Determinants of receiving palliative care and ventilator withdrawal among patients with prolonged mechanical ventilation

Yang Ching Chen, Hsien Yu Fan, J. Randall Curtis, Oscar Kuang Sheng Lee, Chih Kuang Liu, Sheng Jean Huang

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Increasing numbers of patients with prolonged mechanical ventilation generates a tremendous strain on healthcare systems. Patients with prolonged mechanical ventilation suffer from long-term poor quality of life. However, no study has ever explored the willingness to receive palliative care or terminal withdrawal and the factors influencing willingness. Design: Cross-sectional study. Setting: Five different hospitals of Taipei City Hospital system. Patients: Adult patients with ventilatory support for more than 60 days. Interventions: None. Measurements and Main Results: We identified the family members of 145 consecutive patients with prolonged mechanical ventilation in five hospitals of Taipei City Hospital system and enrolled family members for 106 patients (73.1%). We collected information from patient families' regarding concepts (knowledge, attitude, and experiences) of palliative care, caregiver burden, family function, patient quality of life, and physician-family communications. From the medical record, we obtained duration of hospitalization, consciousness level, disease severity, medical cost, and the presence of do-not-resuscitate orders. The vast majority of family members agreed with the concept of palliative care (90.4%) with 17.3% of the family members agreeing to ventilator withdrawal currently and 67.5% terminally in anticipation of death. Approximately half of the family members regretted having chosen prolonged mechanical ventilation (56.7%). Reduced patient quality of life and increased family understanding of palliative care significantly associated with increased caregiver willingness to endorse palliative care and withdraw life-sustaining agents in anticipation of death. Longer duration of ventilator usage and hospitalization was associated with increased feelings of regret about choosing prolonged mechanical ventilation. Conclusions: During prolonged mechanical ventilation, physicians should thoroughly discuss its benefits and burdens. Families should be given the opportunity to discuss the circumstances under which they might request the implementation of palliative care or withdrawal of mechanical ventilation in order to avoid prolonging the dying process.

Original languageEnglish
Pages (from-to)1625-1634
Number of pages10
JournalCritical Care Medicine
Volume45
Issue number10
DOIs
Publication statusPublished - Oct 1 2017

Fingerprint

Mechanical Ventilators
Palliative Care
Artificial Respiration
Urban Hospitals
Quality of Life
Caregivers
Emotions
Hospitalization
Resuscitation Orders
Family Physicians
Consciousness
Medical Records
Cross-Sectional Studies
Communication
Delivery of Health Care
Physicians
Costs and Cost Analysis

Keywords

  • caregiver burden
  • life-sustaining agents
  • palliative care
  • prolonged mechanical ventilation
  • terminal withdrawal

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Determinants of receiving palliative care and ventilator withdrawal among patients with prolonged mechanical ventilation. / Chen, Yang Ching; Fan, Hsien Yu; Curtis, J. Randall; Lee, Oscar Kuang Sheng; Liu, Chih Kuang; Huang, Sheng Jean.

In: Critical Care Medicine, Vol. 45, No. 10, 01.10.2017, p. 1625-1634.

Research output: Contribution to journalArticle

Chen, Yang Ching ; Fan, Hsien Yu ; Curtis, J. Randall ; Lee, Oscar Kuang Sheng ; Liu, Chih Kuang ; Huang, Sheng Jean. / Determinants of receiving palliative care and ventilator withdrawal among patients with prolonged mechanical ventilation. In: Critical Care Medicine. 2017 ; Vol. 45, No. 10. pp. 1625-1634.
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abstract = "Objectives: Increasing numbers of patients with prolonged mechanical ventilation generates a tremendous strain on healthcare systems. Patients with prolonged mechanical ventilation suffer from long-term poor quality of life. However, no study has ever explored the willingness to receive palliative care or terminal withdrawal and the factors influencing willingness. Design: Cross-sectional study. Setting: Five different hospitals of Taipei City Hospital system. Patients: Adult patients with ventilatory support for more than 60 days. Interventions: None. Measurements and Main Results: We identified the family members of 145 consecutive patients with prolonged mechanical ventilation in five hospitals of Taipei City Hospital system and enrolled family members for 106 patients (73.1{\%}). We collected information from patient families' regarding concepts (knowledge, attitude, and experiences) of palliative care, caregiver burden, family function, patient quality of life, and physician-family communications. From the medical record, we obtained duration of hospitalization, consciousness level, disease severity, medical cost, and the presence of do-not-resuscitate orders. The vast majority of family members agreed with the concept of palliative care (90.4{\%}) with 17.3{\%} of the family members agreeing to ventilator withdrawal currently and 67.5{\%} terminally in anticipation of death. Approximately half of the family members regretted having chosen prolonged mechanical ventilation (56.7{\%}). Reduced patient quality of life and increased family understanding of palliative care significantly associated with increased caregiver willingness to endorse palliative care and withdraw life-sustaining agents in anticipation of death. Longer duration of ventilator usage and hospitalization was associated with increased feelings of regret about choosing prolonged mechanical ventilation. Conclusions: During prolonged mechanical ventilation, physicians should thoroughly discuss its benefits and burdens. Families should be given the opportunity to discuss the circumstances under which they might request the implementation of palliative care or withdrawal of mechanical ventilation in order to avoid prolonging the dying process.",
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AB - Objectives: Increasing numbers of patients with prolonged mechanical ventilation generates a tremendous strain on healthcare systems. Patients with prolonged mechanical ventilation suffer from long-term poor quality of life. However, no study has ever explored the willingness to receive palliative care or terminal withdrawal and the factors influencing willingness. Design: Cross-sectional study. Setting: Five different hospitals of Taipei City Hospital system. Patients: Adult patients with ventilatory support for more than 60 days. Interventions: None. Measurements and Main Results: We identified the family members of 145 consecutive patients with prolonged mechanical ventilation in five hospitals of Taipei City Hospital system and enrolled family members for 106 patients (73.1%). We collected information from patient families' regarding concepts (knowledge, attitude, and experiences) of palliative care, caregiver burden, family function, patient quality of life, and physician-family communications. From the medical record, we obtained duration of hospitalization, consciousness level, disease severity, medical cost, and the presence of do-not-resuscitate orders. The vast majority of family members agreed with the concept of palliative care (90.4%) with 17.3% of the family members agreeing to ventilator withdrawal currently and 67.5% terminally in anticipation of death. Approximately half of the family members regretted having chosen prolonged mechanical ventilation (56.7%). Reduced patient quality of life and increased family understanding of palliative care significantly associated with increased caregiver willingness to endorse palliative care and withdraw life-sustaining agents in anticipation of death. Longer duration of ventilator usage and hospitalization was associated with increased feelings of regret about choosing prolonged mechanical ventilation. Conclusions: During prolonged mechanical ventilation, physicians should thoroughly discuss its benefits and burdens. Families should be given the opportunity to discuss the circumstances under which they might request the implementation of palliative care or withdrawal of mechanical ventilation in order to avoid prolonging the dying process.

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