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Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic
CONTEXT: For many patients, end-of-life care (EOLC) wishes are unknown and are generally only brought up during healthcare crises. During such healthcare episodes, loved ones are often distraught, and as such, can find it difficult to focus on details surrounding the event. The best place for these...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MSU College of Osteopathic Medicine Statewide Campus System
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746112/ https://www.ncbi.nlm.nih.gov/pubmed/33655164 http://dx.doi.org/10.51894/001c.9204 |
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author | Dang, My-Trang T. Ahmed, Zohair Betcher, Jason M. Kadakia, Saloni Wisniewski, Samuel J. Sealey, John W. |
author_facet | Dang, My-Trang T. Ahmed, Zohair Betcher, Jason M. Kadakia, Saloni Wisniewski, Samuel J. Sealey, John W. |
author_sort | Dang, My-Trang T. |
collection | PubMed |
description | CONTEXT: For many patients, end-of-life care (EOLC) wishes are unknown and are generally only brought up during healthcare crises. During such healthcare episodes, loved ones are often distraught, and as such, can find it difficult to focus on details surrounding the event. The best place for these discussions may be in non-acute settings including primary care clinics. The purpose of this study was to examine how well a sample of patients (N = 177) in three Michigan-based primary care teaching clinics thought they and their loved ones were prepared in terms of having their EOLC wishes known. METHODS: Prospective data were collected from three Internal Medicine teaching clinics in the Metro-Detroit area through an anonymous written survey addressing EOLC issues in a 16-item cross-sectional study. Respondents were adult patients at one of three participating primary care clinics. Perceived preparedness for EOLC was measured by: 1) possibly having had a prior EOLC discussion with a healthcare provider 2) having created an Advance Directive, such as a Durable Power of Attorney (DPOA) or Living Will with medical decision preferences, 3) reported preferences for quality versus quantity of life, and 4) preferences for CPR and other specific life-sustaining interventions. RESULTS: In this sample, 77 (43.5%) of 177 respondents had discussed their EOLC wishes with a provider. Regarding Advance Directives, 63/177 (35.6%) had established a DPOA, and 59/177 (22%) had made a Living Will. The majority of respondents preferred quality over quantity of life. The most difficult EOLC questions included the decision for CPR, tracheostomy, and PEG tube placement. CONCLUSIONS: Based on these results, EOLC discussions probably occur infrequently in the primary care or other healthcare settings. Most survey responses indicated that sample patients were unprepared concerning the details of future EOLC decisions. Engagement of such discussions should be a part of routine visits in the primary care clinic and should be re-visited when there is a change in a patient’s health. Further larger-scale studies using validated surveys are required in this vitally important area of practice. Key Words: advance care planning, end-of-life care conversations, primary care |
format | Online Article Text |
id | pubmed-7746112 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | MSU College of Osteopathic Medicine Statewide Campus System |
record_format | MEDLINE/PubMed |
spelling | pubmed-77461122021-03-01 Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic Dang, My-Trang T. Ahmed, Zohair Betcher, Jason M. Kadakia, Saloni Wisniewski, Samuel J. Sealey, John W. Spartan Med Res J Original Contribution CONTEXT: For many patients, end-of-life care (EOLC) wishes are unknown and are generally only brought up during healthcare crises. During such healthcare episodes, loved ones are often distraught, and as such, can find it difficult to focus on details surrounding the event. The best place for these discussions may be in non-acute settings including primary care clinics. The purpose of this study was to examine how well a sample of patients (N = 177) in three Michigan-based primary care teaching clinics thought they and their loved ones were prepared in terms of having their EOLC wishes known. METHODS: Prospective data were collected from three Internal Medicine teaching clinics in the Metro-Detroit area through an anonymous written survey addressing EOLC issues in a 16-item cross-sectional study. Respondents were adult patients at one of three participating primary care clinics. Perceived preparedness for EOLC was measured by: 1) possibly having had a prior EOLC discussion with a healthcare provider 2) having created an Advance Directive, such as a Durable Power of Attorney (DPOA) or Living Will with medical decision preferences, 3) reported preferences for quality versus quantity of life, and 4) preferences for CPR and other specific life-sustaining interventions. RESULTS: In this sample, 77 (43.5%) of 177 respondents had discussed their EOLC wishes with a provider. Regarding Advance Directives, 63/177 (35.6%) had established a DPOA, and 59/177 (22%) had made a Living Will. The majority of respondents preferred quality over quantity of life. The most difficult EOLC questions included the decision for CPR, tracheostomy, and PEG tube placement. CONCLUSIONS: Based on these results, EOLC discussions probably occur infrequently in the primary care or other healthcare settings. Most survey responses indicated that sample patients were unprepared concerning the details of future EOLC decisions. Engagement of such discussions should be a part of routine visits in the primary care clinic and should be re-visited when there is a change in a patient’s health. Further larger-scale studies using validated surveys are required in this vitally important area of practice. Key Words: advance care planning, end-of-life care conversations, primary care MSU College of Osteopathic Medicine Statewide Campus System 2019-07-01 /pmc/articles/PMC7746112/ /pubmed/33655164 http://dx.doi.org/10.51894/001c.9204 Text en https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (4.0) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Original Contribution Dang, My-Trang T. Ahmed, Zohair Betcher, Jason M. Kadakia, Saloni Wisniewski, Samuel J. Sealey, John W. Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic |
title | Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic |
title_full | Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic |
title_fullStr | Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic |
title_full_unstemmed | Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic |
title_short | Do Not Let it Be the Last: End-of-Life Care Decisions in the Primary Care Clinic |
title_sort | do not let it be the last: end-of-life care decisions in the primary care clinic |
topic | Original Contribution |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746112/ https://www.ncbi.nlm.nih.gov/pubmed/33655164 http://dx.doi.org/10.51894/001c.9204 |
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