End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany
<i>Background and Objectives</i>: Mortality on Intensive Care Units (ICUs) is high and death frequently occurs after decisions to limit life-sustaining therapies. An advance directive is a tool meant to preserve patient autonomy by guiding anticipated future treatment decisions once deci...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-09-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/9/930 |
| _version_ | 1797518338179465216 |
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| author | Jan A. Graw Fanny Marsch Claudia D. Spies Roland C. E. Francis |
| author_facet | Jan A. Graw Fanny Marsch Claudia D. Spies Roland C. E. Francis |
| author_sort | Jan A. Graw |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Mortality on Intensive Care Units (ICUs) is high and death frequently occurs after decisions to limit life-sustaining therapies. An advance directive is a tool meant to preserve patient autonomy by guiding anticipated future treatment decisions once decision-making capacity is lost. Since September 2009, advance directives are legally binding for the caregiver team and the patients’ surrogate decision-maker in Germany. The change in frequencies of end-of-life decisions (EOLDs) and completed advance directives among deceased ICU patients ten years after the enactment of a law on advance directives in Germany is unknown. <i>Materials and Methods</i>: Retrospective analysis on all deceased patients of surgical ICUs of a German university medical center from 08/2008 to 09/2009 and from 01/2019 to 09/2019. Frequency of EOLDs and advance directives and the process of EOLDs were compared between patients admitted before and after the change in legislation. (No. of ethical approval EA2/308/20) <i>Results:</i> Significantly more EOLDs occurred in the 2019 cohort compared to the 2009 cohort (85.8% vs. 70.7% of deceased patients, <i>p</i> = 0.006). The number of patients possessing an advance directive to express a living or therapeutic will was higher in the 2019 cohort compared to the 2009 cohort (26.4% vs. 8.9%; difference: 17.5%, <i>p</i> < 0.001). Participation of the patients’ family in the EOLD process (74.7% vs. 60.9%; difference: 13.8%, <i>p</i> = 0.048) and the frequency of documentation of EOLD-relevant information (50.0% vs. 18.7%; difference: 31.3%, <i>p</i> < 0.001) increased from 2009 to 2019. <i>Discussion</i>: During a ten-year period from 2009 to 2019, the frequency of EOLDs and the completion rate of advance directives have increased considerably. In addition, EOLD-associated communication and documentation have further improved. |
| first_indexed | 2024-03-10T07:28:28Z |
| format | Article |
| id | doaj.art-e0d0d725ebd84da8a2733b1ff9d89697 |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T07:28:28Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-e0d0d725ebd84da8a2733b1ff9d896972023-11-22T14:08:28ZengMDPI AGMedicina1010-660X1648-91442021-09-0157993010.3390/medicina57090930End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in GermanyJan A. Graw0Fanny Marsch1Claudia D. Spies2Roland C. E. Francis3Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, GermanyDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, GermanyDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, GermanyDepartment of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany<i>Background and Objectives</i>: Mortality on Intensive Care Units (ICUs) is high and death frequently occurs after decisions to limit life-sustaining therapies. An advance directive is a tool meant to preserve patient autonomy by guiding anticipated future treatment decisions once decision-making capacity is lost. Since September 2009, advance directives are legally binding for the caregiver team and the patients’ surrogate decision-maker in Germany. The change in frequencies of end-of-life decisions (EOLDs) and completed advance directives among deceased ICU patients ten years after the enactment of a law on advance directives in Germany is unknown. <i>Materials and Methods</i>: Retrospective analysis on all deceased patients of surgical ICUs of a German university medical center from 08/2008 to 09/2009 and from 01/2019 to 09/2019. Frequency of EOLDs and advance directives and the process of EOLDs were compared between patients admitted before and after the change in legislation. (No. of ethical approval EA2/308/20) <i>Results:</i> Significantly more EOLDs occurred in the 2019 cohort compared to the 2009 cohort (85.8% vs. 70.7% of deceased patients, <i>p</i> = 0.006). The number of patients possessing an advance directive to express a living or therapeutic will was higher in the 2019 cohort compared to the 2009 cohort (26.4% vs. 8.9%; difference: 17.5%, <i>p</i> < 0.001). Participation of the patients’ family in the EOLD process (74.7% vs. 60.9%; difference: 13.8%, <i>p</i> = 0.048) and the frequency of documentation of EOLD-relevant information (50.0% vs. 18.7%; difference: 31.3%, <i>p</i> < 0.001) increased from 2009 to 2019. <i>Discussion</i>: During a ten-year period from 2009 to 2019, the frequency of EOLDs and the completion rate of advance directives have increased considerably. In addition, EOLD-associated communication and documentation have further improved.https://www.mdpi.com/1648-9144/57/9/930end-of-life decisionadvance directiveintensive care unitshared decision-making |
| spellingShingle | Jan A. Graw Fanny Marsch Claudia D. Spies Roland C. E. Francis End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany Medicina end-of-life decision advance directive intensive care unit shared decision-making |
| title | End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany |
| title_full | End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany |
| title_fullStr | End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany |
| title_full_unstemmed | End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany |
| title_short | End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany |
| title_sort | end of life decision making in intensive care ten years after a law on advance directives in germany |
| topic | end-of-life decision advance directive intensive care unit shared decision-making |
| url | https://www.mdpi.com/1648-9144/57/9/930 |
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