life sustaining treatment
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2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Lone Doris Tuesen ◽  
Hans-Henrik Bülow ◽  
Anne Sophie Ågård ◽  
Sverre Mainz Strøm ◽  
Erik Fromme ◽  
...  

Abstract Background Medically frail and/or chronically ill patients are often admitted to Danish hospitals without documentation of patient preferences. This may lead to inappropriate care. Modelled on the American Physician Orders for Life-Sustaining Treatment (POLST) form, the purpose of the study was to develop and pilot test a Danish POLST form to ensure that patients’ preferences for levels of life-sustaining treatment are known and documented. Methods The study was a mixed methods study. In the initial phase, a Danish POLST form was developed on the basis of literature and recommendations from the National POLST organisation in the US. A pilot test of the Danish POLST form was conducted in hospital wards, general practitioners’ clinics, and nursing homes. Patients were eligible for inclusion if death was assessed as likely within 12 months. The patient and his/her physician engaged in a conversation where patient values, beliefs, goals for care, diagnosis, prognosis, and treatment alternatives were discussed. The POLST form was completed based on the patient’s values and preferences. Family members and/or nursing staff could participate. Participants’ assessments of the POLST form were evaluated using questionnaires, and in-depth interviews were conducted to explore experiences with the POLST form and the conversation. Results In total, 25 patients participated, 45 questionnaires were completed and 14 interviews were conducted. Most participants found the POLST form readable and understandable, and 93% found the POLST form usable to a high or very high degree for discussing preferences regarding life-sustaining treatment. Three themes emerged from the interviews: (a) an understandable document is essential for the conversation, (b) handling and discussing wishes, and (c) significance for the future. Conclusion The Danish version of the POLST form is assessed by patients, families, physicians, and nurses as a useful model for obtaining and documenting Danish patients’ preferences for life-sustaining treatment. However, this needs to be confirmed in a larger-scale study.


Neurology ◽  
2022 ◽  
Vol 98 (2) ◽  
pp. 73-79
Author(s):  
Justin A. Sattin ◽  
Winston Chiong ◽  
Richard J. Bonnie ◽  
Matthew P. Kirschen ◽  
James A. Russell ◽  
...  

This position statement briefly reviews the principle of informed consent, the elements of decisional capacity, and how acute stroke may affect this capacity. It further reviews the role of surrogate decision-making, including advance directives, next of kin, physician orders for life-sustaining treatment, and guardianship. In some cases of acute stroke in which the patient lacks decisional capacity and no advance directives or surrogates are available, consent to treatment may be presumed. The document describes the rationale for this position and various considerations regarding its application to IV thrombolysis, neuroendovascular intervention, decompressive craniectomy, and pediatric stroke. The document also reviews consent issues in acute stroke research.


Author(s):  
Yuchi Young ◽  
Arianna Stone ◽  
Taylor Perre

Introduction: The dual objective of this study is to examine the perspectives of young adults toward advance directives (ADs) and their preferences related to life-sustaining treatment and care options. Methods: Participants include graduate students (n = 30) attending a university in New York State. Data were collected using a structured survey questionnaire and Medical Orders for Life-Sustaining Treatment (MOLST) form. Bivariate summary statistics were performed to address the study aims. Results: The mean age of study participants was 24 years, 60% were female, 60% white, and 27% Black. Most (87%) participants reported being comfortable discussing death and end-of-life care and preferring to make their own decisions. Under the circumstance of no pulse and/or not breathing, 87% want CPR. With a pulse and respiration, 96% want artificially administered fluids and nutrition, 90% want a trial period of intubation and/or mechanical ventilation, 67% want to be sent to a hospital, 67% want antibiotics, and 53% want no limitations on medical intervention. Conclusion: Our findings extend upon previous research by quantifying young adults’ specific beliefs, experiences, and preferences regarding advance directives and life-sustaining interventions. Young adults in our study preferred maximum medical interventions for life-sustaining treatment and care. Given the troubling trends in unintended injury (eg, car crashes and drug overdose) as the leading cause of death among young adults, they should be given an opportunity to understand the options and treatments available and should be encouraged to complete an AD.


2021 ◽  
Vol 9 (2) ◽  
pp. 1-18
Author(s):  
Muhamad Rafiqi Hehsan ◽  
Wan Fadzlina Wan Muhd Shukeri

Withholding and withdrawal of life-sustaining treatments is one of the hot topics discussing in intensive care unit as most of the death occurs as a result of it. This point of transition from active intervention to the palliation process required a crucial decision-making process. The decision conveys information to families to be well prepared beforehand especially during the process of withdrawing life-sustaining treatment. Once the final decision to withdraw the treatment has been made, procedure of cessation of care, treatment withdrawal and nature of follow-up support will be informed to the family members. This article aims to explore the relationship between decision in withholding and withdrawal of life-sustaining treatment based on Malaysian intensive care unit protocol and the related fatwa in Malaysia. The methodology chosen for this study is content analysis of the relevant published literatures. This study reveals the decision for withholding and withdrawal life sustaining treatment in intensive care unit has correlation between the protocol and related fatwa in Malaysia.


2021 ◽  
Vol 10 (24) ◽  
pp. 5962
Author(s):  
JinShil Kim ◽  
Seongkum Heo ◽  
Bong Roung Kim ◽  
Soon Yong Suh ◽  
Jae Lan Shim ◽  
...  

Evidence for non-modifiable and modifiable factors associated with the utilization of advance directives (ADs) in heart failure (HF) is lacking. The purpose of this study was to examine baseline-to-3-month changes in knowledge, attitudes, and benefits/barriers regarding ADs and their impact on the completion of life-sustaining treatment (LST) decisions at 3-month follow-up among patients with HF. Prospective, descriptive data on AD knowledge, attitudes, and benefits/barriers and LSTs were obtained at baseline and 3-month follow-up after outpatient visits. Of 64 patients (age, 68.6 years; male, 60.9%; New York Heart Association (NYHA) classes I/II, 70.3%), 53.1% at baseline and 43.8% at 3-month follow-up completed LST decisions. Advanced age (odds ratio (OR) = 0.91, p = 0.012) was associated with less likelihood of the completion of LST decisions at 3-month follow-up, while higher education (OR = 1.19, p = 0.025) and NYHA class III/IV (OR = 4.81, p = 0.049) were associated with more likelihood. In conclusion, advanced age predicted less likelihood of LST decisions at 3 months, while higher education and more functional impairment predicted more likelihood. These results imply that early AD discussion seems feasible in mild symptomatic HF patients with poor knowledge about ADs, considering the non-modifiable and modifiable factors.


2021 ◽  
Author(s):  
Haruaki Wakatake ◽  
Koichi Hayashi ◽  
Yuka Kitano ◽  
Hsiang-Chin Hsu ◽  
Toru Yoshida ◽  
...  

Abstract BackgroundSevere brain hemorrhage/infarction and cardiac arrest constitute the most critical situations leading to poor neurological prognosis. Characterization of these patients is required to offer successful end-of-life care, but actual practice is affected by multiple confounding factors, including ethicolegal issues, particular in Japan and Asia. The aim of this study is to evaluate the clinical courses of patients with severe brain damage and to assess the preference of end-of-life care for these patients in Japanese hospitals.MethodsA retrospective observational study was conducted between 2008 and 2018. All intracranial hemorrhage/infarction and cardiac arrest out-patients (n=510) who were admitted to our two affiliated hospitals and survived but with poor neurologic outcomes were included. Demographic characteristics as well as prognosis and treatment policies were also assessed. Results Patients were divided into two categories; cases with absent brainstem reflex (BSR) (BSR[-]) and those with preserved BSR (BSR[+]). The survival rate was higher and the length of hospitalization was longer in patients with BSR[+] than in those with BSR[-]. Among three life-sustaining policies (i.e., aggressive treatment, withdrawal of treatment, and withholding of treatment), withholding of treatment was adopted to most patients. In BSR[-], the proportion of three treatment policies performed at the final decision did not differ from that at the initial diagnosis on neurological status (p=0.432). In contrast, this proportion tended to be altered in BSR[+] (p=0.072), with a decreasing tendency of aggressive treatment and a modest increasing tendency of withdrawal of treatment. Furthermore, the requests from patients’ families to withdraw life-sustaining treatment, including discontinuation of mechanical ventilation, increased, but actual implementation of withdrawal by physicians was less than half of the requests. ConclusionsBSR constitutes a crucial determinant of mortality and length of hospitalization in comatose patients with severe brain damage. Although the number of withdrawal of life-sustaining treatment tends to increase over time in BSR[+] patients, there are many more requests from patients’ families for withdrawal. Since physicians has a tendency to desist from withdrawing life-sustaining treatment, more in-depth communication between medical staff and patients’ families will facilitate mutual understanding over ethicolegal and religious issues and may thus improve end-of-life care.


2021 ◽  
pp. 1-7
Author(s):  
Lone Doris Tuesen ◽  
Hans-Henrik Bülow ◽  
Anne Sophie Ågård ◽  
Sverre Maintz Strøm ◽  
Erik Fromme ◽  
...  

Abstract Objective In 2019, the Danish parliament issued legislation requiring Danish physicians to clarify and honor seriously ill patients’ treatment preferences. The American POLST (Physician Orders for Life-Sustaining Treatment) document could be a valuable model for this process. The aim of the study was to examine patients' preferences for life-sustaining treatment and participant assessment of a Danish POLST form. Methods The study is a prospective intervention based on a pilot-tested Danish POLST form. Participant assessments were examined using questionnaire surveys. Patients with serious illness and/or frailty from seven hospital wards, two general practitioners, and four nursing homes were included. The patients and their physicians completed the POLST form based on a process of shared decision-making. Results A total of 95 patients (aged 41–95) participated. Hereof, 88% declined cardiopulmonary resuscitation, 83% preferred limited medical interventions or comfort care, and 74% did not require artificial nutrition. The preferences were similar within age groups, genders, and locations, but with a tendency toward younger patients being more in favor of full treatment and nursing home residents being more in favor of cardiopulmonary resuscitation. Questionnaire response rates were 69% (66/95) for patients, 79% (22/28) for physicians, and 31% (9/29) for nurses. Hereof, the majority of patients, physicians, and nurses found that the POLST form was usable for conversations and decision-making about life-sustaining treatment to either a high or very high degree. Significance of results The majority of seriously ill patients did not want a resuscitation attempt and opted for selected treatments. The majority of participants found that the Danish POLST was usable for conversations and decisions about life-sustaining treatment to either a high or a very high degree, and that the POLST form facilitated an opportunity to openly discuss life-sustaining treatment.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 755-755
Author(s):  
Shirin Hiatt ◽  
Jia-Wen Guo ◽  
Lee Ellington ◽  
Djin Tay

Abstract Caregivers are often engaged in decision making with and for patients. However, the role of patient-caregiver interpersonal processes on decisions about advance care planning (ACP) are not well known. This secondary data analysis examined the effects of patient-caregiver enjoyment about collaboration regarding choices for life-sustaining treatment on patients’ and caregivers’ decisional uncertainty following a dyadic ACP intervention. A purposive sample of 18 adult home health patients and their informal caregivers (N=36) participated in a one-group pretest posttest study. The Interpersonal Enjoyment subscale of the Perceptions of Collaboration Questionnaire and the Decisional Uncertainty subscale of the Decisional Conflict Scale were administered using parallel questionnaires. The Actor-Partner Interdependence Model (APIM) was used to examine actor and partner effects of patients and caregivers’ interpersonal enjoyment on their uncertainty in decisions about ACP before and after the intervention. The mean age was 68.2±9.6 years for patients and 61.3±13.6 years for caregivers. The majority of patients (61.1%) and caregivers (72.2%) were female and married (55.6% and 66.7%, respectively). Almost all were non-Hispanic White (97.0%). Patients’ and caregivers’ interpersonal enjoyment and uncertainty scores were similar before the intervention. A significant partner effect between greater interpersonal enjoyment among caregivers at pretest and greater patient uncertainty at posttest (β=0.44, p=.037) was found. Previous analyses found that overall patients improved in decisional uncertainty at posttest. However, these findings suggest that for some dyads, interpersonal factors can negatively affect patients’ decisional certainty. Future research is needed to verify this finding with a larger sample.


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