Factors associated with treatment restriction orders and hospice in older nursing home residents

Lu, Chu-Yun; Johantgen, Meg

doi:10.1111/j.1365-2702.2010.03346.x

Cited by 19 publications

(14 citation statements)

References 46 publications

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“…Our respondents similarly reported discomfort and a lack of confidence around discussions, especially for younger staff, and they often mentioned that it was unclear whose role it was to initiate discussions. Our findings further support those of a recent mixed-methods, anonymous online questionnaire of 1,040 multi-specialty trainees caring for seriously ill patients in the USA health system (Periyakoil, Neri, & Kraemer, 2015) frequently report a greater preference for life-prolonging measures (Ohr, Jeong, & Saul, 2017) which contrasts with some from Caucasian backgrounds who are more likely to have do-not-resuscitate and do-not-hospitalise orders (Lu & Johantgen, 2011). Chinese communities prefer shared family decision making over more autonomous decision making as espoused by Western cultures (Bellamy & Gott, 2013).…”

Section: Discussionsupporting

confidence: 86%

Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

Trankle

Shanmugam

Lewis

et al. 2018

Health Communication

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Initiating end-of-life discussions with patients is often delayed or avoided altogether by health care practitioners even in light of imminent death. This continues despite the availability of guidelines and conceptual frameworks on how to communicate prognoses at end-of-life. We surveyed health care practitioners to elicit their exposure to and confidence in end-of-life discussions and to better understand factors that enable or challenge the initiation of discussions in Australian health care settings. Thematic analysis identified that end-of-life discussions could be emotionally burdensome for health care practitioners but were regarded as valuable. Effective communications were challenged by conflict with families and between health care practitioners as to appropriate care goal transition, and by prognostic uncertainty. Communication skills appeared to be developed more from experience, and beneficial strategies such as role-play and mentoring particularly for younger nurses and doctors were identified. Specific training in end-of-life communications should target undergraduates and new health care practitioners 3

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Section: Discussionsupporting

confidence: 86%

Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

Trankle

Shanmugam

Lewis

et al. 2018

Health Communication

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“…Moreover, these groups of patients are less likely to be Full Code, as are female patients; these latter findings are consistent with results from prior studies (3, 24, 25). Our results also demonstrate that a little over a third of patients have previously discussed ADs with their physicians.…”

Section: Discussionsupporting

confidence: 91%

Use of a standardized code status explanation by residents among hospitalized patients

Mittal

Sharma

Dangayach

et al. 2014

Journal of Community Hospital Internal Medicine Perspectives

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ObjectivesThere is wide variability in the discussion of code status by residents among hospitalized patients. The primary objective of this study was to determine the effect of a scripted code status explanation on patient understanding of choices pertaining to code status and end-of-life care.MethodsThis was a single center, randomized trial in a teaching hospital. Patients were randomized to a control (questionnaire alone) or intervention arm (standardized explanation+ questionnaire). A composite score was generated based on patient responses to assess comprehension.ResultsThe composite score was 5.27 in the intervention compared to 4.93 in the control arm (p=0.066). The score was lower in older patients (p<0.001), patients with multiple comorbidities (p≤0.001), KATZ score <6 (p=0.008), and those living in an assisted living/nursing home (p=0.005). There were significant differences in patient understanding of the ability to receive chest compressions, intravenous fluids, and tube feeds by code status.ConclusionThe scripted code status explanation did not significantly impact the composite score. Age, comorbidities, performance status, and type of residence demonstrated a significant association with patient understanding of code status choices.Practice implicationsStandardized discussion of code status and training in communication of end-of-life care merit further research.

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“…The predictors of a DNR order include older age [ 9 , 10 ], a cancer diagnosis or poor prognosis [ 10 ], poor health condition [ 9 ], poor activities of daily living [ 10 ], terminal illness with pain symptoms [ 11 ], and awareness of prognosis and the survival time following CPR [ 12 ]. A study used scenarios with various conditions, and the results showed that patients tended to accept a DNR order under the conditions with older age, pain symptoms, and dementia; and for incurable conditions, better quality of life was an important consideration of DNR [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Allow natural death versus do-not-resuscitate: titles, information contents, outcomes, and the considerations related to do-not-resuscitate decision

2018

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BackgroundAs the “do not resuscitate” (DNR) discussion involves communication, this study explored (1) the effects of a title that included “allow natural death”, and of information contents and outcomes of the decision; and (2) the information needs and consideration of the DNR decision, and benefits and barriers of the DNR discussion.MethodsHealthy adults (n = 524) were presented with a scenario with different titles, information contents, and outcomes, and they rated the probability of a DNR decision. A questionnaire including information needs, consideration of the decision, and benefits and barriers of DNR discussion was also used.ResultsThere was a significantly higher probability of signing the DNR order when the title included “allow natural death” (t = − 4.51, p < 0.001), when comprehensive information was provided (F = 60.64, p < 0.001), and when there were worse outcomes (F = 292.16, p < 0.001). Common information needs included remaining life period and the prognosis. Common barriers were the families’ worries and uncertainty about future physical changes.ConclusionThe title, information contents, and outcomes may influence the DNR decisions. Health-care providers should address the concept of natural death, provide comprehensive information, and help patients and families to overcome the barriers.

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Factors associated with treatment restriction orders and hospice in older nursing home residents

Cited by 19 publications

References 46 publications

Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

Use of a standardized code status explanation by residents among hospitalized patients

Allow natural death versus do-not-resuscitate: titles, information contents, outcomes, and the considerations related to do-not-resuscitate decision

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