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Ahrenfeldt LJ, Möller S, Hvidt NC, VanderWeele TJ, Stripp TA. Effect of religious service attendance on mortality and hospitalisations among Danish men and women: longitudinal findings from REGLINK-SHAREDK. Eur J Epidemiol 2023; 38:281-289. [PMID: 36646924 DOI: 10.1007/s10654-023-00964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023]
Abstract
Research suggests a protective effect of religious service attendance on various health outcomes. However, most research has been done in religious societies, raising the question of whether these associations are also prominent in secular cultures. Here we examine mortality and hospitalisations by religious service attendance among men and women in a secular society. We performed a cohort study including 2987 Danes aged 40+ interviewed in SHARE from 2004 to 2007 and followed up in the Danish registries until 2018. We used Cox regressions and negative binomial regressions to examine associations, including interactions with sex and adjusting for age, wave, socioeconomic factors, lifestyle factors, body mass index, and history of diseases. Overall, 5.0% of men and 6.6% of women reported that they had taken part in a religious organisation within the last month. Among 848 deaths, we found lower mortality for people who attended religious services (hazard ratio (HR) 0.70; 95% CI 0.50-0.99). There was evidence for an association among women (HR 0.56; 95% CI 0.35-0.89), but not among men (HR 0.95; 95% CI 0.59-1.53). In contrast, regarding hospital admissions (n = 12,010), we found lower hospitalisation rates among men who attended religious services (incidence rate ratio (IRR) 0.67; 95% CI 0.45-0.98), whereas no association was found among women (IRR 0.95; 95% CI 0.70-1.29). Sensitivity analyses with E-values were moderately robust. Our results contribute to the limited literature on possible health benefits of religious service attendance in secular societies, demonstrating lower mortality among women and fewer hospitalisations among men.
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Affiliation(s)
- Linda Juel Ahrenfeldt
- Unit for Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9B, 5000, Odense, Denmark.
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, 5000, Odense, Denmark
- Research unit OPEN, Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, 5000, Odense, Denmark
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Tobias Anker Stripp
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
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The decision-making process of transferring patients home to die from an intensive care unit in mainland China: A qualitative study of family members' experiences. Intensive Crit Care Nurs 2023; 76:103399. [PMID: 36731266 DOI: 10.1016/j.iccn.2023.103399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To map the decision-making process of family members involved in transferring a critically ill patient home to die from an intensive care unit in mainland China and to explore the experiences of those family members. DESIGN A constructivist qualitative study. SETTING One hospitals intensive care unit in Southeast China. METHODS Thirteen adult family members (of ten patients) who participated in decision-making related to transferring a relative home to die from the intensive care unit were purposively selected. Data were collected via interviews and analysed applying thematic analysis. FINDINGS A two-stage decision-making process was identified. Family decision-making was mediated by factors including: accepting the impending death and hope that the patient would not die; time pressures in which decisions had to be made, and the challenges of meeting cultural expectations of a home death. Transfer home was a family-centred decision constrained by a gender-based hierarchy restricting the involvement of different family members. CONCLUSION The stages and key factors in the decision-making process of family members when involved in transferring a patient home to die from an intensive care unit in China are rooted and informed by cultural expectations and limits in the current healthcare system regarding end-of-life care options. Understanding the climate in which family members must make decisions will facilitate supportive interventions to be implemented by healthcare professionals. Further empirical research is needed to explore family members' needs when the patient has been transferred and dies at home in mainland China. IMPLICATIONS FOR CLINICAL PRACTICE Healthcare professionals need to understand the challenges family members face when deciding to transfer a relative home to die from an intensive care unit. For example time pressures can limit the choices of family members so that to provide them with timely, ongoing, realistic updates for a greater involvement of family members in generating end of life care plans could be beneficial.1.
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Ho JFV, Marzuki NS, Meseng NSM, Kaneisan V, Lum YK, Pui EWW, Yaakup H. Symptom Prevalence and Place of Death Preference in Advanced Cancer Patients: Factors Associated With the Achievement of Home Death. Am J Hosp Palliat Care 2021; 39:762-771. [PMID: 34657488 PMCID: PMC9210115 DOI: 10.1177/10499091211048767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: Achievement of patients’ preferred place of death is recognized as a component of a good death. This study aimed to investigate the symptom burden in advanced cancer patients, achievement of their place of death preferences and factors associated with home death. Methods: In this retrospective review of 287 patient deaths, we examined patients’ symptom prevalence, preferred and actual place of death and achievement of their place of death preferences using descriptive statistics. Associations between patient factors, home death preference and actual home death were further analyzed using multivariate logistic regression. Results: The most prevalent symptoms were weakness, pain and poor appetite, with a mean of 5.77(SD: 2.37) symptoms per patient. The median interval from palliative care referral to death was 21 (IQR: 74) days. Of the 253 patients with documented place of death preference, 132 (52.1%) preferred home death, 111(43.9%) preferred hospital death, 1 (0.4%) preferred to die at a temple and 9(3.6%) expressed no preference. Overall, 221 of 241(91.7%) patients with known actual place of death achieved their preference. Older patients were more likely to prefer home death (OR 1.021; 95% CI 1.004-1.039, p = 0.018) and die at home (OR 1.023; 95% CI 1.005-1.041, p = 0.014). Gender, marital status, cancer diagnosis and symptoms were not associated with preference for or actual home death. Conclusion: Despite a high symptom burden, most patients preferred and achieved a home death. Late palliative care referral and difficult symptom management contributed to failure to fulfill home death preference. Preference for home death should be considered when managing terminally ill geriatric patients.
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Affiliation(s)
- Julia Fee Voon Ho
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | - Nur Syafiqah Marzuki
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | | | - Viknaswary Kaneisan
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | - Yin Khek Lum
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | | | - Hayati Yaakup
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
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Lin Y, Long-Sutehall T, Myall M. Transferring home to die from critical care units: A scoping review of international practices. J Crit Care 2021; 65:205-215. [PMID: 34243069 DOI: 10.1016/j.jcrc.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify and characterise the international practices of transferring a dying patient home to die from critical care units. MATERIALS AND METHODS A systematic scoping review following the Joanne Briggs Institute methodology was applied searching fifteen data sources to identify papers published in English and Chinese from 1970 to 2019. RESULTS Of the 28 papers meeting eligibility criteria 19 were published in the West and seven in China. The number of patients being transferred home to die was larger in China (74/184-96/159) than in the West (1-7). Clinical characteristics of patients transferred included: consciousness, with or without intubation and ventilation, and clinical stability. Reported key barriers to transfer included: Lack of evidence guiding transfer practice, the CCU environment and culture, Practical and logistical factors and Family members expectations and reactions. Key facilitators of transfer were reported as: Engagement with the multidisciplinary team and Personal patient and family wishes. CONCLUSIONS Transferring patients home to die from critical care is a complex practice varying significantly across countries. Further research to address current knowledge gaps is important to inform policy and practice.
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Affiliation(s)
- Yanxia Lin
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
| | - Tracy Long-Sutehall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Michelle Myall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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Divatia JV, Chawla R, Kapadia F, Myatra SN, Rajagopalan R, Amin P, Khilnani P, Prayag S, Todi SK, Uttam R. Guidelines for end-of-life and palliative care in Indian intensive care to units: ISCCM consensus Ethical Position Statement. Indian J Crit Care Med 2020. [DOI: 10.5005/ijccm-17-s1-26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hutchinson AL, Van Wissen KA. Home to die from the intensive care unit: A qualitative descriptive study of the family’s experience. Intensive Crit Care Nurs 2017; 43:116-122. [DOI: 10.1016/j.iccn.2017.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/17/2017] [Accepted: 07/15/2017] [Indexed: 11/27/2022]
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Venkatasalu MR. Let him not be alone: perspectives of older British South Asian minority ethnic patients on dying in acute hospitals. Int J Palliat Nurs 2017; 23:432-439. [PMID: 28933991 DOI: 10.12968/ijpn.2017.23.9.432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To investigate older British South Asians' views on dying at acute hospitals. BACKGROUND Older people, including those from ethnic minorities prefer 'home as a haven' for their last days of life; however, they are more likely to die in hospital. METHODS Constructive grounded theory was used as a methodological approach that informed data collection to data analysis. Open meetings with 11 local South Asian community organisations enabled the researchers to recruit a total of 55 older South Asians in this study. Data were collected using gender-based focus groups (n=5) and in-depth, semi-structured interviews (n=29). Transcripts were analysed using Nvivo 9. RESULTS Three key themes were identified: 'mistrust', 'let him not be alone' and 'family as a protective shield'. The theme 'mistrust' is explored through examination of beliefs, attitudes and expectations about 'hospital' as a place in the care of the dying. The theme of 'let him not be alone' draws the family's preferences and concerns in relation to leaving their older dying relative alone in the hospital. The final theme of 'family as a protective shield' describes the element of family care as a protective shield for their older one to have peaceful end-of-life care moments in the hospital. CONCLUSIONS Allowing older relatives to die in hospital seems to evoke feelings of missed filial responsibilities and guilt among family carers among older ethnic minorities. The presence of cultural paranoia and mistrust often led minorities to experience sub-standard end-of-life care in acute hospitals.
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Affiliation(s)
- Munikumar Ramasamy Venkatasalu
- Professor in Cancer and Palliative Care, Pengiran Anak Puteri Rashidah Sa'adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Negara Brunei Darussalam
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Lin Y, Myall M, Jarrett N. Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review. J Adv Nurs 2017. [DOI: 10.1111/jan.13368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yanxia Lin
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Michelle Myall
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Nikki Jarrett
- Faculty of Health Sciences; University of Southampton; Southampton UK
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Coombs MA, Darlington ASE, Long-Sutehall T, Pattison N, Richardson A. Transferring patients home to die: what is the potential population in UK critical care units? BMJ Support Palliat Care 2015; 7:98-101. [PMID: 26628534 PMCID: PMC5339543 DOI: 10.1136/bmjspcare-2014-000834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 09/02/2015] [Accepted: 11/12/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Most people when asked, express a preference to die at home, but little is known about whether this is an option for critically ill patients. A retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish. METHODS Medical notes of all patients who died in, or within 5 days of discharge from seven critical care units across two hospital sites over a 12-month period were reviewed. Inclusion/exclusion criteria were developed and applied to identify the number of patients who had potential to be transferred home to die and demographic and clinical data (eg, conscious state, respiratory and cardiac support therapies) collected. RESULTS 7844 patients were admitted over a 12-month period. 422 (5.4%) patients died. Using the criteria developed 100 (23.7%) patients could have potentially been transferred home to die. Of these 41 (41%) patients were diagnosed with respiratory disease. 53 (53%) patients were conscious, 47 (47%) patients were self-ventilating breathing room air/oxygen via a mask. 20 (20%) patients were ventilated via an endotracheal tube. 76 (76%) patients were not requiring inotropes/vasopressors. Mean time between discussion about treatment withdrawal and time of death was 36.4 h (SD=46.48). No patients in this cohort were transferred home. CONCLUSIONS A little over 20% of patients dying in critical care demonstrate potential to be transferred home to die. Staff should actively consider the practice of transferring home as an option for care at end of life for these patients.
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Affiliation(s)
- Maureen A Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
| | | | | | | | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Coombs M, Long-Sutehall T, Darlington AS, Richardson A. Doctors' and nurses' views and experience of transferring patients from critical care home to die: a qualitative exploratory study. Palliat Med 2015; 29:354-62. [PMID: 25519147 PMCID: PMC4370931 DOI: 10.1177/0269216314560208] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. AIM To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. DESIGN Exploratory two-stage qualitative study SETTING/PARTICIPANTS Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. FINDINGS The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. CONCLUSION There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.
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Affiliation(s)
- Maureen Coombs
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | | | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Darlington ASE, Long-Sutehall T, Richardson A, Coombs MA. A national survey exploring views and experience of health professionals about transferring patients from critical care home to die. Palliat Med 2015; 29:363-70. [PMID: 25656087 DOI: 10.1177/0269216315570407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transferring critically ill patients home to die is poorly explored in the literature to date. This practice is rare, and there is a need to understand health care professionals' (HCP) experience and views. OBJECTIVES To examine (1) HCPs' experience of transferring patients home to die from critical care, (2) HCPs' views about transfer and (3) characteristics of patients, HCPs would hypothetically consider transferring home to die. DESIGN A national study developing a web-based survey, which was sent to the lead doctors and nurses in critical care units. SETTING/PARTICIPANTS Lead doctors and senior nurses (756 individuals) working in 409 critical care units across the United Kingdom were invited to participate in the survey. RESULTS In total, 180 (23.8%) completed surveys were received. A total of 65 (36.1%) respondents had been actively involved in transferring patients home to die and 28 (15.5%) had been involved in discussions that did not lead to transfer. Respondents were supportive of the idea of transfer home to die (88.8%). Patients identified by respondents as unsuitable for transfer included unstable patients (61.8%), intubated and ventilated patients (68.5%) and patients receiving inotropes (65.7%). There were statistically significant differences in views between those with and without experience and between doctors and nurses. Nurses and those with experience tended to have more positive views. CONCLUSION While transferring patients home to die is supported in critical care, its frequency in practice remains low. Patient stability and level of intervention are important factors in decision-making in this area. Views held about this practice are influenced by previous experience and the professional role held.
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Affiliation(s)
| | | | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Maureen A Coombs
- Faculty of Health Sciences, University of Southampton, Southampton, UK Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
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Mani RK, Amin P, Chawla R, Divatia JV, Kapadia F, Khilnani P, Myatra SN, Prayag S, Rajagopalan R, Todi SK, Uttam R. Guidelines for end-of-life and palliative care in Indian intensive care units' ISCCM consensus Ethical Position Statement. Indian J Crit Care Med 2012. [PMID: 23188961 PMCID: PMC3506078 DOI: 10.4103/0972-5229.102112] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- R K Mani
- Committee for the Development of Guidelines for limiting life-prolonging interventions and providing palliative care towards the end-of-life: Indian Society of Critical Care Medicine
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Affiliation(s)
- Vineet Sarode
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC
| | - John Reeves
- Intensive Care Unit, Cabrini Hospital, Melbourne, VIC
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Ouanes I, Stambouli N, Dachraoui F, Ouanes-Besbes L, Toumi S, Ben Salem F, Gahbiche M, Abroug F. Pattern of end-of-life decisions in two Tunisian intensive care units: the role of culture and intensivists' training. Intensive Care Med 2012; 38:710-7. [PMID: 22327558 DOI: 10.1007/s00134-012-2500-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 11/20/2011] [Indexed: 01/01/2023]
Abstract
PURPOSE End-of-life (EOL) decisions are not well studied in developing countries. We report EOL decision patterns in two Tunisian intensive care units [ICUs, medical (MICU) and surgical (SICU)] belonging to the same teaching hospital. METHODS Consecutive deaths that occurred in participating ICUs over 2 years were analysed. End-of-life decisions were prospectively recorded by the senior attending physicians, while subject's characteristics were retrospectively collected. RESULTS Deaths occurred in 326 of 1,733 ICU-admitted patients (median age: 64 years; median SAPS II at admission = 36). Overall, a decision for full support was taken in 69%, while decisions to withhold or withdraw life support were held in 22.1 and 8.9% of deaths, respectively. The rate of end-of-life decisions was similar in the MICU and the SICU. In no instance was there MV withdrawal during ICU stay. Discharging patients to die at home was observed only in the MICU (10 out of the 20 patients with a withdrawal decision). Two factors were independently associated with WH or WD decisions: a severe and ultimately fatal underlying disease was positively associated with such decisions (OR = 2.4, 95% CI: 1.3-4.36; p = 0.003), while having an independent functional status before the ICU was associated with a decreased rate of physician decisions of WH or WD (OR = 0.32, 95% CI: 0.15-0.67; p = 0.002). CONCLUSION Withholding and withdrawing life support are common in medical and surgical ICUs of a Tunisian hospital. Withholding is more frequent than withdrawing life support. These decisions appear to be effected by functional status and underlying conditions.
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Affiliation(s)
- Islem Ouanes
- Medical Intensive Care Unit, Fattouma Bourguiba University Hospital, University of Monastir, 5000 Monastir, Tunisia
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Lusardi P, Jodka P, Stambovsky M, Stadnicki B, Babb B, Plouffe D, Doubleday N, Pizlak Z, Walles K, Montonye M. The Going Home Initiative: Getting Critical Care Patients Home With Hospice. Crit Care Nurse 2011; 31:46-57. [DOI: 10.4037/ccn2011415] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Although considerable effort is being directed at providing patients and their families with a “good death,” most patients in intensive care units, if given the choice, would prefer to die at home. With little guidance from the literature, the palliative care committee of an intensive care unit developed guidelines to get patients home from the intensive care unit to die. In the past few years, the unit has transferred many patients home with hospice care, much to the delight of their families. Although several obstacles to achieving this goal exist, the unit has achieved success in a small-scale implementation of its Going Home Initiative.
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Affiliation(s)
- Paula Lusardi
- Paula Lusardi is a clinical nurse specialist in the adult intensive care unit, cochair of the intensive care unit’s palliative care committee, and director of nursing research at Baystate Medical Center, Springfield, Massachusetts
| | - Paul Jodka
- Paul Jodka is attending physician in the critical care division, director of anesthesia/critical care fellowship, and cochair of the intensive care unit’s palliative care committee at Baystate Medical Center and an assistant professor of medicine at Tufts University School of Medicine, Boston, Massachusetts
| | - Mark Stambovsky
- Mark Stambovsky is a staff nurse in the intensive care unit at Baystate Medical Center
| | - Beth Stadnicki
- Beth Stadnicki is a staff nurse in the intensive care unit and cochair of the intensive care unit’s palliative care committee at Baystate Medical Center
| | - Betty Babb
- Betty Babb is a staff nurse in the intensive care unit at Baystate Medical Center
| | - Danielle Plouffe
- Danielle Plouffe is a staff nurse in the intensive care unit and cochair of the intensive care unit’s palliative care committee at Baystate Medical Center
| | - Nancy Doubleday
- Nancy Doubleday is an adult nurse practitioner with Baystate Medical Practices, Adult Medicine, Springfield, Massachusetts
| | - Zophia Pizlak
- Zophia Pizlak is a staff nurse in the intensive care unit at Baystate Medical Center
| | - Katherine Walles
- Katherine Walles is a staff nurse in the intensive care unit at Baystate Medical Center
| | - Martin Montonye
- Martin Montonye is the vice president of academic affairs at HealthCare Chaplaincy, New York, New York
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17
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Abstract
OBJECTIVE To assess the adequacy of preparedness planning for an influenza pandemic by modeling the pediatric surge capacity of healthcare facility and pediatric intensive care unit (PICU) requirements over time. Governments and Public Health authorities have planned preparedness activities and training for a flu pandemic. PICU facilities will be the limiting factor in healthcare provision for children but detailed analyses for needs and demands in PICU care have not been published. DESIGN Based on the Center for Disease Control and Prevention and World Health Organization estimates and published models of the expected evolution of pandemic flu, we modeled the pediatric surge capacity of healthcare facility and PICU requirements over time. Various scenarios with different assumptions were explored. We compared these demands with estimates of maximal PICU capacity factoring in healthcare worker absenteeism as well as reported and more realistic estimates derived from semistructured telephone interviews with key stakeholders in ICUs in the study area. SETTING All hospitals and intensive care facilities in the Northern Region in The Netherlands with near 1.7 million inhabitants, of whom approximately 25% is <18 yrs. MEASUREMENTS AND MAIN RESULTS Using well-established modeling techniques, evidence-based medicine, and incorporating estimates from the Centers for Disease Control and Prevention and World Health Organization, we show that PICU capacity may suffice during an influenza pandemic. Even during the peak of the pandemic, most children requiring PICU admission may be served, even those who have nonflu-related conditions, provided that robust indications and decision rules are maintained, both for admission, as well as continuation (or discontinuation) of life support. CONCLUSIONS We recommend that a model, with assumptions that can be adapted with new information obtained during early stages of the pandemic that is evolving, be an integral part of a preparedness plan for a pandemic influenza with new human transmissible agent like influenza A virus.
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Mani RK, Mandal AK, Bal S, Javeri Y, Kumar R, Nama DK, Pandey P, Rawat T, Singh N, Tewari H, Uttam R. End-of-life decisions in an Indian intensive care unit. Intensive Care Med 2009; 35:1713-9. [PMID: 19568731 DOI: 10.1007/s00134-009-1561-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 06/06/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a paucity of data on end-of-life decisions (EOLD) for patients in Indian intensive care units (ICUs). OBJECTIVE To document the end-of-life and full-support (FS) decisions among patients dying in an ICU, to compare the respective patient characteristics and to describe the process of decision-making. DESIGN Retrospective, observational. PATIENTS Consecutive patients admitted to a 12-bed closed medical-surgical ICU. EXCLUSIONS Patients with EOLD discharged home or transferred to another hospital. MEASUREMENTS AND RESULTS Demographic profile, APACHE IV at 24 h, ICU outcome, type of limitation, disease category, pre-admission functional status, reasons for EOLD, interventions and therapies within 3 days of death, time to EOLD, time to death after EOLD and ICU length of stay. Out of 88 deaths among 830 admissions, 49% were preceded by EOLD. Of these 58% had withholding of treatment, 35% had do-not-resuscitate orders (DNR) and 7% had a withdrawal decision. Mean age and APACHE IV scores were similar between EOLD and FS groups. Functional dependence before hospitalization favored EOLD. Patients receiving EOLD as opposed to FS had longer stays. Fifty-three percent of limitations were decided during the first week of ICU stay well before the time of death. Escalation of therapy within 3 days of death was less frequent in the EOLD group. CONCLUSIONS Despite societal and legal barriers, half the patients dying in the ICU received a decision to limit therapy mostly as withholding or DNR orders. These decisions evolved early in the course of stay and resulted in significant reduction of therapeutic burdens.
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Affiliation(s)
- Raj Kumar Mani
- Pulmonology-Thoracic Surgery and MICU, Fortis Flt. Lt. Rajan Dhall Hospital, B-1, Aruna Asif Ali Marg, Vasant Kunj, New Delhi, 110070, India.
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Going home to die from surgical intensive care units. Intensive Care Med 2009; 35:810-5. [DOI: 10.1007/s00134-009-1452-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 02/15/2009] [Indexed: 10/21/2022]
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Kompanje EJO. Should we discharge comatose patients from intensive care to die in their own bed at home after withdrawal of mechanical ventilation? Intensive Care Med 2009; 35:773-4. [DOI: 10.1007/s00134-009-1453-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 10/21/2022]
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Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Groeneveld J, Hedenstierna G, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Metnitz P, Pugin J, Wernerman J, Zhang H. Year in review in Intensive Care Medicine, 2007. III. Ethics and legislation, health services research, pharmacology and toxicology, nutrition and paediatrics. Intensive Care Med 2008; 34:598-609. [PMID: 18309475 DOI: 10.1007/s00134-008-1053-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 02/18/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Largo A. Gemelli, 8, 00168, Rome, Italy.
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Abstract
Using estimates from the Centers for Disease Control and Prevention, the World Health Organization, and published models of the expected evolution of pandemic influenza, we modeled the surge capacity of healthcare facility and intensive care unit (ICU) requirements over time in northern Netherlands (approximately 1.7 million population). We compared the demands of various scenarios with estimates of maximum ICU capacity, factoring in healthcare worker absenteeism as well as reported and realistic estimates derived from semistructured telephone interviews with key management in ICUs in the study area. We show that even during the peak of the pandemic, most patients requiring ICU admission may be served, even those who have non-influenza-related conditions, provided that strong indications and decision-making rules are maintained for admission as well as for continuation (or discontinuation) of life support. Such a model should be integral to a preparedness plan for a pandemic with a new human-transmissible agent.
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Affiliation(s)
- Raoul E Nap
- University Medical Center Groningen, Groningen, the Netherlands.
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