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Prior capacity of patients lacking decision making ability early in hospitalization: implications for advance directive administration. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.
J Gen Intern Med. 1994 Oct; 9(10):539-43.JG

Abstract

OBJECTIVE

To investigate the appropriateness of hospitalization as the time to elicit patients' medical care preferences, the authors evaluated the capability of seriously ill patients to participate in decision making early in hospitalization and their decision making capacity two weeks before hospital entry.

DESIGN

Cross-sectional study with retrospective evaluation of preadmission decision making capacity.

SETTING

Five acute care teaching hospitals.

PATIENTS

Four thousand three hundred one acutely ill hospitalized adults meeting predetermined severity of illness criteria in nine specific disease categories.

MEASUREMENTS

Surrogate decision makers' estimates of the prior mental capacities of patients unable to be interviewed early in hospitalization about care preferences due to intubation, coma, or cognitive impairment. Comparison of the demographics, degrees of sickness at admission, and outcomes of interviewable vs noninterviewable patients.

MAIN RESULTS

Forty percent of the patients were not interviewable concerning preferences. Of these, 83% could have participated in treatment decisions two weeks prior to hospitalization. The patients who were not interviewable were more acutely ill, had less chronic disease, and were more likely to die during hospitalization than the interviewable patients.

CONCLUSIONS

Many acutely ill patients likely to die in the hospital lost their ability to make medical care decisions around the time of hospital admission. Preferences for care and advance directives should be discussed in the outpatient setting or very early in hospital admission.

Authors+Show Affiliations

UCLA School of Medicine.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

7823223

Citation

Wenger, N S., et al. "Prior Capacity of Patients Lacking Decision Making Ability Early in Hospitalization: Implications for Advance Directive Administration. the SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments." Journal of General Internal Medicine, vol. 9, no. 10, 1994, pp. 539-43.
Wenger NS, Oye RK, Bellamy PE, et al. Prior capacity of patients lacking decision making ability early in hospitalization: implications for advance directive administration. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Gen Intern Med. 1994;9(10):539-43.
Wenger, N. S., Oye, R. K., Bellamy, P. E., Lynn, J., Phillips, R. S., Desbiens, N. A., Kussin, P., & Youngner, S. J. (1994). Prior capacity of patients lacking decision making ability early in hospitalization: implications for advance directive administration. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. Journal of General Internal Medicine, 9(10), 539-43.
Wenger NS, et al. Prior Capacity of Patients Lacking Decision Making Ability Early in Hospitalization: Implications for Advance Directive Administration. the SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. J Gen Intern Med. 1994;9(10):539-43. PubMed PMID: 7823223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prior capacity of patients lacking decision making ability early in hospitalization: implications for advance directive administration. The SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. AU - Wenger,N S, AU - Oye,R K, AU - Bellamy,P E, AU - Lynn,J, AU - Phillips,R S, AU - Desbiens,N A, AU - Kussin,P, AU - Youngner,S J, PY - 1994/10/1/pubmed PY - 1994/10/1/medline PY - 1994/10/1/entrez KW - Death and Euthanasia KW - Empirical Approach KW - Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) SP - 539 EP - 43 JF - Journal of general internal medicine JO - J Gen Intern Med VL - 9 IS - 10 N2 - OBJECTIVE: To investigate the appropriateness of hospitalization as the time to elicit patients' medical care preferences, the authors evaluated the capability of seriously ill patients to participate in decision making early in hospitalization and their decision making capacity two weeks before hospital entry. DESIGN: Cross-sectional study with retrospective evaluation of preadmission decision making capacity. SETTING: Five acute care teaching hospitals. PATIENTS: Four thousand three hundred one acutely ill hospitalized adults meeting predetermined severity of illness criteria in nine specific disease categories. MEASUREMENTS: Surrogate decision makers' estimates of the prior mental capacities of patients unable to be interviewed early in hospitalization about care preferences due to intubation, coma, or cognitive impairment. Comparison of the demographics, degrees of sickness at admission, and outcomes of interviewable vs noninterviewable patients. MAIN RESULTS: Forty percent of the patients were not interviewable concerning preferences. Of these, 83% could have participated in treatment decisions two weeks prior to hospitalization. The patients who were not interviewable were more acutely ill, had less chronic disease, and were more likely to die during hospitalization than the interviewable patients. CONCLUSIONS: Many acutely ill patients likely to die in the hospital lost their ability to make medical care decisions around the time of hospital admission. Preferences for care and advance directives should be discussed in the outpatient setting or very early in hospital admission. SN - 0884-8734 UR - https://www.unboundmedicine.com/medline/citation/7823223/Prior_capacity_of_patients_lacking_decision_making_ability_early_in_hospitalization:_implications_for_advance_directive_administration__The_SUPPORT_Investigators__Study_to_Understand_Prognoses_and_Preferences_for_Outcomes_and_Risks_of_Treatments_ L2 - https://medlineplus.gov/advancedirectives.html DB - PRIME DP - Unbound Medicine ER -