Advance Directives and Powers of Attorney in Intensive Care Patients

Heer, Geraldine de; Saugel, Bernd; Sensen, Barbara; Rübsteck, Charlotte; Pinnschmidt, Hans O.; Kluge, Stefan

doi:10.3238/arztebl.2017.0363

Cited by 36 publications

(42 citation statements)

References 27 publications

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“…Statements made by small or underrepresented stakeholder groups might not get attention in expert panels, as the focus might be dominated by the strongest stakeholder group in the panel. These results might be an explanation for the influence that the selection of the experts plays in Delphi studies [13]. The main limitation of this study is the small number of participants.…”

Section: Discussionmentioning

confidence: 84%

“…The participants in the survey rounds are experts selected by the science or monitoring team. The definition of an expert in a certain area is subjective and finding the consensus can be influenced by the selection of the experts or the number of iterative rounds in the study [13].…”

Section: Methodsmentioning

confidence: 99%

“…Only 23% of these were integrated in the digital health records of the hospital. In conclusion, out of 998 patients 8.5% empowered the health care professionals to decide in their interest in case of an emergency [13]. The topic of end-oflife health information is a topic needed to be solved, because the current situation is insufficient, for example documents already created do not reach the decision maker.…”

mentioning

confidence: 99%

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360-Degree Delphi: addressing sociotechnical challenges of healthcare IT

Waldmueller

Spreckelsen

Rudat

et al. 2020

Preprint

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This approach uses the strong advantages a Delhi study has, identifies the disadvantages of traditional Delphi techniques and aims to introduce and evaluate a modified approach called 360-Degree Delphi. Key aspects of 360-Degree Delphi are tested by applying the approach to the needs and requirements analysis of a system for managing patients’ advance directives and living wills. 360-Degree Delphi, as a modified Delphi process, is specified as a structured workflow with the optional use of stakeholder groups. Consensus is created within individual stakeholder groups, but is also communicated between groups, while the iterative structure of the Delphi process remains unchanged. We hypothesize that (1) 360-Degree Delphi yields complementary statements from different stakeholders, which would be lost in classical Delphi; while (2) the variation of statements within individual stakeholder groups is lower than within the total collective. A user study is performed that addresses five stakeholder groups (patients, relatives, medical doctors, nurses and software developers) on the topic of living will communication in an emergency context. About 25% of the invited experts (stakeholders) agreed to take part in the Delphi round 0 (three patients, two relatives, three medical doctors, two qualified nurses and three developers), forming a structured panel of the five stakeholder groups. Two raters created a bottom-up coding, and 238 thematic codes were identified by the qualitative text analysis. Based on a consented coding list, a quantitative online-questionnaire was developed and send to different stakeholder groups. With respect to the hypotheses, Delphi round 0 had the following results: (1) doctors had a completely different focus from all the other stakeholder groups on possible channels of communications with the patient; (2) the dispersion of codes within individual stakeholder groups and within the total collective was approximately 28% higher in the total collective than in the sub-collectives, but without a marked effect size. With respect to the hypotheses, Delphi round 1 had the following results: different stakeholder groups had highly diverging opinions with respect to central questions on IT-development. In comparison, the total group would not be representative of either of these individual stakeholder needs (mean 4.344, stdev +/- 1.870)

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Section: Discussionmentioning

confidence: 84%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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360-Degree Delphi: addressing sociotechnical challenges of healthcare IT

Waldmueller

Spreckelsen

Rudat

et al. 2020

Preprint

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“…Intensivpatient eines Universitätsklinikums eine Vorsorgevollmacht oder eine Patientenverfügung aufweise und 39 % der Befragten ohne Dokument sich noch nie Gedanken über diese Thematik gemacht hätten. Bei 40 % der Vorsorgevollmachten sowie 44 % der Patientenverfügungen lagen unvollständig ausgefüllte Dokumente vor, die nur schwer oder gar nicht interpretierbar waren [1]. Leder et al zeigten in ihrer Befragung von Ärzten und Angehörigen auf Intensivstationen, dass die Anwendbarkeit der vorgelegten Patientenverfügungen auf die gegebene Akutsituation von Angehörigen und Ärzten, aber auch von Ober-und Assistenzärzten höchst unterschiedlich bewertet wurde und die Verfügungen somit als für die intensivmedizinische Situation ungeeignet anzusehen waren [2].…”

Section: Introductionunclassified

Behandlung im Voraus planen – Bedeutung für die Intensiv- und Notfallmedizin

Nauck¹,

Marckmann²,

Schmitten³

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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Like in other countries, advance care planning (ACP) is currently being implemented in Germany as a new concept to realise valid and effective advance directives. This concept comprises processes to explore and document individual preferences for future treatment, and to honour them at a time when the person is incapacitated. ACP aims to ensure that patients will be treated according to their preferences when they are no longer capable due to acute health crises or chronic diseases. This paper gives an overview of the concept of ACP with a focus on relevant issues for emergency and intensive care medicine.

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“…Auch wenn mittlerweile mehr Menschen in Deutschland eine Patientenverfügung verfassen und damit ihren Willen vorausverfügen, sind diese Schriftstücke häufig nicht griffbereit, nicht eindeutig und für notfall-oder intensivmedizinische Entscheidungen ungeeignet. Sie können ein Gespräch mit den Angehörigen (oder Ärzten) auch keineswegs ersetzen [30]. Kommunikationsbarrieren bei Patienten und Angehörigen beeinflussen nicht nur die familiäre Gesprächskultur, sondern auch Gespräche mit medizinischen Ansprechpartnern.…”

Section: Spezifische Untersuchungen In Der Intensivmedizin Geben Hinwunclassified