tetano
Editor, Senior Moderator
Scand J Trauma Resusc Emerg Med
. 2021 Dec 20;29(1):173.
doi: 10.1186/s13049-021-00984-1.
Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort
Hanne Irene Jensen[SUP] 1 2 3 [/SUP], Sevim Ozden[SUP] 4 [/SUP], Gitte Schultz Kristensen[SUP] 5 [/SUP], Mihnaz Azizi[SUP] 6 [/SUP], Siri Aas Smedemark[SUP] 7 [/SUP], Christian Backer Mogensen[SUP] 8 5 [/SUP]
Affiliations
Abstract
Background: The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions.
Methods: A retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality.
Results: A total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement.
Conclusions: Life-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.
Keywords: COVID-19; End-of-life; Life-sustaining treatment; Patient involvement; Shared decision-making.
. 2021 Dec 20;29(1):173.
doi: 10.1186/s13049-021-00984-1.
Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort
Hanne Irene Jensen[SUP] 1 2 3 [/SUP], Sevim Ozden[SUP] 4 [/SUP], Gitte Schultz Kristensen[SUP] 5 [/SUP], Mihnaz Azizi[SUP] 6 [/SUP], Siri Aas Smedemark[SUP] 7 [/SUP], Christian Backer Mogensen[SUP] 8 5 [/SUP]
Affiliations
- PMID: 34930420
- DOI: 10.1186/s13049-021-00984-1
Abstract
Background: The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions.
Methods: A retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality.
Results: A total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement.
Conclusions: Life-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.
Keywords: COVID-19; End-of-life; Life-sustaining treatment; Patient involvement; Shared decision-making.