Limitation of life-sustaining treatment and patient involvement in decision-making: a retrospective study of a Danish COVID-19 patient cohort

Hanne Irene Jensen,Sevim Ozden,Mihnaz Azizi,Gitte Schultz Kristensen,Christian Backer Mogensen,Siri Aas Smedemark

doi:10.1186/s13049-021-00984-1

Abstract

BackgroundThe coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The purpose of the study was to investigate the proportion and characteristics of COVID-19 patients with limitation of life-sustaining treatment decisions and the degree of patient involvement in the decisions.MethodsA retrospective observational descriptive study was conducted in three Danish regional hospitals, looking at all patients ≥ 18 years of age admitted in 2020 with COVID-19 as the primary diagnosis. Lists of hospitalised patients admitted due to COVID-19 were extracted. The data registration included age, gender, comorbidities, including mental state, body mass index, frailty, recent hospital admissions, COVID-19 life-sustaining treatment, ICU admission, decisions on limitations of life-sustaining treatment before and during current hospitalisation, hospital length of stay, and hospital mortality.ResultsA total of 476 patients were included. For 7% (33/476), a decision about limitation of life-sustaining treatment had been made prior to hospital admission. At the time of admission, one or more limitations of life-sustaining treatment were registered for 16% (75/476) of patients. During the admission, limitation decisions were made for an additional 11 patients, totaling 18% (86/476). For 40% (34/86), the decisions were either made by or discussed with the patient. The decisions not made by patients were made by physicians. For 36% (31/86), no information was disclosed about patient involvement.ConclusionsLife-sustaining treatment limitation decisions were made for 18% of a COVID-19 patient cohort. Hereof, more than a third of the decisions had been made before hospital admission. Many records lacked information on patient involvement in the decisions.

Highlights

The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation
As the pandemic has highlighted the need for goal-concordant care [2], it is of interest to examine how EOL practice and limitation decisions are executed in a population of hospitalised patients with COVID-19 to improve our efforts in these critical decisions
For patients less than 70 years of age, length of stay (LOS) was a median of 5 days (IQR 2–8 days), and for patients 70 years or more, LOS was median 8 days (IQR 5–15 days)

Summary

Introduction

The coronavirus (COVID-19) pandemic and the risk of an extensive overload of the healthcare systems have elucidated the need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation. The coronavirus (COVID-19) pandemic and the risk of an extensive strain of the healthcare systems have made it clear that there is a need to make decisions on the level of life-sustaining treatment for patients requiring hospitalisation, including which patients should be Jensen et al Scand J Trauma Resusc Emerg Med (2021) 29:173 offered care in an intensive care unit (ICU). Frailty and old age are more likely to develop severe symptoms of COVID-19 and death [1, 2], and the chance of a successful outcome from ICU therapy may be minimal [3, 4]. As the pandemic has highlighted the need for goal-concordant care [2], it is of interest to examine how EOL practice and limitation decisions are executed in a population of hospitalised patients with COVID-19 to improve our efforts in these critical decisions

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