Prevalence and Contents of Advance Directives in Patients Receiving Home Parenteral Nutrition

Bui, Gloria T.; Varayil, Jithinraj Edakkanambeth; Hurt, Ryan T.; Neutzling, Kari A.; Cook, Katlyn E.; Head, Debra; Mueller, Paul S.; Swetz, Keith M.

doi:10.1177/0148607114544323

Cited by 2 publications

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References 19 publications

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“…Por ello, según recomiendan Bui y cols. (27), los pacientes recibiendo NP en su domicilio, deben ser alentados para redactar su VA que se refiera específicamente a la NP domiciliaria al final de la vida y los especialistas en nutrición que manejan a estos pacientes deben abordar las VA y como la NP Tabla III. Aceptación, rechazo o no pronunciamiento de soporte nutricional especializado e hidratación por grupos de edad domiciliaria va a afectar a la calidad de vida cuando la enfermedad del paciente empeore.…”

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Relevancia del soporte nutricional especializado en las declaraciones de voluntades anticipadas. Experiencia de un centro hospitalario de especialidades

et al. 2017

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Palabras clave:Voluntades anticipadas. Bioética. Nutrición artifi cial. Nutrición parenteral. Nutrición enteral. Soporte nutricional especializado. ResumenIntroducción: la declaración de voluntades anticipadas (DVA) es un documento que contiene las preferencias sobre los cuidados y tratamientos sanitarios que se desea recibir cuando no se tenga capacidad para expresarlos. Objetivo: estudiar el contenido de las DVA inscritas en la sede del Registro de Voluntades Anticipadas del Hospital Universitario Puerta del Mar, respecto al soporte nutricional especializado (SNE) e hidratación en el periodo de noviembre 2013 a diciembre 2015. Método: estudio transversal realizado sobre el contenido de las DVA inscritas en el modelo del Decreto 59/2012. Se estudian 9 variables de relevancia relacionadas con el SNE e hidratación en las DVA. Resultados: se analizan 414 DVA de las que el 60% corresponden a mujeres. La edad media de los declarantes es 55,2 años. El 41,7% inscribieron su DVA por automotivación. El 84,78% no desea recibir nutrición parenteral, el 91,06% rechaza la alimentación mediante tubo de gastrostomía y el 89,37% no desea recibir la sonda nasogástrica. La hidratación es rechazada por el 71,26%. Las tres posibles opciones de SNE dependen signifi cativamente de la edad del declarante (p < 0,001) pero no así la hidratación. Ambos, SNE e hidratación, sí se asociaron signifi cativamente con los motivos para inscribir las voluntades anticipadas (p < 0,001). Conclusiones: la edad es el principal factor que condiciona la opción de aceptación o rechazo de SNE. Por el contrario, la elección de la hidratación no está condicionada por la edad. Los motivos por los que se inscriben los otorgantes son otro determinante en la elección de si desean recibir o no SNE e hidratación. Key words:Advance directives. Bioethics. Artifi cial nutrition. Parenteral nutrition. Enteral nutrition. Specialized nutritional support. AbstractIntroduction: The Statement of Advance Directives (SAD) is a written document that contains the preferences for health care and treatments desired to receive when the capacity to express is lost. Objective: To study the content of SAD registered in the offi ce of Register of Advance Directives of the Hospital Universitario Puerta del Mar regarding Specialized Nutritional Support (SNS) and hydration in the period from November 2013 to December 2015. Method: Cross-sectional study on the content of the SAD written in the form of Decree 59/2012. Nine relevant variables related with SNS-H are studied in the DVA. Results: 414 SAD are analysed, 60% of which belong to women. The average age is 55.2 years. 41.7% of the SAD was registered by self-motivation. 84.78% do not wish to receive parenteral nutrition, 91.06% reject feeding through gastrostomy intubation, and 89.37% do not want to receive the nasogastric intubation. Hydration is rejected by 71.25%. The three possible options of SNS depend on the age of the declarant with statistical signifi cance (p < 0.001), but not so for hydration. Both SNE and hydration are ...

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Relevancia del soporte nutricional especializado en las declaraciones de voluntades anticipadas. Experiencia de un centro hospitalario de especialidades

et al. 2017

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Advance Directives in the Neurocritically Ill: A Systematic Review

Sutter¹,

Meyer-Zehnder

Baumann

et al. 2020

Critical Care Medicine

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Objectives: To determine the frequency of advance directives or directives disclosed by healthcare agents and their influence on decisions to withdraw/withhold life-sustaining care in neurocritically ill adults. Data Sources: PubMed, Embase, and Cochrane databases. Study Selection: Screening was performed using predefined search terms to identify studies describing directives of neurocritically ill patients from 2000 to 2019. The review was registered prior to the screening process (International Prospective Register of Systematic Reviews identification number 149185). Data Extraction: Data were collected using standardized forms. Primary outcomes were the frequency of directives and associated withholding/withdrawal of life-sustaining care. Data Synthesis: Out of 721 articles, 25 studies were included representing 35,717 patients. The number of studies and cohort sizes increased over time. A median of 39% (interquartile range, 14–72%) of patients had directives and/or healthcare agents. The presence of directives was described in patients with stroke, status epilepticus, neurodegenerative disorders, neurotrauma, and neoplasms, with stroke patients representing the largest subgroup. Directives were more frequent among patients with neurodegenerative disorders compared with patients with other illnesses (p = 0.043). In reference to directives, care was adapted in 71% of European, 50% of Asian, and 42% of American studies, and was withheld or withdrawn more frequently over time with a median of 58% (interquartile range, 39–89%). Physicians withheld resuscitation in reference to directives in a median of 24% (interquartile range, 22–70%). Conclusions: Studies regarding the use and translation of directives in neurocritically ill patients are increasing. In reference to directives, care was adapted in up to 71%, withheld or withdrawn in 58%, and resuscitation was withheld in every fourth patient, but the quality of evidence regarding their effects on critical care remains weak and the risk of bias high. The limited number of patients having directives is worrisome and studies aiming to increase the use and translation of directives are scarce. Efforts need to be made to increase the perception, use, and translation of directives of the neurocritically ill.

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Prevalence and Contents of Advance Directives in Patients Receiving Home Parenteral Nutrition

Abstract: Although almost one-third of the patients had an AD, less than half specifically mentioned HPN in it, which suggests that such patients should be encouraged to execute an AD that specifically addresses end-of-life management of HPN.

Cited by 2 publications

References 19 publications

Relevancia del soporte nutricional especializado en las declaraciones de voluntades anticipadas. Experiencia de un centro hospitalario de especialidades

Relevancia del soporte nutricional especializado en las declaraciones de voluntades anticipadas. Experiencia de un centro hospitalario de especialidades

Advance Directives in the Neurocritically Ill: A Systematic Review

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