Advance care planning by proxy in German nursing homes: Descriptive analysis and policy implications
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| Název: | Advance care planning by proxy in German nursing homes: Descriptive analysis and policy implications |
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| Autoři: | in der Schmitten, Jürgen, Jox, Ralf J., Pentzek, Michael, Marckmann, Georg |
| Zdroj: | Journal of the American Geriatrics Society, vol. 69, no. 8, pp. 2122-2131 |
| Informace o vydavateli: | Wiley, 2021. |
| Rok vydání: | 2021 |
| Témata: | Aged, 80 and over, Male, Medizin, Advance Care Planning/ethics, Advance Care Planning/legislation & jurisprudence, Advance Care Planning/standards, Aged, Cross-Sectional Studies, Female, Germany, Homes for the Aged/statistics & numerical data, Humans, Nursing Homes/statistics & numerical data, Policy, Proxy, Surveys and Questionnaires, advance care planning, advance directives, healthcare proxy, nursing homes, surrogate decision-making, Nursing Homes, 3. Good health, Advance Care Planning, Homes for the Aged |
| Popis: | BackgroundLegally recognized advance directives (ADs) have to be signed by the person to whom the decisions apply. In practice, however, there are also ADs written and signed by legal proxies (surrogates) on behalf of patients who lack decision‐making capacity. Given their practical relevance and substantial ethical and legal implications, ADs by proxy (AD‐Ps) have received surprisingly little scientific attention so far.ObjectivesTo study the form, content, validity, and applicability of AD‐Ps among German nursing home residents and develop policy implications.MethodsSecondary analysis of two independent cross‐sectional studies in three German cities, comprising 21 nursing homes and 1528 residents. The identified AD‐Ps were analyzed in parallel by three independent raters. Inter‐rater agreement was measured using free‐marginal multi‐rater kappa statistics.ResultsAltogether, 46 AD‐Ps were identified and pooled for analysis. On average (range), AD‐Ps were 1 (1‐7) year(s) old, 0.5 (0.25–4) pages long, signed by 1 (0–5) person, with evidence of legal proxy involvement in 35%, and signed by a physician in 20% of cases. Almost all the AD‐Ps reviewed aimed to limit life‐sustaining treatment (LST), but had widely varying content and ethical justifications, including references to earlier statements (30%) or actual behavior (11%). The most frequent explicit directives were: do‐not‐hospitalize (67%), do‐not‐tube‐feed (37%), do‐not‐attempt‐resuscitation (20%), and the general exclusion of any LST (28%). Inter‐rater agreement was mostly moderate (kappa ≥0.6) or strong (kappa ≥0.8).ConclusionsAlthough AD‐Ps are an empirical reality in German nursing homes, formal standards for such directives are lacking and their ethical justification based on substituted judgment or best interest standard often remains unclear. A qualified advance care planning process and corresponding documentation are required in order to safeguard the appropriate use of this important instrument and ensure adherence to ethico‐legal standards. |
| Druh dokumentu: | Article |
| Popis souboru: | application/pdf |
| Jazyk: | English |
| ISSN: | 1532-5415 0002-8614 |
| DOI: | 10.1111/jgs.17147 |
| Přístupová URL adresa: | https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/jgs.17147 https://pubmed.ncbi.nlm.nih.gov/33951187 https://agsjournals.onlinelibrary.wiley.com/doi/pdf/10.1111/jgs.17147 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17147 https://www.ncbi.nlm.nih.gov/pubmed/33951187 https://europepmc.org/article/MED/33951187 https://serval.unil.ch/notice/serval:BIB_06A6F3EBBE43 http://nbn-resolving.org/urn/resolver.pl?urn=urn:nbn:ch:serval-BIB_06A6F3EBBE430 https://serval.unil.ch/resource/serval:BIB_06A6F3EBBE43.P002/REF.pdf |
| Rights: | CC BY NC ND |
| Přístupové číslo: | edsair.doi.dedup.....9214638c2c2c1dd1ddeb2858898b947e |
| Databáze: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstrakt: | BackgroundLegally recognized advance directives (ADs) have to be signed by the person to whom the decisions apply. In practice, however, there are also ADs written and signed by legal proxies (surrogates) on behalf of patients who lack decision‐making capacity. Given their practical relevance and substantial ethical and legal implications, ADs by proxy (AD‐Ps) have received surprisingly little scientific attention so far.ObjectivesTo study the form, content, validity, and applicability of AD‐Ps among German nursing home residents and develop policy implications.MethodsSecondary analysis of two independent cross‐sectional studies in three German cities, comprising 21 nursing homes and 1528 residents. The identified AD‐Ps were analyzed in parallel by three independent raters. Inter‐rater agreement was measured using free‐marginal multi‐rater kappa statistics.ResultsAltogether, 46 AD‐Ps were identified and pooled for analysis. On average (range), AD‐Ps were 1 (1‐7) year(s) old, 0.5 (0.25–4) pages long, signed by 1 (0–5) person, with evidence of legal proxy involvement in 35%, and signed by a physician in 20% of cases. Almost all the AD‐Ps reviewed aimed to limit life‐sustaining treatment (LST), but had widely varying content and ethical justifications, including references to earlier statements (30%) or actual behavior (11%). The most frequent explicit directives were: do‐not‐hospitalize (67%), do‐not‐tube‐feed (37%), do‐not‐attempt‐resuscitation (20%), and the general exclusion of any LST (28%). Inter‐rater agreement was mostly moderate (kappa ≥0.6) or strong (kappa ≥0.8).ConclusionsAlthough AD‐Ps are an empirical reality in German nursing homes, formal standards for such directives are lacking and their ethical justification based on substituted judgment or best interest standard often remains unclear. A qualified advance care planning process and corresponding documentation are required in order to safeguard the appropriate use of this important instrument and ensure adherence to ethico‐legal standards. |
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| ISSN: | 15325415 00028614 |
| DOI: | 10.1111/jgs.17147 |