Evidence map›Paper›PMID 23888937›Full record

ArticleJournal of the American Geriatrics Society2013

Do-not-hospitalize orders for individuals with advanced dementia: healthcare proxies' perspectives.

Elizabeth Mann, Sarah L Goff, Wanda Colon-Cartagena, Sandra Bellantonio, Michael B Rothberg

Abstract readComparative Study
In one paragraph

Article in Journal of the American Geriatrics Society, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  8. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Elizabeth MannDepartment of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Sarah L Goff
Wanda Colon-Cartagena
Sandra Bellantonio
Michael B Rothberg

Funding

Tufts Clinical and Translational Science Institute (K12)KL2RR025751 · NCRR · TUFTS UNIVERSITY BOSTON · PI SELKER, HARRY P. · 2008 to 2011
$596k
Tufts Clinical and Translational Science Institute (K12)KL2TR000074 · NCATS · TUFTS UNIVERSITY BOSTON · PI SELKER, HARRY P. · 2012 to 2013
$149k
NCATS NIH HHS KL2 TR000074NCRR NIH HHS KL2 RR025751
6 · The paper itself

Abstract

objectivesTo determine how well healthcare proxies (HCPs) understand do-not-hospitalize (DNH) orders and why they may or may not initiate them.

designSemistructured qualitative interviews.

settingTwo nursing homes in western Massachusetts.

participantsHCPs of nursing home residents with advanced dementia. MEASUREMENT: In-depth interviews were audiotaped and transcribed verbatim. Data were qualitatively analyzed in an iterative process, and emergent concepts were conceptually ordered into explanatory categories. Pertinent demographic and clinical information was collected from the Minimum Data Set (MDS) and patient charts.

resultsSixteen of 31 eligible HCPs were interviewed. Major findings included barriers to and facilitators of initiating DNH orders. Barriers included a perceived lack of physician involvement in decision-making and limited understanding of DNH orders and the resident's prognosis. Facilitators included a HCPs' personal experience in health care, understanding the prognosis of advanced dementia, and a desire to limit resident distress.

conclusionThe potential barriers to and facilitators of HCPs initiating DNH orders identified in this study suggest that HCPs may benefit from more in-depth discussions with healthcare providers when making this decision. Interventions to address these barriers may improve the capacity of HCPs to make informed decisions about DNH orders that reflect individuals' values and wishes.

Indexed as

Advance DirectivesDecision MakingNursing HomesProxyAged, 80 and overDementiaFemaleHospitalizationHumansMaleMassachusettsadvanced dementiado-not-hospitalize ordersqualitative

Identifiers

PMID23888937
PMCPMC3773256

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.