A Structured Tool for Communication and Care Planning in the Era of the COVID-19 Pandemic.
Swati Gaur, Naushira Pandya, Ghinwa Dumyati and 3 others
PMID 32674824WHAT IT FOUND
Staff at nursing homes used a single-page COVID advance care planning tool after positive COVID tests; 9 residents had do-not-hospitalize status and DNR status rose from 7 to 15, without a control group.
Key findings
01After positive tests and use of the tool, 9 residents had a do-not-hospitalize status, and DNR status rose from 7 to 15.
02Ten medical directors said the tool contained essential advance care planning elements, provided context about the expected course of COVID-19, emphasized monitoring and supportive care, and noted the need to acknowledge families' inability to visit.
03Staff who used the tool valued a single-page format, found some resuscitation discussions difficult, and reported conversations took 20 to 25 minutes plus 10 minutes for documentation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Only 18 residents at 2 nursing homes were included, so the counts are small and may not apply to other settings. The report does not describe a control group or a formal outcome measure, so the rise in DNR and do-not-hospitalize status cannot be attributed to the tool alone. Staff feedback was collected by phone and daily conferences, not a validated survey. The authors state there is no evidence to support any one clinical tool for advance care planning and that strong evidence does not exist regarding efficacy.
Declared interests
No authors' conflict or funding declaration appears in the supplied article text. The publication type lists non-U.S. government research support.
The easy way to misread this
Do not read the rise in do-not-hospitalize and DNR status as proof that the tool caused those changes. The report does not describe a control group, includes only 18 residents, and the authors state that strong evidence does not exist regarding efficacy.