Your browser doesn't support javascript.
Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data.
Straw, Sam; McGinlay, Melanie; Drozd, Michael; Slater, Thomas A; Cowley, Alice; Kamalathasan, Stephe; Maxwell, Nicholas; Bird, Rory A; Koshy, Aaron O; Prica, Milos; Patel, Peysh A; Relton, Samuel D; Gierula, John; Cubbon, Richard M; Kearney, Mark T; Witte, Klaus K.
  • Straw S; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • McGinlay M; Leeds Teaching Hospitals NHS Trust, Leeds, UK.
  • Drozd M; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Slater TA; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Cowley A; Leeds Teaching Hospitals NHS Trust, Leeds, UK.
  • Kamalathasan S; Leeds Teaching Hospitals NHS Trust, Leeds, UK.
  • Maxwell N; School of Medicine, University of Leeds, Leeds, UK.
  • Bird RA; School of Medicine, University of Leeds, Leeds, UK.
  • Koshy AO; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Prica M; Leeds Teaching Hospitals NHS Trust, Leeds, UK.
  • Patel PA; Leeds Teaching Hospitals NHS Trust, Leeds, UK.
  • Relton SD; Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
  • Gierula J; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Cubbon RM; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Kearney MT; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Witte KK; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. k.k.witte@leeds.ac.uk.
BMC Palliat Care ; 20(1): 10, 2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1021391
ABSTRACT

BACKGROUND:

Observational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and their association with demographic and clinical characteristics as well as outcomes during the COVID-19 pandemic.

METHODS:

Retrospective, observational study conducted between 5th March and 7th May 2020 of all hospitalised patients with COVID-19. Ceiling of care and CPR decisions were documented using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. Unadjusted and multivariable regression analyses were used to determine factors associated with ceiling of care decisions and death during hospitalisation.

RESULTS:

A total of 485 patients were included, of whom 409 (84·3%) had a documented ceiling of care; level one for 208 (50·9%), level two for 75 (18·3%) and level three for 126 (30·8%). CPR decisions were documented for 451 (93·0%) of whom 336 (74·5%) were 'not for resuscitation'. Advanced age, frailty, White-European ethnicity, a diagnosis of any co-morbidity and receipt of cardiovascular medications were associated with ceiling of care decisions. In a multivariable model only advanced age (odds 0·89, 0·86-0·93 p < 0·001), frailty (odds 0·48, 0·38-0·60, p < 0·001) and the cumulative number of co-morbidities (odds 0·72, 0·52-1·0, p = 0·048) were independently associated. Death during hospitalisation was independently associated with age, frailty and requirement for level two or three care.

CONCLUSION:

Ceiling of care decisions were made for the majority of patients during the COVID-19 pandemic, broadly in line with known predictors of poor outcomes in COVID-19, but with a focus on co-morbidities suggesting ICU admission might not be a reliable end-point for observational studies where advanced care planning is routine.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Advance Care Planning / Clinical Decision-Making / COVID-19 Type of study: Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: BMC Palliat Care Year: 2021 Document Type: Article Affiliation country: S12904-021-00711-8

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Advance Care Planning / Clinical Decision-Making / COVID-19 Type of study: Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: BMC Palliat Care Year: 2021 Document Type: Article Affiliation country: S12904-021-00711-8