Changes in Advance Care Planning for Nursing Home Residents During the COVID-19 Pandemic.
Ping Ye, Liam Fry, Jane Dimmitt Champion
PMID 33290730WHAT IT FOUND
During early pandemic, proactive goals-of-care conversations with nursing home residents or surrogates changed documented preferences.
Fewer remained full resuscitation, and more chose do-not-resuscitate outside hospital and do-not-hospitalize.
Key findings
01After proactive goals-of-care conversations, full-code status fell from 361 to 273 residents, while out-of-hospital DNR rose from 602 to 690.
02Do Not Hospitalize preference rose from 188 to 455 residents, and resuscitation and hospitalization preferences changed significantly before and after conversations.
03Residents older than 88 years were more likely than residents 70 years or younger to choose out-of-hospital DNR and Do Not Hospitalize after conversations, and the same direction of change was seen in each facility.
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
This was a retrospective chart review, so it cannot prove that the conversations caused the preference changes. The study compared the same residents before and after conversations, without a separate group of residents who did not have conversations. The conversations happened during the early pandemic, when residents and families were also dealing with illness risk and hospital concerns that may have influenced preferences. Sixty-six residents or surrogates were still pending decisions and were excluded. More than 20 practitioners delivered the conversations, and only a 1-hour training was documented, so delivery could have varied. The study reported documented code status and Do Not Hospitalize preferences, not patient outcomes such as hospitalization or death location.
The easy way to misread this
Do not read these changes as proof that advance care planning improves survival, comfort, or hospitalization outcomes. The study only compared documented preferences before and after conversations during a pandemic, with no control group, so other factors may have influenced decisions.