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End of life issues in ESRD. A study of three decision variables that affect patient attitudes.
ASAIO J. 1994 Jul-Sep; 40(3):M798-802.AJ

Abstract

The substantial end-stage renal disease (ESRD) mortality rate reflects an older population, worsening comorbidity, and increased cardiovascular disease. Advance directives in ESRD may simplify issues such as cardiopulmonary resuscitation (CPR) and dialysis discontinuation. However, ESRD patients with advance directives may change their mind or allow surrogate leeway for override of end-of-life decisions. Three decision variables (requesting CPR, discontinuation of dialysis with depression, or discontinuation with dementia) were studied in 141 ESRD patients through a 47 item questionnaire. Duration of dialysis (> or = 4 years) (P = 0.002) and prior CPR experience (P = 0.02) increased the probability of refusing CPR by 12 times. The use of surrogates and substituted judgement for dialysis discontinuation with depression was more likely in women (P = 0.0006) and in patients with higher levels of education (P = 0.003). The odds of deciding to discontinue given dementia were three times greater for hemodialysis than peritoneal dialysis patients (P = 0.03). Eighty-three percent of the patients requested that physicians periodically check with them to determine if their advance directives had changed. The authors conclude that advance directives may assist ESRD patients, families, and staff with end-of-life decisions. Three end-of-life decision variables are significantly affected by duration and type of dialysis, previous CPR, gender, and level of education.

Authors+Show Affiliations

Department of Internal Medicine, Northeastern Ohio University College of Medicine Affiliated Hospitals at Canton, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8555624

Citation

Rutecki, G W., et al. "End of Life Issues in ESRD. a Study of Three Decision Variables That Affect Patient Attitudes." ASAIO Journal (American Society for Artificial Internal Organs : 1992), vol. 40, no. 3, 1994, pp. M798-802.
Rutecki GW, Rodriguez L, Cugino A, et al. End of life issues in ESRD. A study of three decision variables that affect patient attitudes. ASAIO J. 1994;40(3):M798-802.
Rutecki, G. W., Rodriguez, L., Cugino, A., Jarjoura, D., Hastings, F., & Whittier, F. C. (1994). End of life issues in ESRD. A study of three decision variables that affect patient attitudes. ASAIO Journal (American Society for Artificial Internal Organs : 1992), 40(3), M798-802.
Rutecki GW, et al. End of Life Issues in ESRD. a Study of Three Decision Variables That Affect Patient Attitudes. ASAIO J. 1994 Jul-Sep;40(3):M798-802. PubMed PMID: 8555624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - End of life issues in ESRD. A study of three decision variables that affect patient attitudes. AU - Rutecki,G W, AU - Rodriguez,L, AU - Cugino,A, AU - Jarjoura,D, AU - Hastings,F, AU - Whittier,F C, PY - 1994/7/1/pubmed PY - 1994/7/1/medline PY - 1994/7/1/entrez KW - Death and Euthanasia KW - Empirical Approach SP - M798 EP - 802 JF - ASAIO journal (American Society for Artificial Internal Organs : 1992) JO - ASAIO J VL - 40 IS - 3 N2 - The substantial end-stage renal disease (ESRD) mortality rate reflects an older population, worsening comorbidity, and increased cardiovascular disease. Advance directives in ESRD may simplify issues such as cardiopulmonary resuscitation (CPR) and dialysis discontinuation. However, ESRD patients with advance directives may change their mind or allow surrogate leeway for override of end-of-life decisions. Three decision variables (requesting CPR, discontinuation of dialysis with depression, or discontinuation with dementia) were studied in 141 ESRD patients through a 47 item questionnaire. Duration of dialysis (> or = 4 years) (P = 0.002) and prior CPR experience (P = 0.02) increased the probability of refusing CPR by 12 times. The use of surrogates and substituted judgement for dialysis discontinuation with depression was more likely in women (P = 0.0006) and in patients with higher levels of education (P = 0.003). The odds of deciding to discontinue given dementia were three times greater for hemodialysis than peritoneal dialysis patients (P = 0.03). Eighty-three percent of the patients requested that physicians periodically check with them to determine if their advance directives had changed. The authors conclude that advance directives may assist ESRD patients, families, and staff with end-of-life decisions. Three end-of-life decision variables are significantly affected by duration and type of dialysis, previous CPR, gender, and level of education. SN - 1058-2916 UR - https://www.unboundmedicine.com/medline/citation/8555624/End_of_life_issues_in_ESRD__A_study_of_three_decision_variables_that_affect_patient_attitudes_ L2 - https://Insights.ovid.com/pubmed?pmid=8555624 DB - PRIME DP - Unbound Medicine ER -