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Discussions about end-of-life care in nursing homes
E H Bradley1, V Peiris, T Wetle
1Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Connecticut 06520-8034, USA.
Journal of the American Geriatrics Society
|October 20, 1998
Summary
Discussions about future treatment wishes in nursing homes increased after the Patient Self Determination Act (PSDA), but most residents still lack documented conversations, with limited scope when they occur.
Area of Science:
- Gerontology
- Healthcare Policy
- Medical Ethics
Background:
- Advance care planning is crucial for nursing home residents.
- The Patient Self Determination Act (PSDA) aimed to improve patient rights regarding future treatment wishes.
Purpose of the Study:
- To quantify discussions about future treatment wishes between nursing home residents, surrogates, and clinicians.
- To evaluate the impact of the PSDA on the frequency and nature of these discussions.
Main Methods:
- Retrospective cohort study involving 600 residents from six Connecticut nursing homes.
- Analysis of medical records for documented discussions before and after PSDA implementation.
Main Results:
- A majority (71.5%) of residents had no documented discussion of future treatment wishes.
- Documented discussions increased from 20.3% pre-PSDA to 36.7% post-PSDA.
- Discussions were often limited to life-support, occurring rarely and within the first year of admission.
Conclusions:
- The PSDA led to a modest increase in documented discussions, but most residents remain without them.
- When discussions occur, they are infrequent and narrow in scope, potentially limiting resident and family involvement in decision-making.