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Ethics palliative care

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https://www.readbyqxmd.com/read/28196784/addressing-palliative-care-clinician-burnout-in-organizations-a-workforce-necessity-an-ethical-imperative
#1
Krista L Harrison, Elizabeth Dzeng, Christine S Ritchie, Tait D Shanafelt, Arif H Kamal, Janet H Bull, Jon C Tilburt, Keith M Swetz
Clinician burnout reduces the capacity for providers and health systems to deliver timely, high quality, patient-centered care and increases the risk that clinicians will leave practice. This is especially problematic in hospice and palliative care: patients are often frail, elderly, vulnerable and complex; access to care is often outstripped by need; and demand for clinical experts will increase as palliative care further integrates into usual care. Efforts to mitigate and prevent burnout currently focus on individual clinicians...
February 11, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28169857/intersection-of-prognosis-and-palliation-in-neurocritical-care
#2
Michael Rubin, Jordan Bonomo, J Claude Hemphill
PURPOSE OF REVIEW: Difficult discussions regarding end-of-life care are common in neurocritical care. Because of a patient's neurological impairment, decisions regarding continuing or limiting aggressive care must often be made by patients' families in conjunction with medical providers. This review provides perspective on three major aspects of this circumstance: prognostication, family-physician discussions, and determination of death (specifically as it impacts on organ donation). RECENT FINDINGS: Numerous studies have now demonstrated that prediction models developed from populations of brain-injured patients may be misleading when applied to individual patients...
February 4, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28164359/off-label-drug-use-in-oncology-a-systematic-review-of-literature
#3
REVIEW
M M Saiyed, P S Ong, L Chew
WHAT IS KNOWN AND OBJECTIVE: The off-label use of medicines is widespread in several diseases. This type of prescribing practice is particularly more acute in oncology. However, the suitability of anticancer medications for off-label use remains an issue of controversy, due to uncertainty around the clinical benefits and potential toxicities, limited evidence to support clinical decision-making, increased out-of-pocket costs for patients and ethical concerns around the lack of informed consent...
February 5, 2017: Journal of Clinical Pharmacy and Therapeutics
https://www.readbyqxmd.com/read/28156654/recovery-of-cancer-patients-social-lives-upon-referral-to-palliative-care-units
#4
Yasuo Hirayama, Takayuki Machino, Toshiro Kusakabe, Kenji Nakamura, Hiroyoshi Mihara, Satoko Itoh, Kunihiko Ishitani
: 107 Background: Our hospital is a cancer-specific facility that treats patients from diagnosis to terminal care. We evaluate the possibility of effective cancer chemotherapies for patients referred to our palliative care unit from other hospitals through case conferences in our institution. Even the patients referred to the palliative care unit of our institution are sometimes assessed as "very likely to be improved by standard or semi-standard treatment" by the palliative care and oncologic teams in our institution...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156629/a-whole-greater-than-the-sum-of-the-parts-close-collaboration-between-palliative-care-and-clinical-ethics
#5
(no author information available yet)
: 53 Background: The disciplines of palliative care (PC) and clinical ethics (CE) share common content but also important distinctions in method, skill set, and clinical role in a given patient encounter. Particularly in cases of advance care planning, complex decision-making, and clarifying goals oncology teams may be challenged to know which consultation service to involve. METHODS: Case report and commentary. RESULTS: A 60 year-old man with a 3-year history of glioblastoma multiforme presented with sudden onset right-sided weakness and altered mental status...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156610/decision-of-palliative-chemotherapy-in-late-stage-cancer-the-doctor-patient-relationship-and-the-decision-making-process-as-seen-by-an-oncologist
#6
Marie Pechard, Ivan Krakowski, Christophe Tournigand, Marcel-Louis Viallard
: 48 Background: We conducted a literature review on the administration of palliative chemotherapy in cancer patients at advanced stage. We wondered about ethical tensions encountered by the oncologists during the decision process to meet or not the patients' demand to have access to a palliative chemotherapy at a late stage of the disease. METHODS: We conducted a multicenter, qualitative study of senior oncologists in university hospitals and cancer centers in France, by carrying out interviews with eleven oncologists...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28148444/-responsibility-compassion-and-ethics
#7
REVIEW
Cécile Furstenberg
The concepts of responsibility and compassion are fundamental in ethics. These notions help to safeguard humaneness, especially in the field of health care and notably in palliative care. These concepts can be put into practice by caregivers and applied to daily practice.
August 2016: Revue de L'infirmière
https://www.readbyqxmd.com/read/28146566/general-practitioners-attitudes-towards-essential-competencies-in-end-of-life-care-a-cross-sectional-survey
#8
Stéphanie Giezendanner, Corinna Jung, Hans-Ruedi Banderet, Ina Carola Otte, Heike Gudat, Dagmar M Haller, Bernice S Elger, Elisabeth Zemp, Klaus Bally
BACKGROUND: Identifying essential competencies in end-of-life care, as well as general practitioners' (GPs) confidence in these competencies, is essential to guide training and quality improvement efforts in this domain. AIM: To determine which competencies in end-of-life care are considered important by GPs, to assess GPs' confidence in these competencies in a European context and their reasons to refer terminally ill patients to a specialist. DESIGN AND SETTING: Cross-sectional postal survey involving a stratified random sample of 2000 GPs in Switzerland in 2014...
2017: PloS One
https://www.readbyqxmd.com/read/28129658/-dying-at-life-s-beginning
#9
Franziska Frank, Franziska Maurer, Jessica Pehlke-Milde, Valerie Fleming
Aim: When parents-to-be are faced with a terminal prenatal diagnosis, they are confronted with the decision either to continue the pregnancy or to terminate it at an advanced stage. This difficult decision is intimately affected by the experience of the inevitability of loss, and ethical dilemmas posed in this usually completely unexpected situation. Studies indicate that perinatal child loss due to lethal foetal anomalies is a major life event and a source of serious psychological issues, which can last for many years after the experience...
January 27, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28122553/undergraduate-curriculum-in-palliative-medicine-at-tampere-university-increases-students-knowledge
#10
Juho T Lehto, Kati Hakkarainen, Pirkko-Liisa Kellokumpu-Lehtinen, Tiina Saarto
BACKGROUND: Education in palliative medicine (PM) at medical schools reveals wide variation despite the increasing importance of palliative care. Many universities present poor description of the benefits and detailed content of the total curriculum in PM. Using the recommendations of European Association for Palliative Care (EAPC) as a reference, we evaluated the content and outcomes of the curriculum in PM at the University of Tampere, Finland. METHODS: We searched for a PM curriculum by examining the teaching offered by every specialty and compared it to EAPC recommendations...
January 25, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28095908/limiting-treatment-and-shortening-of-life-data-from-a-cross-sectional-survey-in-germany-on-frequencies-determinants-and-patients-involvement
#11
Birte Malena Dahmen, Jochen Vollmann, Stephan Nadolny, Jan Schildmann
BACKGROUND: Limiting treatment forms part of practice in many fields of medicine. There is a scarcity of robust data from Germany. Therefore, in this paper, we report results of a survey among German physicians with a focus on frequencies, aspects of decision making and determinants of limiting treatment with expected or intended shortening of life. METHODS: Postal survey among a random sample of physicians working in the area of five German state chambers of physicians using a modified version of the questionnaire of the EURELD Consortium...
January 17, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28079553/end-of-life-decisions-in-heart-failure-to-turn-off-the-intracardiac-device-or-not
#12
Bilal Ayach, Amrit Malik, Colette Seifer, Shelley Zieroth
PURPOSE OF REVIEW: Heart failure is a significant public health concern around the world. Implantable cardioverter defibrillators with or without cardiac resynchronization therapy (CRT-D) have proven survival benefit. As patients progress to end-stage disease, management shifts to palliative care, and cardiologists are often confronted with how to best manage these devices. RECENT FINDINGS: Studies suggest that up to one-third of patients with an implantable cardioverter defibrillator receive painful shocks in the last 24 h of life...
March 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/28062650/euthanasia-embedded-in-palliative-care-responses-to-essentialistic-criticisms-of-the-belgian-model-of-integral-end-of-life-care
#13
Jan L Bernheim, Kasper Raus
The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects...
January 6, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28050134/chemotherapy-in-recurrent-advanced-non-small-cell-lung-cancer-after-adjuvant-chemotherapy
#14
M Valdes, G Nicholas, G D Goss, P Wheatley-Price
INTRODUCTION: Despite adjuvant systemic therapy in patients with completely resected non-small-cell lung cancer (nsclc), many will subsequently relapse. We investigated treatment choices at relapse and assessed the effect of palliative platinum doublet systemic therapy in this population. METHODS: With research ethics board approval, we performed a retrospective chart review of all patients with resected nsclc who received adjuvant systemic therapy from January 2002 until December 2008 at our institution...
December 2016: Current Oncology
https://www.readbyqxmd.com/read/28042069/comprehensive-and-integrated-palliative-care-for-people-with-advanced-chronic-conditions-an-update-from-several-european-initiatives-and-recommendations-for-policy
#15
Xavier Gómez-Batiste, Scott A Murray, Keri Thomas, Carles Blay, Kirsty Boyd, Sebastien Moine, Maxime Gignon, Bart Van den Eynden, Bert Leysen, Johan Wens, Yvonne Engels, Marianne Dees, Massimo Costantini
The number of people in their last years of life with advanced chronic conditions, palliative care needs, and limited life prognosis due to different causes including multi-morbidity, organ failure, frailty, dementia, and cancer is rising. Such people represent more than 1% of the population. They are present in all care settings, cause around 75% of mortality, and may account for up to one-third of total national health system spend. The response to their needs is usually late and largely based around institutional palliative care focused on cancer...
December 30, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28041869/-palliative-care-after-neonatal-intensive-care-contributions-of-leonetti-law-and-remaining-challenges
#16
P Kuhn, L Dillenseger, N Cojean, B Escande, C Zores, D Astruc
The 2005 enactment of the "Patients' rights and end-of-life care" act, known as the Leonetti law, has been accompanied by practical changes in the processes of withdrawal and withholding of active life-sustaining treatments. This law has also promoted the implementation of palliative care in perinatal medicine to avoid unreasonable therapeutic interventions and to preserve the dying patient's quality of life and human dignity. Recently, a new law has been voted by the French National Assembly and new reflections on the ethical aspects of the end of life in neonatal medicine should resume again within the French Society of Neonatology in the working group on ethical issues in neonatology...
February 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28025426/life-and-medical-ethics-in-pediatric-neurosurgery
#17
Mami Yamasaki
Ethical issues in the field of pediatric neurosurgery, including prenatal diagnosis, palliative care for children with an intractable serious disease, and medical neglect, are discussed. An important role of medicine is to offer every possible treatment to a patient. However, it also is the responsibility of medicine to be conscious of its limitations, and to help parents love and respect a child who suffers from an incurable disease. When dealing with cases of medical neglect and palliative care for an incurable disease, it is critical to diagnose the child's condition accurately and evaluate the outcome...
December 26, 2016: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28009422/position-paper-of-the-italian-association-of-medical-oncology-on-early-palliative-care-in-oncology-practice-simultaneous-care
#18
REVIEW
Vittorina Zagonel, Vittorio Franciosi, Antonella Brunello, Guido Biasco, Chiara Broglia, Daniela Cattaneo, Luigi Cavanna, Domenico Corsi, Gabriella Farina, Luisa Fioretto, Teresa Gamucci, Gaetano Lanzetta, Roberto Magarotto, Marco Maltoni, Paolo Marchetti, Elena Massa, Cataldo Mastromauro, Barbara Melotti, Fausto Meriggi, Angelo Nacci, Ida Pavese, Erico Piva, Michela Quirino, Mario Roselli, Cosimo Sacco, Giuseppe Tonini, Leonardo Trentin, Giovanni Ucci, Roberto Labianca, Stefania Gori, Carmine Pinto, Stefano Cascinu
One of the priorities of personalized medicine regards the role of early integration of palliative care with cancer-directed treatments, called simultaneous care. This article, written by the Italian Association of Medical Oncology (AIOM) Simultaneous and Continuous Care Task Force, represents the position of Italian medical oncologists about simultaneous care, and is the result of a 2-step project: a Web-based survey among medical oncologists and a consensus conference. We present the opinion of more than 600 oncologists who helped formulate these recommendations...
January 21, 2017: Tumori
https://www.readbyqxmd.com/read/28007511/-neonatal-palliative-care-at-home-contribution-of-the-regional-pediatric-palliative-care-team
#19
N Cojean, C Strub, P Kuhn, L Calvel
The "patients' rights and end-of-life care" act, known as the Leonetti law, has allowed implementation of palliative care in neonatology as an alternative to unreasonable therapeutic interventions. A palliative care project can be offered to newborns suffering from intractable diseases. It must be focused on the newborn's quality of life and comfort and on family support. Palliative care for newborns can be provided in the delivery room, in the neonatal unit, and also at home. Going home is possible but requires medical support...
February 2017: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
https://www.readbyqxmd.com/read/28006887/palliative-sedation-the-position-statement-of-the-italian-national-committee-for-bioethics-incb
#20
Luciano Orsi, Giuseppe R Gristina
In January 2016 the Italian National Bioethics Committee (NBC) published a position statement entitled "Deep and continuous palliative sedation in the imminence of death", related to the use of sedation and analgesia for relief from pain and psychological distress in dying patients. The Committee, in this statement, points out the clinical and ethical appropriateness of palliative sedation as a therapeutic procedure. As a result, palliative sedation has to be considered today useful, scientifically safe and reliable, and acknowledged as an integral part of good clinical practice...
December 22, 2016: Minerva Anestesiologica
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