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"Advance Directive"

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https://www.readbyqxmd.com/read/29328354/end-of-life-conversations-as-a-legacy
#1
Jeanne M Sorrell
Advance directives such as living wills and health care powers of attorney are important documents that offer patients ways to avoid unwanted care when they are unable to express their wishes. Although health care professionals have increased focus on advance care planning in recent years, approximately two thirds of American adults do not have advance medical directives. In addition, 90% of individuals believe that talking to loved ones about end-of-life wishes is important, but only 27% have done so. It is important for nurses to understand the complex factors that influence how individuals make health care decisions and identify ways to encourage conversations with family, friends, and health care providers to help clarify patients' wishes for endof-life care...
January 1, 2018: Journal of Psychosocial Nursing and Mental Health Services
https://www.readbyqxmd.com/read/29320792/-advanced-care-planning-and-its-relevance-for-emergency-and-intensive-care-medicine
#2
Friedemann Nauck, Georg Marckmann, Jürgen In der Schmitten
Like in other countries, advance care planning (ACP) is currently being implemented in Germany as a new concept to realise valid and effective advance directives. This concept comprises processes to explore and document individual preferences for future treatment, and to honour them at a time when the person is incapacitated. ACP aims to ensure that patients will be treated according to their preferences when they are no longer capable due to acute health crises or chronic diseases. This paper gives an overview of the concept of ACP with a focus on relevant issues for emergency and intensive care medicine...
January 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29302602/what-are-the-ethical-questions-raised-by-the-integration-of-intensive-care-into-advance-care-planning
#3
REVIEW
Jean-Pierre Quenot, Fiona Ecarnot, Nicolas Meunier-Beillard, Auguste Dargent, Audrey Large, Pascal Andreu, Jean-Philippe Rigaud
A major goal of intensive care units (ICUs) is to offer optimal management, but for many patients admitted to the ICU, they are unlikely to yield any lasting benefit. In this context, the ICU physician remains a key intermediary, particularly when a decision regarding possible limitation or withdrawal of life-sustaining therapy becomes necessary. The possibility of admission to the ICU, and the type of care the patient would like to receive there, should be integrated into the healthcare project in agreement with the patient, regardless of the stage of disease that the patient suffers from...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29302599/what-are-the-ethical-aspects-surrounding-the-collegial-decisional-process-in-limiting-and-withdrawing-treatment-in-intensive-care
#4
REVIEW
Jean-Pierre Quenot, Fiona Ecarnot, Nicolas Meunier-Beillard, Auguste Dargent, Audrey Large, Pascal Andreu, Jean-Philippe Rigaud
The decision to limit or withdraw life-support treatment is an integral part of the job of a physician working in the intensive care unit, and of the approach to care. However, this decision is influenced by a number of factors. It is widely accepted that a medical decision that will ultimate lead to end-of-life in the intensive care unit (ICU) must be shared between all those involved in the care process, and should give precedence to the patient's wishes (either directly expressed by the patient or in written form, such as advance directives), and taking into account the opinion of the patient's family, including the surrogate if the patient is no longer capable of expressing themselves...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29290278/validation-of-the-decisional-conflict-scale-for-evaluating-advance-care-decision-conflict-in-community-dwelling-older-adults
#5
JinShil Kim, Shinmi Kim, Sun Woo Hong, Se-Won Kang, Minjeong An
PURPOSE: Decisional conflict is a significant and important barrier in end-of-life care planning, and it is often encountered in health professionals' discussions with patients and their families. Little is known about the measurement of decisional conflict, and existing measures are not suitable for all contexts. In this study, psychometric properties of the Decisional Conflict Scale, which was translated for the first time into Korean [Korean version of DCS (K-DCS)], were examined. METHODS: A sample of 273 community-dwelling elders was surveyed (mean age: 77...
December 2017: Asian Nursing Research
https://www.readbyqxmd.com/read/29284475/existential-decision-making-in-a-fatal-progressive-disease-how-much-do-legal-and-medical-frameworks-matter
#6
Christian Weber, Barbara Fijalkowska, Katarzyna Ciecwierska, Anna Lindblad, Gisela Badura-Lotter, Peter M Andersen, Magdalena Kuźma-Kozakiewicz, Albert C Ludolph, Dorothée Lulé, Tomasz Pasierski, Niels Lynöe
BACKGROUND: Healthcare legislation in European countries is similar in many respects. Most importantly, the framework of informed consent determines that physicians have the duty to provide detailed information about available therapeutic options and that patients have the right to refuse measures that contradict their personal values. However, when it comes to end-of-life decision-making a number of differences exist in the more specific regulations of individual countries. These differences and how they might nevertheless impact patient's choices will be addressed in the current debate...
December 28, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29276843/making-your-wishes-known-who-completes-an-advance-directive-and-shares-it-with-their-health-care-team-or-loved-ones
#7
Megumi Inoue, Emily Ihara, Albert Terrillion
Using Andersen's health behavioral model as a framework, this study examined factors associated with the completion of advance directives and the behavior of sharing them with one's family and health care providers. Data were from the 2014 United States of Aging Survey ( N = 1,153; aged 60 or older), and multinomial logistic regression was used for analysis. We found that 73% of respondents had advance directives. However, 28% have not shared their advance directives with anyone. The sense of having completed a great deal of preparation for the future and the number of illnesses were found to be relevant to the behavior of sharing advance directives...
December 1, 2017: Journal of Applied Gerontology: the Official Journal of the Southern Gerontological Society
https://www.readbyqxmd.com/read/29273648/determinants-of-completion-of-advance-directives-a-cross-sectional-comparison-of-649-outpatients-from-private-practices-versus-2158-outpatients-from-a-university-clinic
#8
Jochen Pfirstinger, Bernhard Bleyer, Christian Blum, Michael Rechenmacher, Christoph H Wiese, Hans Gruber
OBJECTIVES: To compare outpatients from private practices and outpatients from a university clinic regarding the determinants of completion of advance directives (AD) in order to generalise results of studies from one setting to the other. Five determinants of completion of AD were studied: familiarity with AD, source of information about AD, prior experiences with own life-threatening diseases or family members in need of care and motives in favour and against completion of AD. DESIGN: Observational cross-sectional study...
December 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/29261248/investigating-the-impact-of-intervention-refusal-on-hospital-readmission
#9
Alexis Coulourides Kogan, Eileen Koons, Susan Enguidanos
OBJECTIVES: To identify characteristics and readmission risks associated with opting out of a social work-driven transition intervention. STUDY DESIGN: Secondary data analysis of a randomized controlled pilot study at a large nonprofit urban community hospital. METHODS: Hospitalized English-speaking, cognitively intact adults 65 years or older with expected discharge back to the community were eligible for enrollment. Additionally, patients met at least 1 of the 3 criteria: 1) 75 years or older, 2) taking 5 or more medications, or 3) had 1 or more prior inpatient stays or emergency department visits in the previous 6 months...
December 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29234508/national-survey-of-training-of-psychiatrists-on-advance-directives-to-refuse-treatment-in-bipolar-disorder
#10
Richard Morriss, Mohan Mudigonda, Peter Bartlett, Arun Chopra, Steven Jones
Aims and method To determine features associated with better perceived quality of training for psychiatrists on advance decision-making in the Mental Capacity Act 2005 (MCA), and whether the quality or amount of training were associated with positive attitudes or use of advance decisions to refuse treatment (ADRTs) by psychiatrists in people with bipolar disorder. An anonymised national survey of 650 trainee and consultant psychiatrists in England and Wales was performed. Results Good or better quality of training was associated with use of case summaries, role-play, ADRTs, assessment of mental capacity and its fluctuation...
December 2017: BJPsych Bulletin
https://www.readbyqxmd.com/read/29223941/-medical-futility-and-family-obstinacy-in-intensive-therapy-when-to-stop-and-when-to-keep-going
#11
Alejandro R Grinberg, Vilma A Tripodoro
There have been several recent publications related to therapeutic obstinacy and futility in the Intensive Care Unit. However, little has been published about "the family obstinacy" in persisting with invasive measures in seriously ill patients, despite the appropriate information provided to them about the patient's poor short-term prognosis. On certain occasions, these critical patients are unable to make decisions on the proposed treatments and, unfortunately, many of them have not previously indicated their preferences in terms of limits to invasive measures (advanced directives)...
2017: Medicina
https://www.readbyqxmd.com/read/29222680/-life-and-death-decisions-the-german-federal-court-of-justice-states-new-requirements-for-advance-directives
#12
REVIEW
R Sailer, A Wienke
No abstract text is available yet for this article.
December 8, 2017: HNO
https://www.readbyqxmd.com/read/29221885/-design-of-a-questionnaire-on-the-knowledge-and-attitudes-of-the-population-of-madrid-spain-facing-the-end-of-life
#13
Belén Ortiz-Gonçalves, Andrés Santiago-Sáez, Elena Albarrán Juan, Elena Labajo González, Bernardo Perea-Pérez
OBJECTIVE: To create and validate a questionnaire about knowledge and attitudes of the general population in Madrid (Spain) about life's end stage. METHOD: A descriptive study designed as a structured self-administered questionnaire, validated by seven Madrid Health Service professional experts and assessed through a pilot study. RESULTS: The questionnaire consisted of 42 questions, divided into six modules: 1) decisions and psychological-physical care at life's end; 2) palliative care; 3) euthanasia and assisted suicide; 4) advance directives document; 5) spiritual factors; and 6) socio-demographic data...
December 5, 2017: Gaceta Sanitaria
https://www.readbyqxmd.com/read/29221846/prevailing-ethical-dilemmas-encountered-by-physicians-in-terminal-cancer-care-changed-after-the-enactment-of-the-natural-death-act-fifteen-years-follow-up-survey
#14
Hsien-Liang Huang, Chien-An Yao, Wen-Yu Hu, Shao-Yi Cheng, Shinn-Jang Huang, Chih-Dao Chen, Wen-Yuan Lin, Yen-Chun Lin, Tai-Yuan Chiu
CONTEXT: Advance directive laws have influences on ethical dilemmas encountered by physicians caring for terminal cancer patients. OBJECTIVES: To identify the prevailing ethical dilemmas among terminal care physicians fifteen years after the Natural Death Act was enacted in Taiwan. METHODS: This study is a cross-sectional survey from April 2014 to February 2015 using the clustering sampling method and a well-structured questionnaire. Targeted participants included physicians at oncology and related wards or palliative care units where terminal cancer care may be provided in Taiwan...
December 5, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29219936/end-of-life-care-discussion-for-residents-with-dementia-in-long-term-care-facilities
#15
Hsiu-Li Huang, Li-Chueh Weng, WeWen-Yu Hu, Yea-Ing Lotus Shyu, Wen-Pin Yu, Kang-Hua Chen
BACKGROUND: Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts. PURPOSE: The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families...
December 6, 2017: Journal of Nursing Research: JNR
https://www.readbyqxmd.com/read/29214649/climate-driven-build-up-of-temporal-isolation-within-a-recently-formed-avian-hybrid-zone
#16
Päivi M Sirkiä, S Eryn McFarlane, William Jones, David Wheatcroft, Murielle Ålund, Jakub Rybinski, Anna Qvarnström
Divergence in the onset of reproduction can act as an important source of reproductive isolation (i.e. allochronic isolation) between co-occurring young species, but evidence for the evolutionary processes leading to such divergence is often indirect. While advancing spring seasons strongly affect the onset of reproduction in many taxa, it remains largely unexplored whether contemporary spring advancement directly affects allochronic isolation between young species. We examined how increasing spring temperatures affected onset of reproduction and thereby hybridization between pied and collared flycatchers (Ficedula spp...
December 6, 2017: Evolution; International Journal of Organic Evolution
https://www.readbyqxmd.com/read/29211632/an-employer-health-incentive-plan-for-advance-care-planning-and-goal-aligned-care
#17
Matthew J Gonzales, Jeff Dobro, Katy Guilfoile, Keegan Fisher, Ira Byock
One strategy to promote workforce well-being has been health incentive plans, in which a company's insured employees are offered compensation for completing a particular health-related activity. In 2015, Providence Health & Services adopted an Advance Care Planning (ACP) activity as a 2015-2016 health incentive option. More than 51,000 employees and their insured relatives chose the ACP incentive option. More than 80% rated the experience as helpful or very helpful. A high proportion (95%) of employees responded that they had someone they trusted who could make medical care decisions for them, yet only 23% had completed an advance directive, and even fewer (11%) had shared the document with their health care provider...
December 6, 2017: Population Health Management
https://www.readbyqxmd.com/read/29206578/wellness-in-sickness-and-health-the-w-i-s-h-project-advance-care-planning-preferences-and-experiences-among-elderly-latino-patients
#18
Lauren Y Maldonado, Ruth B Goodson, Matthew C Mulroy, Emily M Johnson, Jo M Reilly, Diana C Homeier
OBJECTIVE: To assess advance care planning (ACP) preferences, experiences, and comfort in discussing end-of-life (EOL) care among elderly Latinos. METHODS: Patients aged 60 and older from the Los Angeles County and University of Southern California (LAC+USC) Medical Center Geriatrics Clinic (n = 41) participated in this intervention. Trained staff conducted ACP counseling with participants in their preferred language, which included: (a) pre-counseling survey about demographics and EOL care attitudes, (b) discussion of ACP and optional completion of an advance directive (AD), and (c) post-session survey...
October 25, 2017: Clinical Gerontologist
https://www.readbyqxmd.com/read/29206564/advance-care-planning-in-an-accountable-care-organization-is-associated-with-increased-advanced-directive-documentation-and-decreased-costs
#19
William F Bond, Minchul Kim, Chris M Franciskovich, Jason E Weinberg, Jessica D Svendsen, Linda S Fehr, Amy Funk, Robert Sawicki, Carl V Asche
BACKGROUND: Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. OBJECTIVE: To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. DESIGN: This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs...
December 5, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29194358/automated-ecological-assessment-of-physical-activity-advancing-direct-observation
#20
Jordan A Carlson, Bo Liu, James F Sallis, Jacqueline Kerr, J Aaron Hipp, Vincent S Staggs, Amy Papa, Kelsey Dean, Nuno M Vasconcelos
Technological advances provide opportunities for automating direct observations of physical activity, which allow for continuous monitoring and feedback. This pilot study evaluated the initial validity of computer vision algorithms for ecological assessment of physical activity. The sample comprised 6630 seconds per camera (three cameras in total) of video capturing up to nine participants engaged in sitting, standing, walking, and jogging in an open outdoor space while wearing accelerometers. Computer vision algorithms were developed to assess the number and proportion of people in sedentary, light, moderate, and vigorous activity, and group-based metabolic equivalents of tasks (MET)-minutes...
December 1, 2017: International Journal of Environmental Research and Public Health
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