Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Dec;34(12):3165-3169.
doi: 10.1007/s40520-022-02281-y. Epub 2022 Nov 5.

Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study

Victoria Johanna Jacoba Hendriks  1 , Miriam C Faes  2 , Jop B L van der Meer  2   3 , Emma S Janse  2 , Nardo J M van der Meer  4 , Carolien M J van der Linden  4
Affiliations
Multicenter Study

Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study

Victoria Johanna Jacoba Hendriks et al. Aging Clin Exp Res. 2022 Dec.

Abstract

Background: In the Netherlands, it is customary to discuss directives regarding resuscitation, intubation, and ICU-admission with patients and/or their relatives upon hospital-admission. The outcome of this discussion is documented in a code status. Ideally, these advance care planning (ACP)-related decisions are made by a patient (and/or their relatives) and a professional together in a shared decision-making (SDM) process, to improve patient satisfaction and prevent undesired care. Given the bad outcomes in older COVID-19 patients, it is particularly important to discuss the code status upon admission. This study aims to describe the practice of SDM regarding code status during the COVID-pandemic. Specific aims were to find out to what extend patients took part in this decision-making process and whether all key elements of SDM for a shared decision were documented in medical reports.

Methods: In this retrospective cohort study, we included COVID-19 patients aged 70 years and older, admitted to two large teaching hospitals in the Netherlands, during the first months of the COVID-19 pandemic in 2020. Data about code status and the decision-making process were extracted from electronic healthcare records.

Results: Code status was documented for 274 of 275 included patients. Patient participation in the decision-making process was described in 48%. In 19% all key elements of shared decision-making have been described. Key elements of SDM were defined as the presence of a completed code status form, the presence of clinical notes showing that both patient's wishes and values and the opinion of the healthcare professional about the predicted outcome was taken into consideration and clinical notes of a patient-healthcare professional interaction during the admission.

Conclusion: Our results show that a proper SDM process regarding code status is possible, even in hectic times like the COVID-19-pandemic. However, shared decision-making was not common practice in older patients with COVID-19 regarding code status (an ACP-related decision) in the early phase of the COVID-19 pandemic. Only in 19% of the patients, all key elements of SDM regarding code status were described.

Keywords: Advance care planning; COVID-19; Code status; Older persons; Shared decision-making.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflict of interest.

References

    1. van de Pol MH, Fluit CR, Lagro J, et al. Model voor gezamenlijke besluitvorming met kwetsbare ouderen [A model for shared decision-making with frail older patients: consensus reached using Delphi technique] Ned Tijdschr Geneeskd. 2017;161:D811. - PubMed
    1. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27:1361–1367. doi: 10.1007/s11606-012-2077-6. - DOI - PMC - PubMed
    1. Elwyn G, Laitner S, Coulter A, et al. Implementing shared decision making in the NHS. BMJ. 2010;341:c5146. doi: 10.1136/bmj.c5146. - DOI - PubMed
    1. van Beek-Peeters JJAM, van der Meer JBL, Faes MC, et al. Professionals' views on shared decision-making in severe aortic stenosis. Heart. 10.1136/heartjnl-2021-320194 - PubMed
    1. Légaré F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff (Millwood) 2013;32:276–284. doi: 10.1377/hlthaff.2012.1078. - DOI - PubMed

Publication types