Differences in Code Status and End-of-Life Decision Making in Patients With Limited English Proficiency in the Intensive Care Unit

Barwise, Amelia; Jaramillo, Carolina; Novotny, Paul J.; Wieland, Mark L.; Gajic, Ognjen; Wilson, Michael E.

doi:10.1016/j.mayocp.2018.04.021

Cited by 47 publications

(49 citation statements)

References 45 publications

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“…There is a growing body of literature that underscores the importance of ethnic, racial, religious, and language barriers in decision-making at the end of life. [1][2][3][4][5][6][7] These factors have been previously studied as predictors and moderators of various aspects of care, including advance care planning, receiving comfort care, and resuscitation preferences. Although low SES has been noted to negatively affect access to care, quality of care, and potentially, health-care outcomes, its role in end-of-life decision-making and care has not been extensively studied, and there is no consensus about its role or importance.…”

Section: Introductionmentioning

confidence: 99%

An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

Barwise

Juhn

et al. 2018

Am J Hosp Palliat Care

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Background: Socioeconomic status (SES) is an important determinant of disparities in health care and may play a role in end-of-life care and decision-making. The SES is difficult to retrospectively abstract from current electronic medical records and data sets. Objective: Using a validated SES measuring tool derived from home address, the HOUsing-based SocioEconomic Status index, termed HOUSES we wanted to determine whether SES is associated with differences in end-of-life care and decision-making. Design/Setting/Participants: This cross-sectional study utilized a cohort of Olmsted County adult residents admitted to 7 intensive care units (ICUs) at Mayo Rochester between June 1, 2011, and May 31, 2014. Measurements: Multiple variables that reflect decision-making and care at end of life and during critical illness were evaluated, including presence of advance directives and discharge disposition. The SES was measured by individual housing-based SES index (HOUSES index; a composite index derived from real property as a standardized z-score) at the date of admission to the ICU which was then divided into 4 quartiles. The greater HOUSES, the higher SES, outcomes were adjusted for age, 24-hour Acute Physiology and Chronic Health Evaluation III score, sex, race/ethnicity, and insurance. Results: Among the eligible 4134 participants, the addresses of 3393 (82%) were successfully geocoded and formulated into HOUSES. The adjusted odds ratios comparing HOUSES 1 versus 2, 3, and 4 demonstrated lower likelihood of advance directives −0.77(95% CI: 0.63-0.93) and lower likelihood of discharge to home −0.60(95% CI: 1.0.5-0.72). Conclusion: Lower SES, derived from a composite index of housing attributes, was associated with lower rates of advance directives and lower likelihood of discharge to home.

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Section: Introductionmentioning

confidence: 99%

An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

Barwise

Juhn

et al. 2018

Am J Hosp Palliat Care

Self Cite

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“…Hispanics are less likely than non-Hispanic whites to complete an advanced directive and to have discussions with family members and health care professionals about the type of care they want to receive at the (26). This disparity may be due to several factors including a lack of awareness about advanced care resources (26), language barriers and low health literacy (7,27), disagreement about prognosis and care goals between family members or with clinicians (28), and distrust in the medical system because of negative past experiences (29). The critical role of family in EOL care decision making among Hispanics suggests there is a need for more culturally competent health policies and patient-centered education that facilitate patient and family decision making (5).…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer’s Disease and Related Dementias

Nguyen¹,

Downer²,

Chou

et al. 2019

The Journals of Gerontology: Series A

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Background Little is known about the patterns of end-of-life health care for older Mexican Americans with or without a diagnosis of Alzheimer’s disease and related dementias (ADRD). Our objective was to investigate the frequency of acute hospital admissions, intensive care unit use, and ventilator use during the last 30 days of life for deceased older Mexican American Medicare beneficiaries with and without an ADRD diagnosis. Methods We used Medicare claims data linked with survey information from 1,090 participants (mean age of death 85.1 years) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly. Multivariable logistic regression models were used to estimate the odds for hospitalization, intensive care unit use, and ventilator use in the last 30 days of life for decedents with ADRD than those without ADRD. Generalized linear models were used to estimate the risk ratio (RR) for length of stay in hospital. Results Within the last 30 days of life, 64.5% decedents had an acute hospitalization (59.1% ADRD, 68.3% no ADRD), 33.9% had an intensive care unit stay (31.3% ADRD, 35.8% no ADRD), and 17.2% used a ventilator (14.9% ADRD, 18.8% no ADRD). ADRD was associated with significantly lower hospitalizations (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.50–0.89) and shorter length of stay in hospital (RR = 0.77, 95% CI = 0.65–0.90). Conclusion Hospitalization, intensive care unit stay, and ventilator use are common at the end of life for older Mexican Americans. The lower hospitalization and shorter length of stay in hospital of decedents with ADRD indicate a modest reduction in acute care use. Future research should investigate the impact of end-of-life planning on acute-care use and quality of life in terminally ill Mexican American older adults.

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“…A study from 2018 of decedents in one hospital found that it took an average of 19 days longer for patients with limited English proficiency to transition to care focused on comfort compared with English-speaking patients after adjusting for differences in education and insurance status. 34 These challenges make it difficult to forecast how communication interventions might affect care in ICUs serving diverse or disadvantaged populations. Fourth, randomisation levels vary and blinding is nearly impossible in clinical trials of communication interventions.…”

Section: Challenges In the Design And Interpretation Of Icu Communicamentioning

confidence: 99%

Aligning use of intensive care with patient values in the USA: past, present, and future

Turnbull

Bosslet

Kross

2019

The Lancet Respiratory Medicine

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For more than three decades, both medical professionals and the public have worried that many patients receive non-beneficial care in US intensive care units during their final months of life. Some of these patients wish to avoid severe cognitive and physical impairments, and protracted deaths in the hospital setting. Recognising when intensive care will not restore a person’s health, and helping patients and families embrace goals related to symptom relief, interpersonal connection, or spiritual fulfilment are central challenges of critical care practice in the USA. We review trials from the past decade of interventions designed to address these challenges, and present reasons why evaluating, comparing, and implementing these interventions have been difficult. Careful scrutiny of the design and interpretation of past trials can show why improving goal concordant care has been so elusive, and suggest new directions for the next generation of research.

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Differences in Code Status and End-of-Life Decision Making in Patients With Limited English Proficiency in the Intensive Care Unit

Abstract: There are important differences in end-of-life care and decision making for patients with LEP.

Cited by 47 publications

References 45 publications

An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer’s Disease and Related Dementias

Aligning use of intensive care with patient values in the USA: past, present, and future

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