Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data

BMC Palliative Care

Research Article

Aaron O. Koshy¹  John Gierula¹  Richard M. Cubbon¹  Michael Drozd¹  Sam Straw¹  Klaus K. Witte¹  Mark T. Kearney¹  Thomas A. Slater¹  Samuel D. Relton²  Melanie McGinlay³  Stephe Kamalathasan³  Peysh A. Patel³  Alice Cowley³  Milos Prica³  Nicholas Maxwell⁴  Rory A. Bird⁴ 

[1] Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK;Leeds Institute of Health Sciences, University of Leeds, Leeds, UK;Leeds Teaching Hospitals NHS Trust, Leeds, UK;School of Medicine, University of Leeds, Leeds, UK;

关键词: COVID-19;    Resuscitation;    Advanced care planning;    Comorbidity;    Elderly;    Geriatrics;   

DOI  :  10.1186/s12904-021-00711-8

 received in 2020-08-20, accepted in 2021-01-03,  发布年份 2021

来源: Springer

【 摘 要 】

BackgroundObservational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and their association with demographic and clinical characteristics as well as outcomes during the COVID-19 pandemic.MethodsRetrospective, observational study conducted between 5th March and 7th May 2020 of all hospitalised patients with COVID-19. Ceiling of care and CPR decisions were documented using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. Unadjusted and multivariable regression analyses were used to determine factors associated with ceiling of care decisions and death during hospitalisation.ResultsA total of 485 patients were included, of whom 409 (84·3%) had a documented ceiling of care; level one for 208 (50·9%), level two for 75 (18·3%) and level three for 126 (30·8%). CPR decisions were documented for 451 (93·0%) of whom 336 (74·5%) were ‘not for resuscitation’. Advanced age, frailty, White-European ethnicity, a diagnosis of any co-morbidity and receipt of cardiovascular medications were associated with ceiling of care decisions. In a multivariable model only advanced age (odds 0·89, 0·86–0·93 p < 0·001), frailty (odds 0·48, 0·38–0·60, p < 0·001) and the cumulative number of co-morbidities (odds 0·72, 0·52–1·0, p = 0·048) were independently associated. Death during hospitalisation was independently associated with age, frailty and requirement for level two or three care.ConclusionCeiling of care decisions were made for the majority of patients during the COVID-19 pandemic, broadly in line with known predictors of poor outcomes in COVID-19, but with a focus on co-morbidities suggesting ICU admission might not be a reliable end-point for observational studies where advanced care planning is routine.

【 授权许可】

CC BY   
© The Author(s) 2021. corrected publication 2022

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