Journal of the American Geriatrics Society
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Clinical Trial Controlled Clinical Trial
Description of the SUPPORT intervention. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.
The purpose of Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) was to improve outcomes for seriously ill hospitalized adults by improving information and decision-making. The SUPPORT intervention has been characterized only briefly in previous publications. ⋯ The SUPPORT intervention was implemented vigorously and completely.
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Despite concern about the high costs and the uncertain benefit of prolonged treatment in the intensive care unit (ICU), there has been little research examining decision-making and outcomes for patients with prolonged ICU stays. ⋯ Prolonged ICU stays were expensive and were often followed by death or disability. Patients reported low rates of discussions with their physicians about their prognoses and preferences for life-sustaining treatments. Many preferred that care focus on palliation and believed that care was inconsistent with their preferences. Patients were more likely to receive care consistent with their preferences if they had discussed their care preferences with their physicians.
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Comparative Study
Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT.
To review previously published findings about how patient age influenced patterns of care for seriously ill patients enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). ⋯ Even after adjustment for patients' prognoses and care preferences, seriously ill hospitalized older patients were treated less aggressively than younger patients. SUPPORT cannot fully identify whether the relationship between older age and less aggressive treatment is better explained by the withholding of potentially beneficial treatments from older patients, or by the excessive provision of ineffective treatment to younger patients. However, the latter explanation is favored by the SUPPORT finding that less aggressive treatment for older patients does not contribute to the modest survival disadvantage associated with older age.
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To examine the ability of activity of daily living (ADL)-impaired older adults to successfully rise, and, when successful, the time taken to rise, from a bed and chair under varying rise task demands. ⋯ Lowering HOB height and seat height increased bed and chair rise task difficulty, particularly when hand use was restricted. Restricting hand use in low HOB height or lowered seat height conditions may help to identify older adults with declining rise ability. Yet, many of those who could not rise under "without hands" conditions could rise under "with hands" conditions, suggesting that dependency on hand use may be a marker of progressive rise impairment but may not predict day-to-day natural milieu rise performance. Intertask differences in performance time may be statistically significant but are clinically small. Given the relationship between self-reported ADL disability and rise performance, impaired rise performance may be considered a marker for ADL disability. These bed and chair rise tasks can serve as outcomes for an intervention to improve bed and chair rise ability and might also be used in future studies to quantify improvements or declines in function over time, to refine physical therapy protocols, and to examine the effect of bed and chair design modifications on bed and chai
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To describe physician understanding of patient preferences concerning cardiopulmonary resuscitation (CPR) and to assess the relationship of physician understanding of patient preferences with do not resuscitate (DNR) orders and in-hospital CPR. ⋯ Physicians often misunderstand seriously ill, hospitalized patients' resuscitation preferences, especially preferences to forego CPR. Factors associated with misunderstanding suggest that physicians infer patients' preferences without asking the patient. Patients who prefer to forego CPR but whose wishes are not understood by their physician may receive unwanted treatment.