Advance Care Planning in Patients with Suspected or Proven COVID: Are We Meeting Our Own Standards?

Oyungerel Byambasuren, Jananee Myooran, Aishah Virk, Rida Hanna, Onur Tanglay, Sarah Younan, Nikk Moore, Paul Middleton, Danielle Ní Chróinín
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Abstract

Objective: Given the importance of advance care planning (ACP) in the context of a pandemic, we aimed to assess current adherence to local policy recommending ACP in all hospitalised adult patients with suspected or proven COVID-19 at Liverpool Hospital, Sydney, Australia.

Design: A retrospective cohort study.

Setting: A tertiary referral and teaching hospital.

Participants: A select sample of adult patients admitted to Liverpool Hospital in 2019-2021 with suspected or proven COVID-19.

Main outcome measures: Proportion of patients with documented ACP and format of ACP.

Results: Amongst 209 patients with proven or suspected COVID-19 hospitalised between March 2019 through to September 2021, median frailty score was 3, the median Charlson Comorbidity Score was 4, median age of the patients was 71 years, and median length of hospital stay was 5 days (range 0-98 days). Almost all patients were tested for COVID-19 (n = 207, 99%) of which 15% (31) were positive. Fewer than a quarter of the patients had documented ACPs (50, 24%) and 17 patients had existing formal advance care directives. Patients who had ACP were older, more likely to be frail and more likely to have higher rates of comorbidity compared to those without ACP. ACP was more commonly discussed with family members (41/50) than patients (25/50) and others (5/50).

Conclusion: Adherence to the local ACP policy mandating such discussions was low. This reinforces the need for prioritising ACP discussions, especially for unwell patients such as those with COVID, likely involving further input to improve awareness and rates of formal documentation.

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对疑似或确诊的COVID患者进行预先护理规划:我们是否达到了自己的标准?
目的:考虑到大流行背景下预先护理计划(ACP)的重要性,我们旨在评估澳大利亚悉尼利物浦医院所有疑似或证实患有COVID-19的住院成年患者目前对当地政策推荐的ACP的依从性。设计:回顾性队列研究。环境:三级转诊教学医院。参与者:选择2019-2021年利物浦医院疑似或确诊COVID-19的成年患者样本。主要观察指标:记录ACP的患者比例和ACP格式。结果:2019年3月至2021年9月期间住院的209例确诊或疑似COVID-19患者中,虚弱评分中位数为3,Charlson共病评分中位数为4,患者年龄中位数为71岁,住院时间中位数为5天(范围0-98天)。几乎所有患者都接受了COVID-19检测(n = 207, 99%),其中15%(31)呈阳性。不到四分之一的患者有acp记录(50.24%),17例患者有现有的正式提前护理指令。与没有ACP的患者相比,患有ACP的患者年龄更大,更容易虚弱,更有可能出现更高的合并症。家庭成员(41/50)比患者(25/50)和其他人(5/50)更常讨论ACP。结论:当地ACP政策要求进行此类讨论的依从性较低。这加强了优先考虑ACP讨论的必要性,特别是对于COVID等身体不适的患者,可能需要进一步投入,以提高正式文件的认识和使用率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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