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Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study

BACKGROUND: In the Netherlands, it is customary to discuss directives regarding resuscitation, intubation, and ICU-admission with patients and/or their relatives upon hospital-admission. The outcome of this discussion is documented in a code status. Ideally, these advance care planning (ACP)-related...

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Autores principales: Hendriks, Victoria Johanna Jacoba, Faes, Miriam C., van der Meer, Jop B. L., Janse, Emma S., van der Meer, Nardo J. M., van der Linden, Carolien M. J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9638468/
https://www.ncbi.nlm.nih.gov/pubmed/36334244
http://dx.doi.org/10.1007/s40520-022-02281-y
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author Hendriks, Victoria Johanna Jacoba
Faes, Miriam C.
van der Meer, Jop B. L.
Janse, Emma S.
van der Meer, Nardo J. M.
van der Linden, Carolien M. J.
author_facet Hendriks, Victoria Johanna Jacoba
Faes, Miriam C.
van der Meer, Jop B. L.
Janse, Emma S.
van der Meer, Nardo J. M.
van der Linden, Carolien M. J.
author_sort Hendriks, Victoria Johanna Jacoba
collection PubMed
description BACKGROUND: In the Netherlands, it is customary to discuss directives regarding resuscitation, intubation, and ICU-admission with patients and/or their relatives upon hospital-admission. The outcome of this discussion is documented in a code status. Ideally, these advance care planning (ACP)-related decisions are made by a patient (and/or their relatives) and a professional together in a shared decision-making (SDM) process, to improve patient satisfaction and prevent undesired care. Given the bad outcomes in older COVID-19 patients, it is particularly important to discuss the code status upon admission. This study aims to describe the practice of SDM regarding code status during the COVID-pandemic. Specific aims were to find out to what extend patients took part in this decision-making process and whether all key elements of SDM for a shared decision were documented in medical reports. METHODS: In this retrospective cohort study, we included COVID-19 patients aged 70 years and older, admitted to two large teaching hospitals in the Netherlands, during the first months of the COVID-19 pandemic in 2020. Data about code status and the decision-making process were extracted from electronic healthcare records. RESULTS: Code status was documented for 274 of 275 included patients. Patient participation in the decision-making process was described in 48%. In 19% all key elements of shared decision-making have been described. Key elements of SDM were defined as the presence of a completed code status form, the presence of clinical notes showing that both patient’s wishes and values and the opinion of the healthcare professional about the predicted outcome was taken into consideration and clinical notes of a patient–healthcare professional interaction during the admission. CONCLUSION: Our results show that a proper SDM process regarding code status is possible, even in hectic times like the COVID-19-pandemic. However, shared decision-making was not common practice in older patients with COVID-19 regarding code status (an ACP-related decision) in the early phase of the COVID-19 pandemic. Only in 19% of the patients, all key elements of SDM regarding code status were described. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40520-022-02281-y.
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spelling pubmed-96384682022-11-07 Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study Hendriks, Victoria Johanna Jacoba Faes, Miriam C. van der Meer, Jop B. L. Janse, Emma S. van der Meer, Nardo J. M. van der Linden, Carolien M. J. Aging Clin Exp Res Original Article BACKGROUND: In the Netherlands, it is customary to discuss directives regarding resuscitation, intubation, and ICU-admission with patients and/or their relatives upon hospital-admission. The outcome of this discussion is documented in a code status. Ideally, these advance care planning (ACP)-related decisions are made by a patient (and/or their relatives) and a professional together in a shared decision-making (SDM) process, to improve patient satisfaction and prevent undesired care. Given the bad outcomes in older COVID-19 patients, it is particularly important to discuss the code status upon admission. This study aims to describe the practice of SDM regarding code status during the COVID-pandemic. Specific aims were to find out to what extend patients took part in this decision-making process and whether all key elements of SDM for a shared decision were documented in medical reports. METHODS: In this retrospective cohort study, we included COVID-19 patients aged 70 years and older, admitted to two large teaching hospitals in the Netherlands, during the first months of the COVID-19 pandemic in 2020. Data about code status and the decision-making process were extracted from electronic healthcare records. RESULTS: Code status was documented for 274 of 275 included patients. Patient participation in the decision-making process was described in 48%. In 19% all key elements of shared decision-making have been described. Key elements of SDM were defined as the presence of a completed code status form, the presence of clinical notes showing that both patient’s wishes and values and the opinion of the healthcare professional about the predicted outcome was taken into consideration and clinical notes of a patient–healthcare professional interaction during the admission. CONCLUSION: Our results show that a proper SDM process regarding code status is possible, even in hectic times like the COVID-19-pandemic. However, shared decision-making was not common practice in older patients with COVID-19 regarding code status (an ACP-related decision) in the early phase of the COVID-19 pandemic. Only in 19% of the patients, all key elements of SDM regarding code status were described. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40520-022-02281-y. Springer International Publishing 2022-11-05 2022 /pmc/articles/PMC9638468/ /pubmed/36334244 http://dx.doi.org/10.1007/s40520-022-02281-y Text en © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Article
Hendriks, Victoria Johanna Jacoba
Faes, Miriam C.
van der Meer, Jop B. L.
Janse, Emma S.
van der Meer, Nardo J. M.
van der Linden, Carolien M. J.
Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study
title Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study
title_full Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study
title_fullStr Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study
title_full_unstemmed Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study
title_short Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study
title_sort shared decision-making in advance care planning among hospitalized older covid-19 patients: a multicenter, retrospective cohort study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9638468/
https://www.ncbi.nlm.nih.gov/pubmed/36334244
http://dx.doi.org/10.1007/s40520-022-02281-y
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