Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment

Wright, Alexi A.; Zhang, Baohui; Ray, Avik; Mack, Jennifer W.; Trice, E. D.; Balboni, Tracy A.; Mitchell, Susan L.; Jackson, Vicki A.; Block, Susan D.; Maciejewski, Paul K.; Prigerson, Holly G.

doi:10.1001/jama.300.14.1665

Cited by 2,390 publications

(2,121 citation statements)

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“…Both FC and DNR patients often reported being shocked or upset by the conversation, either because of the timing or the content, or simply being confronted with their own mortality. Advance Care Planning may help reduce this negative response; by normalizing the subject and raising it before an acute illness, physicians may help reduce anxiety and shock when it is raised during a deterioration 18,23 .Both FC and DNR patients emphasized the importance of honesty, clarity, and sensitivity when discussing this issue. Previous studies have highlighted the deficiencies of resuscitation conversations 7,[24][25][26] , and others have proposed techniques to improve them 11,19,25,[27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

et al. 2011

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BACKGROUND:The majority of patients who die in hospital have a "Do Not Resuscitate" (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don't, and how they view discussions of resuscitation status. METHODS:We conducted semi-structured interviews of English-speaking medical inpatients who had clearly requested a DNR or full code (FC) order after a discussion with their admitting team, and analyzed the transcripts using a modified grounded-theory approach. RESULTS:We achieved conceptual saturation after conducting 44 interviews (27 DNR, 17 FC) over a 4-month period. Patients in the DNR group were much older than those in the FC group, but they had broadly similar admission diagnoses and comorbidities. DNR patients reported much greater familiarity with the subject and described a more positive experience than FC patients with their resuscitation discussions. Participants typically requested FC or DNR orders based on personal, relational or philosophical considerations, but these considerations manifested differently depending on the participant's preference for resuscitation. Most FC patients stated that would not want a prolonged period of life support, and they would not want resuscitation in the event of a poor quality of life. FC and DNR patients understood resuscitation and DNR orders differently. DNR patients described resuscitation in graphic, concrete terms that emphasized suffering and futility, and DNR orders in terms of comfort or natural processes. FC patients understood resuscitation in an abstract sense as something that restores life, while DNR orders were associated with substandard care or even euthanasia.CONCLUSION: Our study identified important differences and commonalities between the perspectives of DNR and FC patients. We hope that this information can be used to help physicians better understand the needs of their patients when discussing resuscitation.

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Section: Discussionmentioning

confidence: 99%

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

et al. 2011

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“…While the use of technology and life‐sustaining therapies near the end of life (EOL) is increasing, many patients with HF would prefer treatment aimed at improving quality of life and symptoms 3, 4, 5. Technology‐laden EOL care is associated with poorer ratings of quality of life, lower ratings of satisfaction with EOL care, and increased family anxiety and depression 6. Furthermore, the use of intensive technology at the EOL incurs significant costs, placing increased strain on finite healthcare resources.…”

Section: Introductionmentioning

confidence: 99%

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

et al. 2016

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AimsGood end‐of‐life communication and decision‐making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision‐making about goals of care for hospitalized patients with advanced HF.MethodsWe distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital. The questionnaire asked about the importance of various barriers to goals of care discussions. It also asked participants to rank their willingness to engage in goals of care discussions and their views on other clinicians could engage in such discussions.ResultsOf 76 clinicians, 44 (58%) completed the questionnaire (median completion time, 17 min). Individual survey questions had few missing responses (0% to 2%) for questions about barriers to goals of care discussions. There was appreciable discrimination of the importance of different barriers (mean scores 2.2 to 6.0 on a 7‐point scale). Preliminary data suggest that clinicians perceive patient and family factors, such as difficulty accepting a poor prognosis, as the most important barriers preventing goals of care discussions.ConclusionsIn this pilot study, we have demonstrated the feasibility of a novel questionnaire to be used in a larger multi‐centre study of end‐of‐life HF care. Essential information will be obtained to inform the design and evaluation of interventions that seek to improve communication and decision‐making about goals of care with HF patients.

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“…In general medical settings, ACP has been shown to increase patient and family satisfaction with care 10,11 and the likelihood that doctors and family members will understand and comply with patients' wishes for EOL care 10,[12][13][14] . It also increases the likelihood of a person dying in their preferred place, increases hospice use 14,15 , reduces hospitalisation 11,15 , leads to less 'aggressive' medical care at EOL 14,16,17 , and contributes to lower stress, anxiety and depression in surviving relatives 10,11,13,14 .…”

Section: Introductionmentioning

confidence: 99%

Advance Care Planning for Adults With CKD: A Systematic Integrative Review

Luckett

Sellars

Tieman

et al. 2014

American Journal of Kidney Diseases

106

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Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment

Cited by 2,390 publications

References 45 publications

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

Barriers to goals of care discussions with hospitalized patients with advanced heart failure: feasibility and performance of a novel questionnaire

Advance Care Planning for Adults With CKD: A Systematic Integrative Review

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