An Observational Study on the Effects of Delayed Initiation of End-of-Life Care in Terminally ill Young Adults in the
Anirban Hom Choudhuri1, Sakshi Duggal1, Bhuvna Ahuja1
1Department of Anaesthesiology and Intensive Care, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India.
Insights
Delayed end-of-life (EOL) care is common in young adults in the ICU. Early EOL discussions reduce resource use without impacting patient satisfaction.
Area of Science:
- Critical Care Medicine
- Palliative Care
- Medical Ethics
Background:
- Early initiation of end-of-life (EOL) care in intensive care units (ICUs) offers benefits but faces challenges, particularly with young adults.
- Terminally ill young adults present unique difficulties in obtaining consent for EOL care discussions.
Purpose of the Study:
- To determine the prevalence of delayed EOL care initiation in terminally ill young adults.
- To identify and compare risk factors associated with delayed EOL care.
Main Methods:
- Retrospective study of 66 terminally ill young adults (20-40 years) in a mixed medical-surgical ICU (June 2014 - November 2018).
- Patients with "treatment futile" status were included; those already on EOL care or with unproven diagnoses were excluded.
- Comparison of "normal" (N) and "late" (L) EOL care initiation groups based on demographics, outcomes, and satisfaction.
Main Results:
- A high prevalence of delayed EOL care was observed, with 61.1% in the "late" group (mean 3.1 days) versus 38.9% in the "normal" group (mean 0.8 days).
- Relatives in the "normal" group had higher education and social support.
- The "normal" group showed reduced medication and ICU resource utilization.
Conclusions:
- Delayed EOL care initiation is prevalent in terminally ill young adults.
- Factors such as lower education and social support among relatives contribute to delays.
- Timely EOL care initiation conserves resources without compromising patient satisfaction.
Introduction:
The early initiation of end-of-life (EOL) care in terminally ill patients in the intensive care unit (ICU) offers distinct advantages but requires the consent and cooperation of the patients or their relatives. The terminally ill young adults pose distinct set of challenges. The present study was conducted to measure the prevalence and identify and compare the risk factors for the delayed initiation of EOL in terminally ill young adults.
Methods:
The retrospective study was conducted in a mixed medical-surgical 7-bedded ICU after extracting the medical records of all terminally ill young adults in the age group of 20-40 years admitted between June 2014 and November 2018. Only "treatment futile" patients were eligible for inclusion. The patients already on EOL care or with unproven diagnosis were excluded from the study. The commencement of EOL care was divided into (a) normal group (N) and (b) late group (L). The two groups were compared with respect to the demographic factors, outcome, and patient satisfaction level. The factors responsible for the delay were investigated. All statistical analyses were performed using software SPSS 21.0 (SPSS, Inc., Chicago, IL, USA).
Results:
Out of 66 terminally ill young adults with treatment futility, 23 (38.9%) were in the N group and 36 (61.1%) were in the L group (0.8 ± 0.4 days vs. 3.1 ± 1.6 days; P = 0.01). The education level and social and family support of the relatives of the N group were higher (P = 0.03; P - 0.04). The N group had lesser drug consumption of ICU resource usage (14.7% vs. 36.1%, P = 0.01; 18.5% vs. 24.7%, P = 0.04). There was no difference in the duration of mechanical ventilation, ICU stay, and satisfaction level at the time of discharge (or death) from the ICU.
Conclusions:
Our study found a high prevalence of delayed initiation of EOL care in terminally ill young adults and identified the factors responsible for them. The normal initiation of EOL care reduced the usage of medications and resources without affecting the level of patient satisfaction.
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