Considering the CPR Decision Through the Lens of Prospect Theory in the Context of Advanced Chronic Illness

Perception Bias Effects on Healthcare Management in COVID-19 Pandemic: An Application of Cumulative Prospect Theory

Coronavirus disease 2019 (COVID-19) has posed severe threats to human safety in the healthcare sector, particularly in residents in long-term care facilities (LTCFs) at a higher risk of morbidity and mortality. This study aims to draw on cumulative prospect theory (CPT) to develop a decision model to explore LTCF administrators’ risk perceptions and management decisions toward this pandemic. This study employed the policy Delphi method and survey data to examine managers’ perceptions and attitudes and explore the effects of sociodemographic characteristics on healthcare decisions. The findings show that participants exhibited risk aversion for small losses but became risk-neutral when considering devastating damages. LTCF managers exhibited perception bias that led to over- and under-estimation of the occurrence of infection risk. The contextual determinants, including LTCF type, scale, and strategy, simultaneously affect leaders’ risk perception toward consequences and probabilities. Specifically, cost-leadership facilities behave in a loss-averse way, whereas hybrid-strategy LTCFs appear biased in measuring probabilities. This study is the first research that proposes a CPT model to predict administrators’ risk perception under varying mixed gain–loss circumstances involving considerations of healthcare and society in the pandemic context. This study extends the application of CPT into organizational-level decisions. The results highlight that managers counteract their perception bias and subjective estimation to avoid inappropriate decisions in healthcare operations and risk governance for a future health emergency.

Age and Life-Sustaining Treatment Preferences in Parkinson Disease

Objective

Advance Care Planning (ACP) is one of 10 key elements in the American Academy of Neurology Parkinson disease (PD) clinical practice quality measures. We know little about how aging influences ACP views in people with PD.

Methods

We conducted a cross-sectional survey of 39 participants (mean age 70.3 years; range: 52-81) with PD to explore correlations between older age and life-sustaining treatment preferences while controlling for confounders including years of education, Montreal Cognitive Assessment score and Movement Disorders Society Unified Parkinson's disease Rating Scale motor score. Scenarios asked participants to choose their level of interest in pursuing life-sustaining measures in the setting of specific medical illnesses including stroke, metastatic cancer, severe heart attack, and dementia. All participants were men and were recruited from the Veterans Affairs Ann Arbor Healthcare System.

Results

In the hypothetical stroke, metastatic colon cancer, and dementia scenarios, older age correlated with more aggressive care goals related to the use cardiopulmonary resuscitation to treat cardiopulmonary arrest.

Conclusions

Advancing age in PD may correlate with paradoxically more aggressive goals as it relates to life-sustaining treatment preferences including cardiopulmonary resuscitation. This may reflect a response to heightened concern among older adults with PD about the potential for compromised autonomy in the setting of aging.

A comparative study on decision and documentation of refraining from resuscitation in two medical home care units in Sweden

Background

A decision to refrain from cardiopulmonary resuscitation (CPR) in the case of cardiac arrest is recommended in terminally ill patients to avoid unnecessary suffering at time of death. The aim of this study was to describe the frequency of decisions and documentation of “do not attempt cardiopulmonary resuscitation” (DNACPR) in two Medical Home Care Units in Stockholm. Unit A had written guidelines about how to document CPR-decisions in the medical records, including a requirement for a decision to be taken (CPR: yes/no) while Unit B had no such requirement.

Method

The medical records for all patients in palliative phase of their disease at the two Units were reviewed. Data was collected on documentation of decisions about CPR (yes/no), DNACPR-decisions and documentation regarding whether the patient or next-of-kin had been informed about the DNACPR-decision.

Results

In the two Units, 316 and 219 patients in palliative phase were identified. In Unit A 100% of the patients had a CPR-decision (yes/no) compared to 79% in Unit B (p < 0.001). There was no statistically significant difference in DNACPR-decisions between the two Units, 43 and 37%. Documentation about informing the patient regarding the decision was significantly higher in Unit A, 53% compared to 14% at Unit B (p < 0.001). Documentation about informing the next-of-kin was also significantly higher at Unit A; 42% compared to 6% at Unit B (p < 0.001).

Conclusion

Less than 50% of patients in palliative phase had a decision of DNACPR in two Medical Home Care Units in Stockholm. The presence of written guidelines and a requirement for a CPR-decision did not increase the frequency of DNACPR-decisions but was associated with a higher frequency of documentation of decisions and of information given to both the patients and the next-of-kin.