Patient Participation and Associated Factors in the Discussions on Do-Not-Attempt-Resuscitation and End-of-Life Disclosure: A Retrospective Chart Review Study
| Autor: | Masato Kobayashi, Daisuke Fujisawa, Takashi Kohno, Saori Hashiguchi, Mari Takeuchi, Akiko Abe, Masaru Mimura |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Advance care planning medicine.medical_specialty Resuscitation Time Factors Palliative care medicine.medical_treatment Respiratory Tract Diseases lcsh:Special situations and conditions Disclosure Do-not-attempt-resuscitation (DNAR) orders 03 medical and health sciences Sex Factors 0302 clinical medicine Residence Characteristics End-of-life discussion Neoplasms Odds Ratio medicine Humans 030212 general & internal medicine Cardiopulmonary resuscitation Patient participation Aged Resuscitation Orders Cardiopulmonary resuscitation (CPR) Aged 80 and over Terminal Care business.industry Liver Diseases Mental Disorders lcsh:RC952-1245 General Medicine Odds ratio Middle Aged Mental illness medicine.disease Confidence interval Cerebrovascular Disorders Cardiovascular Diseases 030220 oncology & carcinogenesis Family medicine Female business Research Article |
| Zdroj: | BMC Palliative Care, Vol 20, Iss 1, Pp 1-10 (2021) BMC Palliative Care |
| DOI: | 10.21203/rs.3.rs-90726/v1 |
| Popis: | Background Patient participation is a key foundation of advance care planning (ACP). However, a patient himself/herself may be left out from sensitive conversations such as end-of-life (EOL) care discussions. The objectives of this study were to investigate patients’ participation rate in the discussion of Cardiopulmonary Resuscitation (CPR) / Do-Not-Attempt-Resuscitation (DNAR) order, and in the discussion that the patient is at his/her EOL stage (EOL disclosure), and to explore their associated factors. Methods This is a retrospective chart review study. The participants were all the patients who were hospitalized and died in a university-affiliated teaching hospital (tertiary medical facility) in central Tokyo, Japan during the period from April 2018 to March 2019. The following patients were excluded: (1) cardiopulmonary arrest on arrival; (2) stillbirth; (3) under 18 years old at the time of death; and (4) refusal by their bereaved family. Presence or absence of CPR/DNAR discussion and EOL disclosure, patients’ involvement in those discussions, and their associated factors were investigated. Results CPR/DNAR discussions were observed in 336 out of the 358 patients (93.9%). However, 224 of these discussions were carried out without a patient (patient participation rate 33.3%). Male gender (odds ratio (OR) = 2.37 [95% confidence interval (CI) 1.32–4.25]), living alone (OR = 2.51 [1.34–4.71]), and 1 year or more from the date of diagnosis (OR = 1.78 [1.03–3.10]) were associated with higher patient’s participation in CPR/DNAR discussions. The EOL disclosure was observed in 341 out of the 358 patients (95.3%). However, 170 of the discussions were carried out without the patient (patient participation rate 50.1%). Patients who died of cancer (OR = 2.41[1.45–4.03]) and patients without mental illness (OR=2.41 [1.11–5.25]) were more likely to participate in EOL disclosure. Conclusions In this clinical sample, only up to half of the patients participated in CPR/DNAR discussions and EOL disclosure. Female, living with family, a shorter period from the diagnosis, non-cancer, and mental illness presence are risk factors for lack of patients’ participation in CPR/DNAR or EOL discussions. Further attempts to facilitate patients’ participation, based on their preference, are warranted. |
| Databáze: | OpenAIRE |
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