The Specification of Levels of Active Intervention in a Chronic Care Hospital

Abstract

Although decisions regarding the level of active intervention specified for a chronic care patient would ideally be made by autonomous individuals, these decisions may be influenced by a number of physical, psychological, and social factors. Some aspects of one's life experience would usually be considered reasonable criteria to form the basis for these decisions (e.g., severity of physical impairment), but the influence of other factors (e.g., social isolation) may be less appropriate. This study examines the characteristics associated with the specification of comfort measures only on the charts of patients in a Canadian chronic care hospital. Based on the results of multiple logistic regression models, patients with comfort measures only specified were significantly more likely to be older, recently admitted, incontinent, requiring special nutritional regimens, and were less likely to have been visited recently by key contact persons. The results raise the ethical question of what dimensions of quality of life should be considered as relevant determinants of advance treatment plans for the elderly.