End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home

Reinhardt, Joann P.; Downes, Deirdre; Cimarolli, Verena R.; Bomba, Patricia A.

doi:10.1080/15524256.2017.1282919

Cited by 25 publications

(47 citation statements)

References 37 publications

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“…Gaining insight into what is important for the resident 66 helps healthcare professionals to guide families across the end-of-life decision-making process. 67 However, previous authors found only one out of five family members were involved in the plan meetings 22 and only half of the decisions to withdraw or withhold treatments were routinely discussed. 19,68 Furthermore, most elders had never talked about their preferences about end-of-life care with their family or staff and trusted their preferences were known.…”

Section: Discussionmentioning

confidence: 99%

Good end-of-life care in nursing home according to the family carers’ perspective: A systematic review of qualitative findings

et al. 2019

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Background: Nursing homes are becoming a common site where delivering end-of-life care for older adults. They often represent the junction between the curative and the palliative phase. Aim: To identify the elements that nursing home residents’ family carers perceive as good end-of-life care and develop a conceptual model of good end-of-life care according to the family perspective. Design: Systematic review (PROSPERO no. 95581) with meta-aggregation method. Data Sources: Five electronic databases were searched from inception between April and May 2018. Published qualitative studies (and mixed-method designs) of end-of-life care experience of nursing home family carers whose relative was dead or at the end-of-life were included. No language or temporal limits were applied. Results: In all, 18 studies met inclusion criteria. A ‘life crisis’ often resulted in a changed need of care, and the transition towards palliative care was sustained by a ‘patient-centered environment’. Family carers described good end-of-life care as providing resident basic care and spiritual support; recognizing and treating symptoms; assuring continuity in care; respecting resident’s end-of-life wishes; offering environmental, emotional and psychosocial support; keeping family informed; promoting family understanding; and establishing a partnership with family carers by involving and guiding them in a shared decision-making. These elements improved the quality of end-of-life of both residents and their family, thus suggesting a common ground between good end-of-life care and palliative care. Conclusion: The findings provide a family-driven framework to guide a sensitive and compassionate transition towards palliative care in nursing home.

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Section: Discussionmentioning

confidence: 99%

Good end-of-life care in nursing home according to the family carers’ perspective: A systematic review of qualitative findings

et al. 2019

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“…Clinician training in ACP and communication skills that support the eMOLST process using a team-based interdisciplinary approach within scope of practice is imperative (Reinhardt et al, 2017). The PC Service at ORMC has conducted training for the clinical staff and continual training sessions are warranted for the eMOLST Registry user numbers to increase.…”

Section: Discussionmentioning

confidence: 99%

Electronic medical orders for life-sustaining treatment in New York State: Length of stay, direct costs in an ICU setting

et al. 2019

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ObjectiveIn the United States, approximately 20% patients die annually during a hospitalization with an intensive care unit (ICU) stay. Each year, critical care costs exceed $82 billion, accounting for 13% of all inpatient hospital costs. Treatment of sepsis is listed as the most expensive condition in US hospitals, costing more than $20 billion annually. Electronic Medical Orders for Life-Sustaining Treatment (eMOLST) is a standardized documentation process used in New York State to convey patients’ wishes regarding cardiopulmonary resuscitation and other life-sustaining treatments. No study to date has looked at the effect of eMOLST as an advance care planning tool on ICU and hospital costs using estimates of direct costs. The objective of our study was to investigate whether signing of eMOLST results in any reduction in length of stay and direct costs for a community-based hospital in New York State.MethodA retrospective chart review was conducted between July 2016 and July 2017. Primary outcome measures included length of hospital stay, ICU length of stay, total direct costs, and ICU costs. Inclusion criteria were patients ≥65 years of age and admitted into the ICU with a diagnosis of sepsis. An independent samples t test was used to test for significant differences between those who had or had not completed the eMOLST form.ResultThere were no statistical differences for patients who completed or did not complete the eMOLST form on hospital's total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU.Significance of resultsCompleting an eMOLST form did not have any effect on reducing total direct cost, ICU cost, total length of hospital stay, and total hours spent in the ICU.

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“…Of note, 10 trials recruited mainly cancer patients. Four of the trials were RCTs (Engelhardt et al, 2006; Temel et al, 2010, 2017; Radwany et al, 2014), nine were cohort studies (Rabow et al, 2004; O'Mahony et al, 2010; Lustbader et al, 2011; Sacco et al, 2013; Bailey et al, 2014; Kao et al, 2014; Kerr et al, 2014; Tan et al, 2014; Ferrell et al, 2015), and 13 were cross-sectional studies (Parker-Oliver et al, 2003; Buchanan et al, 2004; Sato et al, 2008; Nakano et al, 2012; De Gendt et al, 2013; Bhatraju et al, 2014; Alsirafy et al, 2015; Chen et al, 2015; Patel et al, 2016; Huang et al, 2017; McDonald et al, 2017; Omondi et al, 2017; Reinhardt et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

Association between palliative care and the rate of advanced care planning: A systematic review

2019

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Objective Advanced care planning (ACP) is central to patients' dignity and autonomy; however, in many countries it is underutilized. Studies that tested the effects of palliative care (PC) often included the rate of documented ACP as a secondary end point. We aimed to assess the contribution of PC to the rate of ACP among terminally ill patients by systematically reviewing relevant clinical trials. Method PUBMED and “Cochrane trials” databases were screened for clinical trials published until October 2017 that compared the addition of PC to standard treatment and that had ACP as a primary or a secondary end point. Studies were assessed for validity by three investigators using the Cochrane Collaboration tool and the ROBINS-I tool for randomized controlled trials (RCTs) and for cohort studies, respectively. Results Twenty-six trials with 37,924 patients were included. Four were RCTs, nine were cohort studies, and 12 were cross-sectional studies. Randomized trials had the lowest risk of bias. There was a positive correlation between the addition of PC and ACP in 25 studies, among them four randomized trials. Significance of results In this systematic review, PC was associated with improvement in the rate of ACP. Understanding the significant effect of PC on the completion of ACP is an additional emphasis on the importance of this treatment among terminally ill patients.

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End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home

Cited by 25 publications

References 37 publications

Good end-of-life care in nursing home according to the family carers’ perspective: A systematic review of qualitative findings

Good end-of-life care in nursing home according to the family carers’ perspective: A systematic review of qualitative findings

Electronic medical orders for life-sustaining treatment in New York State: Length of stay, direct costs in an ICU setting

Association between palliative care and the rate of advanced care planning: A systematic review

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