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"Advance Directive"

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https://www.readbyqxmd.com/read/28210847/ethical-considerations-in-the-long-term-ventricular-assist-device-patient
#1
REVIEW
Amanda Cai, Howard J Eisen
PURPOSE OF REVIEW: As the heart failure population continues to age, the need for definitive therapies such as ventricular assist devices (VADs) to extend life and alleviate suffering from end-stage disease directly increases. The goal of this article is to examine the ethical principles of autonomy, beneficence, non-maleficence, and justice within the context of long-term VAD patients. RECENT FINDINGS: Survival rates in VAD-implanted patients have improved in parallel with modernization of device design and surgical technique, reaching that of cardiac transplantation at 1 year post-procedure...
February 16, 2017: Current Heart Failure Reports
https://www.readbyqxmd.com/read/28209392/transfer-of-do-not-resuscitate-orders-to-the-emergency-department-from-extended-care-facilities
#2
Colleen M McQuown, Jennifer A Frey, Ahmad Amireh, Ali Chaudhary
PURPOSE/OBJECTIVE: With an elderly and chronically ill patient population visiting the emergency department, it is important to know patients' wishes regarding care preferences and advanced directives. Ohio law states DNR orders must be transported with the patient when they leave an extended care facility (ECF). We reviewed the charts of ECF patients to evaluate which patients presenting to the ED had their DNR status recognized by the physician and DNR orders that were made during their hospital stay...
February 4, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28206733/end-of-life-decisions-in-34-slovene-intensive-care-units-a-nationwide-prospective-clinical-study
#3
Miha Orazem, Urh Groselj, Manca Stojan, Neza Majdic, Gaj Vidmar, Stefan Grosek
BACKGROUND: To determine how end-of-life decisions (EOLD) on limitations of life- sustaining treatment (LST) are made in three different types of intensive care units (ICUs) in Slovenia. METHODS: A national multicenter prospective study among 31 adult and three pediatric/neonatal ICUs (PICUs). The questionnaire form on EOLD was designed to assess the clinical practice. Data were collected between January 1, 2013, and March 31, 2013. For statistical analysis we used IBM® SPSS® Statistics 20 software package...
February 15, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28182261/improving-the-electronic-capture-of-advance-care-directives-in-a-healthcare-delivery-system
#4
Norifumi Kamo, Barbara L Williams, Donna L Smith, C Craig Blackmore
OBJECTIVES: To determine the effectiveness of a multifaceted quality improvement intervention in outpatient clinics at an integrated healthcare delivery system on capture rate of advance directives (ADs) in the electronic medical record (EMR). DESIGN: Interrupted time series analysis with control groups between January 2010 and June 2015. SETTING: Oncology, nephrology, and primary care outpatient clinics in an integrated healthcare delivery system...
February 9, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28156662/the-inclusion-of-palliative-care-in-initial-treatment-planning-for-women-with-gynecologic-cancer-and-the-use-of-advanced-directives
#5
William Robinson, William R Robinson
: 23 Background: To determine differences in Advanced Directive (AD) utilization among women with gynecologic cancer at a facility with a functioning Palliative Care (PC) program, vs those in a facility without access to a PC program. Also, to identify possible ethnic differences or relationships to other PC needs to AD utilization. METHODS: 95 subjects with gynecologic cancer were prospectively identified, 30 from an inner-city academic facility (Site A), and 65 from a suburban community facility in the same metropolitan area...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156656/systematic-review-of-interventions-to-facilitate-advance-care-planning-acp-in-cancer-patients
#6
Hao-Wen Sim, Camilla Zimmermann, Monika K Krzyzanowska
: 21 Background: ACP refers to the process of consideration, documentation and communication of preferences for future care. ACP is crucial for patients (pts) with advanced cancer as it can guide substitute decision makers (SDM) and health care providers (HCP) to align care with preferences, thus improving quality of end-of-life care. METHODS: We performed a systematic review of MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane (Systematic Review and Clinical Trial) databases (1995 to 2015) to identify interventions that facilitate ACP for cancer pts (documentation or discussion of advance directives, SDM or code status)...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156632/end-of-life-care-for-glioblastoma-multiforme-gbm-patients-at-a-large-academic-center
#7
Xiao Wang, Jiangxia Wang, Anne Evans, W Anthony Riley, Thomas J Smith
: 56 Background: GBM is a uniformly fatal disease with average survival of < 3 years and universal cognitive problems, making advance care planning paramount. End of life (EOL) patterns of GBM care in the US have not been studied. We examined care in a cohort of GBM and brain tumor (BT) patients as part of a program to provide individual provider feedback about EOL care. METHODS: We reviewed the care of all GBM patients over 3 years with a random sample of 100, and a 5-yr subset of 45 who received their care at Gilchrist Hospice (GH), our largest provider...
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
#8
(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/28156602/integration-of-palliative-care-for-patients-with-solid-tumors-on-phase-i-clinical-trials
#9
Vincent M Chung, Marianna Koczywas, Anna Cathy Williams, Arti Hurria, Tami R Borneman, Rhonda Cooper, Louise Knight, Patricia Fischer, Denise Gallagher, Thomas J Smith
: 138 Background: Cancer patients receiving Phase I clinical trials are a population with advanced disease, high symptom burden, and with multiple QOL concerns including use of advance directives. METHODS: An NCI funded R01 is currently in progress (2014-2019) as a randomized clinical trial to test a palliative care intervention (PCI) in this population. The PCI includes comprehensive patient assessment, goals of care communication, interdisciplinary care planning and patient teaching...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156575/using-a-values-assessment-as-a-bridge-to-advance-care-planning-results-of-1286-patient-reports
#10
Cynthia Taniguchi, Kathryn J Eagye, Susan Ash-Lee, Angela Kalisiak, Sabrina Q Mikan, Nicole Hartung
: 12 Background: Recent studies have shown that formal Palliative Care (PC) improves care at the end of life for cancer patients. The role of communication in PC is not defined. Other studies have shown that communication alone can be associated with better end of life outcomes. The US Oncology Network developed and tested a Values Assessment (VA) instrument for routinely broaching difficult topics to facilitate more formal advance care planning (ACP). The results of the first 28 months of the program on over 1200 patients are reported here...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156572/end-of-life-care-decisions-using-korean-advance-directives-among-cancer-patient-caregiver-dyads
#11
Shinmi Kim, JinShil Kim
: 11 Background: The Korean advance directives (K-ADs) consist of a value statement, treatment directives (cardiopulmonary resuscitation [CPR], preferences for artificial ventilation, tube feeding, and hospice care). K-ADs can facilitate a patient's decision-making for end-of-life (EOL) care. This study aims to examine the extent to which patient-caregiver dyads agreed on decisions for EOL care using the K-ADs. METHODS: Using a descriptive study design, 81 cancer patients were invited to participate...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156567/are-hospital-clinicians-aware-of-legislation-surrounding-provision-of-palliative-care
#12
(no author information available yet)
: 118 Background: Many deaths require medical treatment to be withheld or withdrawn. Patients or their substitute decision makers may disagree with these decisions, and sometimes refuse the right to appropriate palliative care. An awareness of legal frameworks surrounding end of life decisions is vital to navigate through these conflicts. Without this, patients suffer unnecessarily. METHODS: 542 hospital doctors and nurses were recruited from a large metropolitan public tertiary teaching hospital network involving 5 campuses and 2 medical schools...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156559/palliative-care-consultation-and-advance-care-planning-for-adults-with-poor-risk-leukemia-admitted-to-an-academic-medical-center
#13
William A Wood, Alexandra Fox, Laura C Hanson
: 13 Background: Despite high mortality for certain patients with hematologic malignancies, integration of palliative care (PC) and documentation of advance care planning (ACP) is lacking. Our primary objective was to determine the frequency of PC consultation and ACP for inpatients with poor-risk leukemia at our institution. Our secondary objectives were to describe the content of goals of care (GOC) discussions and to characterize PC and end-of-life quality measures. METHODS: Chart reviews were conducted for patients with poor risk leukemia (acute leukemia ≥ 65 years or relapsed leukemia > 18 years) admitted to the University of North Carolina from October 1, 2015 to March 31, 2016...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156434/earlier-access-to-palliative-medicine-an-experience-of-integration-into-a-community-oncology-practice
#14
Jacqueline Matthews
: 92 Background: A growing body of evidence supports the integration of palliative care as a standard for comprehensive cancer care. Through our experience as an inpatient palliative care provider, with 50% of our population having advanced cancer, we recognized the value proposition to provide continuity in the outpatient setting. Innovative Care Solutions developed a partnership with a large, community oncology program late 2015 for a palliative care multidisciplinary team to be embedded into one location of their practice...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152998/critical-appraisal-of-advance-directives-given-by-patients-with-fatal-acute-stroke-an-observational-cohort-study
#15
A Alonso, D Dörr, K Szabo
BACKGROUND: Advance directives (AD) imply the promise of determining future medical treatment in case of decisional incapacity. However, clinical practice increasingly indicates that standardized ADs often fail to support patients' autonomy. To date, little data are available about the quality and impact of ADs on end-of-life decisions for incapacitated acute stroke patients. METHODS: We analyzed the ADs of patients with fatal stroke, focusing on: (a) their availability and type, (b) stated circumstances to which the AD should apply, and (c) stated wishes regarding specific treatment options...
February 2, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28152940/code-status-documentation-in-the-electronic-medical-record-for-patients-with-stage-iv-pancreatic-cancer
#16
Janet M Armstrong, Joseph D Ma, Carolyn Revta, Eric Roeland
: 125 Background: Improving incidence of code status documentation in the electronic medical record (EMR) has been suggested a better guidance for clinical care compared with a traditional advance directive. We have previously reported that in the absence of a template in the EMR, code status documentation was 36% and inconsistent in patients with advanced cancer. Utilizing a different cohort of patients with metastatic pancreatic cancer, we examined the prevalence of EMR code status documentation...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152900/hardwiring-advance-directives-into-an-electronic-medical-record
#17
Tyler Buckley, Andrew Badke, Amy Horyna, Julie Howell, Lisa Gren, Anna Catherine Beck
: 146 Background: Patient preference at the end of life has been extensively researched and documented. Advance Directives (AD) have been shown to make a difference for patients in the areas of quality, cost, and patient satisfaction. Organizations struggle with meeting federal laws and accreditation expectations due to our complex systems. Literature supports "hardwiring" AD documentation into the EMR and providing "one click" accessibility to AD's. Changing EMR vendors provides a unique opportunity to optimize access to AD's, both through patient education /endorsement, review of providers' role, and engagement of IT...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152813/early-discussion-of-advance-directives-for-patients-with-newly-diagnosed-cancer
#18
Suvarna Sundaram, Andrea Finlay, Natalia Romanova, Laura Knopp, Chiara Pierattini, Jenny Fuentes, Emily Hidalgo, Marian Daye, Megan Kokon, Christina Gustavson, Pamela Radomsky, Josefina Buras, Jennifer DeSimone, Suraj S Venna, John F Deeken, Donald L Trump
: 91 Background: Although advance care planning and the completion of advance directives (ADs) are important methods to prevent unwanted aggressive care once patients have lost their decision-making capacity, only a minority of patients have ADs at the time of cancer diagnosis. METHODS: We established a new multidisciplinary outpatient clinic to provide comprehensive care to patients with newly diagnosed cancer at the Inova Dwight and Martha Schar Cancer Institute in Northern Virginia...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152749/end-of-life-care-for-glioblastoma-multiforme-patients-at-an-academic-institution
#19
Roy E Strowd, Anne Evans, Louise Knight, W Anthony Riley, Thomas J Smith
: 202 Background: End of life care for glioblastoma patients has not been studied in the United States. We studied 100 patients with GBM to examine use of advance directives (AD), symptom assessments, hospitalizations, chemotherapy use, and hospice use. METHODS: A single center retrospective cohort study of adult patients actively treated for GBM at Johns Hopkins Hospital from 2009-2014. 100 patients were randomly chosen from the group of 317 GBM patients. Information included documentation of AD, code status, hospitalizations, chemotherapy use, code status and symptom assessments...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28151787/critical-care-nurses-perceptions-of-end-of-life-care-obstacles-comparative-17-year-data
#20
Renea L Beckstrand, Nicole Lamoreaux, Karlen E Luthy, Janelle L B Macintosh
BACKGROUND: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end of life (EOL). Providing high-quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made for the last 17 years. OBJECTIVE: The aims of this study were to determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether meaningful changes have occurred since data were first gathered in 1998...
March 2017: Dimensions of Critical Care Nursing: DCCN
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