Factors affecting end-of-life care in patients lacking decision-making capacity
Thursday, October 12, 2023
4:00 PM – 5:15 PM ET
Location: Heron (Fourth Floor)
Patients lacking decision-making capacity face challenges at end-of-life arising from differing goals of care between families and providers, caregiver fatigue, and lapses in communication. In this work, we investigate factors that play a role in care outcomes for these patients. Using ethics consults spanning a 10-year period (2013-2022), we analyzed 106 end-of-life consults involving patients with no decision-making capacity. Demographic data, individual factors (patient and family preferences, effects of religious beliefs, advance directives), and institutional trends (time to consult, involvement of ancillary hospital services), were investigated to determine factors that modulate care in end-of-life cases. Our findings indicate that disagreement between patient families and care teams regarding the appropriateness of level of care, and the presence of strong spiritual beliefs are correlated with prolonged hospital stay and delay in code status change, with no effect on patient outcomes. We also found that the presence of documented advance directives is associated with a relative decrease in length of hospital stay, complementing the positive impact of advance directives reported in existing literature. These results highlight important issues pertaining to medical futility and unnecessary suffering that arise during prolonged care, while emphasizing the protective role of advance directives. Findings from this work can be next used to explore factors that persuade or dissuade patients from obtaining advance directives and identification of other intervention points, with the overarching goal of improving care for this vulnerable patient population.
Christina Lepore – School of Medicine – Yale University; Gary Kopf – Department of Cardiac Surgery – Yale University; Benjamin Tolchin – Department of Neurology – Yale University