scholarly journals Health Care System Distrust, Race, and Surrogate Decision Making Regarding Code Status

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Sang Yoon Na, BS, MS ◽  
James E. Slaven, MS ◽  
Emily S. Burke, BA ◽  
Alexia M. Torke, MD, MS
Keyword(s):  
Health Care ◽  
African American ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Surrogate Decision ◽  
Care System

Background and Hypothesis: Studies have shown African American patients are more likely to prefer aggressive life-sustaining treatments such as cardiopulmonary resuscitation (CPR) at end-of-life compared to non-Hispanic White patients. Given prior racial disparities in healthcare, low trust has been proposed to explain these preferences. We examined factors that influence surrogate decision makers’ preference for Do Not Resuscitate (DNR) status for hospitalized older adults who cannot make their own medical decisions. We explored whether race is associated with surrogate preference for DNR status for a hospitalized older adult. We also examine if race is associated with distrust and if the race/code status relationship is partially explained (mediated) by distrust in the healthcare system. Experimental Design or Project Methods: Analyses were conducted using data from an observational study of patient/surrogate dyads admitted to an ICU in a Midwest metropolitan area. Distrust was assessed using the Revised Health Care System Distrust Scale. A single item asked the surrogate which status they thought was best for the patient, full code or DNR. Results: In bivariate analysis, higher proportion of African American surrogates showed preference for full code (62.4% vs 37.6%, p=0.0001). After adjusting for trust and sociodemographic and psychological covariates, race was still significantly associated with DNR preference (aOR = 1.92; 95% CI: 1.04, 3.55; p=0.0382). Surrogate race did not show significant association with distrust in bivariate or multivariable analysis, which adjusted for sociodemographic and psychological covariates (p=0.3867). Conclusion and Potential Impact: Contrary to previous studies, we observed no association between surrogate race and distrust of the health care system. Differences in code status preference may be due to other factors related to race and culture. In order to ensure patients are receiving end-of-life care that is consistent with their values, more work is needed to understand the cultural complexities behind end-of-life care preference.

scholarly journals End-of-Life Care for Patients With Advanced Kidney Disease in the US Veterans Affairs Health Care System, 2000-2011

2018 ◽  
Vol 72 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Susan P.Y. Wong ◽  
Margaret K. Yu ◽  
Pamela K. Green ◽  
Chuan-Fen Liu ◽  
Paul L. Hebert ◽  
...  
Keyword(s):  
Health Care ◽  
Kidney Disease ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Veterans Affairs ◽  
Life Care ◽  
The Us ◽  
Us Veterans ◽  
Care System

scholarly journals Palliative and End-of-Life Care in the Home in Regional/Rural Victoria, Australia: The Role and Lived Experience of Primary Carers

2021 ◽  
Vol 7 ◽  
pp. 237796082110362
Author(s):  
Elizabeth M. Miller ◽  
Joanne E. Porter ◽  
Rebecca Peel
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Lived Experience ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Primary Health Care System ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Care System

Introduction Palliative support services (generalist or specialist) can provide much-needed assistance to carers who are providing palliative and end-of-life care in their homes, but access to such services in regional and rural areas of Australia is poorly understood. Objectives This study aimed to explore the role and lived experience of primary carers who are providing palliative and end-of-life care in the home in regional/rural Victoria, Australia. Methods Nine female participants, of whom six were bereaved between 7 and 20 months were interviewed using a semistructured interview technique. Each interview was audio-recorded, transcribed verbatim, and analyzed thematically. Results Two themes emerged: “ Negotiating healthcare systems” which described the needs for multidisciplinary supports and “ The caring experience” which discussed daily tasks, relationships, mental and physical exhaustion, respite, isolation, medication management, and grief and loss. Findings show that regional/rural carers have an added burden of travel stress as well as feeling overwhelmed, isolated, and physically and emotionally exhausted. Carers would benefit from greater flexibility for short-term respite care. The engagement of specialist palliative care services assisted the participants to navigate the health care system. Some participants did not understand the value of palliative care, highlighting the need for general practitioners to conduct early conversations about this with their patients. Education is needed to build capacity within the primary palliative care workforce, confirming the importance of timely referrals to a specialist palliative care practitioner if pain or symptom control is not effectively managed. Conclusion Providing palliative and end-of-life care in the home is an exhausting and emotionally draining role for unpaid, primary carers. Multiple supports are needed to sustain primary carers, as they play an essential role in the primary health care system.

scholarly journals Barriers and perceptions regarding code status discussion with families of critically ill patients in a tertiary care hospital of a developing country: A cross-sectional study

2016 ◽  
Vol 31 (2) ◽  
pp. 147-157 ◽  
Author(s):  
Ahsan A Syed ◽  
Aysha Almas ◽  
Quratulain Naeem ◽  
Umer F Malik ◽  
Tariq Muhammad
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Sectional Study ◽  
Cross Sectional ◽  
Code Status

Background: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown. Aim: To determine the barriers and perceptions in discussion of code status by physicians. Design: Questionnaire-based cross-sectional study. Setting and participants: This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included. Results: A total of 77 (57.4%) physicians responded. Family-related barriers were found to be the most common barriers. They include family denial (74.0%), level of education of family (66.2%), and conflict between individual family members (66.2%). Regarding personal barriers, lack of knowledge regarding prognosis (44.1%), personal discomfort in discussing death (29.8%), and fear of legal consequences (28.5%) were the top most barriers. In hospital-related barriers, time constraint (57.1%), lack of hospital administration support (48.0%), and suboptimal nursing care after do not resuscitate (48.0%) were the most frequent. There were significant differences among opinions of trainees when compared to those of attending physicians. Conclusion: Family-related barriers are the most frequent roadblocks in the end-of-life care discussions for physicians in Pakistan. Strengthening communication skills of physicians and family education are the potential strategies to improve end-of-life care. Large multi-center studies are needed to better understand the barriers of code status discussion in developing countries.

Prognostication Accuracy, Confidence, and Decisional Conflict Across Training Levels of Internal Medicine Providers

2019 ◽  
Vol 35 (4) ◽  
pp. 226-231
Author(s):  
Aram A. Namavar ◽  
Sitaram Vangala ◽  
Christopher Pietras ◽  
Erin P. Dowling
Keyword(s):  
Internal Medicine ◽  
Health Care ◽  
Patient Care ◽  
End Of Life ◽  
Health Care System ◽  
End Of Life Care ◽  
Decisional Conflict ◽  
Survival Outcomes ◽  
Life Care ◽  
Level Of Training

Context: Providing patient care at the end of a patient’s life is a humbling and sacred experience for both patient and provider. Without a truthful and meaningful conversation about end-of-life care preferences, the care that is delivered may not be the care that the patient prefers. Objectives: Determine if there is a relationship between level of training, confidence, and presence of decisional conflict in making an accurate prognosis for 2 standardized cases. Additionally, we evaluated the correctness of the prognosis as measured against survival outcomes for patients with similar diagnoses. Methods: Decisional conflict was measured with the SURE tool, a validated 4-item tool that has been used in assessing for the presence of decisional conflict. Results: Following analysis of data, it was found that providers with no decisional conflict were much more likely to be attendings with more than 5 years’ experience. Providers were more conflicted overall when confronted with a case with a more grave prognosis. It was determined that providers with a lower level of training were more likely to have decisional conflict. Conclusions: Provider confidence increases and decisional conflict decreases as one increases their level of training. However, the degree in which the provider is correct in their prognosis does not change as one increases their level of training. These findings have broad implications on patients, providers, and the health-care system.

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