Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Sevim Ozden¹  Hanne Irene Jensen²  Gitte Schultz Kristensen³  Siri Aas Smedemark⁴  Christian Backer Mogensen⁵  Mihnaz Azizi⁶ 

[1] Department of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark;Department of Anaesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Sygehusvej 24, 6000, Kolding, Denmark;Department of Anaesthesiology and Intensive Care, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark;Department of Regional Health Research, University of Southern Denmark, Odense, Denmark;Department of Emergency, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark;Department of Geriatric Medicine, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark;Department of Regional Health Research, University of Southern Denmark, Odense, Denmark;Department of Emergency, Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark;Emergency Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark;

关键词: End-of-life;    Patient involvement;    Life-sustaining treatment;    COVID-19;    Shared decision-making;   

DOI  :  10.1186/s13049-021-00984-1

来源: Springer

【 摘 要 】

BackgroundThe coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions.MethodsA retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality.ResultsA total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement.ConclusionsLife-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.

【 授权许可】

CC BY