Advance care planning for the severely ill in the hospital: a randomized trial
| Autor: | I Karzig, Ana Budilivschi, Christine Mitchell, Fabio Valeri, Tanja Krones, Theodore Otto, Barbara Loupatatzis, Nikola Biller-Andorno |
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| Přispěvatelé: | University of Zurich, Krones, Tanja |
| Rok vydání: | 2019 |
| Předmět: |
11035 Institute of General Practice
Advance care planning Resuscitation medicine.medical_specialty Medicine (miscellaneous) 610 Medicine & health Intervention group 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Primary outcome Randomized controlled trial law Intervention (counseling) medicine 030212 general & internal medicine Oncology (nursing) business.industry 2701 Medicine (miscellaneous) General Medicine After discharge University hospital Medical–Surgical Nursing Emergency medicine 10222 Institute of Biomedical Ethics and History of Medicine 2917 Oncology (nursing) business 2914 Medical and Surgical Nursing |
| Zdroj: | BMJ Support & Palliative Care, 12 (3) |
| ISSN: | 2045-4368 2045-435X |
| DOI: | 10.1136/bmjspcare-2017-001489 |
| Popis: | Objectives To investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients. Methods Single-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded. 115 competent severely ill adults, their surrogates and their attending physicians were enrolled and followed for 6 months after discharge or 3 months after death. The patient’s wishes regarding resuscitation (primary outcome), last place of care and other end-of-life wishes were recorded. Knowledge and respect of the patient’s wishes by the surrogates and attending physician were monitored. Results Compared with controls, 6 months after the intervention, fewer patients wished to be resuscitated or were undecided (p=0.01), resuscitation wishes were documented more frequently (89% vs 64%, p=0.02) and surrogates and/or attending physicians had greater knowledge of the patient’s wishes (62% vs 30%, p=0.01). Groups were not different with regard to wishes being fulfilled, with the exception of last place of care being achieved more frequently in the intervention group (29% vs 11 %, p=0.05). Conclusion ACP including decision aids offered to severely ill medical inpatients leads to greater knowledge, documentation and respect of treatment and end-of-life wishes. Introducing ACP to these patients however may be too late for many patients. Early integration of ACP during the illness trajectory and a broader regional approach may be more appropriate. BMJ Support & Palliative Care, 12 (3) ISSN:2045-435X |
| Databáze: | OpenAIRE |
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