Advance Directives in the Emergency Department – a Systematic Review of the Status Quo
Bibliographic record
Abstract
Abstract Background Providing individualised healthcare in line with patient wishes is a particular challenge for emergency healthcare professionals. Documentation of patient wishes (DPW), e.g., in the form of advance directives, can guide clinicians in making end-of-life decisions that respect the patient’s wishes and autonomy. However, these are hindered by limited availability in emergency settings.Objective This systematic review aims to congregate existing data on DPW possesion and availability in the emergency department (ED) as well as contributing factors.Methods We searched the MEDLINE database (PubMed) in October 2021. All publications that provided primary quantitative data on DPW in the ED were assessed, culminating in a total of 16 studies included in the analysis. Most (n = 9) were from the US, followed by Australia (4), Germany (1), Canada (1) and Switzerland (1). Publication dates ranged from 1996 to 2020.Results In the general adult population presenting to the ED, 19.9–27.0% of patients possessed some variation of DPW, fewer than 3.2% had it available on presentation. In older people, possession rates (7.9–51.9%) as well as availability (1.7–48.8%) varied widely. The following variables were identified as positive predictors for DPW possession: older age, poorer overall health and presence of comorbidities, as well as several sociodemographic factors, such as female gender, having children, being in a relationship and higher level of education.Conclusion Possession and availability of DPW among ED patients was low in general and even in the older population mostly below 50%. While we were able to gather data on prevalence and predictors, we believe that further research is needed to explore the quality of DPW and possible public health measures to encourage patients to document their healthcare wishes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.065 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.005 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".