End-of-life medical interventions: the use of advance directives beyond the "DNR"
The body of research regarding the use of advance directives is sizable, providing information on utilization patterns, financial implications, provider compliance with directives, efficacy of consultation programs, and beyond. The literature, however, sometimes groups advance directives together, failing to distinguish between specific end-of-life care decisions such as feeding restrictions, organ donation requests, or do-not-hospitalize orders. The purpose of this study is to analyze correlation between utilization of specific end-of-of life medical decisions and various demographic, medical, and lifestyle characteristics of individuals currently residing in nursing homes. The data are drawn from the 2004 National Nursing Home Survey, which includes 14,017 individual-level observations from 1,174 facilities. Two logit models were used: one including only time-invariant independent variables (gender, race, etc.), and a second with additional variables specific to an individual's nursing home condition (depression, number of prescription medications, etc.) The second model assumes that some individuals execute advance directives when they live in a nursing home, and circumstances regarding their condition at that time and the environment of the home influence those end-of-life decisions. The data do not include advance directive execution dates, so this model is highly speculative and results should be interpreted conservatively given this limitation. Overall, the breakdown of the advance directive category into its smaller subgroups was informative. Results varied within demographic, medical, and lifestyle characteristic categories based on the specific end-of-life medical decision. For example, while men have fewer do-not-hospitalize and do-not-resuscitate (DNR) orders than women, the genders are equally likely to have an organ donation or autopsy request report. While individuals who receive spiritual care are far more likely to have a DNR than those who did not receive spiritual care, they are less likely to have a feeding or medication restriction. I conclude that a given characteristic may have different effects on different types of end-of-life decisions.
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Advance Directives: Assisting Patients With End-of-Life Decisions Advance Directives: Making Informed End-of-Life Decisions Unknown author (1996)"Talking with patients about the dying process and the use of life-sustaining technology can be emotionally challenging for all concerned. Helping patients to participate in planning for future health care crises, including ...