Pilot of the Life-Sustaining Treatment Decisions Initiative Among Veterans With Serious Illness

Author:

Giannitrapani Karleen F.12ORCID,Walling Anne M.345,Garcia Ariadna6,Foglia MaryBeth78,Lowery Jill S.910,Lo Natalie1,Bekelman David1112,Brown-Johnson Cati2,Haverfield Marie12,Festa Natalia13,Shreve Scott T.14,Gale Randall C.1,Lehmann Lisa Soleymani1516,Lorenz Karl A.12

Affiliation:

1. Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA

2. Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA

3. Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, West Los Angeles, CA, USA

4. David Geffen School of Medicine, University of California Los Angeles, CA, USA

5. Co-first author

6. Quantitative Sciences Unit, Stanford University, Stanford, CA, USA

7. National Center for Ethics in Health Care, Veterans Health Administration, Seattle, WA, USA

8. University of Washington School of Medicine, Department of Bioethics and Humanities, Seattle, WA, USA

9. National Center for Ethics in Health Care, Veterans Health Administration, Durham, NC, USA

10. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA

11. Center of Innovation for Veteran-Centered and Value Driven Care, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA

12. University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA

13. Division of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA

14. Hospice and Palliative Care Program, VHA Lebanon VA Medical Center, Lebanon, PA, USA

15. VA New England Healthcare System, Veterans Health Administration, Bedford, MA, USA

16. Harvard Medical School, Boston, MA, USA

Abstract

Background: Prior to national spread, the Department of Veterans Affairs implemented a pilot of the life-sustaining treatment decisions initiative (LSTDI) to promote proactive goals of care conversations (GoCC) with seriously ill patients, including policy and practice standards, an electronic documentation template and order set, and implementation support. Aim: To describe a 2-year pilot of the LSTDI at 4 demonstration sites. Design: Prospective observational study. Setting/Participants: A total of 6664 patients who had at least one GoCC. Results: Descriptive statistics characterized patient demographics, goals of care, LST decisions, and risk of hospitalization or mortality among patients with at least one GoCC. Participants were on average 71.4 years old, 93.2% male, 87.1% white, and 64.7% urban; 27.3% died by the end of the pilot period. Fifteen percent lacked decision-making capacity (DMC). Nonmutually exclusive goals included to be cured (7.6%), to prolong life (34%), to improve/maintain quality of life (61.5%), to be comfortable (53%), to obtain support for family/caregiver (8.4%), to achieve life goals (2.1%), and other (10.5%). Many GoCCs resulted in a do not resuscitate (DNR) order (58.8%). Patients without DMC were more likely to have comfort-oriented goals (77.3% vs 48.8%) and a DNR (84% vs 52.6%). Chart abstraction supported content validity of GoCC documentation. Conclusion: The pilot demonstrated that standardizing practices for eliciting and documenting GoCCs resulted in customized documentation of goals of care and LST decisions of a large number of seriously ill patients and established the feasibility of spreading standardized practices throughout a large integrated health care system.

Funder

U.S. Department of Veterans Affairs

Publisher

SAGE Publications

Subject

General Medicine

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3