Levels of Medical Intervention and End-of-Life Practices in Long-Term Care Centres

Authors

  • Jérôme Leclerc-Loiselle Université de Montréal https://orcid.org/0000-0002-9258-5004
  • Sylvie Gendron Université de Montréal
  • Andréanne Côté Université de Montréal; Centre intégré universitaire de santé et de services sociaux du Nord-de-l’Île-de-Montréal
  • Serge Daneault Université de Montréal; Centre de recherche de l’Institut universitaire de gériatrie de Montréal; Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l’Île-de-Montréal

DOI:

https://doi.org/10.5770/cgj.25.531

Keywords:

long-term care, prescription of narcotics, administration of narcotics, pain management, levels of care, levels of medical intervention, patient preferences

Abstract

Background
Levels of medical intervention (LMI) are legal documents in which physicians record patient preferences, or those of their designated substitute decision-makers, concerning end-of-life care. Studies suggest that, although LMI are intended to orient clinical practice, their function tends to be limited to logistical aspects of care. How LMI shapes or guides patient-centred, end-of-life care remains unclear. The aim of this study was to examine possible associations between LMI and certain aspects of end-of-life care practices in LTCC, such as nurse-documented patient experiences of pain, and prescription and administration of medication.

Methods
A retrospective descriptive study of 100 files retrieved from a clinical database of deceased patients in LTCCs located in an urban integrated health and social service organization in Québec, Canada, was conducted.

Results
Significant associations between last documented LMI and frequency of narcotic prescription and administration, at either regular intervals or PRN, are highlighted. The time delay between last LMI assessment and patient death was one week or less for 39.4% of cases.

Conclusion
These results suggest that LMI assessment practices may not correspond to their intended use. A short time frame between last LMI (L-LMI) assessment and patient death may suggest less-than-optimal patient comfort in end-of-life care.

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Published

2022-06-01

How to Cite

1.
Leclerc-Loiselle J, Gendron S, Côté A, Daneault S. Levels of Medical Intervention and End-of-Life Practices in Long-Term Care Centres. Can Geriatr J [Internet]. 2022 Jun. 1 [cited 2022 Jul. 3];25(2):197-201. Available from: https://cgjonline.ca/index.php/cgj/article/view/531

Issue

Section

Original Research