Lone Doris Tuesen
Knowing and honoring patients´ wishes for end-of-life treatment.
A mixed method study.
Nurses and other healthcare professionals often experience that wishes for end-of-life treatment are unknown. Due to this lack of knowledge, patients, citizens, and nursing home residents may risk cardiopulmonary resuscitation (CPR) attempts and intensive care treatment against their wishes. In a medical culture heavily intent on informed consent, CPR is one of few medical interventions that individuals receive with little or no warning, let alone consent. CPR is not inherently beneficial to all patients; yet it has somehow become the standard treatment to many patients experiencing cardiac arrest. A Living Will in Denmark can be registered by all adults, and only about two percent of the Danish population has filled one in. Wishes in the Living Will about withholding or withdrawing treatment at end-of-life (if the patient does not have decision-making capacity at the time) are only legally binding for physicians if the patient is moribund.
Currently a bill about changing the Living Will to a Treatment Will is being processed in the Danish parliament. A Treatment Will will extend the wishes to be legally binding, also if the patient is not unavoidable dying. Therefore, this study seeks to develop and test a model to ease the communication between healthcare professionals and patients, citizens, and nursing home residents about wishes for end-of-life treatment, and through those making sure patients preferences, once thoughtfully determined with physician guidance, are known and if possible honored. Inspired by the American POLST (Physician Orders for Life Sustaining Treatment) the aim of this study is to develop and test a Danish version of the POLST. The American POLST was developed in Oregon, USA and has been used since 1995. A study from Oregon shows that the POLST form is widely used in honoring patients´ wishes for end-of-life treatments. The target group for the POLST form is patients with serious illness or frailty for whom their health care professionals would not be surprised if they died within six to twelve months. The POLST form helps secure that wishes regarding CPR, level of treatment and use of artificial nutrition are known, documented and legally binding, and using a POLST form enhances that a conversation about end-of-life preferences and wishes are conducted ahead of an acute situation.
1. maj 2017 - 30. april 2020
Associate Professor Hanne Irene Jensen, Department of Anasthesiology, Vejle
MD, Research Consultant, Hans- Henrik Bülow, Department of Intensive Care, Holbaek Hospital
Assistant professor, Anne Sophie Ågård, Department of Intensive Care, Aarhus University Hospital, Skejby
Publikationer og aktiviteter
Se link til Lone Doris Tuesen's publikationer, aktiviteter mv. på SDU.dk - link