Discussing treatment limitations in frail older COVID-19 patients: A
Framework Analysis.
Abstract
Aims and objectives: The COVID-19 pandemic caused an increase in
hospitalizations for frail older people and required healthcare
professional to make difficult ethical and medical decisions regarding
intensive care unit admission and treatment. This study investigates the
experiences of healthcare professionals with the use of a decision
support tool when discussing treatment limitations with older patients
with COVID-19. Methods: A qualitative approach was chosen to obtain
further in-depth information on the experiences of the healthcare
professionals with the conversations about treatment limitation and on
the contribution of a decision support tool for frail older adults with
COVID-19. The framework method was used for the data analysis. Results:
The following themes illustrate the analyzed concepts for the subject
conversations about treatment limitation: careful consideration, the
conversation is a part of the job, the burden of the conversation,
scheduling conversation and acquiring skills to perform the
conversation. The concepts of the theme AGE-ICU evaluation are included
in the following themes: considered and comprehensible overview,
confirmation of own assessment, every decision is context and person
dependent, contributes to considered decision and tool not needed
because of own expertise. Conclusion: A decision support tool for older
patients with COVID-19 may help the healthcare professional to objectify
the patients’ health status and functioning and discuss risk factors for
adverse outcomes. Besides this, the tool helps to initiate the difficult
conversation with the patient and their family. Finally, the AGE-ICU
contributes to shared-decision making because it helps patients to
understand the suggested decision and patients are more involved in the
decision-making process.