An empirical analysis of the decision-making of limiting life-sustaining treatment for patients with advanced chronic obstructive pulmonary disease in Hong Kong, China

Pang, S.F.; Tse, C.Y.; Chan, Kin‐Sang; Chung, Betty Pui Man; Leung, Amanda K.A.; Leung, Edward M. F.; Ko, Stanley K.K.

doi:10.1016/j.jcrc.2004.08.001

Cited by 26 publications

(40 citation statements)

References 18 publications

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“…[10][11][12] Existential issues are important in palliative care at the end of life. 28,29 In COPD patients in Hong Kong who took 'Do not intubate and ventilate' decisions, Pang et al categorised patients' existential concerns as the will to live, life value, and concerns about death and dying. 29 Direct reference was not made to the meaning or value of life at interview in this study, but subjects were indirectly given the opportunity to consider existential issues at five points in the interview, including: 'Do you want more information about what the future holds for you?…”

Section: How This Fits Inmentioning

confidence: 99%

“…[nippy is the popular term for non-invasive positive pressure ventilation -NIPPV] Existential concerns, that is to say concerns about the meaning or value of life in relation to dying or possible death, were not expressed in the need for information about the future, in plans considered for the Mean score of 3.0 across three domains of symptoms, functional state, and mental state equates to mean frequency of "several times" in the six questions using frequency, and mean severity of 'moderately limited' in the four domains using severity. 29 future, in the reporting of action preferred in the event of a future exacerbation, or alongside open statements about the expectation of death from the disease, the making of wills, and anticipated dependence on relatives and carers.…”

Section: Information Needsmentioning

confidence: 99%

See 1 more Smart Citation

Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease A prospective community survey

White¹,

White²,

Edmonds

et al. 2011

Br J Gen Pract

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Section: How This Fits Inmentioning

confidence: 99%

Section: Information Needsmentioning

confidence: 99%

Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease A prospective community survey

White¹,

White²,

Edmonds

et al. 2011

Br J Gen Pract

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“…Some studies have investigated factors associated with the life-sustaining treatment restriction in specific patient groups, such as trauma patients [12], neurological patients [13], surgical patients [14, 15], patients receiving haemodialysis [16], patients undergoing cardiac arrest [17], or patients with advanced chronic obstructive pulmonary disease [18]. A British multicentre study found that older age, a history of one or more severe medical conditions, emergency surgery, medical admission, cardiopulmonary resuscitation within 24 h prior to ICU admission, mechanical ventilation during the first 24 h in the ICU, and sedation and/or paralysis were independently associated with the decision to withdraw active treatment [19].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with life-sustaining treatment restriction in a general intensive care unit

et al. 2017

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PurposeFew previous studies have investigated associations between clinical variables available after 24 hours in the intensive care unit (ICU), including the Charlson Comorbidity Index (CCI), and decisions to restrict life-sustaining treatment. The aim of this study was to identify factors associated with the life-sustaining treatment restriction and to explore if CCI contributes to explaining decisions to restrict life-sustaining treatment in the ICU at a university hospital in Norway from 2007 to 2009.MethodsPatients’ Simplified Acute Physiology Score II (SAPS II), age, sex, type of admission, and length of hospital stay prior to being admitted to the unit were recorded. We retrospectively registered the CCI for all patients based on the medical records prior to the index stay. A multivariable logistic regression analysis was used to assess factors associated with treatment restriction during the ICU stay.ResultsWe included 936 patients, comprising 685 (73%) medical, 204 (22%) unscheduled and 47 (5%) scheduled surgical patients. Treatment restriction was experienced by 241 (26%) patients during their ICU stay. The variables that were significantly associated with treatment restriction in multivariable analysis were older age (odds ratio [OR] = 1.48 per 10 years, 95% confidence interval [CI] = 1.28–1.72 per 10 years), higher SAPS II (OR = 1.05, 95% CI = 1.04–1.07) and CCI values relative to the reference of CCI = 0: CCI = 2 (OR = 2.08, 95% CI = 1.20–3.61) and CCI≥3 (OR = 2.72, 95% CI = 1.65–4.47).ConclusionsIn multivariable analysis, older age, greater illness severity after 24 h in the ICU and greater comorbidity at hospital admission were independently associated with subsequent life-sustaining treatment restriction. The CCI score contributed additional information independent of the SAPS II illness severity rating.

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“…Instead, it introduces the concept of advance directives to the public and invites views on the concept in order to inform future directions and actions (Food & Health Bureau 2009). Empirical studies concerning end-of-life decision making are few but start to grow in number in recent years in Hong Kong (Hui et al 1997, Lee et al 2003, Chu & Woo 2004, Pang et al 2004, Sham et al 2007, Tang et al 2007). In general, these studies found that people in Hong Kong might not have sufficient knowledge regarding advance directives and related issues but they were open to talk about concerns at the end of life instead of considering death a taboo subject as traditionally believed to be the case in Chinese societies (Tse et al 2003).…”

Section: Introductionmentioning

confidence: 99%

Advance directives and life‐sustaining treatment: informed attitudes of Hong Kong Chinese elders with chronic disease

Mok¹,

Ting²,

Lau³

2010

J of Nursing and Healthcare

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mok e, ting fh & lau k‐p (2010) Journal of Nursing and Healthcare of Chronic Illness2, 313–319 Advance directives and life‐sustaining treatment: informed attitudes of Hong Kong Chinese elders with chronic disease Aim. The aim of this study was to examine attitudes towards advance directives and life‐sustaining treatment of Chinese older persons with chronic disease in Hong Kong. Background. The concept of advance directives and related issues are fairly new to people in Hong Kong but they are open to talk about concerns at the end of life rather than treating death as a taboo. Older persons with chronic disease are a group to which end‐of‐life decision making is particularly relevant. Studies on attitudes of Chinese older persons with chronic disease towards advance directives and life‐sustaining treatment will be useful for culturally sensitive practice. Method. A cross sectional survey was carried out in 2009 in the in‐patient wards of a hospital in Hong Kong. Advance directives and related concepts were explained to participants before they were interviewed to ensure they had sufficient background information to give informed attitudes. Quantitative data regarding their attitudes towards the use of advance directives and limited use of life‐sustaining treatment were collected. Conclusions. Two hundred and nineteen participants completed the survey. Being informed of the concept of advance directives and related issues, in general they were able to take side regarding their attitudes regarding advance directives and life‐sustaining treatment. They also had a general positive attitude towards the use of advance directives and limited use of life‐sustaining treatment for a good death. To them, family was an indispensable part of end‐of‐life decision making. Relevance to clinical practice. While concepts such as advance care planning, advance directives and life‐sustaining treatment are fairly new to people in Hong Kong, clinicians should make sure patients are fully informed before they are required to make any life‐and‐death decision. Family members should also be involved in the process of discussion and decision‐making.

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An empirical analysis of the decision-making of limiting life-sustaining treatment for patients with advanced chronic obstructive pulmonary disease in Hong Kong, China

Cited by 26 publications

References 18 publications

Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease A prospective community survey

Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease A prospective community survey

Factors associated with life-sustaining treatment restriction in a general intensive care unit

Advance directives and life‐sustaining treatment: informed attitudes of Hong Kong Chinese elders with chronic disease

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