Life-Sustaining Treatment Decision in Palliative Care Based on Electronic Health Records Analysis.
Sanghee Kim, Arum Lim, Hyoeun Jang and 1 others
PMID 35023248WHAT IT FOUND
Families made 53.9% of life-sustaining treatment decisions in 2,721 Korean palliative records.
Decisions occurred a median 3 days before discharge or death. Nursing records per patient were 28.6 seven days before, 37.7 three days before, and 67.7 on the decision day.
Key findings
01Families made 53.9% of life-sustaining treatment decisions, while patients made decisions through physician orders for life-sustaining treatment in 44.7% and through advance directives in 1.4%.
02The median time from life-sustaining treatment decision to discharge or death was 3 days.
03On the decision day, nursing records per patient were 67.7, and vital sign change emerged as the second most frequent nursing protocol.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single centre in Korea, so the patterns may not apply to other hospitals or countries. Retrospective record review; no treatment was assigned, so it cannot show what caused a decision. Laboratory and vital-sign comparisons used different patients tested at different times, not the same patient followed over time. The study recorded only the type of life-sustaining treatment form, not the level of treatment withdrawal. Group comparisons were unadjusted, so differences may reflect other factors such as age, diagnosis or admission route. Several analyses used subsets of records because some data were missing.
The easy way to misread this
Do not use the laboratory and vital-sign changes as a tested prediction rule for an individual patient. The study compared different patients tested at different times, not the same patient over time, and it did not validate these markers as predictors of imminent death.