 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
20 May 2003 | Volume 138 Issue 10 | Pages 812-818
Patients with eventually fatal illnesses often receive routine treatments in response to health problems rather than treatments arising from planning that incorporates the patient's situation and preferences. This paper considers the case of an elderly man with advanced lung disease who had mechanical ventilation and aggressive intensive care, in part because his nursing home clinicians did not complete an advance care plan and his do-not-resuscitate order did not accompany him to the hospital. The errors that led to his hospitalization and his unwanted treatment there demonstrate how the ordinary lack of advance care planning is deleterious for patients who are nearing the end of life. We discuss serious, recurring, and generally unnoticed errors in planning for care near the end of life and possible steps toward improvement. Repairing these shortcomings will require quality improvement and system redesign efforts, methods familiar from patient safety initiatives. Reliable improvement will also require making it unacceptable for clinicians to fail to plan ahead for care during fatal chronic illness.
Author and Article Information
From The Washington Home Center for Palliative Care Studies and RAND Health, Washington, DC, and The Robert Wood Johnson Clinical Scholars Program, Yale University, New Haven, Connecticut.
*This paper was prepared by Joanne Lynn, MD, MA, MS, and Nathan Goldstein, MD, for the Quality Grand Rounds series. Sanjay Saint, MD, MPH, prepared the case for presentation. The case and discussion were presented at the Sixth Annual UCSF Management of the Hospitalized Patient Conference in San Francisco, California, on 11 October 2002.
Grant Support: Funding for the Quality Grand Rounds series is supported by the California HealthCare Foundation as part of its Quality Initiative. Dr. Lynn is supported by The Center for Patient Safety at the End of Life, which is funded by the Agency for Healthcare Research and Quality, grant 1P20HS11558-01. Dr. Goldstein is supported by the Robert Wood Johnson Foundation and the Department of Veterans Affairs.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Joanne Lynn, MD, MA, MS, Center for Palliative Care Studies, The Washington Home and Community Hospice, 4200 Wisconsin Avenue NW, 4th Floor, Washington, DC 20016; e-mail, jlynn{at}thewashingtonhome.org.
Current Author Addresses: Dr. Lynn: Center for Palliative Care Studies, The Washington Home and Community Hospice, 4200 Wisconsin Avenue, NW, 4th Floor, Washington, DC 20016.
Dr. Goldstein: Robert Wood Johnson Clinical Scholars Program, Yale University, IE-61 SHM, PO Box 208025, New Haven, CT 06520-8025. ACADEMIA AND CLINIC
QUALITY GRAND ROUNDS
Series Editors: Robert M. Wachter, MD; Kaveh G. Shojania, MD; Sanjay Saint, MD, MPH; Amy J. Markowitz, JD; and Mark Smith,MD, MBA
Advance Care Planning for Fatal Chronic Illness: Avoiding Commonplace Errors and Unwarranted Suffering
This article has been cited by other articles:
|
|
 |
|
  S. Wingate and D. L.-M. Wiegand End-of-Life Care in the Critical Care Unit for Patients With Heart Failure Crit. Care Nurse, April 1, 2008; 28(2): 84 - 94. [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Patel and J. L. Holley Withholding and Withdrawing Dialysis in the Intensive Care Unit: Benefits Derived from Consulting the Renal Physicians Association/American Society of Nephrology Clinical Practice Guideline, Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis Clin. J. Am. Soc. Nephrol., March 1, 2008; 3(2): 587 - 593. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. C. White, H. H. O'Connor, and K. Kirby Prolonged Mechanical Ventilation: Review of Care Settings and an Update on Professional Reimbursement Chest, February 1, 2008; 133(2): 539 - 545. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Z. Aminoff The New Israeli Law "The Dying Patient" and Relief of Suffering Units American Journal of Hospice and Palliative Medicine, February 1, 2007; 24(1): 54 - 58. [Abstract] [PDF]
|
|
|
|
 |
|
 R. M. Wachter, K. G. Shojania, A. J. Markowitz, M. Smith, and S. Saint Quality grand rounds: the case for patient safety. Ann Intern Med, October 17, 2006; 145(8): 629 - 630. [Full Text] [PDF]
|
|
|
|
 |
|
 S C Seiden, C Galvan, and R Lamm Role of medical students in preventing patient harm and enhancing patient safety. Qual. Saf. Health Care, August 1, 2006; 15(4): 272 - 276. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kellermann and J. Lynn Withholding Resuscitation in Prehospital Care Ann Intern Med, May 2, 2006; 144(9): 692 - 693. [Full Text] [PDF]
|
|
|
|
 |
|
 T. P. Daaleman Reorganizing medicare for older adults with chronic illness. J Am Board Fam Med, May 1, 2006; 19(3): 303 - 309. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Bernat and L. M. Peterson Patient-Centered Informed Consent in Surgical Practice Arch Surg, January 1, 2006; 141(1): 86 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. K Das and G. P Mulley The value of an ethics history? J R Soc Med, June 1, 2005; 98(6): 262 - 266. [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Pearlman, H. Starks, K. C. Cain, and W. G. Cole Improvements in Advance Care Planning in the Veterans Affairs System: Results of a Multifaceted Intervention Arch Intern Med, March 28, 2005; 165(6): 667 - 674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. W. Rabow, J. M. Hauser, and J. Adams Supporting Family Caregivers at the End of Life: "They Don't Know What They Don't Know" JAMA, January 28, 2004; 291(4): 483 - 491. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Reisfield and G. R. Wilson Advance care planning redux: It's time to talk American Journal of Hospice and Palliative Medicine, January 1, 2004; 21(1): 7 - 9. [PDF]
|
|
Article
