End-of-life Decisions for People With Intellectual Disabilities: Prehospital Providers’ Perspective
Year: 2017
Type: conference-abstract
Abstract: Individuals with intellectual disabilities (ID) represent 1% of the population. Older adults are the fastest growing segment of this population with projections for a doubling by 2030 and a tripling within the foreseeable future The Institute of Medicine (2014) found that only 1% of this population engage in advance care planning (ACP). Prehospital providers (Paramedics and Emergency Medical Technicians) are often first responders when family or professional caregivers find a person with ID in medical crisis and their decisions about treatment or transport influence how and where the person will die. The purpose of this two-phase, mixed methods study was to explore how frequently medical orders (MOs) inform decision making during end-of-life calls and prehospital providers’ opinions about MOs in emergency care for people with ID. Phase one survey data (N=245) was collected to determine the frequency of different end-of-life calls; 62.7% of prehospital providers treated an individual with ID and a completed MO. Phase two in-depth interviews (N=50) explored how prehospital providers made end-of-life decisions. Utilizing a critical discourse analysis approach, three themes were identified as informing prehospital providers’ opinions about MOs for this population: provider familiarity; organizational processes; sociocultural context of ID. Ethical challenges raised by providers, including decision making capacity, are elucidated. Results suggest that end-of-life decision making among older adults with ID is multifaceted. Although MOs are being presented with increased frequency during emergency calls, multiple (individual, facility and systems) factors inform prehospital providers’ opinions of these documents and subsequently may impact decision making at end-of-life.
Source: Innovation in Aging
Authors: J. McGinley, D.P. Waldrop
Institution: University at Buffalo, State University of New York
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,977
OpenAlex ID: W2731091190