Evaluation of a decision aid for making choices about intubation and mechanical ventilation in chronic obstructive pulmonary disease

2005 ◽  
Vol 57 (1) ◽  
pp. 88-95 ◽  
Author(s):  
Keith G. Wilson ◽  
Shawn D. Aaron ◽  
Katherine L. Vandemheen ◽  
Paul C. Hébert ◽  
Douglas A. McKim ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Pulmonary Disease ◽  
Decision Aid ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Making Choices

scholarly journals A Decision Aid to Support Shared Decision Making About Mechanical Ventilation in Severe Chronic Obstructive Pulmonary Disease Patients (InformedTogether): Feasibility Study (Preprint)

2018 ◽  
Author(s):  
Melissa Basile ◽  
Johanna Andrews ◽  
Sonia Jacome ◽  
Meng Zhang ◽  
Andrzej Kozikowski ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Pulmonary Disease ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Chronic Obstructive ◽  
Shared Decision ◽  
Obstructive Pulmonary Disease

BACKGROUND Severe Chronic Obstructive Pulmonary Disease patients are often unprepared to make decisions about accepting intubation for respiratory failure. We developed a Web-based decision aid, InformedTogether, to facilitate severe Chronic Obstructive Pulmonary Disease patients’ preparation for decision making about whether to accept invasive mechanical ventilation for respiratory failure. OBJECTIVE We describe feasibility testing of the InformedTogether decision aid. METHODS Mixed methods, pre- and postintervention feasibility study in outpatient pulmonary and geriatric clinics. Clinicians used InformedTogether with severe Chronic Obstructive Pulmonary Disease patients. Patient-participants completed pre- and postassessments about InformedTogether use. The outcomes measured were the following: feasibility/acceptability, communication (Combined Outcome Measure for Risk Communication [COMRADE], Medical Communication Competency Scale [MCCS], Observing Patient Involvement [OPTION] scales), and effectiveness of InformedTogether on changing patients' knowledge, Decisional Conflict Scale, and motivation. RESULTS We enrolled 11 clinicians and 38 Chronic Obstructive Pulmonary Disease patients at six sites. Feasibility/acceptability: Clinicians and patients gave positive responses to acceptability questions (mean 74.1/89 max [SD 7.24] and mean 59.63/61 [SD 4.49], respectively). Communication: 96% of clinicians stated InformedTogether improved communication (modified MCCS mean 44.54/49 [SD 2.97]; mean OPTION score 32.03/48 [SD 9.27]; mean COMRADE Satisfaction 4.31/5.0 [SD 0.58]; and COMRADE Confidence 4.18/5.0 [SD 0.56]). Preference: Eighty percent of patients discussed preferences with their surrogates by 1-month. Effectiveness: Knowledge scores increased significantly after using InformedTogether (mean difference 3.61 [SD 3. 44], P=.001) and Decisional Conflict decreased (mean difference Decisional Conflict Scale pre/post -13.76 [SD 20.39], P=.006). Motivation increased after viewing the decision aid. CONCLUSIONS InformedTogether supports high-quality communication and shared decision making among Chronic Obstructive Pulmonary Disease patients, clinicians, and surrogates. The increased knowledge and opportunity to deliberate and discuss treatment choices after using InformedTogether should lead to improved decision making at the time of critical illness.

scholarly journals COVID-19 health inequities and association with mechanical ventilation and prolonged length of stay at an urban safety-net health system in Chicago

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258243
Author(s):  
Jacquelyn Jacobs ◽  
Amy K. Johnson ◽  
Arianna Boshara ◽  
Bijou Hunt ◽  
Christina Khouri ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Pulmonary Disease ◽  
Safety Net ◽  
Chronic Obstructive ◽  
Minority Population ◽  
Obstructive Pulmonary Disease ◽  
Ethnic Minority Population ◽  
Prolonged Length

Millions of Americans have been infected with COVID-19 and communities of color have been disproportionately burdened. We investigated the relationship between demographic characteristics and COVID-19 positivity, and comorbidities and severe COVID-19 illness (use of mechanical ventilation and length of stay) within a racial/ethnic minority population. Patients tested for COVID-19 between March 2020 and January 2021 (N = 14171) were 49.9% (n = 7072) female; 50.1% (n = 7104) non-Hispanic Black; 33.2% (n = 4698) Hispanic; and 23.6% (n = 3348) aged 65+. Overall COVID-19 positivity was 16.1% (n = 2286). Compared to females, males were 1.1 times more likely to test positive (p = 0.014). Compared to non-Hispanic Whites, non-Hispanic Black and Hispanic persons were 1.4 (p = 0.003) and 2.4 (p<0.001) times more likely, respectively, to test positive. Compared to persons ages 18–24, the odds of testing positive were statistically significantly higher for every age group except 25–34, and those aged 65+ were 2.8 times more likely to test positive (p<0.001). Adjusted for race, sex, and age, COVID-positive patients with chronic obstructive pulmonary disease were 1.9 times more likely to require a ventilator compared to those without chronic obstructive pulmonary disease (p = 0.001). Length of stay was not statistically significantly associated with any of the comorbidity variables. Our findings emphasize the importance of documenting COVID-19 disparities in marginalized populations.

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