Table 3.
Association between treatment-limiting directive and surrogate decision-maker with treatments in the last month of life and site of death among patients with ESRD
| Treatment | Treatment-Limiting Directive | Adjusted Risk Difference, % (95% CI) | Surrogate Decision-Maker | Adjusted Risk Difference, % (95% CI) | ||
|---|---|---|---|---|---|---|
| Absent % (n=21,364) | Present % (n=9352) | Absent % (n=25,221) | Present % (n=5495) | |||
| Hospitalization | 71 | 62 | −7 (−8 to −6) | 70 | 62 | −4 (−6 to −3) |
| Intensive care unit admission | 47 | 32 | −12 (−13 to −10) | 44 | 34 | −5 (−6 to −3) |
| Mechanical ventilation | 19 | 6 | −10 (−11 to −9) | 16 | 10 | −2 (−3 to −1) |
| CPR | 6 | 2 | −3 (−3 to −2) | 5 | 3 | −1 (−2 to 0) |
| Gastrostomy tube | 2 | 1 | −1 (−1 to 0) | 2 | 2 | 0 (0, 1) |
| Inpatient death | 46 | 34 | −9 (−10 to −8) | 44 | 35 | −4 (−6 to −3) |
| Hospice admission | 23 | 33 | 5 (4 to 6) | 25 | 31 | 1 (−1 to 2) |
| Dialysis discontinuation | 27 | 41 | 6 (5 to 7) | 30 | 41 | 2 (1 to 3) |
Models adjusted for age, sex, race, duration of dialysis, length of nursing home stay, days in hospital in prior year, dialysis modality, functional status, diabetes, ischemic heart disease, heart failure, stroke, chronic liver disease, chronic lung disease, cancer, depression, dementia, impaired decision-making skills, hospital referral region spending quintile, treatment-limiting directive, and surrogate decision-maker, in addition to correlation of subjects within nursing home facilities. 95% CI, 95% confidence interval; CPR, cardiopulmonary resuscitation.