Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis
ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are inte...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2016-12, Vol.11 (12), p.2204-2209 |
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| container_title | Clinical journal of the American Society of Nephrology |
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| creator | Feely, Molly A Hildebrandt, Daniel Edakkanambeth Varayil, Jithinraj Mueller, Paul S |
| description | ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives.
We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis.
Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P |
| doi_str_mv | 10.2215/CJN.12131115 |
| format | Article |
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We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis.
Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P<0.001) and have died during the study period (64.4% versus 46.6%; P<0.001) than patients who did not have advance directives. Notably, for patients receiving dialysis who had advance directives, more of the advance directives addressed cardiopulmonary resuscitation (44.2%), mechanical ventilation (37.1%), artificial nutrition and hydration (34.3%), and pain management (43.4%) than dialysis (10.6%).
Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.12131115</identifier><identifier>PMID: 27856490</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Advance Directives ; Age Factors ; Aged ; Aged, 80 and over ; Cardiopulmonary Resuscitation ; Female ; Humans ; Kidney Failure, Chronic - therapy ; Male ; Middle Aged ; Nutritional Support ; Original ; Pain Management ; Renal Dialysis ; Respiration, Artificial ; Retrospective Studies ; Terminal Care</subject><ispartof>Clinical journal of the American Society of Nephrology, 2016-12, Vol.11 (12), p.2204-2209</ispartof><rights>Copyright © 2016 by the American Society of Nephrology.</rights><rights>Copyright © 2016 by the American Society of Nephrology 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-1dad1b2a7e0ffcfaf3f5733acbd5e63b39304189b80d808c0b5f17b7f2a1e9e13</citedby><cites>FETCH-LOGICAL-c384t-1dad1b2a7e0ffcfaf3f5733acbd5e63b39304189b80d808c0b5f17b7f2a1e9e13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142080/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142080/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27856490$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Feely, Molly A</creatorcontrib><creatorcontrib>Hildebrandt, Daniel</creatorcontrib><creatorcontrib>Edakkanambeth Varayil, Jithinraj</creatorcontrib><creatorcontrib>Mueller, Paul S</creatorcontrib><title>Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives.
We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis.
Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P<0.001) and have died during the study period (64.4% versus 46.6%; P<0.001) than patients who did not have advance directives. Notably, for patients receiving dialysis who had advance directives, more of the advance directives addressed cardiopulmonary resuscitation (44.2%), mechanical ventilation (37.1%), artificial nutrition and hydration (34.3%), and pain management (43.4%) than dialysis (10.6%).
Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients.</description><subject>Advance Directives</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiopulmonary Resuscitation</subject><subject>Female</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nutritional Support</subject><subject>Original</subject><subject>Pain Management</subject><subject>Renal Dialysis</subject><subject>Respiration, Artificial</subject><subject>Retrospective Studies</subject><subject>Terminal Care</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkUlPwzAQhS0EoqVw44xy5ECLx46b5IKE2rKpgqos4mY5zrg1SpMSp0H996Sr4DSjmU9vnuYRcg60wxiI697TcwcYcAAQB6QJQoh2RMXn4b73oUFOnPui1Pc5E8ekwYJQdP2INsnHqMBKpZhp9FSWeL08KzErnZcb7zap1GretwXq0la4no5UadfEjy2n3uB13PfGqNFWNpvUqEqXzrpTcmRU6vBsW1vk_W7w1ntoD1_uH3u3w7bmoV-2IVEJxEwFSI3RRhluRMC50nEisMtjHvHafRjFIU1CGmoaCwNBHBimACME3iI3G935Ip5homtjhUrlvLAzVSxlrqz8v8nsVE7ySgrwGQ1pLXC5FSjy7wW6Us6s05imKsN84SSE9X3K_YjV6NUG1UXuXIFmfwaoXEUh6yjkLooav_hrbQ_vfs9_AUOihZI</recordid><startdate>20161207</startdate><enddate>20161207</enddate><creator>Feely, Molly A</creator><creator>Hildebrandt, Daniel</creator><creator>Edakkanambeth Varayil, Jithinraj</creator><creator>Mueller, Paul S</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161207</creationdate><title>Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis</title><author>Feely, Molly A ; Hildebrandt, Daniel ; Edakkanambeth Varayil, Jithinraj ; Mueller, Paul S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-1dad1b2a7e0ffcfaf3f5733acbd5e63b39304189b80d808c0b5f17b7f2a1e9e13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Advance Directives</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiopulmonary Resuscitation</topic><topic>Female</topic><topic>Humans</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nutritional Support</topic><topic>Original</topic><topic>Pain Management</topic><topic>Renal Dialysis</topic><topic>Respiration, Artificial</topic><topic>Retrospective Studies</topic><topic>Terminal Care</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Feely, Molly A</creatorcontrib><creatorcontrib>Hildebrandt, Daniel</creatorcontrib><creatorcontrib>Edakkanambeth Varayil, Jithinraj</creatorcontrib><creatorcontrib>Mueller, Paul S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Feely, Molly A</au><au>Hildebrandt, Daniel</au><au>Edakkanambeth Varayil, Jithinraj</au><au>Mueller, Paul S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2016-12-07</date><risdate>2016</risdate><volume>11</volume><issue>12</issue><spage>2204</spage><epage>2209</epage><pages>2204-2209</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives.
We retrospectively reviewed the medical records of all patients receiving maintenance in-center hemodialysis at a tertiary academic medical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis.
Among 808 patients (mean age of 68.6 years old; men =61.2%), 49% had advance directives, of which only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P<0.001) and have died during the study period (64.4% versus 46.6%; P<0.001) than patients who did not have advance directives. Notably, for patients receiving dialysis who had advance directives, more of the advance directives addressed cardiopulmonary resuscitation (44.2%), mechanical ventilation (37.1%), artificial nutrition and hydration (34.3%), and pain management (43.4%) than dialysis (10.6%).
Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>27856490</pmid><doi>10.2215/CJN.12131115</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Advance Directives Age Factors Aged Aged, 80 and over Cardiopulmonary Resuscitation Female Humans Kidney Failure, Chronic - therapy Male Middle Aged Nutritional Support Original Pain Management Renal Dialysis Respiration, Artificial Retrospective Studies Terminal Care |
| title | Prevalence and Contents of Advance Directives of Patients with ESRD Receiving Dialysis |
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