Statler TM, Hsu FC, Silla L, Sheehan KN, Cowles A, Brooten JK, Omlor RL, Gabbard J. Occurrence of Advance Care Planning and Hospital Course in Patients Admitted for Coronavirus Disease 2019 (COVID-19) During the Pandemic.
Am J Hosp Palliat Care 2022:10499091221123570. [PMID:
36018339 PMCID:
PMC9420734 DOI:
10.1177/10499091221123570]
[Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
The Coronavirus Disease 2019 (COVID-19) pandemic highlighted the importance
of understanding patients’ goals, values, and medical care preferences given
the high morbidity and mortality. We aimed to examine rates of advance care
planning (ACP) documentation along with hospital course differences in the
absence or presence of ACP among hospitalized patients with COVID-19.
Methods
This retrospective cohort study was performed at a single tertiary academic
medical center. All adults admitted between March 1, 2020, and June 30,
2020, for COVID-19 were included. Demographics, ACP documentation rates,
presence of ACP forms, palliative care consultation (PCC) rates, code
status, and hospital outcome data were collected. Data were analyzed with
multivariable analysis to identify predictors of ACP documentation.
Results
Among 356 patients (mean age 60.0, 153 (43%) female), 97 (27.2%) had
documented ACP and 20 (5.6%) had completed ACP forms. In patients with
documented ACP, 52.4% (n = 55) de-escalated care to do-not-resuscitate
(DNR)-limited or comfort measures. PCC occurred rarely (<8%), but 78% (n
= 21) of those consulted de-escalated care. Being admitted to the intensive
care unit (ICU) (OR = 11.1, 95% CI = 5.9-21.1), mechanical intubation (OR =
15.8, 95% CI = 7.4-32.1), and discharge location other than home (OR = 11.3,
95% CI = 5.7-22.7) were associated with ACP documentation.
Conclusions
This study found low ACP documentation and PCC rates in patients admitted for
COVID-19. PCC and completion of ACP were associated with higher rates of
care de-escalation. These results support the need for pro-active ACP and
PCC for patients admitted for serious illnesses, like COVID-19, to improve
goal-informed care.
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