Dissertation
The effect of palliative care team-led family meetings on end-of-life decision-making among medical surrogates of hospitalized, incapacitated, senior, African Americans with life limiting illnesses
Doctor of Nursing Practice (D.N.P.), Drexel University
May 2015
DOI:
https://doi.org/10.17918/etd-6312
Abstract
Culture and ethnicity are known to influence end-of-life decision-making. The purpose of this study was to conduct a retrospective chart review to explore whether Palliative Care Team (PCT)-led family meetings influence end-of-life decisions made by medical surrogates of hospitalized, incapacitated, senior, African Americans suffering with life limiting illnesses. Using Imogene King's nursing theory of Goal Attainment as the overarching framework in achieving effective caring, the electronic medical records (EMRs) of 96 African Americans, whose medical surrogates participated in a PCT-led family meeting on their behalf to discuss end-of-life care options from April 1, 2013 to March 31, 2014 were reviewed. Data extracted from EMRs identified end-of-life decisions made by the surrogates. The data were also examined to compare decisions made by surrogates with what the patients documented in their Living Wills (LW). Finally, the data were used to examine relationships between age, gender, and kinship, and end-of-life decisions made by surrogates on the patient's behalf. Demographics and variables were examined using descriptive statistics. ANOVA and Pearson Chi-Square were utilized to evaluate relational significance. A significant relationship was noted between decreased length of hospital stay and those transitioned to comfort care. Additionally, a representative number (40%) of these patients were transitioned from restorative to comfort care following their surrogate's participation in a PCT-led meeting. While few (13.5%) had a LW, of those LWs available, the medical surrogates generally upheld the patients' wishes documented within their LW. Age, gender, and kinship played an insignificant role in the surrogate's care pathway decision. Meetings were conducted by PCT physicians or nurse practitioners. Both obtained similar meeting outcomes, thus implying that family meeting facilitation skills are similar between these disciplines. This work suggests that the PCT-led family meeting can influence medical surrogate decision-making. Future efforts must focus on fostering the right of autonomy among African Americans, and providing education concerning the importance of the LW. Making PCTs available to those involved in end-of-life decision-making can further efforts to eliminate health care disparities which African Americans continue to face.
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Details
- Title
- The effect of palliative care team-led family meetings on end-of-life decision-making among medical surrogates of hospitalized, incapacitated, senior, African Americans with life limiting illnesses
- Creators
- Maria Doll Shaw - DU
- Contributors
- Linda Wilson (Advisor) - DU
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Nursing Practice (D.N.P.)
- Publisher
- Drexel University; Philadelphia, Pennsylvania
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Doctoral Nursing; Nursing (Graduate); College of Nursing and Health Professions; Drexel University
- Other Identifier
- 6312; 991014632396704721