Advanced Care Planning During the COVID-19 Pandemic: Ceiling of Care Decisions and Their Implications for Observational Data
Background
Observational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and their association with demographic and clinical characteristics as well as outcomes during the COVID-19 pandemic.
Methods
Retrospective, observational study conducted between 5th March and 7th May 2020 of all hospitalised patients with COVID-19. Ceiling of care and CPR decisions were documented using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. Unadjusted and multivariate regression analyses were used to determine factors associated with ceiling of care decisions and death during hospitalisation.
Results
A total of 485 patients were included, of whom 409 (84·3%) had a documented ceiling of care which was level one for 208 (50·9%), level two for 75 (18·3%) and level three for 126 (30·8%). CPR decisions were documented for 451 (93·0%) and 336 (74·5%) were not for resuscitation. Advanced age, frailty, White-European ethnicity, a diagnosis of any co-morbidity and receipt of cardiovascular medications were associated with ceiling of care decisions. In a multivariate model only advanced age (odds 0·89, 0·86-0·93 p<0·001), frailty (odds 0·48, 0·38-0·60, p<0·001) and the cumulative number of co-morbidities (odds 0·72, 0·52-1·0, p=0·048) were independently associated. Death during hospitalisation was independently associated with age, frailty and requirement for level two or three care.
Conclusion
Ceiling of care decisions were made for the majority of patients during the COVID-19 pandemic, broadly in line with known predictors of poor outcomes in COVID-19, but with a focus on co-morbidities suggesting ICU admission might not be a reliable end-point for observational studies where advanced care planning is routine.
Publisher URL: https://www.researchsquare.com/article/rs-62241/latest
DOI: 10.21203/rs.3.rs-62241/v1
Keeping up-to-date with research can feel impossible, with papers being published faster than you'll ever be able to read them. That's where Researcher comes in: we're simplifying discovery and making important discussions happen. With over 19,000 sources, including peer-reviewed journals, preprints, blogs, universities, podcasts and Live events across 10 research areas, you'll never miss what's important to you. It's like social media, but better. Oh, and we should mention - it's free.
Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.