Levels of Intervention: How Are They Used in Quebec Hospitals?
In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called "Levels of Intervention" (LOI). No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of patients who had died in three Quebec hospitals with a LOI ordered. Results were analysed through a principlism ethical framework. High compliance with the level of intervention ordered at the time of death was recorded, as well as high involvement of patient and/or family, demonstrating the efficiency of LOI in promoting respect for autonomy. Other results show delays in end-of-life care discussions in the course of the hospitalization. Only a small proportion of patients who died had a palliative care consultation, which may reflect equity issues in access to care. This study highlights the importance of the LOI in Quebec and the role it is playing in respect for end-of-life preferences as well as in the involvement of patients and families in the decision-making process. Training specific to end-of-life decision-making conversations would help support the LOI form's use, as would developing provincial or national guidelines on the use of LOI to standardize organizational policies and practice around end-of-life care.
Public Health School (local 3035), University of Montreal, C. P. 6128, succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada. marjolaine.frenette@umontreal.ca.
Marjolaine
M
Frenette
Department of Social and Preventive Medicine, Public Health School, University of Montreal and Center for Research in Ethics (CRÉ), President Clinical Ethics Committee, Sacré-Coeur Hospital, Montreal, QC, Canada.
Jocelyne
J
Saint-Arnaud
Sacré-Coeur Hospital and University of Montreal, Montreal, QC, Canada.
Karim
K
Serri
D003142:Communication; D003657:Decision Making; D026689:Ethical Analysis; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D000069576:Health Equity; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008297:Male; D010166:Palliative Care; D010358:Patient Participation; D026684:Personal Autonomy; D028723:Personhood; D057766:Policy; D011792:Quebec; D012189:Retrospective Studies; D013727:Terminal Care
Canada; Clinical ethics; Decision-making; End of life; Levels of care; Levels of intervention