End-of-Life Decision-Making in the Hospital

Fins, Joseph J.; Miller, Franklin G.; Acres, Cathleen A.; Bacchetta, Matthew; Huzzard, Lynn L.; Rapkin, Bruce D.

doi:10.1016/s0885-3924(98)00109-2

Cited by 114 publications

(8 citation statements)

References 22 publications

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“…A second limitation is that the chart abstraction was conducted by a single reviewer without inter-rater assessment, although the abstraction tool was modified from a well-established tool. 24 A third limitation is that all of the patients were from a single academic center and the results may not generalize to other regions. Fourth, we did not assess for the potential effect of individual clinicians.…”

Section: Discussionmentioning

confidence: 99%

Opportunity lost: End‐of‐life discussions in cancer patients who die in the hospital

Zaros

Curtis

Silveira

et al. 2012

Journal of Hospital Medicine

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BACKGROUND End-of-life discussions are associated with decreased use of life-sustaining treatments in patients dying of cancer in the outpatient setting, but little is known about discussions that take place during terminal hospitalizations. OBJECTIVES To determine the proportion of patients assessed by the clinical team to have decisional capacity on admission, how many of these patients participated or had a surrogate participate in a discussion about end-of-life care, and whether patient participation was associated with treatments received. DESIGN Retrospective review. SETTING Inpatient. PATIENTS Adult patients with advanced cancer who died in the hospital between January 1, 2004 and December 31, 2007. RESULTS Of the 145 inpatients meeting inclusion criteria, 115 patients (79%) were documented to have decisional capacity on admission. Among these patients, 46 (40%) were documented to lose decisional capacity prior to an end-of-life discussion and had the discussion held instead by a surrogate. Patients who had surrogate participation in the end-of-life discussions were more likely to receive mechanical ventilation (56.5% vs 23.2%, P < 0.01), artificial nutrition (45.7% vs 25.0%, P = 0.03), chemotherapy (39.1% vs 5.4%, P <0.01), and intensive care unit (ICU) treatment (56.5% vs 23.2%, P <0.01) compared to patients who participated in discussions. There was no difference between palliative treatments received. CONCLUSION The majority of patients with advanced cancer are considered to have decisional capacity at the time of their terminal hospitalization. Many lose decisional capacity before having an end-of-life discussion and have surrogate decision-makers participate in these discussions. These patients received more aggressive life-sustaining treatments prior to death and represent a missed opportunity to improve end-of-life care.

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Section: Discussionmentioning

confidence: 99%

Opportunity lost: End‐of‐life discussions in cancer patients who die in the hospital

Zaros

Curtis

Silveira

et al. 2012

Journal of Hospital Medicine

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“…Several authors have already noted that in an acute care hospital, such therapeutic interventions, considered as comfort care, were continued for the majority of dying patients [26,29,30]. However, as these studies were retrospective charts reviews, the detailed reasons for the therapeutic procedures could not be clearly determined.…”

Section: Discussionmentioning

confidence: 99%

Palliative inpatients in general hospitals: a one day observational study in Belgium

et al. 2011

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BackgroundHospital care plays a major role at the end-of-life. But little is known about the overall size and characteristics of the palliative inpatient population. The aim of our study was to analyse these aspects.MethodsWe conducted a one-day observational study in 14 randomly selected Belgian hospitals. Patients who met the definition of palliative patients were identified as palliative. Then, information about their socio-demographic characteristics, diagnoses, prognosis, and care plan were recorded and analysed.ResultsThere were 2639 in-patients on the day of the study; 9.4% of them were identified as "palliative". The mean age of the group was 72 years. The primary diagnosis was cancer in 51% of patients and the estimated life expectancy was shorter than 3 months in 33% of patients and longer than 1 year in 28% of patients. The professional caregivers expected for most of the patients (73%), that the treatment would improve patient comfort rather than prolong life. Antibiotics, transfusions, treatments specific to the pathology, and artificial nutrition were administered in 90%, 78%, 57% and 50% of the patients, respectively, but were generally given with a view to controlling the symptoms.ConclusionsThis analysis presents a first national estimate of the palliative inpatient population. Our results confirm that hospitals play a major role at the end-of-life, with one out of ten inpatients identified as a "palliative" patient. These data also demonstrate the complexity of the palliative population and the substantial diversity of care that they can require.

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“…nally ill patients [7][8][9][10][11][12][13][14], the results of which are summarized in table 1. In most studies, a significant proportion of terminally ill patients continued to receive antibiotics, which is consistent with the view that physicians may find the administration of these drugs "routine" and less subject to either withdrawal or withholding.…”

Section: Ethical Principlesmentioning

confidence: 99%

Ethical Issues Relating to the Use of Antimicrobial Therapy in Older Adults

Marcus¹,

Clarfield

Moses

2001

CLIN INFECT DIS

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This article aims to review the literature relating to the ethics of antibiotic prescription decisions in older adults and to offer some suggestions as to how one might approach these difficult problems. According to many studies, most patients and their family members wish to receive antibiotics even when they are terminally ill or suffering from advanced dementia. Health care professionals are also frequently reluctant to deny the use of antibiotics in such situations. We suggest that the difficult decisions regarding whether one should withhold treatment can be based on consideration of the ethical principles of autonomy, beneficence, nonmaleficence, and justice. From the public health point of view, one should also take into account the need to avoid the emergence of antimicrobial resistance, keeping in mind the balance between the benefit to the specific patient and the cost to future patients. Infectious diseases consultants should actively participate in these ethical dilemmas.

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End-of-Life Decision-Making in the Hospital

Cited by 114 publications

References 22 publications

Opportunity lost: End‐of‐life discussions in cancer patients who die in the hospital

Opportunity lost: End‐of‐life discussions in cancer patients who die in the hospital

Palliative inpatients in general hospitals: a one day observational study in Belgium

Ethical Issues Relating to the Use of Antimicrobial Therapy in Older Adults

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