Prevalence and contents of advance directives in patients receiving home parenteral nutrition

Gloria T. Bui, Jithinraj Edakkanambeth Varayil, Ryan T Hurt, Kari A. Neutzling, Katlyn E. Cook, Debra L. Head, Paul Mueller, Keith M. Swetz

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Ethical issues may arise with patients who receive home parenteral nutrition (HPN) and have a change in their overall health status. We sought to determine the extent of advance care planning and the use of advance directives (ADs) by patients receiving HPN. Materials and Methods: Retrospective review of the medical records of adult patients newly started on HPN at the Mayo Clinic, Rochester, Minnesota, between January 1, 2003, and December 31, 2012, to determine the prevalence and contents of their ADs. Results: A total of 537 patients met the inclusion criteria. Mean (SD) age at commencement of HPN was 52.8 (15.2) years, and 39% (n = 210) were men. Overall, 159 patients (30%) had ADs. Many mentioned specific life-prolonging treatments: cardiopulmonary resuscitation (44 [28%]), mechanical ventilation (43 [27%]), and hemodialysis (19 [12%]). Almost half mentioned pain control (78 [49%]), comfort measures (65 [41%]), and end-of-life management of HPN (76 [48%]). Many also contained general statements about end-of-life care (no "heroic measures"). The proportion specifically addressing end-of-life management of HPN (48%) was much higher than that previously reported in other populations with other life-supporting care such as cardiac devices. The primary diagnosis or the indication for HPN was not correlated with whether or not the patient had an AD (P =.07 and.46, respectively). Conclusion: Although almost one-third of the patients had an AD, less than half specifically mentioned HPN in it, which suggests that such patients should be encouraged to execute an AD that specifically addresses end-of-life management of HPN.

Original languageEnglish (US)
Pages (from-to)399-404
Number of pages6
JournalJournal of Parenteral and Enteral Nutrition
Volume40
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Home Parenteral Nutrition
Advance Directives
Advance Care Planning
Terminal Care
Cardiopulmonary Resuscitation
Artificial Respiration
Ethics
Health Status
Medical Records
Renal Dialysis

Keywords

  • advance directives
  • end-of-life care
  • ethics
  • parenteral nutrition

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Bui, G. T., Edakkanambeth Varayil, J., Hurt, R. T., Neutzling, K. A., Cook, K. E., Head, D. L., ... Swetz, K. M. (2016). Prevalence and contents of advance directives in patients receiving home parenteral nutrition. Journal of Parenteral and Enteral Nutrition, 40(3), 399-404. https://doi.org/10.1177/0148607114544323

Prevalence and contents of advance directives in patients receiving home parenteral nutrition. / Bui, Gloria T.; Edakkanambeth Varayil, Jithinraj; Hurt, Ryan T; Neutzling, Kari A.; Cook, Katlyn E.; Head, Debra L.; Mueller, Paul; Swetz, Keith M.

In: Journal of Parenteral and Enteral Nutrition, Vol. 40, No. 3, 01.03.2016, p. 399-404.

Research output: Contribution to journalArticle

Bui, Gloria T. ; Edakkanambeth Varayil, Jithinraj ; Hurt, Ryan T ; Neutzling, Kari A. ; Cook, Katlyn E. ; Head, Debra L. ; Mueller, Paul ; Swetz, Keith M. / Prevalence and contents of advance directives in patients receiving home parenteral nutrition. In: Journal of Parenteral and Enteral Nutrition. 2016 ; Vol. 40, No. 3. pp. 399-404.
@article{69368824b6d24a839f99bf9a874316a6,
title = "Prevalence and contents of advance directives in patients receiving home parenteral nutrition",
abstract = "Background: Ethical issues may arise with patients who receive home parenteral nutrition (HPN) and have a change in their overall health status. We sought to determine the extent of advance care planning and the use of advance directives (ADs) by patients receiving HPN. Materials and Methods: Retrospective review of the medical records of adult patients newly started on HPN at the Mayo Clinic, Rochester, Minnesota, between January 1, 2003, and December 31, 2012, to determine the prevalence and contents of their ADs. Results: A total of 537 patients met the inclusion criteria. Mean (SD) age at commencement of HPN was 52.8 (15.2) years, and 39{\%} (n = 210) were men. Overall, 159 patients (30{\%}) had ADs. Many mentioned specific life-prolonging treatments: cardiopulmonary resuscitation (44 [28{\%}]), mechanical ventilation (43 [27{\%}]), and hemodialysis (19 [12{\%}]). Almost half mentioned pain control (78 [49{\%}]), comfort measures (65 [41{\%}]), and end-of-life management of HPN (76 [48{\%}]). Many also contained general statements about end-of-life care (no {"}heroic measures{"}). The proportion specifically addressing end-of-life management of HPN (48{\%}) was much higher than that previously reported in other populations with other life-supporting care such as cardiac devices. The primary diagnosis or the indication for HPN was not correlated with whether or not the patient had an AD (P =.07 and.46, respectively). Conclusion: Although almost one-third of the patients had an AD, less than half specifically mentioned HPN in it, which suggests that such patients should be encouraged to execute an AD that specifically addresses end-of-life management of HPN.",
keywords = "advance directives, end-of-life care, ethics, parenteral nutrition",
author = "Bui, {Gloria T.} and {Edakkanambeth Varayil}, Jithinraj and Hurt, {Ryan T} and Neutzling, {Kari A.} and Cook, {Katlyn E.} and Head, {Debra L.} and Paul Mueller and Swetz, {Keith M.}",
year = "2016",
month = "3",
day = "1",
doi = "10.1177/0148607114544323",
language = "English (US)",
volume = "40",
pages = "399--404",
journal = "Journal of Parenteral and Enteral Nutrition",
issn = "0148-6071",
publisher = "SAGE Publications Inc.",
number = "3",

}

TY - JOUR

T1 - Prevalence and contents of advance directives in patients receiving home parenteral nutrition

AU - Bui, Gloria T.

AU - Edakkanambeth Varayil, Jithinraj

AU - Hurt, Ryan T

AU - Neutzling, Kari A.

AU - Cook, Katlyn E.

AU - Head, Debra L.

AU - Mueller, Paul

AU - Swetz, Keith M.

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background: Ethical issues may arise with patients who receive home parenteral nutrition (HPN) and have a change in their overall health status. We sought to determine the extent of advance care planning and the use of advance directives (ADs) by patients receiving HPN. Materials and Methods: Retrospective review of the medical records of adult patients newly started on HPN at the Mayo Clinic, Rochester, Minnesota, between January 1, 2003, and December 31, 2012, to determine the prevalence and contents of their ADs. Results: A total of 537 patients met the inclusion criteria. Mean (SD) age at commencement of HPN was 52.8 (15.2) years, and 39% (n = 210) were men. Overall, 159 patients (30%) had ADs. Many mentioned specific life-prolonging treatments: cardiopulmonary resuscitation (44 [28%]), mechanical ventilation (43 [27%]), and hemodialysis (19 [12%]). Almost half mentioned pain control (78 [49%]), comfort measures (65 [41%]), and end-of-life management of HPN (76 [48%]). Many also contained general statements about end-of-life care (no "heroic measures"). The proportion specifically addressing end-of-life management of HPN (48%) was much higher than that previously reported in other populations with other life-supporting care such as cardiac devices. The primary diagnosis or the indication for HPN was not correlated with whether or not the patient had an AD (P =.07 and.46, respectively). Conclusion: Although almost one-third of the patients had an AD, less than half specifically mentioned HPN in it, which suggests that such patients should be encouraged to execute an AD that specifically addresses end-of-life management of HPN.

AB - Background: Ethical issues may arise with patients who receive home parenteral nutrition (HPN) and have a change in their overall health status. We sought to determine the extent of advance care planning and the use of advance directives (ADs) by patients receiving HPN. Materials and Methods: Retrospective review of the medical records of adult patients newly started on HPN at the Mayo Clinic, Rochester, Minnesota, between January 1, 2003, and December 31, 2012, to determine the prevalence and contents of their ADs. Results: A total of 537 patients met the inclusion criteria. Mean (SD) age at commencement of HPN was 52.8 (15.2) years, and 39% (n = 210) were men. Overall, 159 patients (30%) had ADs. Many mentioned specific life-prolonging treatments: cardiopulmonary resuscitation (44 [28%]), mechanical ventilation (43 [27%]), and hemodialysis (19 [12%]). Almost half mentioned pain control (78 [49%]), comfort measures (65 [41%]), and end-of-life management of HPN (76 [48%]). Many also contained general statements about end-of-life care (no "heroic measures"). The proportion specifically addressing end-of-life management of HPN (48%) was much higher than that previously reported in other populations with other life-supporting care such as cardiac devices. The primary diagnosis or the indication for HPN was not correlated with whether or not the patient had an AD (P =.07 and.46, respectively). Conclusion: Although almost one-third of the patients had an AD, less than half specifically mentioned HPN in it, which suggests that such patients should be encouraged to execute an AD that specifically addresses end-of-life management of HPN.

KW - advance directives

KW - end-of-life care

KW - ethics

KW - parenteral nutrition

UR - http://www.scopus.com/inward/record.url?scp=84959263116&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959263116&partnerID=8YFLogxK

U2 - 10.1177/0148607114544323

DO - 10.1177/0148607114544323

M3 - Article

C2 - 25096547

AN - SCOPUS:84959263116

VL - 40

SP - 399

EP - 404

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

SN - 0148-6071

IS - 3

ER -