Differences in Code Status and End-of-Life Decision Making in Patients With Limited English Proficiency in the Intensive Care Unit

Amelia Barwise, Carolina Jaramillo, Paul Novotny, Mark L. Wieland, Charat Thongprayoon, Ognjen Gajic, Michael Wilson

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English. Patients and Methods: We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014. Results: Of the 27,523 patients admitted to the ICU, 779 (2.8%) had LEP. When adjusted for severity of illness, sex, education level, and insurance status, patients with LEP were less likely to change their code status from full code to do not resuscitate during ICU admission (odds ratio [OR], 0.62; 95% CI, 0.46-0.82; P<.001) and took 3.8 days (95% CI, 1.9-5.6 days; P<.001) longer to change to do not resuscitate. Patients with LEP who died in the ICU were less likely to receive a comfort measures order set (OR, 0.38; 95% CI, 0.16-0.91; P=.03) and took 19.1 days (95% CI, 13.2-25.1 days; P<.001) longer to transition to comfort measures only. Patients with LEP were less likely to have an advance directive (OR, 0.23; 95% CI, 0.18-0.29; P<.001), more likely to receive mechanical ventilation (OR, 1.26; 95% CI, 1.07-1.48; P=.005), and more likely to have restraints used (OR, 1.36; 95% CI, 1.11-1.65; P=.003). The hospital length of stay was 2.7 days longer for patients with LEP. Additional adjustment for religion, race, and age yielded similar results. Conclusion: There are important differences in end-of-life care and decision making for patients with LEP.

Original languageEnglish (US)
JournalMayo Clinic Proceedings
DOIs
StateAccepted/In press - Jan 1 2018

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Intensive Care Units
Decision Making
Odds Ratio
Advance Directives
Length of Stay
Insurance Coverage
Terminal Care
Sex Education
Religion
Artificial Respiration
Cohort Studies
Language
Retrospective Studies

ASJC Scopus subject areas

  • Medicine(all)

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Differences in Code Status and End-of-Life Decision Making in Patients With Limited English Proficiency in the Intensive Care Unit. / Barwise, Amelia; Jaramillo, Carolina; Novotny, Paul; Wieland, Mark L.; Thongprayoon, Charat; Gajic, Ognjen; Wilson, Michael.

In: Mayo Clinic Proceedings, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Objective: To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English. Patients and Methods: We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014. Results: Of the 27,523 patients admitted to the ICU, 779 (2.8{\%}) had LEP. When adjusted for severity of illness, sex, education level, and insurance status, patients with LEP were less likely to change their code status from full code to do not resuscitate during ICU admission (odds ratio [OR], 0.62; 95{\%} CI, 0.46-0.82; P<.001) and took 3.8 days (95{\%} CI, 1.9-5.6 days; P<.001) longer to change to do not resuscitate. Patients with LEP who died in the ICU were less likely to receive a comfort measures order set (OR, 0.38; 95{\%} CI, 0.16-0.91; P=.03) and took 19.1 days (95{\%} CI, 13.2-25.1 days; P<.001) longer to transition to comfort measures only. Patients with LEP were less likely to have an advance directive (OR, 0.23; 95{\%} CI, 0.18-0.29; P<.001), more likely to receive mechanical ventilation (OR, 1.26; 95{\%} CI, 1.07-1.48; P=.005), and more likely to have restraints used (OR, 1.36; 95{\%} CI, 1.11-1.65; P=.003). The hospital length of stay was 2.7 days longer for patients with LEP. Additional adjustment for religion, race, and age yielded similar results. Conclusion: There are important differences in end-of-life care and decision making for patients with LEP.",
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AU - Barwise, Amelia

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AU - Novotny, Paul

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AU - Gajic, Ognjen

AU - Wilson, Michael

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N2 - Objective: To determine whether code status, advance directives, and decisions to limit life support were different for patients with limited English proficiency (LEP) in the intensive care unit (ICU) as compared with patients whose primary language was English. Patients and Methods: We conducted a retrospective cohort study in adult patients admitted to 7 ICUs in a single tertiary academic medical center from May 31, 2011, through June 1, 2014. Results: Of the 27,523 patients admitted to the ICU, 779 (2.8%) had LEP. When adjusted for severity of illness, sex, education level, and insurance status, patients with LEP were less likely to change their code status from full code to do not resuscitate during ICU admission (odds ratio [OR], 0.62; 95% CI, 0.46-0.82; P<.001) and took 3.8 days (95% CI, 1.9-5.6 days; P<.001) longer to change to do not resuscitate. Patients with LEP who died in the ICU were less likely to receive a comfort measures order set (OR, 0.38; 95% CI, 0.16-0.91; P=.03) and took 19.1 days (95% CI, 13.2-25.1 days; P<.001) longer to transition to comfort measures only. Patients with LEP were less likely to have an advance directive (OR, 0.23; 95% CI, 0.18-0.29; P<.001), more likely to receive mechanical ventilation (OR, 1.26; 95% CI, 1.07-1.48; P=.005), and more likely to have restraints used (OR, 1.36; 95% CI, 1.11-1.65; P=.003). The hospital length of stay was 2.7 days longer for patients with LEP. Additional adjustment for religion, race, and age yielded similar results. Conclusion: There are important differences in end-of-life care and decision making for patients with LEP.

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