Life-sustaining treatment decisions for nursing home residents: Who discusses, who decides and what is decided?

被引:58
作者
Levin, JR
Wenger, NS
Ouslander, JG
Zellman, G
Schnelle, JF
Buchanan, JL
Hirsch, SH
Reuben, DB
机构
[1] Univ Calif Los Angeles, Sch Med, Multicampus Program Geriatr Med & Gerontol, Los Angeles, CA 90095 USA
[2] Univ Calif Los Angeles, Sch Med, Los Angeles, CA USA
[3] Emory Univ, Sch Med, Atlanta, GA USA
[4] Rand Corp, Santa Monica, CA USA
[5] Borun Ctr Gerontol Res, Reseda, CA USA
[6] Harvard Univ, Sch Med, Boston, MA USA
关键词
D O I
10.1111/j.1532-5415.1999.tb01905.x
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
OBJECTIVE: To evaluate whether nursing home residents and their families reported discussions about life-sustaining treatment with their physicians, the relationship between such discussions and orders to limit therapy, and predictors of physician-patient communication about life-sustaining treatment. DESIGN: Cross-sectional interviews and retrospective chart abstraction. SETTING: Three regions: West Coast, New England,Western. SAMPLE: A total of 413 nursing home residents, 363 family/surrogate interviews, and 192 resident interviews. MAIN OUTCOME MEASURES: Measured were (1) physician-resident communication about life-sustaining treatment and (2) presence of an advance directive or do not resuscitate (DNR) order in resident's chart. RESULTS: Seventy-four percent of residents had DNR orders, and 32% had advance directives; only 29% of residents reported discussions about life-sustaining treatment. Of residents with DNR orders who could have participated in discussions about life-sustaining treatment, nearly half reported they had not discussed CPR with their caregivers. Older age, longer duration of time living in nursing home, location in a New England nursing home, physician-family member discussion, and the presence of an advance directive in the medical chart were positively associated with having DNR orders. Physician-resident discussion was not associated with having a DNR order. For the subsample of interviewed residents, age and a diagnosis of cognitive impairment were negatively associated with a physician-resident discussion about life-sustaining treatment, whereas the likelihood of having a discussion increased with increasing numbers of medical diagnoses. CONCLUSIONS: Chart orders to limit therapy are common, but physician-resident discussions about lift-sustaining treatments are not. Far more family members than residents report such discussions with the resident's physicians.
引用
收藏
页码:82 / 87
页数:6
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