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"Advance directives"

Priscilla K Gazarian, Julie Cronin, Jodi L Dalto, Kayla M Baker, Barbara J Friel, Winona Bruce-Baiden, Lesley Y Rodriguez
BACKGROUND: Advance care planning (ACP) conversations help individuals exercise autonomy and make informed decisions about their care. There are many ACP resources available to support the process of advance care planning, yet available resources not universally accepted and under-utilized in clinical practice. OBJECTIVE: This study aims to systematically evaluate commonly available general ACP patient educational resources using a comprehensive approach to assess elements ranging from resource inclusion to health literacy...
October 11, 2018: Geriatric Nursing
David Wang, Caleb Ing, Craig Blinderman, May Hua
CONTEXT: In the intensive care unit (ICU), 14% of patients meet criteria for specialized palliative care, but whether subgroups of patients differ in their palliative care needs is unknown. OBJECTIVES: To use latent class analysis (LCA) to separate ICU patients into different classes of palliative care needs, and determine if such classes differ in their palliative care resource requirements. METHODS: Retrospective cohort study of ICU patients who received specialized palliative care, August 2013 - August 2015...
October 10, 2018: Journal of Pain and Symptom Management
Bonnie Steinbock, Paul T Menzel
Aid-in-dying laws in the United States have two important restrictions. First, only patients who are terminally ill, defined as having a prognosis of six months or less to live, qualify. Second, at the time the patients take the lethal medication, they must be competent to make medical decisions. This means that an advance directive requesting aid in dying for a later time when the patient lacks decision-making capacity would be invalid. However, many people are more concerned about avoiding living into severe dementia for years-a time when they will lack decision-making capacity-than they are about preventing suffering or the loss of dignity or autonomy for a few months at the end of life...
September 2018: Hastings Center Report
Nicola Grignoli, Valentina Di Bernardo, Roberto Malacrida
In critical care when unconscious patients are assisted by machines, humanity is mainly ensured by respect for autonomy, realised through advance directives or, mostly, reconstructed by cooperation with relatives. Whereas patient-centred approaches are widely discussed and fostered, managing communication in complex, especially end-of-life, situations in open intensive care units is still a point of debate and a possible source of conflict and moral distress. In particular, healthcare teams are often sceptical about the growing role of families in shared decision-making and their ability to represent patients' preferences...
October 11, 2018: Critical Care: the Official Journal of the Critical Care Forum
Melissa J Armstrong, Slande Alliance, Pamela Corsentino, Steven T DeKosky, Angela Taylor
OBJECTIVES: To investigate the natural history, cause of death, and end-of-life experiences of individuals diagnosed with dementia with Lewy bodies (DLB). DESIGN: Twenty-question online survey administered through the Lewy Body Dementia Association. SETTING: United States. PARTICIPANTS: Caregivers, family, and friends of individuals who died in the past 5 years with a diagnosis of DLB (survey respondents: n = 658, 89% female, median age 50-69)...
October 6, 2018: Journal of the American Geriatrics Society
Fiona Ecarnot, Nicolas Meunier-Beillard, Marie-France Seronde, Romain Chopard, François Schiele, Jean-Pierre Quenot, Nicolas Meneveau
BACKGROUND: Professional societies call for integration of end-of-life discussions early in the trajectory of heart failure, yet it remains unclear where current practices stand in relation to these recommendations. We sought to describe the perceptions and attitudes of caregivers in cardiology regarding end-of-life situations. METHODS: We performed a qualitative study using semi-directive interviews in the cardiology department of a university teaching hospital in France...
October 5, 2018: BMC Palliative Care
Anna Kata, Rebecca Sudore, Emily Finlayson, Jeanette M Broering, Sarah Ngo, Victoria L Tang
OBJECTIVES: To describe an innovative model of care, the Surgery Wellness Program (SWP), that uses a multidisciplinary team to develop and implement preoperative care plans for older adults, and its effect on engagement in advance care planning (ACP). DESIGN: Retrospective analysis of clinical demonstration project. SETTING: Preoperative optimization program for older adults undergoing surgery at a 796-bed academic tertiary hospital. PARTICIPANTS: Older adults (N=131) who participated in the SWP from February 2015 to August 2017...
October 2018: Journal of the American Geriatrics Society
Michael Josephs, Dominique Bayard, Nicole B Gabler, Elizabeth Cooney, Scott D Halpern
Background. Many people recognize the potential benefits of advance directives (ADs), yet few actually complete them. It is unknown whether an active choice intervention influences AD completion. Methods. New employees were randomized to an active choice intervention (n = 642) or usual care (n = 637). The active choice intervention asked employees to complete an AD, confirm prior AD completion, or fill out a declination form. In usual care, participants could complete an AD, confirm prior completion, or skip the task...
January 2018: MDM Policy & Practice
Simon M Cohen, Angelo E Volandes, Michele L Shaffer, Laura C Hanson, Daniel Habtemariam, Susan L Mitchell
CONTEXT: Care consistent with goals is the desired outcome of advance care planning (ACP). OBJECTIVES: To examine concordance between advance directives and proxy care preferences among nursing home residents with advanced dementia, and determine the impact of an ACP video on concordance. METHODS: Data were from Educational Video to Improve Nursing home Care in End-stage dementia (EVINCE); a cluster randomized clinical trial conducted in 64 Boston-area facilities (32/arm) from 2013-2017...
September 28, 2018: Journal of Pain and Symptom Management
Alby Richard, Joël Richard, Wendy Johnston, Janis Miyasaki
BACKGROUND: In the Canadian context, health literacy has been shown to depend on place of birth, education level, socioeconomic status, language spoken and geographic location. This study seeks to determine whether currently available advance directive documentation in Canada is written in accordance with the average reading level of the population and to assess whether recommendations for health literacy are currently being met. METHODS: A cross-sectional study design was used...
July 2018: CMAJ Open
Kensuke Nakamura, Yoshiharu Kinugasa, Shinobu Sugihara, Masayuki Hirai, Kiyotaka Yanagihara, Nobuhiko Haruki, Koichi Matsubara, Masahiko Kato, Kazuhiro Yamamoto
AIMS: Patients with end-stage heart failure (HF) often require surrogate decision making for end-of-life care owing to a lack of decision-making capacity. However, the clinical characteristics of surrogate decision making for life-sustaining treatments in Japan remain to be investigated. METHODS AND RESULTS: Among 934 patients admitted to our hospital for HF from January 2004 to December 2015, we retrospectively reviewed the medical records of consecutive 106 patients who died in hospital (mean age 73 ± 13 years; male, 52...
September 27, 2018: ESC Heart Failure
Hye-Young K Park, Cristina C Hendrix
BACKGROUND: The increasing population of Korean Americans in the US makes it mandatory to develop and provide culturally competent end-of-life (EOL) care for this population. AIMS: To synthesize previous studies on Korean Americans and their end-of-life (EOL) care. METHOD: Four databases (Cinahl, PsycInfo, PubMed, and SocIndex) were searched and 11 articles were selected for review. RESULTS: Korean Americans tend to avoid EOL communication, and instead hope that their families would know about their wishes, without discussing them directly...
September 2, 2018: International Journal of Palliative Nursing
Jessica P Lendon, Christine Caffrey, Denys T Lau
This report describes the percentage of adult day services centers (ADSCs) that typically maintain documentation of participants' advance directives by region and center characteristics. Further, among ADSCs that maintain documentation, this report describes the percentage of participants with advance directives by region and center characteristics.
September 2018: National Health Statistics Reports
Muthuraman Alagappan, Michael T Richardson, Matthew K Schoen, Lori Muffly, Kathryn Tierney, Patricia Jenkins, Eric Neri, Helena C Kraemer, Vyjeyanthi S Periyakoil
BACKGROUND: Little is known about the extent of alignment between hematopoietic stem cell transplant (HSCT) patients and their healthcare proxies with respect to advance care planning (ACP). AIM: To determine if a structured three-step process using the letter advance directive (LAD) could (1) allow for the differences in opinion between patient-proxy dyads to surface and (2) help bridge preexisting discordance about specific treatment choices. DESIGN: Blinded to each other, the HSCT patient (LAD-1) and proxy (LAD-2) each completed the LAD (step 1)...
September 19, 2018: Journal of Palliative Medicine
Blanca Miller
Although nurses have a legal and ethical responsibility to educate and help patients complete advance directives, few nurses have a clear understanding of their role. This review integrates 19 studies published between 1990 and 2018 of the knowledge or confidence of nurses and nursing students regarding advance directives or of education on advance directives in nursing curricula. Fewer than half of working nurses demonstrated knowledge, confidence, or both regarding advance directives, and nursing programs which cover advance directives at all typically devote only 1...
September 2018: Journal of Professional Nursing: Official Journal of the American Association of Colleges of Nursing
Lucy A Kernick, Karen J Hogg, Yvonne Millerick, Fliss E M Murtagh, Ayse Djahit, Miriam Johnson
BACKGROUND: People with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed. AIM: To evaluate the literature regarding advance care planning in heart failure. DESIGN: Systematic review and narrative analysis (PROSPERO CRD42017059190). DATA SOURCES: Electronic databases were searched (1990 to 23 March 2017): MEDLINE(R), Cochrane Library, CINAHL and Scopus...
September 20, 2018: Palliative Medicine
Jill M Steiner, James N Kirkpatrick, Susan R Heckbert, James Sibley, James A Fausto, Ruth A Engelberg, J Randall Curtis
OBJECTIVE: Overall health care resource utilization by adults with congenital heart disease has increased dramatically in the past two decades, yet little is known about utilization patterns at the end of life. The objective of this study is to better understand the patterns and influences on end-of-life care intensity for adults with congenital heart disease. METHODS: We identified a sample of adults with congenital heart disease (n = 65), cancer (n = 10 784), or heart failure (n = 3809) who died between January 2010 and December 2015, cared for in one multi-hospital health care system...
September 19, 2018: Congenital Heart Disease
Rosagemma Ciliberti, Ilaria Gorini, Valentina Gazzaniga, Francesco De Stefano, Matteo Gulino
PURPOSE: Italy has long lacked a law regulating patients' informed consent and advance directives (ADs). All previous attempts to introduce a law on this matter failed to reach positive outcomes, and aroused heated ideological debate over the exact meaning of life and death. We report on the new law on informed consent and ADs approved by the Italian Parliament on 14th December 2017. MATERIALS AND METHODS: We analyse the new law and discuss the main ethical points connected with it, in the Italian context and in comparison with the international situation...
August 29, 2018: Journal of Critical Care
Jessica Shaw, Ellen Wiebe, Amelia Nuhn, Sheila Holmes, Michaela Kelly, Alanna Just
OBJECTIVE: To explore the experiences of the first cohort of physicians to offer medical assistance in dying (MAID) in British Columbia. DESIGN: Qualitative study using semistructured, one-on-one interviews. SETTING: British Columbia. PARTICIPANTS: Eight physicians who offered MAID in British Columbia in 2016. METHODS: The physicians were interviewed by telephone or by e-mail between 4 and 6 months after MAID was made legal in Canada, with follow-up in January 2017...
September 2018: Canadian Family Physician Médecin de Famille Canadien
Blair Wendlandt, Agathe Ceppe, Summer Choudhury, Judith E Nelson, Christopher E Cox, Laura C Hanson, Marion Danis, James A Tulsky, Shannon S Carson
RATIONALE: Chronically critically ill patients are often dependent on family members for surrogate decision-making, and these surrogates are at high risk for emotional distress. We hypothesized that patient- and surrogate-specific risk factors for surrogate post-traumatic stress disorder (PTSD) symptoms can be identified early in the course of chronic critical illness. OBJECTIVES: To identify risk factors for PTSD symptoms in surrogate decision-makers of chronically critically ill patients...
September 10, 2018: Annals of the American Thoracic Society
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