Factors influencing the end-of-life decisionmaking process about care in hospitalized patients
Authors:
Alena Slezáčková 1,2; Kristýna Dvořáčková 1,3; Ondřej Kopecký 4; Kateřina Rusinová 4; Ondřej Sláma 1,5; David Černý 6; Adam Doležal 6; Tomáš Doležal 6; Václav Zvoníček 7; Libuše Čermáková 1; Petra Vysočanová 1,8; Ladislav Kabelka 9; Josef Kuře 1
Authors place of work:
Ústav lékařské etiky LF MU v Brně
1; Ústav psychologie a psychosomatiky LF MU v Brně
2; Psychologický ústav FF MU v Brně
3; Klinika paliativní medicíny 1. LF UK a VFN v Praze
4; Klinika komplexní onkologické péče MOÚ, Brno
5; Ústav státu a práva AV ČR, v. v. i., Praha
6; Klinika anesteziologie a resuscitace 3. LF UK a FNKV, Praha
7; Interní kardiologická klinika LF MU a FN Brno
8; Anesteziologicko-resuscitační klinika LF MU a FN u svaté Anny, Brno
9
Published in the journal:
Čas. Lék. čes. 2021; 160: 176-184
Category:
Original Articles
Summary
The quality of end-of-life care of hospitalized patients is an important topic, but so far little explored in the Czech Republic. The aim of this study was to map the factors influencing the end-of-life care decision-making process in selected Czech hospitals and to describe it based on data from medical records and from the perspective of a doctor. The research included data obtained from the medical records of 240 deceased patients (mean age 76.9 years, 41.6% women). The research sample of medical doctors who commented on the decision-making about end-of-life care for these patients consisted of 369 physicians (mean age 35.9 years, 61% women). The results pointed to persistent deficiencies in the written recording of the care goals, prognosis, and possible decision to limit care. Medical doctors limit health care primarily based on consensus among physicians, the patient is usually not invited to the decision-making process. Patient preferences for the end-of-life period are in most cases not ascertained or this question is postponed. The institute of a previously stated wish did not appear in the examined group at all. It can be concluded that decisions about end-of-life care usually take place without knowledge of patients' values and preferences. The results indicate the need to improve the training of doctors and medical students, which should, in addition to building professional competencies, include training in effective communication with patients at the end of life.
Keywords:
communication – patient preferences – Decision making – End of life care – ethics – end of life – death – advance directives
Zdroje
- Kolektiv autorů. Umírání a péče o nevyléčitelně nemocné II. Závěrečná zpráva. Cesta domů, Praha, 2013. Dostupné na: www.umirani.cz/sites/default/files/custom-files/cesta-domu-zprava-umirani-a-pece-o-nevylecitelne-nemocne-2013.pdf
- Český statistický úřad. Smrt v Česku. ČSÚ, 3. 11. 2020. Dostupné na www.czso.cz/csu/czso/smrt-v-cesku
- Lamont EB. A demographic and prognostic approach to defining the end of life. J Palliat Med 2005; 8: 12–21.
- Doležal T, Doležal A. Právní aspekty rozhodování o zdravotní péči v závěru života člověka. Časopis zdravotnického práva a bioetiky 2020; 10: 105–127.
- Kuře J. Etika rozhodování o zdravotní péči v závěru života. Časopis zdravotnického práva a bioetiky 2020; 10: 84–104.
- Löfmark R, Nilstun T, Cartwright C et al. Physicians' experiences with end-of-life decision-making: Survey in 6 European countries and Australia. BMC Medicine 2008; 6: 4.
- Smulowitz PB, Barrett O, Hall MM et al. Physician variability in management of emergency department patients with chest pain. West J Emerg Med 2017; 18: 592–600.
- Zahuranec DB, Fagerlin A, Sánchez BN et al. Variability in physician prognosis and recommendations after intracerebral hemorrhage. Neurology 2016, 86: 1864–1871.
- Dvořáčková K, Slezáčková A, Čermáková L. Psychosociální faktory na straně lékaře ovlivňující proces péče a rozhodování v závěru života pacientů. Česká psychologie 2021; 4: 369–388.
- Parker SM, Clayton J M, Hancock K et al. A systematic review of prognostic/end-of-life communication with adults in the advanced stages of a life-limiting illness: patient/caregiver preferences for the content, style, and timing of information. J Pain Symptom Manage 2007; 34: 81–93.
- Omilion-Hodges LM, Swords NM. Communication matters: exploring the intersection of family and practitioner end of life communication. Behav Sci 2017; 7: 15.
- Roscoe LA, Tullis JA, Reich RR et al. Beyond good intentions and patient perceptions: competing definitions of effective communication in head and neck cancer care at the end of life. Health Commun 2013; 28: 183–192.
- Doležal A. Informovaný souhlas u osob se sníženou schopností rozhodování. Časopis zdravotnického práva a bioetiky 2019; 9: 68–84.
- Quill TE. Initiating end-of-life discussions with seriously ill patients: addressing the elephant in the room. JAMA 2000; 284: 2502–2507.
- Fallowfield LJ, Jenkins VA, Beveridge HA. Truth may hurt but deceit hurts more: communication in palliative care. Palliat Med 2002; 16: 297–303.
- Mack JW, Cronin A, Taback N et al. End-of-life care discussions among patients with advanced cancer: a cohort study. Ann Intern Med 2012; 156: 204–210.
- Walczak A, Butow PN, Bu S et al. A systematic review of evidence for end-of-life communication interventions: who do they target, how are they structured and do they work? Patient Educ Couns 2016; 99: 3–16.
- Lamont EB, Christakis NA. Prognostic disclosure to patients with cancer near the end of life. Ann Intern Med 2001; 134: 1096–1105.
- Lazenby S, Edwards A, Samuriwo R et al. End-of-life care decisions for haemodialysis patients – ‘We only tend to have that discussion with them when they start deteriorating’. Health Expect 2017; 20: 260–273.
- Krawczyk M, Gallagher R. Communicating prognostic uncertainty in potential end-of-life contexts: experiences of family members. BMC Palliative Care 2016; 15: 59.
- Bastemeijer CM, Voogt L, Van Ewijk JP et al. What do patient values and preferences mean? A taxonomy based on a systematic review of qualitative papers. Patient Educ Couns 2017; 100: 871–881.
- Lee YK, Low WY, Ng CJ. Exploring patient values in medical decision making: a qualitative study. PLoS One 2013; 8: e80051.
- Démuthová S. Vybrané problémy tanatológie. Masarykova univerzita, Brno, 2015.
- Block BL, Jeon SY, Sudore RL et al. Patterns and trends in advance care planning among older adults who received intensive care at the end of life. JAMA Intern Med 2020; 180: 786–789.
- Sláma O, Kabelka L, Vorlíček J a kol. Paliativní medicína pro praxi. Galén, Praha, 2007.
- Sláma O, Kabelka L, Loučka M. Paliativní péče v ČR v roce 2016. Časopis lékařů českých 2016; 8: 445–450.
- Český statistický úřad. Zemřelí podle seznamu příčin smrti, pohlaví a věku v ČR krajích a okresech. ČSÚ, 16. 11. 2000. Dostupné na: www.czso.cz/csu/czso/zemreli-podle-seznamu-pricin-smrti-pohlavi-a-veku-v-cr-krajich-a-okresech-2010-az-2019
- Mentzelopoulos SD, Couper K, Voorde PV et al. European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions. Resuscitation 2021; 161: 408–432.
- Adams JA, Bailey DE Jr, Anderson RA et al. Nursing roles and strategies in end-of-life decision making in acute care: a systematic review of the literature. Nurs Res Pract 2011; 2011: 527834.
- Erickson J. Bedside nurse involvement in end-of-life decision making: a brief review of the literature. Dimens Crit Care Nurs 2013; 32: 65–68.
- Česká společnost intenzivní medicíny ČLS JEP. Doporučené postupy. ČSIM, 2021. Dostupné na: https://csim.cz/dokumenty/postupy
Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
Journal of Czech Physicians
2021 Číslo 5
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
- What Effect Can Be Expected from Limosilactobacillus reuteri in Mucositis and Peri-Implantitis?
Najčítanejšie v tomto čísle
- Antibodies from previous infection bring sufficient and long-term protection against COVID-19
- Using selected POCT methods by general practitioners in the Czech Republic
- Zemřel prof. Oldřich Eliška, doyen českých anatomů
- Factors influencing the end-of-life decisionmaking process about care in hospitalized patients