Deciding in the dark: Advance directives and continuation of treatment in chronic critical illness*

Camhi, Sharon L.; Mercado, Alice F.; Morrison, R. Sean; Du, Qingling; Platt, David; August, Gary I.; Nelson, Judith E.

doi:10.1097/ccm.0b013e31819613ce

Cited by 89 publications

(63 citation statements)

References 57 publications

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“…Low frequencies of LWs have also been documented in patients admitted to adult ICUs (0% to 13%) [18][19][20] and in units for the chronically critically ill (16%-38%). 21,22 These low LW rates are not unexpected, especially in the United States, given the paucity of advance care planning in America, 1 whether among the healthy, the elderly, the hospitalized, 23 those undergoing major surgical procedures, 24 or those with cancer. 25,26 In contrast to the low frequency of LWs, we found a much higher percentage of patients with HCPs.…”

Section: Discussionmentioning

confidence: 99%

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

Halpern¹,

Pastores²,

Chou

et al. 2011

Journal of Palliative Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Halpern¹,

Pastores²,

Chou

et al. 2011

Journal of Palliative Medicine

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“…31,32,[36][37][38] The negative effects of ethical conflicts are widespread for patients, patients' families, and health care providers. Quality care and patient safety are threatened when health care providers are burdened by stressful ethical conflicts that erode interpersonal trust, compromise working relationships, and fragment care.…”

Section: Study Procedures and Data Collectionmentioning

confidence: 99%

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Pavlish¹,

Hellyer²,

Brown-Saltzman³

et al. 2015

American Journal of Critical Care

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A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the impact of ethical conflict in the intensive care unit (ICU) for patients, families, and health care workers. 2. Describe risk factors and early warning signs of potential ethical conflicts with ICU patients. 3. Explain key results of ethical risk factor screening for critical care nurses. Results Older patients with multiple comorbid conditions and aggressive treatments were frequently assessed to be at risk for ethical conflicts. Nurses who witnessed patients' suffering and deterioration were likely to initiate the screening process. The most prominent family risk factors included unrealistic expectations and adamancy about treatment. The most prominent early indicators were signs of patients' suffering, unrealistic expectations, and providers' own moral distress. High-risk situations averaged a greater number of risk factors and early indicators than did medium-and low-risk situations. Certain risk factors featured prominently in high-risk situations. Conclusions A phenomenon of shared suffering emerged from the study and signifies the importance of relational strategies such as routine family conferences and ethics consultation.

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“…In the United States, there is a low frequency of a living will (LW) in patients admitted to adult ICUs (0 to 13%) [16][17][18] and in units for the chronically critically ill (16 to 38%) [19,20], even though all of the patients should be given the opportunity to discuss advance directives according to the Patient Self-Determination Act (PSDA).…”

Section: Discussionmentioning

confidence: 99%

Implementation of Do Not Attempt Resuscitate Orders in a Japanese Nursing Home

Asai

Ohkuni

Ashworth

et al. 2013

Am J Hosp Palliat Care

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Object: To investigate whether DNAR orders can be implemented in a standard nursing home in Japan, where routine Do Not Attempt Resuscitation (DNAR) orders are not yet common in many facilities including hospitals.Method: Ninety-eight residents in a 100-bed nursing home were evaluated. All of the eligible residents and/or their family members were asked if they wanted to receive resuscitation, including mechanical ventilation. Result:The residents were 54 to 101 years of age (mean 83.3), with 27 males and 71 females. After administering the questionnaire, ninety-two patients (94%) did not want resuscitation and mechanical ventilation. Conclusion:In a nursing home, it was possible to obtain advance directives by which most residents/families rejected resuscitation and mechanical ventilation. This could avoid unnecessary and undesirable resuscitation procedures.

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Deciding in the dark: Advance directives and continuation of treatment in chronic critical illness*

Cited by 89 publications

References 57 publications

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

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

Screening Situations for Risk of Ethical Conflicts: A Pilot Study

Implementation of Do Not Attempt Resuscitate Orders in a Japanese Nursing Home

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