J Korean Acad Nurs.  2019 Jun;49(3):329-339. 10.4040/jkan.2019.49.3.329.

Reversals in Decisions about Life-Sustaining Treatment and Associated Factors among Older Patients with Terminal Stage of Cardiopulmonary Disease

• Choi JJ
• Kim SH
• Kim SW

• KMID: 2451300
• DOI: http://doi.org/10.4040/jkan.2019.49.3.329

Abstract

PURPOSE
The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease.
METHODS
This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients' demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment.
RESULTS
The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment.
CONCLUSION
This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.

Keyword

Aged; Cardiopulmonary Resuscitation; Decision Making; Life Support Care; Terminal Care

MeSH Terms

Cardiopulmonary Resuscitation
Decision Making
Divorce
Electronic Health Records
Heart
Humans
Intubation
Life Support Care
Logistic Models
Lung Diseases
Renal Dialysis
Retrospective Studies
Terminal Care
Tertiary Care Centers
Ventilators, Mechanical

Figure

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  Figure 1. Flowchart of study population.

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  Figure 2. Reversals of life-sustaining treatment decisions and administered treatment before death. Numbers show n and % of the decisions and administrations of the treatments.

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  Figure 3. Reversal of code status and administered treatments. Numbers show n (%) of the decisions and administrations of the treatments; †Reversal to higher intensity of life-sustaining treatment.

Reference

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