scholarly journals Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e049711
Author(s):  
Yunji Lee ◽  
Minjeong Jo ◽  
Taehwa Kim ◽  
Kyoungsun Yun
Keyword(s):  
Older Adults ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Health Insurance ◽  
South Korea ◽  
End Of Life ◽  
High Intensity ◽  
End Of Life Care ◽  
Life Care ◽  
Cross Sectional

ObjectivesTo provide useful information for clinicians and policy makers to prepare guidelines for adequate use of medical resources during end-of-life period by analysing the intensive care use and related costs at the end of life in South Korea.DesignCross-sectional, retrospective, observational study.SettingTertiary hospitals in South Korea.ParticipantsWe analysed claim data and patient information from the Health Insurance Review and Assessment Service national dataset. This dataset included 19 119 older adults aged 65 years or above who received high-intensity care at least once and died in the intensive care unit in South Korea between 2016 and 2019. High-intensity care was defined as one of the following treatments or procedures: cardiopulmonary resuscitation, mechanical ventilation, extra-corporeal membrane oxygenation, haemodialysis, transfusion, chemotherapy and vasopressors.Primary and secondary outcome measuresUsage and cost of high-intensity care.ResultsThe most commonly used high-intensity care was transfusion (68.9%), mechanical ventilation (50.6%) and haemodialysis (35.7%) during the study period. The annual cost of high-intensity care at the end of life increased steadily from 2016 to 2019. There existed differences by age, gender, length of hospital stays and primary cause of death in use of high-intensity care and associated costs.ConclusionFindings indicate that invasive and device-dependent high-intensity care is frequently provided at the end of life among older adults, which could potentially place an economic burden on patients and their families. In Korea’s ageing society, increased rates of chronic illness are expected to significantly burden those who lack the financial resources to provide end-of-life care. Therefore, guidelines for the use of high-intensity care are required to ensure affordable end-of-life care.

Nurses’ roles and challenges in providing end-of-life care in neonatal intensive care units in South Korea

2019 ◽  
Vol 50 ◽  
pp. 151204 ◽  
Author(s):  
Sujeong Kim ◽  
Teresa A. Savage ◽  
Mi-Kyung Song ◽  
Catherine Vincent ◽  
Chang G. Park ◽  
...  
Keyword(s):  
Intensive Care ◽  
South Korea ◽  
End Of Life ◽  
Intensive Care Units ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Life Care

Education needed to improve antimicrobial use during end-of-life care of older adults with advanced cancer: A cross-sectional survey

2020 ◽  
pp. 026921632095681
Author(s):  
Rupak Datta ◽  
Jeffrey Topal ◽  
Dayna McManus ◽  
Tara Sanft ◽  
Louise Marie Dembry ◽  
...  
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Advanced Cancer ◽  
End Of Life Care ◽  
Antimicrobial Use ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Factors Influencing ◽  
Advance Care

Background: Antimicrobial use during end-of-life care of older adults with advanced cancer is prevalent. Factors influencing the decision to prescribe antimicrobials during end-of-life care are not well defined. Aim: To evaluate factors influencing medicine subspecialists to prescribe intravenous and oral antimicrobials during end-of-life care of older adults with advanced cancer to guide an educational intervention. Design: 18-item single-center cross-sectional survey. Setting/participants: Inpatient medicine subspecialists in 2018. Results: Of 186 subspecialists surveyed, 67 (36%) responded. Most considered withholding antimicrobials at the time of clinical deterioration during hospitalization ( n = 54/67, 81%), viewed the initiation of additional intravenous antimicrobials as escalation of care ( n = 44/67, 66%), and believed decision-making should involve patients or surrogates and providers ( n = 64/67, 96%). Fifty-one percent ( n = 30/59) of respondents who conducted advance care planning did not discuss antimicrobials. Barriers to discussing end-of-life antimicrobials included the potential to overwhelm patients or families, challenges of withdrawing antimicrobials, and insufficient training. Conclusions: Although the initiation of additional intravenous antimicrobials was viewed as escalation of care, antimicrobials were not routinely discussed during advance care planning. Educational interventions that promote recognition of antimicrobial-associated adverse events, incorporate antimicrobial use into advance care plans, and offer communication simulation training around the role of antimicrobials during end-of-life care are warranted.

scholarly journals End-of-Life Care Related Distress in the PICU and NICU: A Cross-Sectional Survey in a German Tertiary Center

2021 ◽  
Vol 9 ◽  
Author(s):  
Lars Garten ◽  
Andrea Danke ◽  
Tobias Reindl ◽  
Anja Prass ◽  
Christoph Bührer
Keyword(s):  
Intensive Care ◽  
End Of Life ◽  
Intensive Care Units ◽  
End Of Life Care ◽  
Pediatric Intensive Care ◽  
Private Life ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Pediatric Intensive Care Units

Objective: To investigate and compare nurses' perceived care-related distress and experiences in end-of-life situations in neonatal and pediatric intensive care units.Study design: Single-center, cross-sectional survey. Administration of an anonymous self-report questionnaire survey to nurses of two tertiary neonatal intensive care units (NICUs), and two tertiary pediatric intensive care units (PICUs) in Berlin, Germany.Results: Seventy-three (73/227, response rate 32.2%) nurses completed surveys. Both, NICU (32/49; 65.3%) and PICU (24/24; 100.0%) nurses, reported “staffing shortages” to be the most frequent source of distress in end-of-life situations. However, when asked for the most distressing factor, the most common response by NICU nurses (17/49) was “lack of clearly defined and agreed upon therapeutic goals”, while for PICU nurses (12/24) it was “insufficient time and staffing”. No significant differences were found in reported distress-related symptoms in NICU and PICU nurses. The interventions rated by NICU nurses as most helpful for coping were: “discussion time before the patient's death” (89.6%), “team support” (87.5%), and “discussion time after the patient's death” (87.5%). PICU nurses identified “compassion” (98.8%), “team support”, “personal/private life (family, friends, hobbies)”, and “discussion time after the patient's death” (all 87.5%) as most helpful.Conclusions: Distress-related symptoms as a result of end-of-life care were commonly reported by NICU and PICU nurses. The most frequent and distressing factors in end-of-life situations might be reduced by improving institutional/organizational factors. Addressing the consequences of redirection of care, however, seems to be a more relevant issue for the relief of distress associated with end-of-life situations in NICU, as compared to PICU nurses.

scholarly journals Quality indicators for the evaluation of end-of-life care in Germany – a retrospective cross-sectional analysis of statutory health insurance data

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Katharina van Baal ◽  
Sophie Schrader ◽  
Nils Schneider ◽  
Birgitt Wiese ◽  
Jona Theodor Stahmeyer ◽  
...  
Keyword(s):  
Health Insurance ◽  
End Of Life ◽  
Cancer Patients ◽  
Quality Indicators ◽  
End Of Life Care ◽  
Inpatient Treatment ◽  
Statutory Health Insurance ◽  
Life Care ◽  
Cross Sectional ◽  
Number Of Patients

Abstract Background The provision and quality of end-of-life care (EoLC) in Germany is inconsistent. Therefore, an evaluation of current EoLC based on quality indicators is needed. This study aims to evaluate EoLC in Germany on the basis of quality indicators pertaining to curative overtreatment, palliative undertreatment and delayed palliative care (PC). Results were compared with previous findings. Methods Data from a statutory health insurance provider (AOK Lower Saxony) pertaining to deceased members in the years 2016 and 2017 were used to evaluate EoLC. The main indicators were: chemotherapy for cancer patients in the last month of life, first-time percutaneous endoscopic gastrostomy (PEG) for patients with dementia in the last 3 months of life, number of hospitalisations and days spent in inpatient treatment in the last 6 months of life, and provision of generalist and specialist outpatient PC in the last year of life. Data were analysed descriptively. Results Data for 64,275 deceased members (54.3% female; 35.1% cancer patients) were analysed. With respect to curative overtreatment, 10.4% of the deceased with cancer underwent chemotherapy in the last month and 0.9% with dementia had a new PEG insertion in the last 3 months of life. The mean number of hospitalisations and inpatient treatment days per deceased member was 1.6 and 16.5, respectively, in the last 6 months of life. Concerning palliative undertreatment, generalist outpatient PC was provided for 28.0% and specialist outpatient PC was provided for 9.0% of the deceased. Regarding indicators for delayed PC, the median onset of generalist and specialist outpatient PC was 47.0 and 24.0 days before death, respectively. Conclusion Compared to data from 2010 to 2014, the data analysed in the present study suggest an ongoing curative overtreatment in terms of chemotherapy and hospitalisation, a reduction in new PEG insertions and an increase in specialist PC. The number of patients receiving generalist PC remained low, with delayed onset. Greater awareness of generalist PC and the early integration of PC are recommended. Trial registration The study was registered in the German Clinical Trials Register (DRKS00015108; 22 January 2019).

End-of-Life Care for Older Adults in ICUs

2002 ◽  
Vol 20 (1) ◽  
pp. 181-229 ◽  
Author(s):  
JUDITH G. BAGGS
Keyword(s):  
Older Adults ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Support ◽  
Symptom Relief ◽  
Life Support Care ◽  
Life Care ◽  
Care Providers ◽  
Care Needs

This review was undertaken to present and critique the most recent (1990-2000) empirical evidence about end-of-life care for older adult patients in ICUs, their families, and care providers. The studies (including descriptive, correlational, longitudinal, and intervention) were found using a combination of these terms: (a) intensive care (units) or critical care (units), and (b) critical illness, critically ill patients, terminally ill, terminal care, life support care, or palliative care. The computerized databases searched were CINAHL and MEDLINE. Only published studies of persons 44 years of age or older, written in English, and conducted in the U.S. or Canada were included. Research was not limited to studies conducted by or written by nurses. Excluded were articles focused on physiology, for example, studies of treatment for specific conditions, and articles focused on predictors of ICU outcomes.Findings and Implications for ResearchThere is little research specifically focused on end-of-life care of older adults in ICUs. Most research has been retrospective, and most has involved either providers or patients and families but not both.Research is needed in many areas. The mechanism by which age affects choice of care needs further exploration. The experience of patients, families, and providers and how those experiences change with interventions needs investigation. The influence of the ICU culture, variation in decisions made and reasons for that variation, the decision-making process, and variations in care, all require further attention. Four domains were identified for research needed to improve care for older adults at the end of life in intensive care: symptom relief, communication improvement, psychological support, and relationship improvement. No one has assessed whether the ICU is a good place for transition to palliation to occur, or whether it would be better to transfer patients to another type of unit.

Practice of end-of-life care in intensive care unit. A national survey

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
C Schimmer ◽  
C Yildirim ◽  
M Oezkur ◽  
SP Sommer ◽  
B Hörning ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
National Survey ◽  
End Of Life Care ◽  
Life Care
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