care units and the rates of use of cardiopulmonary resuscitation (CPR), ventilators, right heart catheterization, artificial nutrition and hydration, surgical interventions, hemodialysis, and blood transfusions. RESULTS: Of the 1,266 patients enrolled in HELP, 72 died during the enrollment hospitalization. The median age of those who died was 86 (range 83-89). Of the patients who died, the median number of activities of daily living impairments was two (range 1-4) before hospitalization, and 70% reported their baseline quality of life as fair or poor. Most patients who died had stated that they did not want aggressive care; 70% wanted their care focused on comfort rather than prolonging life, and 80% had a do-not-resuscitate order. However, the majority (63%) of the patients received one or more life-sustaining treatments before they died. Fifty-four percent were admitted to intensive or coronary care units, 43% were on a ventilator, 18% received CPR, 18% received tube feeding, 17% underwent surgery, 15% had right heart catheterization, 14% received blood transfusions, and 6% had hemodialysis. Intensive care did not affect survival time. CONCLUSION: The use of life-sustaining treatments was prevalent in very old patients who died in the course of hospitalization, despite the fact that the majority had a preference for comfort care. This lack of congruence warrants further investigation and efforts to provide care that is more consistent with patients' preferences.

Advance Directive Adherence↗
PubMed2006

Living wills and the Mental Capacity Act: a postal questionnaire survey of UK geriatricians.

OBJECTIVE: To determine geriatricians' experience of and views on living wills, National Health Service Trusts' support of advance end-of-life health care planning and geriatricians' views on related legal changes in the Mental Capacity Act. DESIGN: Anonymous postal questionnaire survey of all 1,426 British Geriatrics Society members in England, Wales and Northern Ireland. RESULTS: A total of 842 (59%) questionnaires were returned. Of 811 geriatricians, 454 (56%) had cared for patients with living wills. Of the 280 who cared for patients when the living will had come into effect, 108 (39%) had changed treatment because of the living will and 84 (78%) of those felt that decisions had been easier to make. Living wills not already in effect made discussions with patients [171 of 178 (96%)] and families [135 of 178 (76%)] easier. Of 779 geriatricians, 713 (92%) saw advantages of older people using living wills; 467 of these also expressed concerns. Only 16 (2%) geriatricians who had concerns said that there were no advantages. A total of 214 (27%) were aware that their Trust had a form to help with discussions about cardiopulmonary resuscitation. Fewer [126 of 781 (16%)] were aware of a Trust policy on living wills. The proposal, in the Mental Capacity Bill, for advance refusals of treatment was supported by 59% (476 of 801), yet the proposal for a lasting power of attorney (LPA) covering health care was only supported by 47% (382 of 806). CONCLUSION: Many geriatricians have positive experiences of caring for patients with living wills. Despite recognising potential problems, most geriatricians support the use of living wills by older people. However, most believe that their Trust does not have a policy to support advance health care planning. Geriatricians have reservations about LPAs covering health care.

Advance Directive Adherence↗
PubMedDate not supplied

Advance directives use in acute care hospitals.

It is a federal requirement for health care organizations to provide and obtain information from admitted patients about their rights to self-determination and executing an advance directive. But how compliant are acute care organizations with this law? This article explores the extent to which hospitalized patients in one Southeastern United States organization had advance directive documentation; its correlation with socioeconomic factors, and the success of educating patients and providing care that is consistent with patient's wishes.

Acute Disease↗
PubMed1999

Right to die or duty to live? The problem of euthanasia.

Argument about euthanasia in Australia intensified following the world's first legal euthanasia death of Bob Dent under the Northern Territory's short-lived Rights of the Terminally Ill Act 1995. This paper takes stock of the implacably opposed positions on euthanasia following Bob Dent's death, which provides a focus for the controversy, and identifies the key doctrines which separate adversaries in the euthanasia debate and their associated incommensurable intuitions.

Advance Directive Adherence↗