Ghent University Academic Bibliography

Advanced

Do-not-resuscitate decisions in a large tertiary hospital : differences between specialties and results of a hospital-wide intervention

Ruth Piers UGent, Dominique Benoit UGent, Wim Schrauwen UGent and Nele Van Den Noortgate UGent (2011) ACTA CLINICA BELGICA. 66(2). p.116-122
abstract
Background: Despite the advent of palliative care, the quality of dying in the hospital remains poor. Differences in quality of end-of-life practice between hospital wards are well known in clinical practice but rarely have been investigated. Methods: A prospective observation of do-not-resuscitate (DNR) decisions was conducted in patients dying in a Belgian university hospital before (115 patients) and after (113 patients) a hospital-wide intervention consisting in informing hospital staff on the law on Patient's Rights and the introduction of a new DNR form. The new DNR form puts more emphasis on the motivation of the DNR decision and on the description of the participants in the decision-making process. Results: The completion of DNR forms improved after the intervention: physicians better documented who participated in DNR decisions (for participation of family: 63% after the intervention vs. 44% before the intervention, p=0.022, for nurses: 27% vs. 14%, p=0.047) and the motivation for these decisions (59% vs. 32%,p=0.001). However, there was no difference in referral to the intensive care unit (ICU) at the end of life (in 40% of patients after and 37% before the intervention). Furthermore, the number of patients dying without DNR form on the wards was similar (13% and 8%). Surgical patients and patients with non-malignant diseases were more often referred to ICU at the end of life (71% in surgical vs. 35% in medical patients, p<0.001 and 49% in patients with non-malignant diseases vs. 23% in patients with malignancy, p<0.001). Moreover, surgical patients less frequently received a DNR order (56% in surgical vs. 92% in medical patients, p=0.007). Conclusions: The introduction of a new DNR form and informing hospital staff on patients' right to information did not improve physicians' end-of-life practice. Transition from life-prolonging treatment to a more palliative approach was less anticipated in surgical patients and patients with non-malignant diseases.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
ILL PATIENTS, FOLLOW-UP, QUALITY INDICATORS, ETHICS CONSULTATIONS, CONTROLLED-TRIAL, COMMUNICATION-SKILLS, PALLIATIVE CARE, ACUTE GERIATRIC WARDS, INTENSIVE-CARE-UNIT, END-OF-LIFE, End-of-life decisions, advance care planning, dying in hospital, intervention
journal title
ACTA CLINICA BELGICA
Acta Clin. Belg.
volume
66
issue
2
pages
116 - 122
Web of Science type
Article
Web of Science id
000290931300005
JCR category
MEDICINE, GENERAL & INTERNAL
JCR impact factor
0.592 (2011)
JCR rank
105/153 (2011)
JCR quartile
3 (2011)
ISSN
0001-5512
DOI
10.2143/ACB.66.2.2062529
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1257768
handle
http://hdl.handle.net/1854/LU-1257768
date created
2011-06-08 14:09:07
date last changed
2017-06-19 08:36:04
@article{1257768,
  abstract     = {Background: Despite the advent of palliative care, the quality of dying in the hospital remains poor. Differences in quality of end-of-life practice between hospital wards are well known in clinical practice but rarely have been investigated.
Methods: A prospective observation of do-not-resuscitate (DNR) decisions was conducted in patients dying in a Belgian university hospital before (115 patients) and after (113 patients) a hospital-wide intervention consisting in informing hospital staff on the law on Patient's Rights and the introduction of a new DNR form. The new DNR form puts more emphasis on the motivation of the DNR decision and on the description of the participants in the decision-making process.
Results: The completion of DNR forms improved after the intervention: physicians better documented who participated in DNR decisions (for participation of family: 63\% after the intervention vs. 44\% before the intervention, p=0.022, for nurses: 27\% vs. 14\%, p=0.047) and the motivation for these decisions (59\% vs. 32\%,p=0.001). However, there was no difference in referral to the intensive care unit (ICU) at the end of life (in 40\% of patients after and 37\% before the intervention). Furthermore, the number of patients dying without DNR form on the wards was similar (13\% and 8\%). Surgical patients and patients with non-malignant diseases were more often referred to ICU at the end of life (71\% in surgical vs. 35\% in medical patients, p{\textlangle}0.001 and 49\% in patients with non-malignant diseases vs. 23\% in patients with malignancy, p{\textlangle}0.001). Moreover, surgical patients less frequently received a DNR order (56\% in surgical vs. 92\% in medical patients, p=0.007).
Conclusions: The introduction of a new DNR form and informing hospital staff on patients' right to information did not improve physicians' end-of-life practice. Transition from life-prolonging treatment to a more palliative approach was less anticipated in surgical patients and patients with non-malignant diseases.},
  author       = {Piers, Ruth and Benoit, Dominique and Schrauwen, Wim and Van Den Noortgate, Nele},
  issn         = {0001-5512},
  journal      = {ACTA CLINICA BELGICA},
  keyword      = {ILL PATIENTS,FOLLOW-UP,QUALITY INDICATORS,ETHICS CONSULTATIONS,CONTROLLED-TRIAL,COMMUNICATION-SKILLS,PALLIATIVE CARE,ACUTE GERIATRIC WARDS,INTENSIVE-CARE-UNIT,END-OF-LIFE,End-of-life decisions,advance care planning,dying in hospital,intervention},
  language     = {eng},
  number       = {2},
  pages        = {116--122},
  title        = {Do-not-resuscitate decisions in a large tertiary hospital : differences between specialties and results of a hospital-wide intervention},
  url          = {http://dx.doi.org/10.2143/ACB.66.2.2062529},
  volume       = {66},
  year         = {2011},
}

Chicago
Piers, Ruth, Dominique Benoit, Wim Schrauwen, and Nele Van Den Noortgate. 2011. “Do-not-resuscitate Decisions in a Large Tertiary Hospital : Differences Between Specialties and Results of a Hospital-wide Intervention.” Acta Clinica Belgica 66 (2): 116–122.
APA
Piers, R., Benoit, D., Schrauwen, W., & Van Den Noortgate, N. (2011). Do-not-resuscitate decisions in a large tertiary hospital : differences between specialties and results of a hospital-wide intervention. ACTA CLINICA BELGICA, 66(2), 116–122.
Vancouver
1.
Piers R, Benoit D, Schrauwen W, Van Den Noortgate N. Do-not-resuscitate decisions in a large tertiary hospital : differences between specialties and results of a hospital-wide intervention. ACTA CLINICA BELGICA. 2011;66(2):116–22.
MLA
Piers, Ruth, Dominique Benoit, Wim Schrauwen, et al. “Do-not-resuscitate Decisions in a Large Tertiary Hospital : Differences Between Specialties and Results of a Hospital-wide Intervention.” ACTA CLINICA BELGICA 66.2 (2011): 116–122. Print.