Occurrence of Advance Care Planning and Hospital Course in Patients Admitted for Coronavirus Disease 2019 (COVID-19) During the Pandemic.

Autor:	Statler TM; Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA., Hsu FC; Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA., Silla L; Department of Neurology, University of Utah Health, Salt Lake City, UT, USA., Sheehan KN; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA., Cowles A; Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA., Brooten JK; Department of Internal Medicine, Section on Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.; Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA., Omlor RL; Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA., Gabbard J; Department of Internal Medicine, Section on Gerontology & Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Jazyk:	angličtina
Zdroj:	The American journal of hospice & palliative care [Am J Hosp Palliat Care] 2023 Jun; Vol. 40 (6), pp. 669-676. Date of Electronic Publication: 2022 Aug 26.
DOI:	10.1177/10499091221123570
Abstrakt:	Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic highlighted the importance of understanding patients' goals, values, and medical care preferences given the high morbidity and mortality. We aimed to examine rates of advance care planning (ACP) documentation along with hospital course differences in the absence or presence of ACP among hospitalized patients with COVID-19. Methods: This retrospective cohort study was performed at a single tertiary academic medical center. All adults admitted between March 1, 2020, and June 30, 2020, for COVID-19 were included. Demographics, ACP documentation rates, presence of ACP forms, palliative care consultation (PCC) rates, code status, and hospital outcome data were collected. Data were analyzed with multivariable analysis to identify predictors of ACP documentation. Results: Among 356 patients (mean age 60.0, 153 (43%) female), 97 (27.2%) had documented ACP and 20 (5.6%) had completed ACP forms. In patients with documented ACP, 52.4% (n = 55) de-escalated care to do-not-resuscitate (DNR)-limited or comfort measures. PCC occurred rarely (<8%), but 78% (n = 21) of those consulted de-escalated care. Being admitted to the intensive care unit (ICU) (OR = 11.1, 95% CI = 5.9-21.1), mechanical intubation (OR = 15.8, 95% CI = 7.4-32.1), and discharge location other than home (OR = 11.3, 95% CI = 5.7-22.7) were associated with ACP documentation. Conclusions: This study found low ACP documentation and PCC rates in patients admitted for COVID-19. PCC and completion of ACP were associated with higher rates of care de-escalation. These results support the need for pro-active ACP and PCC for patients admitted for serious illnesses, like COVID-19, to improve goal-informed care.
Databáze:	MEDLINE
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