Full Code to Do-Not-Resuscitate: Culturally Adapted Palliative Care Consultations and Code Status Change Among Seriously Ill Hispanic Patients.
Neela K Patel, Stacey A Passalacqua, Kylie N Meyer and 1 others
PMID 34467766WHAT IT FOUND
In this palliative care consultation service, Hispanic and Spanish-speaking patients were more likely to request DNR rather than remain full code, but the bundled service cannot be shown to cause that.
Key findings
01In the 351-patient sample, 42.74% requested a DNR by discharge and 25.07% remained full code.
02Hispanic ethnicity was associated with requesting a DNR rather than remaining full code after controlling for age; the model estimated a relative risk ratio of 2.04 (p=0.013).
03Spanish primary language was associated with obtaining a DNR rather than not obtaining a DNR; the model estimated a relative risk ratio of 2.10 (p=0.025).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The analysis was retrospective and cross-sectional, so it cannot show that the consultation service caused DNR status change. All culturally adapted elements were delivered together, so the study cannot separate the contribution of language access, family involvement, chaplain support, SPIKES, or any other component. Researchers analyzed only complete cases and excluded 54 incomplete records, patients speaking languages other than Spanish or English, and later admissions for 21 patients with multiple stays. The study analyzed only patients already referred for palliative care consultation, so it cannot compare them with patients who did not receive the service. Hispanic ethnicity and Spanish language overlapped heavily, and models were run separately rather than together.
The easy way to misread this
Do not conclude that culturally adapted palliative care consultations caused more DNR orders. The analysis was retrospective and cross-sectional, all patients received a bundled service, and the authors state that causality cannot be discerned and that it cannot be concluded the consultations were effective purely due to their culturally adapted features.