Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans With Serious Illness.

Aged Communication Decision Making Female Humans Male Patient Care Planning Quality of Life Resuscitation Orders Veterans
decision-making capacity goals of care conversations life-sustaining treatment decisions serious illness

Journal

The American journal of hospice & palliative care
ISSN: 1938-2715
Titre abrégé: Am J Hosp Palliat Care
Pays: United States
ID NLM: 9008229

Informations de publication

Date de publication:
Jan 2021
Historique:
pubmed: 10 5 2020
medline: 29 7 2021
entrez: 9 5 2020
Statut: ppublish

Résumé

Prior to national spread, the Department of Veterans Affairs implemented a pilot of the life-sustaining treatment decisions initiative (LSTDI) to promote proactive goals of care conversations (GoCC) with seriously ill patients, including policy and practice standards, an electronic documentation template and order set, and implementation support. To describe a 2-year pilot of the LSTDI at 4 demonstration sites. Prospective observational study. A total of 6664 patients who had at least one GoCC. Descriptive statistics characterized patient demographics, goals of care, LST decisions, and risk of hospitalization or mortality among patients with at least one GoCC. Participants were on average 71.4 years old, 93.2% male, 87.1% white, and 64.7% urban; 27.3% died by the end of the pilot period. Fifteen percent lacked decision-making capacity (DMC). Nonmutually exclusive goals included to be cured (7.6%), to prolong life (34%), to improve/maintain quality of life (61.5%), to be comfortable (53%), to obtain support for family/caregiver (8.4%), to achieve life goals (2.1%), and other (10.5%). Many GoCCs resulted in a do not resuscitate (DNR) order (58.8%). Patients without DMC were more likely to have comfort-oriented goals (77.3% vs 48.8%) and a DNR (84% vs 52.6%). Chart abstraction supported content validity of GoCC documentation. The pilot demonstrated that standardizing practices for eliciting and documenting GoCCs resulted in customized documentation of goals of care and LST decisions of a large number of seriously ill patients and established the feasibility of spreading standardized practices throughout a large integrated health care system.

Sections du résumé

BACKGROUND BACKGROUND
Prior to national spread, the Department of Veterans Affairs implemented a pilot of the life-sustaining treatment decisions initiative (LSTDI) to promote proactive goals of care conversations (GoCC) with seriously ill patients, including policy and practice standards, an electronic documentation template and order set, and implementation support.
AIM OBJECTIVE
To describe a 2-year pilot of the LSTDI at 4 demonstration sites.
DESIGN METHODS
Prospective observational study.
SETTING/PARTICIPANTS METHODS
A total of 6664 patients who had at least one GoCC.
RESULTS RESULTS
Descriptive statistics characterized patient demographics, goals of care, LST decisions, and risk of hospitalization or mortality among patients with at least one GoCC. Participants were on average 71.4 years old, 93.2% male, 87.1% white, and 64.7% urban; 27.3% died by the end of the pilot period. Fifteen percent lacked decision-making capacity (DMC). Nonmutually exclusive goals included to be cured (7.6%), to prolong life (34%), to improve/maintain quality of life (61.5%), to be comfortable (53%), to obtain support for family/caregiver (8.4%), to achieve life goals (2.1%), and other (10.5%). Many GoCCs resulted in a do not resuscitate (DNR) order (58.8%). Patients without DMC were more likely to have comfort-oriented goals (77.3% vs 48.8%) and a DNR (84% vs 52.6%). Chart abstraction supported content validity of GoCC documentation.
CONCLUSION CONCLUSIONS
The pilot demonstrated that standardizing practices for eliciting and documenting GoCCs resulted in customized documentation of goals of care and LST decisions of a large number of seriously ill patients and established the feasibility of spreading standardized practices throughout a large integrated health care system.

Identifiants

DOI: 10.1177/1049909120923595 PMID: 32383388
pubmed: 32383388
doi: 10.1177/1049909120923595
doi:

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

68-76

Auteurs

Karleen F Giannitrapani (KF)

Center for Innovation to Implementation, 19977VA Palo Alto Health Care System, Menlo Park, CA, USA.
Division of Primary Care and Population Health, 6429Stanford University School of Medicine, Stanford, CA, USA.
ORCID: 0000-0003-0987-6204

Anne M Walling (AM)

Center for the Study of Healthcare Innovation, Implementation and Policy, 19975VA Greater Los Angeles Healthcare System, West Los Angeles, CA, USA.
David Geffen School of Medicine, University of California Los Angeles, CA, USA.
Co-first author.

Ariadna Garcia (A)

Quantitative Sciences Unit, 10624Stanford University, Stanford, CA, USA.

MaryBeth Foglia (M)

National Center for Ethics in Health Care, 7171Veterans Health Administration, Seattle, WA, USA.
University of Washington School of Medicine, Department of Bioethics and Humanities, Seattle, WA, USA.

Jill S Lowery (JS)

National Center for Ethics in Health Care, 7171Veterans Health Administration, Durham, NC, USA.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.

Natalie Lo (N)

Center for Innovation to Implementation, 19977VA Palo Alto Health Care System, Menlo Park, CA, USA.

David Bekelman (D)

Center of Innovation for Veteran-Centered and Value Driven Care, 19983Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA.

Cati Brown-Johnson (C)

Division of Primary Care and Population Health, 6429Stanford University School of Medicine, Stanford, CA, USA.

Marie Haverfield (M)

Center for Innovation to Implementation, 19977VA Palo Alto Health Care System, Menlo Park, CA, USA.
Division of Primary Care and Population Health, 6429Stanford University School of Medicine, Stanford, CA, USA.

Natalia Festa (N)

Division of Internal Medicine, 2348Massachusetts General Hospital, Boston, MA, USA.

Scott T Shreve (ST)

Hospice and Palliative Care Program, VHA 20094Lebanon VA Medical Center, Lebanon, PA, USA.

Randall C Gale (RC)

Center for Innovation to Implementation, 19977VA Palo Alto Health Care System, Menlo Park, CA, USA.

Lisa Soleymani Lehmann (LS)

19914VA New England Healthcare System, 7171Veterans Health Administration, Bedford, MA, USA.
Harvard Medical School, Boston, MA, USA.

Karl A Lorenz (KA)

Center for Innovation to Implementation, 19977VA Palo Alto Health Care System, Menlo Park, CA, USA.
Division of Primary Care and Population Health, 6429Stanford University School of Medicine, Stanford, CA, USA.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Pilot of the Life-Sustaining Treatment...
questionsmedicales.fr › Sciences de l'information › Communication › Pilot of the Life-Sustaining Treatment...
questionsmedicales.fr › Phénomènes psychologiques › Processus mentaux › Pensée (activité mentale) › Prise de décision › Pilot of the Life-Sustaining Treatment...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Pilot of the Life-Sustaining Treatment...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Planification des soins du patient › Pilot of the Life-Sustaining Treatment...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Pilot of the Life-Sustaining Treatment...
questionsmedicales.fr › Organisations et économie des soins de santé › Contrôle social formel › Jurisprudence › Ordres de réanimation › Pilot of the Life-Sustaining Treatment...
questionsmedicales.fr › Personnes › Anciens combattants › Pilot of the Life-Sustaining Treatment...