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Surrogate decision maker

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https://www.readbyqxmd.com/read/29302597/ethical-challenges-involved-in-obtaining-consent-for-research-from-patients-hospitalized-in-the-intensive-care-unit
#1
Fiona Ecarnot, Jean-Pierre Quenot, Guillaume Besch, Gaël Piton
Clinical research remains a vital contributor to medical knowledge, and is an established and integral part of the practice of medicine worldwide. Respect for patient autonomy and ethical principles dictate that informed consent must be obtained from subjects before they can be enrolled into clinical research, yet these conditions may be difficult to apply in real practice in the intensive care unit (ICU). A number of factors serve to complexify the consent process in critically ill patients, notably decisional incapacity of the patient due to illness or sedation...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29260613/documentation-of-crucial-information-relating-to-critically-ill-patients
#2
Alexandria Bear, Elizabeth Thiel
BACKGROUND: Medical decision-making has evolved to the modern model of shared decision-making among patients, surrogate decision-makers, and medical providers. As such, informed consent discussions with critically ill patients often should include larger discussions relating to values and goals of care. Documentation of care options and prognosis serves as an important component of electronic communication relating to patient preferences among care providers. OBJECTIVE: This retrospective chart review study sought to evaluate the prevalence of documentation of critical data, care options, prognosis, and medical plan, within primary team and palliative care consult team documentation...
January 1, 2017: Journal of Palliative Care
https://www.readbyqxmd.com/read/29248434/does-my-older-cancer-patient-have-cognitive-impairment
#3
Jon Snaedal
Cancer and impaired cognition are both frequent conditions in old age and consequently coexist to certain degree. The prevalence of impaired cognition increases sharply after the age of 65 and the more advanced form of cognitive impairment; dementia, is exceeding 30% by the age of 85years. Adequate cognition is crucial for understanding important facts and for giving consent for intervention. There are many different stages of cognitive impairment, ranging from subjective cognitive impairment to severe dementia...
December 13, 2017: Journal of Geriatric Oncology
https://www.readbyqxmd.com/read/29215368/numeracy-and-interpretation-of-prognostic-estimates-in-intracerebral-hemorrhage-among-surrogate-decision-makers-in-the-neurologic-icu
#4
Nikita Leiter, Melissa Motta, Robert M Reed, Temitope Adeyeye, Debra L Wiegand, Nirav G Shah, Avelino C Verceles, Giora Netzer
OBJECTIVE: Clinicians caring for patients with intracerebral hemorrhage must often discuss prognosis and goals of care with their patients' surrogate decision makers, and may make numeric estimates of likelihood of survival and functional independence, informed by validated prediction models. Surrogates' prognostic estimates are often discordant with physicians', suggesting that physicians' numeric statements may not be accurately interpreted. We sought to assess the relationship between numeracy and interpretation of prognostic estimates in intracerebral hemorrhage among surrogate decision makers...
December 5, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29201947/older-adults-more-likely-to-discuss-advance-care-plans-with-an-attorney-than-with-a-physician
#5
Mercedes Bern-Klug, Elizabeth A Byram
Adults are encouraged to discuss their end-of-life health care preferences so that their wishes will be known and hopefully honored. The purpose of this study was to determine with whom older adults had communicated their future health care wishes and the extent to which respondents themselves were serving as a surrogate decision maker. Results from the cross-sectional online survey with 294 persons aged 50 and older reveal that among the married, over 80% had a discussion with their spouse and among those with an adult child, close to two thirds (64%) had...
January 2017: Gerontology & Geriatric Medicine
https://www.readbyqxmd.com/read/29186982/a-randomized-controlled-trial-of-strategies-to-improve-family-members-preparedness-for-surrogate-decision-making
#6
Michael J Green, Lauren J Van Scoy, Andrew J Foy, Renee R Stewart, Ramya Sampath, Jane R Schubart, Erik B Lehman, Anne E F Dimmock, Ashley M Bucher, Lisa S Lehmann, Alyssa F Harlow, Chengwu Yang, Benjamin H Levi
OBJECTIVE: To evaluate 2 strategies for preparing family members for surrogate decision-making. DESIGN: A 2 × 2 factorial, randomized controlled trial testing whether: (1) comprehensive online advance care planning (ACP) is superior to basic ACP, and (2) having patients engage in ACP together with family members is superior to ACP done by patients alone. SETTING: Tertiary care centers in Hershey, Pennsylvania, and Boston, Massachusetts. PARTICIPANTS: Dyads of patients with advanced, severe illness (mean age 64; 46% female; 72% white) and family members who would be their surrogate decision-makers (mean age 56; 75% female; 75% white)...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29148907/impact-of-patients-expressed-wishes-on-their-surrogate-decision-makers-preferred-decision-making-roles-in-japan
#7
Shuji Tsuda, Mieko Nakamura, Shigeru Aoki, Hiroshi Ono, Mitsuru Takagi, Hiroki Ohashi, Junichiro Miyachi, Yoshinori Matsui, Toshiyuki Ojima
BACKGROUND: Home medical care (HMC) patients and their families are expected to prepare for end-of-life decision making. OBJECTIVE: We investigated the decision readiness of HMC patients and their family surrogates. DESIGN: Cross-sectional survey. SETTING/SUBJECTS: We collected data from dyads, consisting of a HMC patient aged 65 years or older and a family member of the patient, recruited at four Japanese primary care clinics from January 2016 to November 2016...
November 17, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29140508/interactions-with-the-healthcare-system-influence-advance-care-planning-activities-results-from-a-representative-survey-in-11-developed-countries
#8
Alex Sable-Smith, Kelly R Arnett, Molly A Nowels, Kathryn Colborn, Hillary D Lum, David Nowels
Aim: To identify factors associated with completion of Advance Care Planning (ACP) by patients seen in primary care in developed countries. We hypothesized that the quality of primary care is associated. Method: We analysed respondent reported individual and healthcare utilization factors associated with the completion of ACP activities from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults in 11 Countries. The primary outcome is the combined number of ACP activities completed...
November 13, 2017: Family Practice
https://www.readbyqxmd.com/read/29117010/assessing-the-methodological-quality-of-glaucoma-clinical-practice-guidelines-and-their-recommendations-on-microinvasive-glaucoma-surgery-a-systematic-review
#9
Evan Michaelov, James J Armstrong, Mary Nguyen, Bridget Instrum, Tracey Lam, James Denstedt, Cindy M L Hutnik
INTRODUCTION: Clinical practice guidelines (CPG) are regarded by many as critical communications providing guidance within specific medical fields. Over a decade ago, the first microinvasive glaucoma surgical procedures (MIGS) were introduced. Since then, a number of these novel intraocular pressure (IOP) controlling surgical options have been approved worldwide. Governing bodies and healthcare administration often utilize CPGs when considering funding for newer technologies. This highlights the importance of well-written, accurate and up-to-date CPGs in the rapidly evolving field of MIGS...
November 7, 2017: Journal of Glaucoma
https://www.readbyqxmd.com/read/29069927/how-to-perform-a-cost-effectiveness-analysis-with-surrogate-endpoint-renal-denervation-in-patients-with-resistant-hypertension-denerhtn-trial-as-an-example
#10
Julie Bulsei, Meryl Darlington, Isabelle Durand-Zaleski, Michel Azizi
Whilst much uncertainty exists as to the efficacy of renal denervation (RDN), the positive results of the DENERHTN study in France confirmed the interest of an economic evaluation in order to assess efficiency of RDN and inform local decision makers about the costs and benefits of this intervention. The uncertainty surrounding both the outcomes and the costs can be described using health economic methods such as the non-parametric bootstrap. Internationally, numerous health economic studies using a cost-effectiveness model to assess the impact of RDN in terms of cost and effectiveness compared to antihypertensive medical treatment have been conducted...
October 26, 2017: Blood Pressure
https://www.readbyqxmd.com/read/29063206/plastic-pollution-in-freshwater-ecosystems-macro-meso-and-microplastic-debris-in-a-floodplain-lake
#11
Martin C M Blettler, Maria Alicia Ulla, Ana Pia Rabuffetti, Nicolás Garello
Plastic pollution is considered an important environmental problem by the United Nations Environment Programme, and it is identified, alongside climate change, as an emerging issue that might affect biological diversity and human health. However, despite research efforts investigating plastics in oceans, relatively little studies have focused on freshwater systems. The aim of this study was to estimate the spatial distribution, types, and characteristics of macro-, meso-, and microplastic fragments in shoreline sediments of a freshwater lake...
October 23, 2017: Environmental Monitoring and Assessment
https://www.readbyqxmd.com/read/28971641/derivation-and-implementation-of-a-protocol-in-israel-for-organ-donation-after-cardio-circulatory-death
#12
Jonathan Cohen, Ruth Rahamimov, Aaron Hoffman, Eyal Katvan, Kyril Grozovski, Tamar Ashkenazi
BACKGROUND: Strategies aimed at expanding the organ donor pool have been sought, which has resulted in renewed interest in donation after cardio-circulatory death (DCCD), also known as non-heart beating donors (NHBDs). OBJECTIVES: To describe the derivation and implementation of a protocol for DCCD in Israel and report on the results with the first six cases. METHODS: After receiving approval from an extraordinary ethics committee, Ministry of Health, the steering committee of the National Transplant Center defined and reached consensus on the unique challenges presented by a DCCD program...
September 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28949899/physician-understanding-and-application-of-surrogate-decision-making-laws-in-clinical-practice
#13
Amber Rose Comer, Margaret Gaffney, Cynthia L Stone, Alexia Torke
BACKGROUND: Although state surrogate laws are the most common way surrogate decision makers are identified, no studies have been conducted to determine physician understanding of these laws or how these laws are utilized during clinical practice. The purpose of this study is to better understand how surrogate decision-making laws function in practice. METHODS: A cross-sectional survey of 412 physicians working in Indiana hospitals was conducted between November 2014 and January 2015 to determine physicians' knowledge of Indiana's surrogate decision-making law and physicians' approaches to hypothetical cases using the law in clinical practice...
July 2017: AJOB Empirical Bioethics
https://www.readbyqxmd.com/read/28930710/at-the-intersection-of-faith-culture-and-family-dynamics-a-complex-case-of-refusal-of-treatment-for-childhood-cancer
#14
Amy E Caruso Brown
Refusing treatment for potentially curable childhood cancers engenders much discussion and debate. I present a case in which the competent parents of a young Amish child with acute myeloid leukemia deferred authority for decision making to the child's maternal grandfather, who was vocal in his opposition to treatment. I analyze three related concerns that distinguish this case from other accounts of refused treatment. First, I place deference to grandparents as decision makers in the context of surrogate decision making more generally...
2017: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/28922998/risk-preferences-in-surrogate-decision-making
#15
Eleonore Batteux, Eamonn Ferguson, Richard J Tunney
There is growing evidence that decisions made on behalf of other people differ from the decisions we make for ourselves because we are less affected by the subjective experience of their outcome. As a result, the decisions we make for other people can be more optimal. This experiment investigated surrogate decision making using a probability discounting task where participants made choices between risky and sure options. Psychological distance between the decision maker and the recipient was manipulated by having participants make decisions for themselves, their friend, and another unknown participant...
July 2017: Experimental Psychology
https://www.readbyqxmd.com/read/28915184/wide-disagreement-between-alternative-assessments-of-premorbid-physical-activity-subjective-patient-and-surrogate-reports-and-objective-smartphone-data
#16
Samuel Gluck, Matthew J Summers, Thomas P Goddard, Alice Andrawos, Natalie C Smith, Kylie Lange, Theodore J Iwashyna, Adam M Deane
OBJECTIVES: Surrogate-decision maker and patient self-reported estimates of the distances walked prior to acute illness are subjective and may be imprecise. It may be possible to extract objective data from a patient's smartphone, specifically, step and global position system data, to quantify physical activity. The objectives were to 1) assess the agreement between surrogate-decision maker and patient self-reported estimates of distance and time walked prior to resting and daily step-count and 2) determine the feasibility of extracting premorbid physical activity (step and global position system) data from critically ill patients...
October 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28846992/improving-research-enrollment-of-severe-burn-patients
#17
Anne M Lachiewicz, Felicia N Williams, Shannon S Carson, Jessica M Trexler, Carrie A Nielsen, David van Duin, David J Weber, Shannon D Williams, Samuel W Jones, Bruce A Cairns
Enrolling severely burn injured patients into prospective research studies poses specific challenges to investigators. The authors describe their experience of recruiting adults with ≥20% TBSA burns or inhalation injury admitted to a single academic burn unit into observational research with minimally invasive specimen collection. The authors outline iterative changes that they made to their recruitment processes in response to perceived weaknesses leading to delays in enrollment. The primary outcome was the change in days to consent for enrolled patients or cessation of recruitment for nonenrolled patients before and after the interventional modifications...
September 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28840485/how-surrogates-decide-a-secondary-data-analysis-of-decision-making-principles-used-by-the-surrogates-of-hospitalized-older-adults
#18
Rohit Devnani, James E Slaven, Gabriel T Bosslet, Kianna Montz, Lev Inger, Emily S Burke, Alexia M Torke
BACKGROUND: Many hospitalized adults do not have the capacity to make their own health care decisions and thus require a surrogate decision-maker. While the ethical standard suggests that decisions should focus on a patient's preferences, our study explores the principles that surrogates consider most important when making decisions for older hospitalized patients. OBJECTIVES: We sought to determine how frequently surrogate decision-makers prioritized patient preferences in decision-making and what factors may predict their doing so...
December 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28813240/when-does-therapeutic-misconception-affect-surrogates-or-subjects-decision-making-about-whether-to-participate-in-dementia-research
#19
Laura B Dunn, Barton W Palmer
"Therapeutic misconception" (TM) refers to inappropriate assumptions and beliefs on the part of research participants regarding key distinctions between the purpose, methods, intended benefits, and potential disadvantages of research compared to those of clinical care. Despite an extensive literature describing TM across varied types of research and populations, minimal work has addressed TM in the context of dementia research. This is a serious gap, for several reasons: people with dementia are at significant risk of diminished capacity; surrogate decision makers are typically asked to provide consent on behalf of the person with dementia; and available treatments for dementia are quite limited...
July 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28805132/evaluation-of-the-decisional-fatigue-scale-among-surrogate-decision-makers-of-the-critically-ill
#20
Ronald L Hickman, Grant A Pignatiello, Sadia Tahir
Intense emotional distress and impaired information processing have been implicated in reducing a surrogate decision maker's ability to formulate informed health care decisions for a critically ill patient. The heightened intensity of negative emotions, mental effort, and impaired judgment is consistent with the manifestation of decision fatigue. The aim of this article is to describe the validity and reliability of the Decision Fatigue Scale (DFS) among surrogate decision makers of the critically ill. A convenience sample of 101 surrogate decision makers were administered the DFS and a battery of psychosocial instruments at two time points...
August 1, 2017: Western Journal of Nursing Research
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