Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans With Serious Illness
| Autor: | Anne Walling, Cati Brown-Johnson, Randall C. Gale, Lisa Soleymani Lehmann, Karl A. Lorenz, Marie C. Haverfield, David B. Bekelman, Ariadna Garcia, Scott Shreve, Karleen F. Giannitrapani, Natalie Lo, Marybeth Foglia, Jill Lowery, Natalia Festa |
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| Rok vydání: | 2020 |
| Předmět: |
Decision making capacity
Male business.industry Communication Decision Making General Medicine Patient Care Planning 03 medical and health sciences 0302 clinical medicine Nursing Life sustaining treatment 030220 oncology & carcinogenesis Quality of Life Medicine Humans Female 030212 general & internal medicine Treatment decision making business Veterans Affairs Aged Resuscitation Orders Veterans |
| Zdroj: | The American journal of hospicepalliative care. 38(1) |
| ISSN: | 1938-2715 |
| Popis: | Background: Prior to national spread, the Department of Veterans Affairs implemented a pilot of the life-sustaining treatment decisions initiative (LSTDI) to promote proactive goals of care conversations (GoCC) with seriously ill patients, including policy and practice standards, an electronic documentation template and order set, and implementation support. Aim: To describe a 2-year pilot of the LSTDI at 4 demonstration sites. Design: Prospective observational study. Setting/Participants: A total of 6664 patients who had at least one GoCC. Results: Descriptive statistics characterized patient demographics, goals of care, LST decisions, and risk of hospitalization or mortality among patients with at least one GoCC. Participants were on average 71.4 years old, 93.2% male, 87.1% white, and 64.7% urban; 27.3% died by the end of the pilot period. Fifteen percent lacked decision-making capacity (DMC). Nonmutually exclusive goals included to be cured (7.6%), to prolong life (34%), to improve/maintain quality of life (61.5%), to be comfortable (53%), to obtain support for family/caregiver (8.4%), to achieve life goals (2.1%), and other (10.5%). Many GoCCs resulted in a do not resuscitate (DNR) order (58.8%). Patients without DMC were more likely to have comfort-oriented goals (77.3% vs 48.8%) and a DNR (84% vs 52.6%). Chart abstraction supported content validity of GoCC documentation. Conclusion: The pilot demonstrated that standardizing practices for eliciting and documenting GoCCs resulted in customized documentation of goals of care and LST decisions of a large number of seriously ill patients and established the feasibility of spreading standardized practices throughout a large integrated health care system. |
| Databáze: | OpenAIRE |
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