Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis
Copyright © 2016 by the American Society of Nephrology..
BACKGROUND AND OBJECTIVES: ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis.
RESULTS: Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P<0.001) and have died during the study period (64.4% versus 46.6%; P<0.001) than patients who did not have advance directives. Notably, for patients receiving dialysis who had advance directives, more of the advance directives addressed cardiopulmonary resuscitation (44.2%), mechanical ventilation (37.1%), artificial nutrition and hydration (34.3%), and pain management (43.4%) than dialysis (10.6%).
CONCLUSIONS: Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients.
| Errataetall: |
CommentIn: Clin J Am Soc Nephrol. 2016 Dec 7;11(12 ):2107-2109. - PMID 27856489 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:11 |
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| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 11(2016), 12 vom: 07. Dez., Seite 2204-2209 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Feely, Molly A [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 01.12.2017 Date Revised 13.08.2023 published: Print-Electronic CommentIn: Clin J Am Soc Nephrol. 2016 Dec 7;11(12 ):2107-2109. - PMID 27856489 Citation Status MEDLINE |
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| doi: |
10.2215/CJN.12131115 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM266281230 |
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| 500 | |a Date Revised 13.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Clin J Am Soc Nephrol. 2016 Dec 7;11(12 ):2107-2109. - PMID 27856489 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2016 by the American Society of Nephrology. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives | ||
| 520 | |a DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis | ||
| 520 | |a RESULTS: Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P<0.001) and have died during the study period (64.4% versus 46.6%; P<0.001) than patients who did not have advance directives. Notably, for patients receiving dialysis who had advance directives, more of the advance directives addressed cardiopulmonary resuscitation (44.2%), mechanical ventilation (37.1%), artificial nutrition and hydration (34.3%), and pain management (43.4%) than dialysis (10.6%) | ||
| 520 | |a CONCLUSIONS: Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients | ||
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| 650 | 4 | |a Respiration, Artificial | |
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| 700 | 1 | |a Edakkanambeth Varayil, Jithinraj |e verfasserin |4 aut | |
| 700 | 1 | |a Mueller, Paul S |e verfasserin |4 aut | |
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