Shared decision-making in advance care planning among hospitalized older COVID-19 patients: a multicenter, retrospective cohort study
Open accessAbstract
Background In the Netherlands, it is customary to discuss directives regarding resuscitation, intubation, and ICU-admission with patients and/or their relatives upon hospital-admission. The outcome of this discussion is documented in a code status. Ideally, these advance care planning (ACP)-related decisions are made by a patient (and/or their relatives) and a professional together in a shared decision-making (SDM) process, to improve patient satisfaction and prevent undesired care. Given the bad outcomes in older COVID-19 patients, it is particularly important to discuss the code status upon admission. This study aims to describe the practice of SDM regarding code status during the COVID-pandemic. Specific aims were to find out to what extend patients took part in this decision-making process and whether all key elements of SDM for a shared decision were documented in medical reports.Methods In this retrospective cohort study, we included COVID-19 patients aged 70 years and older, admitted to two large teaching hospitals in the Netherlands, during the first months of the COVID-19 pandemic in 2020. Data about code status and the decision-making process were extracted from electronic healthcare records.Results Code status was documented for 274 of 275 included patients. Patient participation in the decision-making process was described in 48%. In 19% all key elements of shared decision-making have been described. Key elements of SDM were defined as the presence of a completed code status form, the presence of clinical notes showing that both patient's wishes and values and the opinion of the healthcare professional about the predicted outcome was taken into consideration and clinical notes of a patient-healthcare professional interaction during the admission.Conclusion Our results show that a proper SDM process regarding code status is possible, even in hectic times like the COVID-19-pandemic. However, shared decision-making was not common practice in older patients with COVID-19 regarding code status (an ACP-related decision) in the early phase of the COVID-19 pandemic. Only in 19% of the patients, all key elements of SDM regarding code status were described.
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Patient involvement in the DNACPR decision-making process was reported between 33% and 55% of the time.
“Patient involvement in the decision-making process was reported between 33% and 55% of the time; 33%,28 48%,22 52.8%44 and 55.8%.45”
From Do not attempt cardiopulmonary resuscitation decision-making process: scoping review (2025) · cites this paper as [22]
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Do not attempt cardiopulmonary resuscitation decision-making process: scoping review
Doody, O., Davidson, H., & Lombard, J. (2025) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2023-004573 · Cited by 10 · see citing works
- Authors
- Hendriks, V. J. J., Faes, M. C., van der Meer, J. B. L., Janse, E. S., van der Meer, N. J. M., & van der Linden, C. M. J.
- Affiliations
- Catharina Ziekenhuis (NL)
- Amphia Ziekenhuis (NL)
- Corresponding author
- Hendriks, Victoria Johanna Jacoba
- Venue
- Aging Clinical and Experimental Research
- Published
- 2022-11-05
- Volume
- 34
- Issue
- 12
- Pages
- 3165-3169
- ISSN
- 1594-0667 (ISSN-L)
- 1720-8319
- PMC
- PMC9638468
- OpenAlex
- W4308221237
- Cited by
- 5
- References
- 17
- Citations by year
- 2025: 1 · 2024: 4
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Aging Clinical and Experimental Research (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Funders
- Amphion Foundation (2021-1-010)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- shared decision-making, advance care planning, code status, COVID-19 pandemic, older adults, hospitalized patients, end-of-life care, patient participation, clinical documentation, ICU admission decisions
- MeSH terms
- COVID-19, Aged, Aged, 80 and over, Decision Making, Humans, Patient Participation, Retrospective Studies, Advance Care Planning, Pandemics
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