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Withholding versus withdrawing life-sustaining treatment: patient factors and documentation associated with dialysis decisions.

Publication ,  Journal Article
Wenger, NS; Lynn, J; Oye, RK; Liu, H; Teno, JM; Phillips, RS; Desbiens, NA; Sehgal, A; Kussin, P; Taub, H; Harrell, F; Knaus, W
Published in: J Am Geriatr Soc
May 2000

OBJECTIVE: We evaluated prospectively the use of acute hemodialysis among hospitalized patients to identify demographic and clinical predictors of and chart documentation concerning dialysis withheld and withdrawn. DESIGN: Prospective cohort study. SETTING: Five teaching hospitals. PATIENTS: Five hundred sixty-five seriously ill hospitalized patients who had not previously undergone dialysis who developed renal failure. MAIN OUTCOME MEASURES: Patient demographics, clinical characteristics, preferences, and prognostic estimates associated with having dialysis withheld rather than initiated and withdrawn rather than continued. Differences in chart documentation concerning decision-making for dialysis withheld, withdrawn, and continued. RESULTS: Older patient age, cancer diagnosis, and male gender were associated with dialysis withheld rather than withdrawn. Age and gender differences persisted after adjustment for patients' aggressiveness of care preference. Worse 2-month prognosis was associated with both withholding and withdrawing dialysis. Chart documentation of decision-making was lacking more often for patients with dialysis withheld than for dialysis withdrawn. CONCLUSIONS: Measuring the equity of life-sustaining treatment use will require evaluation of care withheld, not just care withdrawn. Older patients and men, after accounting for prognosis and function, are more likely to have dialysis withheld than withdrawn after a trial. Further exploration is needed into this disparity and the inadequate chart documentation for patients with dialysis withheld.

Duke Scholars

Published In

J Am Geriatr Soc

DOI

ISSN

0002-8614

Publication Date

May 2000

Volume

48

Issue

S1

Start / End Page

S75 / S83

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Social Class
  • Renal Dialysis
  • Prospective Studies
  • Prognosis
  • Physician-Patient Relations
  • Patient Participation
  • Middle Aged
  • Medical Records
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wenger, N. S., Lynn, J., Oye, R. K., Liu, H., Teno, J. M., Phillips, R. S., … Knaus, W. (2000). Withholding versus withdrawing life-sustaining treatment: patient factors and documentation associated with dialysis decisions. J Am Geriatr Soc, 48(S1), S75–S83. https://doi.org/10.1111/j.1532-5415.2000.tb03145.x
Wenger, N. S., J. Lynn, R. K. Oye, H. Liu, J. M. Teno, R. S. Phillips, N. A. Desbiens, et al. “Withholding versus withdrawing life-sustaining treatment: patient factors and documentation associated with dialysis decisions.J Am Geriatr Soc 48, no. S1 (May 2000): S75–83. https://doi.org/10.1111/j.1532-5415.2000.tb03145.x.
Wenger NS, Lynn J, Oye RK, Liu H, Teno JM, Phillips RS, et al. Withholding versus withdrawing life-sustaining treatment: patient factors and documentation associated with dialysis decisions. J Am Geriatr Soc. 2000 May;48(S1):S75–83.
Wenger, N. S., et al. “Withholding versus withdrawing life-sustaining treatment: patient factors and documentation associated with dialysis decisions.J Am Geriatr Soc, vol. 48, no. S1, May 2000, pp. S75–83. Pubmed, doi:10.1111/j.1532-5415.2000.tb03145.x.
Wenger NS, Lynn J, Oye RK, Liu H, Teno JM, Phillips RS, Desbiens NA, Sehgal A, Kussin P, Taub H, Harrell F, Knaus W. Withholding versus withdrawing life-sustaining treatment: patient factors and documentation associated with dialysis decisions. J Am Geriatr Soc. 2000 May;48(S1):S75–S83.
Journal cover image

Published In

J Am Geriatr Soc

DOI

ISSN

0002-8614

Publication Date

May 2000

Volume

48

Issue

S1

Start / End Page

S75 / S83

Location

United States

Related Subject Headings

  • Withholding Treatment
  • Social Class
  • Renal Dialysis
  • Prospective Studies
  • Prognosis
  • Physician-Patient Relations
  • Patient Participation
  • Middle Aged
  • Medical Records
  • Male