BACKGROUND: Our objective was to provide a contemporary analysis of the prevalence, types, and impact of advance health care directives in critically ill cancer patients. METHODS: We retrospectively reviewed all intensive care unit (ICU) admissions (January 1, 2006 to April 25, 2008) at an oncologic center and identified all patients who completed a living will (LW), or health care proxy (HCP), or neither prior to ICU admission. Demographics, clinical data, end-of-life (EOL) parameters and outcomes were compared among three groups: LWs, HCPs, and no LW or HCP. RESULTS: Of 1,333 ICU admissions, 1,121 patients (84%) were included for analysis: 176 patients (15.7%) had LW, 534 (47.6%) had HCP and 411 (36.7%) had no LW or HCP. Patients with LW were significantly more likely to be older and white as compared to patients with HCP alone, or no LW or HCP. There were no significant demographic differences between patients with HCP or no LW or HCP. Patients with HCP alone, or no LW or HCP, were significantly more likely to have Medicaid than patients with LW. There were no differences noted in ICU care, EOL management, or outcomes among the three groups. CONCLUSIONS: The prevalence of LWs in patients admitted to our oncologic ICU is low. More than half of the remaining patients had designated HCPs. Older age and white race were associated with the presence of LWs. However, the presence of LWs or HCPs did not influence ICU care, EOL management or outcomes at our institution.
BACKGROUND: Our objective was to provide a contemporary analysis of the prevalence, types, and impact of advance health care directives in critically ill cancerpatients. METHODS: We retrospectively reviewed all intensive care unit (ICU) admissions (January 1, 2006 to April 25, 2008) at an oncologic center and identified all patients who completed a living will (LW), or health care proxy (HCP), or neither prior to ICU admission. Demographics, clinical data, end-of-life (EOL) parameters and outcomes were compared among three groups: LWs, HCPs, and no LW or HCP. RESULTS: Of 1,333 ICU admissions, 1,121 patients (84%) were included for analysis: 176 patients (15.7%) had LW, 534 (47.6%) had HCP and 411 (36.7%) had no LW or HCP. Patients with LW were significantly more likely to be older and white as compared to patients with HCP alone, or no LW or HCP. There were no significant demographic differences between patients with HCP or no LW or HCP. Patients with HCP alone, or no LW or HCP, were significantly more likely to have Medicaid than patients with LW. There were no differences noted in ICU care, EOL management, or outcomes among the three groups. CONCLUSIONS: The prevalence of LWs in patients admitted to our oncologic ICU is low. More than half of the remaining patients had designated HCPs. Older age and white race were associated with the presence of LWs. However, the presence of LWs or HCPs did not influence ICU care, EOL management or outcomes at our institution.
Authors: Derek C Angus; Amber E Barnato; Walter T Linde-Zwirble; Lisa A Weissfeld; R Scott Watson; Tim Rickert; Gordon D Rubenfeld Journal: Crit Care Med Date: 2004-03 Impact factor: 7.598
Authors: Anthony D Yang; David J Bentrem; Sam G Pappas; Elizabeth Amundsen; James E Ward; Michael B Ujiki; Peter Angelos Journal: Am J Surg Date: 2004-07 Impact factor: 2.565
Authors: Mark D Williams; Lee Ann Braun; Liesl M Cooper; Joseph Johnston; Richard V Weiss; Rebecca L Qualy; Walter Linde-Zwirble Journal: Crit Care Date: 2004-07-05 Impact factor: 9.097
Authors: Geraldine de Heer; Bernd Saugel; Barbara Sensen; Charlotte Rübsteck; Hans O Pinnschmidt; Stefan Kluge Journal: Dtsch Arztebl Int Date: 2017-06-05 Impact factor: 5.594
Authors: Nita Khandelwal; Ann C Long; Robert Y Lee; Cara L McDermott; Ruth A Engelberg; J Randall Curtis Journal: Lancet Respir Med Date: 2019-05-20 Impact factor: 30.700
Authors: Katherine R Waite; Alex D Federman; Danielle M McCarthy; Rebecca Sudore; Laura M Curtis; David W Baker; Elizabeth A H Wilson; Romana Hasnain-Wynia; Michael S Wolf; Michael K Paasche-Orlow Journal: J Am Geriatr Soc Date: 2013-02-04 Impact factor: 5.562
Authors: Eli L Diamond; David Russell; Maria Kryza-Lacombe; Kathryn H Bowles; Allison J Applebaum; Jeanne Dennis; Lisa M DeAngelis; Holly G Prigerson Journal: Neuro Oncol Date: 2015-08-09 Impact factor: 12.300
Authors: Nadja Leder; Daniel Schwarzkopf; Konrad Reinhart; Otto W Witte; Rüüdiger Pfeifer; Christiane S Hartog Journal: Dtsch Arztebl Int Date: 2015-10-23 Impact factor: 5.594
Authors: Katharine E Duckworth; Allison M Forti; Gregory B Russell; Seema Naik; David Hurd; Richard P McQuellon Journal: Am J Hosp Palliat Care Date: 2013-08-13 Impact factor: 2.500