Advance Directives in an Oncologic Intensive Care Unit: A Contemporary Analysis of their Frequency, Type, and Impact

Abstract

Background: Our objective was to provide a contemporary analysis of the prevalence, types, and impact of advance health care directives in critically ill cancer patients. Methods: We retrospectively reviewed all intensive care unit (ICU) admissions ( January 1, 2006 to April 25, 2008 at an oncologic center and identified all patients who completed a living will (LW), or health care proxy (HCP), or neither prior to ICU admission. Demographics, clinical data, end-of-life (EOL) parameters and outcomes were compared among three groups: LWs, HCPs, and no LW or HCP. Results: Of 1,333 ICU admissions, 1,121 patients (84%) were included for analysis: 176 patients (15.7%) had LW, 534 (47.6%) had HCP and 411 (36.7%) had no LW or HCP. Patients with LW were significantly more likely to be older and white as compared to patients with HCP alone, or no LW or HCP. There were no significant demographic differences between patients with HCP or no LW or HCP. Patients with HCP alone, or no LW or HCP, were significantly more likely to have Medicaid than patients with LW. There were no differences noted in ICU care, EOL management, or outcomes among the three groups. Conclusions: The prevalence of LWs in patients admitted to our oncologic ICU is low. More than half of the remaining patients had designated HCPs. Older age and white race were associated with the presence of LWs. However, the presence of LWs or HCPs did not influence ICU care, EOL management or outcomes at our institution.

Advance Directive and End-of-Life Care Preferences Among Nursing Home Residents in Wuhan, China: A Cross-Sectional Study

“…These results suggest that doctors and nurses should broach the subject of end-of-life treatment preferences well before the residents' conditions become worse, so they have time to consider their AD preferences in advance of their conditions deteriorating. Unlike other studies, which have found that older people were more likely to complete an AD, 40,41 we did not find any relationship between age and AD preference. This may reflect Chinese culture, where Confucianism plays an important role with older residents relying on their family for care and decision making.…”

The Development and Validation of a Questionnaire to Audit Advance Care Planning

“…Others have examined hospital records or administrative databases for evidences of discussions and documentations of ACP or goals of care [18,19]. However, these ^as perceived by the Research Nurse The data we generate from evaluating all these perspectives (patient, family member, doctor, and nurse) will most certainly inform quality improvement activities that should result in increased quantity and quality of end of life communication and decision making.…”

The quality of intensive care unit nurse handover related to end of life: A descriptive comparative international study

“…For example, in a report of patients from an Oncology ICU, 15.7% had an advanced directive, 47.6% had a health care proxy and 36.7% had neither (Halpern et al, 2011). These frequencies were higher than those reported for two studies of Medical Intensive Care Units where only 9-15% of patients had a documented advanced directive (Baranowski-Birkmeier et al, 1995;Kemp et al, 2004).…”