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Open Access 01-12-2021 | Care | Research article

Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data

Published in: BMC Palliative Care | Issue 1/2021

Abstract

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 multivariable 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; 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%) of whom 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 multivariable 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.

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Title: Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data
Publication date: 01-12-2021
Keywords: Care
COVID-19
Cardiopulmonary Resuscitation
Published in: BMC Palliative Care / Issue 1/2021
Electronic ISSN: 1472-684X
DOI: https://doi.org/10.1186/s12904-021-00711-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Advanced care planning during the COVID-19 pandemic: ceiling of care decisions and their implications for observational data

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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