Dilemmas in decision-making about resuscitation—a focus group study of older people

Vandrevala, Tushna; Hampson, Sarah E.; Daly, Tom; Arber, Sara; Thomas, Hilary

doi:10.1016/j.socscimed.2005.08.038

Cited by 40 publications

(72 citation statements)

References 56 publications

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“…Older people perceive quality-of-life as the most decisive factor, which has been defined in terms of how much more ''good'' life an individual can expect. It appears that decisions about prolonging life involve weighing pros and cons from a cost-benefit perspective (Vandrevala et al 2006). The bias in favor of quality-of-life as people grow older also puts healthcare professionals, and specifically physicians, in an unfamiliar arena.…”

Section: Discussionmentioning

confidence: 99%

Ageism among physicians, nurses, and social workers: findings from a qualitative study

et al. 2016

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This study investigated ageism among healthcare professionals in various therapeutic settings in Israel. Using a qualitative approach, the current study aimed to examine similarities and differences across healthcare disciplines. Three focus groups were conducted with physicians, nurses, and social workers. Data from each focus group were analyzed separately, and then commonalities and differences across the groups were evaluated. Three main themes relating to older adults emerged from the data. The first theme pertains to perceived difficulties that healthcare professionals experience in working with older adults and their family members; the second focuses on invisibility and discriminatory communication patterns; and the third theme relates to provision of inappropriate care to older adults. Similarities and differences across the three disciplines were found. The differences related mainly to the examples provided for manifestations of ageism in the healthcare system. Provision of inadequate treatment to older adults due to their age appeared to be the most complex theme, and is discussed at length in the Discussion. Briefly, the complexity stems from the fact that although some behaviors can be clearly described as inappropriate and undesirable, other behaviors such as avoidance of invasive medical procedures for older patients raise ethical dilemmas. Potentially, avoidance of invasive medical treatment can be perceived as compassionate care rather than as undertreatment due to ageist perceptions. A related dilemma, i.e., longevity versus quality-of-life, is also discussed in light of the finding that the balance of these two aspects changes as patients grow old.

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Section: Discussionmentioning

confidence: 99%

Ageism among physicians, nurses, and social workers: findings from a qualitative study

et al. 2016

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“…The distinction between good and bad deaths has been useful in other qualitative studies (e.g., Howarth, 1998), and the distinction has been documented as influencing discussions about life prolongation (Age Concern England, 1999;Winzelberg et al, 2005). Previous research has suggested that community dwelling older adults take into account assessment of quality of life when making decisions about the acceptability of life-prolonging measures (e.g., Carmel & Mutran, 1997;Cicirelli, 1997;Landon, 2000;Phillips & Woodward, 1999;Vandrevala et al, 2006). Older adults making decisions about the use of life prolonging medical technologies for themselves in later life based their decisions on the extent to which they might afterwards be mentally or physically impaired (Vandrevala et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has suggested that community dwelling older adults take into account assessment of quality of life when making decisions about the acceptability of life-prolonging measures (e.g., Carmel & Mutran, 1997;Cicirelli, 1997;Landon, 2000;Phillips & Woodward, 1999;Vandrevala et al, 2006). Older adults making decisions about the use of life prolonging medical technologies for themselves in later life based their decisions on the extent to which they might afterwards be mentally or physically impaired (Vandrevala et al, 2006). Interestingly, the findings of the present study suggest that confidants use similar judgements about an acceptable quality of life for their relatives.…”

Section: Discussionmentioning

confidence: 99%

“…For example, Volicer et al (2002) found that 90% of patients preferred family members to doctors as surrogates for decision-making in later life. In the UK, older people living in the community would rather discuss resuscitation issues with family members who can act on their behalf than their doctors (Seymour et al, 2004;Vandrevala et al, 2006). In addition, older patients receive advice on life prolongation from family members (Keith, 1983) and the family role in endof-life decision-making increases with dependency (Pratt et al, 1989) and incompetence (High, 1994).…”

Section: Introductionmentioning

confidence: 99%

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Family members' perspectives on potential discussions about life prolongation for their older relatives

et al. 2008

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Family members (or health-care confidants) of incapacitated patients are often consulted by doctors when making life-prolongation decisions. Little research has been conducted on confidants' views on life prolongation and advance care planning. This study investigated the health-care confidant's view on life prolongation and their involvement in being a potential decision-maker for their relatives in the event of incapacitation. Confidants (N ¼ 12) were interviewed and interviews were analysed using Interpretative Phenomenological Analysis. The analysis revealed three themes relating to their perception of being a potential decision-maker for a relative's life prolonging measures: ''good'' and ''bad'' death based on past experience and perceptions of quality of life, a sense that discussions were inappropriate at present, and strategies which might be used to encourage discussion. The implications of these findings for family involvement in life-prolongation decisions and how to encourage family discussions about life prolongation are discussed.

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“…Our findings support an emphasis on discussing end-of-life care preferences with patients prior to critical illness and documenting their wishes and provide some evidence for a benefit of living wills despite the fact that living wills have not been shown to change the aggressiveness of care provided to patients. (31,32) If these findings are confirmed with further study, measures of preparation and planning for end-of-life care could be used in evaluating the quality of endof-life care.…”

Section: Implications Of Predictors Of the Qoddmentioning

confidence: 95%

Using the medical record to evaluate the quality of end-of-life care in the intensive care unit*

Glavan

Engelberg

Downey

et al. 2008

Critical Care Medicine

117

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Rationale-We investigated whether proposed "quality markers" within the medical record are associated with family assessment of the quality of dying and death in the ICU.Objective-To identify chart-based markers that could be used as measures for improving the quality of end-of-life care.Design-A multi-center study conducting standardized chart abstraction and surveying families of patients who died in the ICU or within 24 hours of being transferred from an ICU. Setting-ICUs at ten hospitals in the Northwest US.Patients-356 patients who died in the ICU or within 24 hours of transfer from an ICU.Measurements-1) the 22-item family-assessed Quality of Dying and Death (QODD-22); 2) a single item rating of the overall quality of dying and death (QODD-1).Analysis-The associations of chart-based quality markers with QODD scores were tested using Mann-Whitney tests, Kruskal Wallis tests, or Spearman correlation coefficients as appropriate.Results-Higher QODD-22 scores were associated with documentation of a living will (p = 0.03), absence of CPR performed in the last hour of life (p = 0.01), withdrawal of tube feeding (p = 0.04), family presence at time of death (p=0.02), and discussion of the patient's wish to withdraw life support during a family conference (p<0.001). Additional correlates with a higher QODD-1 score included use of standardized comfort care orders and occurrence of a family conference (p≤0.05).Conclusions-We identified chart-based variables associated with higher QODD scores. These could serve as targets for measuring and improving the quality of end-of-life care in the ICU. MeSH Headings

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Dilemmas in decision-making about resuscitation—a focus group study of older people

Cited by 40 publications

References 56 publications

Ageism among physicians, nurses, and social workers: findings from a qualitative study

Ageism among physicians, nurses, and social workers: findings from a qualitative study

Family members' perspectives on potential discussions about life prolongation for their older relatives

Using the medical record to evaluate the quality of end-of-life care in the intensive care unit*

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