4.5 Article

Preferences for End-of-Life Care and Decision Making Among Older and Seriously Ill Inpatients: A Cross-Sectional Study

期刊

JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
卷 59, 期 2, 页码 187-196

出版社

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jpainsymman.2019.09.003

关键词

End-of-life; acute care; Australia; communication

资金

  1. Australian Research Council Discovery Early Career Researcher Award [150101262]
  2. Cancer Council New South Wales Strategic Research Partnership [CSR 11-02]
  3. University of Newcastle and Hunter Medical Research Institute

向作者/读者索取更多资源

Context. Older and seriously ill Australians are often admitted to hospital in the last year of their life. The extent to which these individuals have considered important aspects of end-of-life (EOL) care, including location in which care is provided, goals of care, and involvement of others in decision making, is unclear. Objectives. To determine, in a sample of older and seriously ill Australian inpatients, preferences regarding location in which they receive EOL care and reasons for their choice; who is involved in EOL decisions; disclosure of life expectancy; goals of care; and voluntary-assisted dying. Methods. Cross-sectional face-to-face survey interviews conducted with 186 (80% consent) inpatients in a tertiary referral center aged 80 years and older; or aged 55 years and older with progressive chronic disease(s); or with physician-estimated life expectancy of less than 12 months. Results. Home care was preferred (69%), given the perceived availability of family/friends, familiarity of environment, and likelihood of having wishes respected. If unable to make decisions themselves, inpatients wanted family to decide care alone (31%) or with a doctor (49%). Of those who had not discussed life expectancy, 23% wished to. Most (76%) preferred care that maintained quality of life and relieved symptoms. There was some agreement for being sedated at the EOL (63%) and able to access medication to end life (43%). Conclusion. Most inpatients would prefer EOL care that maintains quality and relieves suffering compared with life extension and to receive this care at home. Family involvement in resolution and documentation of EOL decisions should be prioritized. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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