TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life<b>—</b>The Realistic Interpretation of Advance Directives

Mirarchi, Ferdinando L.; Juhasz, Kristin; Cooney, Timothy E.; Desiderio, Daniel

doi:10.1002/jhrm.21453

Cited by 3 publications

(3 citation statements)

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“…Health care providers and legal professionals expected to assist patients with living wills and those who are responsible for their interpretation could be required to complete specific training at the time of licensure, and also be enrolled in mandatory continuing education. Simulation has been shown to be especially effective, at least in theoretical studies, 45 and should be incorporated into such a curriculum. Such educational interventions have been effective in theoretical studies.…”

Section: Discussionmentioning

confidence: 99%

The living will: Patients should be informed of the risks

Kurin

Mirarchi

2021

J of Healthc Risk Manag

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Living wills are designed to ensure that patients’ preferences will be respected at the end of life should they lose capacity to make decisions. However, data on living will use suggest there are barriers to achieving this objective. Moreover, there is evidence that completion of a living will creates a risk of an unwanted outcome: the potential for premature withdrawal of interventions. We suggest a multifaceted approach to improve the ability of living wills to achieve their goals. However, acknowledgment of the current reality should oblige providers offering a living will to their patients to present a balanced view of living wills that includes enumeration of the risk, barriers to achieving the purported benefits, and alternatives to completing a living will, in addition to discussion of the potential benefits. This requires a change in current practice that would encourage shared decision making regarding whether completing a living will or other type of advance directive is desired by the patient and discourage the proliferation of living wills completed without providing these important advantages and disadvantages to the patient.

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Section: Discussionmentioning

confidence: 99%

The living will: Patients should be informed of the risks

Kurin

Mirarchi

2021

J of Healthc Risk Manag

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“…Still, it remains an important question when it comes to end-oflife decision making. Especially when it is not possible to ask patients about their preferred treatment anymore and since there are many types of advance directives that differ greatly in their content and their approach on preserving the patients' autonomy [30][31][32][33]. And yet, there is no established validation process or outcome measurement that shows that the advance directive indeed reflects the patients' wishes and values and is correctly understood by health care providers.…”

Section: Integration Into Current Researchmentioning

confidence: 99%

“SpezPat”- common advance directives versus disease-centred advance directives: a randomised controlled pilot study on the impact on physicians’ understanding of non-small cell lung cancer patients’ end-of-life decisions

Koenig

Asendorf

Simon³

et al. 2022

BMC Palliat Care

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Background The advance directive represents patients’ health care choices and fosters patients’ autonomy. Nevertheless, understanding patients’ wishes based on the information provided in advance directives remains a challenge for health care providers. Based on the ethical premises of positive obligation to autonomy, an advanced directive that is disease-centred and details potential problems and complications of the disease should help health care providers correctly understand patients’ wishes. To test this hypothesis, a pilot-study was conducted to investigate whether physicians could make the correct end-of-life decision for their patients when patients used a disease-centred advance directive compared to a common advance directive. Material and methods A randomised, controlled, prospective pilot study was designed that included patients with non-small cell lung cancer (NSCLC) stage VI from the Department of Haematology and Medical Oncology, University Medical Centre, Goettingen. Patients were randomised into intervention and control groups. The control group received a common advance directive, and the intervention group received a disease-centred advance directive. Both groups filled out their advance directives and returned them. Subsequently, patients were asked to complete nine medical scenarios with different treatment decisions. For each scenario the patients had to decide whether they wanted to receive treatment on a 5-point Likert scale. Four physicians were given the same scenarios and asked to decide on the treatment according to the patients’ wishes as stated in their advance directives. The answers by patients and physicians were then compared to establish whether physicians had made the correct assumptions. Results Recruitment was stopped prior to reaching anticipated sample target. 15 patients with stage IV NSCLC completed the study, 9 patients were randomised into the control group and 6 patients in the intervention group. A total of 135 decisions were evaluated. The concordance between physicians’ and patients’ answers, was 0.83 (95%-CI 0.71–0.91) in the intervention group, compared to 0.60 (95%-CI 0.48–0.70) in the control group, and the difference between the two groups was statistically significant (p = 0.005). Conclusion This pilot study shows that disease-centred advance directives help physicians understand their NSCLC patients’ wishes more precisely and make treatment choices according to these wishes. Trial registration The study is registered at the German Clinical Trial Register (no. DRKS00017580, registration date 27/08/2019).

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“…Still, it remains an important question when it comes to end of life decision making, especially when it is not possible anymore to ask patients about their preferred treatment. Especially as there are many types of advance directives that differ greatly in their content and their approach on preserving the patients' autonomy [22][23][24][25] . Yet there is no validation process that shows that the advance directive indeed re ects the patients' wishes and values and is correctly understood by health care providers.…”

Section: Integration Into Current Researchmentioning

confidence: 99%

“SpezPat”- common advance directives versus disease-centred advance directives: a randomised controlled pilot study on the impact in physicians’ understanding of patients’ end-of- life decisions

Koenig

Asendorf

Simon

et al. 2022

Preprint

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Background: The advance directive holds patients’ health care choices and fosters the patients’ autonomy. Nevertheless, understanding the patients’ wishes based on the information provided in advance directives, remains a challenge for health care providers. Based on the ethical premises of positive obligation to autonomy, an advanced directive that is disease-centred and features problems and complications of the disease the patient has, should help the health care providers to understand the patients’ wishes correctly. To test this hypothesis, a pilot-study was conducted to compare if physicians could make the correct end-of-life decision for their patients when patients used a disease-centred advance directive versus a common advance directive.Material and Methods: A randomised, controlled, prospective pilot study was designed, that included patients with NSCLC stage VI from the Department of Haematology and Medical Oncology, University Medical Centre, Goettingen. Patients were randomised into intervention and control groups. The control group received a common advance directive and the intervention group a disease-centred advance directive. Both groups filled out their advance directives and returned it. Subsequent, patients were asked to complete nine medical scenarios with different treatment decisions. For each scenario the patients had to decide whether they wanted to receive treatment on a 5-point-Likert scale. Four physicians were given the same scenarios and asked to decide on the treatment, according to the patients’ wishes as stated in the advance directive. The answers by patients and physicians were compared whether the physicians had made the correct assumptions.Results: Recruitment was stopped prematurely. 15 patients completed the study, 9 patients were randomised into the control group and 6 patients in the intervention group. A total of 135 decisions were evaluated. Concordance of physicians’ and patient’s answers, was 0.83 (95%-CI 0.71-0.91) in the intervention group, compared to 0.60 (95%-CI 0.48-0.70) in the control group and the difference between the two groups was statistically significant (p=0.005).Conclusions: This pilot study showed that disease-centred advance directives help physicians to understand their patients’ wishes more precisely and make treatment choices according to their wishes. Trial registration: The study is registered at the German Clinical Trial Register (no. DRKS00017580, registration date 27/08/2019)

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TRIAD XI: Utilizing simulation to evaluate the living will and POLST ability to achieve goal concordant care when critically ill or at end‐of‐life—The Realistic Interpretation of Advance Directives

Cited by 3 publications

References 25 publications

The living will: Patients should be informed of the risks

The living will: Patients should be informed of the risks

“SpezPat”- common advance directives versus disease-centred advance directives: a randomised controlled pilot study on the impact on physicians’ understanding of non-small cell lung cancer patients’ end-of-life decisions

“SpezPat”- common advance directives versus disease-centred advance directives: a randomised controlled pilot study on the impact in physicians’ understanding of patients’ end-of- life decisions

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