Assessment of Discordance Between Surrogate Care Goals and Medical Treatment Provided to Older Adults With Serious Illness

Comer, Amber; Hickman, Susan E.; Slaven, James E.; Monahan, Patrick O.; Sachs, Greg A.; Wocial, Lucia D.; Burke, Emily S.; Torke, Alexia M.

doi:10.1001/jamanetworkopen.2020.5179

Cited by 30 publications

(21 citation statements)

References 56 publications

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“…For patients, it provided assurance that the relatives now knew, and would help ensuring that the preferences would be honoured. The need for relatives to have actual knowledge about the patient’s preferences instead of having to guess when they are asked to speak on behalf of the patient is supported by research showing discordance between surrogate decision-maker goals for care and medical orders and treatments provided to hospitalised, incapacitated older patients [ 27 ]. The physicians found that during the conversations, relatives may support explicating patient preferences, and shed light on possible conflicts between the patient’s and the relative’s opinions.…”

Section: Discussionmentioning

confidence: 99%

Decision-making conversations for life-sustaining treatment with seriously ill patients using a Danish version of the US POLST: a qualitative study of patient and physician experiences

Tuesen

Ågård

Bülow

et al. 2022

Scandinavian Journal of Primary Health Care

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Objective To explore patients’ and physicians’ perspectives on a decision-making conversation for life-sustaining treatment, based on the Danish model of the American Physician Orders for Life Sustaining Treatment (POLST) form. Design Semi-structured interviews following a conversation about preferences for life-sustaining treatment. Setting Danish hospitals, nursing homes, and general practitioners’ clinics. Subjects Patients and physicians. Main outcome measures Qualitative analyses of interview data. Findings After participating in a conversation about life-sustaining treatment using the Danish POLST form, a total of six patients and five physicians representing different settings and age groups participated in an interview about their experience of the process. Within the main research questions, six subthemes were identified: Timing, relatives are key persons, clarifying treatment preferences, documentation across settings, strengthening patient autonomy, and structure influences conversations. Most patients and physicians found having a conversation about levels of life-sustaining treatment valuable but also complicated due to the different levels of knowledge and attending to individual patient needs and medical necessities. Relatives were considered as key persons to ensure the understanding of the treatment trajectory and the ability to advocate for the patient in case of a medical crisis. The majority of participants found that the conversation strengthened patient autonomy. Conclusion Patients and physicians found having a conversation about levels of life-sustaining treatment valuable, especially for strengthening patient autonomy. Relatives were considered key persons. The timing of the conversation and securing sufficient knowledge for shared decision-making were the main perceived challenges. KEY POINTS Conversations about preferences for life-sustaining treatment are important, but not performed systematically. When planning a conversation about preferences for life-sustaining treatment, the timing of the conversation and the inclusion of relatives are key elements. Decision-making conversations can help patients feel in charge and less alone, and make it easier for health professionals to provide goal-concordant care. Using a model like the Danish POLST form may help to initiate, conduct and structure conversations about preferences for life-sustaining treatment.

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Section: Discussionmentioning

confidence: 99%

Decision-making conversations for life-sustaining treatment with seriously ill patients using a Danish version of the US POLST: a qualitative study of patient and physician experiences

Tuesen

Ågård

Bülow

et al. 2022

Scandinavian Journal of Primary Health Care

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“…( 6 ) Higher quality communication with clinical staff can contribute to reducing disparities between interventions and GOC. ( 15 ) The SeeMe™ Care Conference structure facilitates early communication about GOC, and families reported transparent communication about the state of the resident’s health. The SeeMe™ Program seeks to ensure that nurses are equipped to have discussions with families and to verify these preferences “in the moment”, when an acute health event occurs.…”

Section: Discussionmentioning

confidence: 99%

Program Evaluation of SeeMe™: Understanding Frailty Together

Liu¹,

Sinden²,

Plant³

et al. 2022

Can Geriatr J

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Background Perley Health has implemented SeeMe™: Understanding frailty together (www.perleyhealth.ca), a comprehensive approach to care that integrates the assessment and management of frailty, with an emphasis on goals of care planning. Methods Program evaluation over the first year of SeeMe™ used a mixed-methods approach involving quantitative data from surveys, goals of care preferences, hospital transfers, and qualitative data from interviews. Results The SeeMe™ training is an effective way to educate nurses and physicians in long-term care about frailty. For residents with documented care preferences prior to SeeMe™, there was a 15% reduction in the number of residents who preferred to be transferred to hospital post-SeeMe™ implementation. There was no significant decrease in hospital transfers during the first year the program was introduced. Conclusion After the roll-out of SeeMe™, nurses, physicians, and families reported high satisfaction with the program, and nurses reported an increase in knowledge and confidence. There was also a reduction in the number of residents and families selecting to transfer to hospital. This suggests that the education from SeeMe™ influenced residents and families to choose less invasive interventions in the context of frailty and quality of life goals.

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“…Although Danish family members do not have legal rights to make decisions on behalf of the patient without decision-making capacity, family members are involved as the patient’s advocate in presenting the patient’s values and preferences. However, several studies have shown discrepancies between patients’ and families opinions [ 40 ], and therefore discussions with old, sick and frail patients about values, wishes, and preferences should be conducted in a stable disease period whenever possible.…”

Section: Discussionmentioning

confidence: 99%

Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort

Jensen

Ozden

Kristensen

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions. Methods A retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality. Results A total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement. Conclusions Life-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.

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Assessment of Discordance Between Surrogate Care Goals and Medical Treatment Provided to Older Adults With Serious Illness

Cited by 30 publications

References 56 publications

Decision-making conversations for life-sustaining treatment with seriously ill patients using a Danish version of the US POLST: a qualitative study of patient and physician experiences

Decision-making conversations for life-sustaining treatment with seriously ill patients using a Danish version of the US POLST: a qualitative study of patient and physician experiences

Program Evaluation of SeeMe™: Understanding Frailty Together

Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort

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