The study by Dr Biola et al
1
is one of those good-news-bad-news pieces that certainly points out some areas for
growth and improvement, while on a positive note demonstrating that both skilled nursing
facilities and assisted living facilities are doing a decent job of at least discussing
residents' preferences with respect to end-of-life care and life-sustaining treatment
(LST). Although this study is of limited scope with about 300 residents from a small
sample of facilities in 4 states, there are lessons to be learned from its results.
Perhaps most importantly, this work highlights the need for improved processes to
ensure that we do indeed provide care that is in keeping with our patients' wishes.
We should also be cautious when we use the words “life-sustaining treatment” because
they imply to our patients that they actually do sustain life, when in fact we know
that in our population, “successful” cardiopulmonary resuscitation (CPR) is a rarity—in
spite of the fact that it works almost every time we see it done on television! So
it's good to start from that discussion point with our patients and their families.
(Even the term “CPR” explicitly contains a reference to “resuscitation,” so it is
no wonder that people think they will survive it, even without the TV shows)!To read this article in full you will need to make a payment
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Reference
- Preferences versus practice: Life-sustaining treatments in last months of life in long-term care.J Am Med Dir Assoc. 2010; 11: 42-51
Article info
Publication history
Published online: November 26, 2009
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
