In a
new study published in the Journal of Clinical Oncology, researchers
found that showing patients with advanced cancer a video of simulated
cardiopulmonary resuscitation (CPR) improved their understanding of the
intervention and caused more patients to opt against CPR.
The innovative Advance Care Planning Decisions video used
in the study was created by a nonprofit foundation led by physicians who aim to
empower terminally ill and elderly patients and their families to make informed
choices about end-of-life care. These videos are created based on rigorous
research and review from leading medical experts, and are in use at 35 health
systems across the U.S. They improve decisions by overcoming the inability of
patients to envision what CPR and subsequent care on a ventilator entails, as
well as overcoming variability in the quality of physician counseling.
This sounds like a good idea. However, this is NO substitute for the urgent need for a federal mandate that physicians seek informed consent for EITHER curative care OR palliative care from elderly cancer patients -- is it?
ReplyDeleteSurely, physicians could use the currently available statistics on survival rates and complications of treatment, etc.. and permit elderly Medicare/Medicaid patients to elect curative treatment or NO treatment, palliative care/hospice, whichever is in their best interests. This would go a long way in preventing non-beneficial and expensive "overtreatment" of the elderly that is currently reimbursed by CMS and private insurers up to the DRG caps.
When elderly patients who are being treated for cancer by an oncologist elect "NO CPR" this means that they will be put on a DNR Code Status if they are hospitalized from complications from the treatment or for other reasons, pneumonia, etc. -- and their lives will be "shortened" because NO life extending or life saving treatment will be offered when DNR is in the hospital chart.
Informed Consent that educates the patient rather than ugly pictures of CPR is a moral and better way to go than influenced requests for "NO CPR" that permits hospitals to keep elderly patients out of ICUs and CCUs.
New York's new law in 2011 is a move in this direction, isn't it?
I am not surprised that people are making different decisions. When people see what they are choosing, they choose differently. If you don't have a video to describe what you are discussing with a patient, use visual words to describe the surgery/procedure/treatment. The question patients/families need to understand is, "What will it feel like and be like to experience _____?"
ReplyDeleteYes! But the request for "NO CPR" translates to DNR Code Status in the Hospital chart which enables the hospitals to keep elderly and ill patients out of expensive ICUs. The "NO CPR" results in DNR code status that is interpreted broadly and intubation and other life-saving procedures other that Heart Resuscitation are then not offered to the DNR patient.
ReplyDeleteWhen elderly patients are receiving "curative" or "palliative" treatments and are in surgery, the DNR code is suspended during the surgery, because, of course, the physician/hospital want to be paid by Medicare and the private insurers for a completed and successful surgical procedure.
Most lay people think of CPR as being the process of bringing back a person who is already dead after a sudden heart attack.
Many of the old people watching this film are not in danger of a heart attacks but they may be in danger when they elect "slow code" status i.e. DNR status because they told their physician they didn't want CPR after seeing this film.
Obviously, when physicians and hospitals are paid for life-extending and life-saving procedures, there is no problem. But, OVERTREATMENT and non-beneficial treatment of elderly patients with late stage diseases are NOT being reimbursed by CMS and the private insurers. They have to EAT these costs --and can't bill the patients.
When push comes to shove because of fiscal pain, the need to influence the elderly to shorten their lives is obvious and okey with me as long as the autonomy of elderly patients is protected and there is really informed consent to the shortening of one's life.
Yes! But the request for "NO CPR" translates to DNR Code Status in the Hospital chart which enables the hospitals to keep elderly and ill patients out of expensive ICUs. The "NO CPR" results in DNR code status that is interpreted broadly and intubation and other life-saving procedures other that Heart Resuscitation are then not offered to the DNR patient.
ReplyDeleteWhen elderly patients are receiving "curative" or "palliative" treatments and are in surgery, the DNR code is suspended during the surgery, because, of course, the physician/hospital want to be paid by Medicare and the private insurers for a completed and successful surgical procedure.
Most lay people think of CPR as being the process of bringing back a person who is already dead after a sudden heart attack.
Many of the old people watching this film are not in danger of a heart attacks but they may be in danger when they elect "slow code" status i.e. DNR status because they told their physician they didn't want CPR after seeing this film.
Obviously, when physicians and hospitals are paid for life-extending and life-saving procedures, there is no problem. But, OVERTREATMENT and non-beneficial treatment of elderly patients with late stage diseases are NOT being reimbursed by CMS and the private insurers. They have to EAT these costs --and can't bill the patients.
When push comes to shove because of fiscal pain, the need to influence the elderly to shorten their lives is obvious and okey with me as long as the autonomy of elderly patients is protected and there is really informed consent to the shortening of one's life.