End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home
End-of-Life Conversations and Hospice Placement: Association with Less Aggressive Care Desired in the Nursing Home
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DOI：
10.1080/15524256.2017.1282919
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发表时间：
2017-01-01
影响因子：
1.6
通讯作者：
Bomba, Patricia
中科院分区：
文献类型：
--
作者：
Reinhardt, Joann P.;Downes, Deirdre;Bomba, Patricia
关于临终关怀和治疗选择的教育，家庭和医疗保健提供者之间的沟通，以及预先指示和医疗命令对于患有慢性，进行性衰退和终末期疾病的老年人来说非常重要，他们在养老院度过了最后的日子。本研究使用了从电子健康记录中获取的长期入住养老院死者（N = 300）的回顾性数据（死亡前6个月），以获取临终体验。调查结果显示，几乎所有的死者，不复苏和不插管的命令到位，只有一半以上的不住院和不人工喂养的命令到位。一小部分人没有人工水合作用或没有抗生素订单。总体而言，记录的医嘱和接受的治疗之间存在一致性。研究结果表明，使用临终关怀和讨论特定的生命维持治疗，每一个有显着的关联，具有较低的侵略性医疗秩序到位。这些结果可以为最佳实践的发展提供信息，以促进养老院居民的高质量，以人为本，临终关怀。
Education about end-of-life care and treatment options, communication between family and health care providers, and having advance directives and medical orders in place are important for older adults with chronic, progressive decline and end-stage disease who spend their last days in the nursing home. This study used retrospective data (6 months before death) of long-stay nursing home decedents (N = 300) taken from electronic health records to capture the end-of-life experience. Findings showed for almost all decedents, Do Not Resuscitate and Do Not Intubate orders were in place, and just over one-half had Do Not Hospitalize and No Artificial Feeding orders in place. A small proportion had No Artificial Hydration or No Antibiotic orders in place. Overall, there was congruence between documented medical orders and treatment received. Findings showed that use of hospice and discussions about particular life-sustaining treatments each had significant associations with having less aggressive medical orders in place. These results can inform best practice development to promote high quality, person-directed, end-of-life care for nursing home residents.