An Exploratory Study of Goals of Care Conversations Initiated with Seriously Ill Veterans in the Emergency Room
| Autor: | Mary Beth Foglia, Jennifer H. Cohen, Adam Batten, David Alfandre |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Palliative care medicine.medical_treatment Exploratory research Disease Patient Care Planning 03 medical and health sciences 0302 clinical medicine 030502 gerontology medicine Humans Cardiopulmonary resuscitation General Nursing Retrospective Studies Veterans Mechanical ventilation Terminal Care business.industry Medical record Retrospective cohort study General Medicine Emergency department Cross-Sectional Studies Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Emergency medicine Emergency Service Hospital 0305 other medical science business |
| Zdroj: | Journal of Palliative Medicine. 24:873-878 |
| ISSN: | 1557-7740 1096-6218 |
| DOI: | 10.1089/jpm.2020.0401 |
| Popis: | Background: Emergency department (ED) visits are common for older patients with chronic, life-limiting illnesses and may offer a valuable opportunity for clinicians to initiate proactive goals of care conversations (GoCC) to ensure end-of-life care that aligns with the patients' values, goals, and preferences. Objectives: The purpose of this study is to assess whether GoCC are occurring with patients in Department of Veteran Affairs (VA) EDs, to characterize these patients' goals of care and life-sustaining treatment (LST) decisions, and to examine the extent to which palliative or hospice consultations occur following the ED visit. Design: We conducted a cross-sectional retrospective study using health record data. Settings/Subjects: A total of 10,780 patients receiving care in VA, whose first GoCC occurred during an ED visit. Results: Of the patients in the study, approximately half were at least 70 years of age, three-quarters were white, and half had multiple serious disease comorbidities. The percentage of patients who desired cardiopulmonary resuscitation was lower among the highest risk (i.e., of hospitalization and death) patients (64% vs. 51%). The percentage of patients wanting other LSTs (e.g., mechanical ventilation) was higher among the lowest risk patients; and the percentage of patients requesting limits to LSTs was highest among higher risk patients. Eighteen percent of patients had a palliative or hospice care consult within three months of their ED visit. Conclusions: In this study, we verified that GoCC are being initiated in the ED with Veterans at differing stages in their illness trajectory and that higher proportions of higher risk patients preferred to limit LSTs. |
| Databáze: | OpenAIRE |
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