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Surrogate decision maker

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https://www.readbyqxmd.com/read/29741765/advance-care-planning-for-older-homeless-experienced-adults-results-from-the-health-outcomes-of-people-experiencing-homelessness-in-older-middle-age-study
#1
Rebecca L Sudore, Isabel Arellano Cuervo, Lina Tieu, David Guzman, Lauren M Kaplan, Margot Kushel
Older homeless-experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. We conducted a cross-sectional analysis of a cohort of 350 homeless-experienced adults aged 50 and older in Oakland, California. We assessed the prevalence of potential surrogate decision-makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). We used multivariable logistic regression to examine factors associated with ACP discussions and documentation...
May 9, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29714995/issues-in-geriatric-care-medical-decision-making
#2
Jayesh Patel, Richard J Ackermann
Medical decision-making capacity (DMC), which is determined by clinicians, is the ability of patients to understand information about options for their care, express a choice among those options, appreciate the benefits and risks of those options, and explain the reasoning behind their particular choice. DMC differs from competence, which is a legal concept concerning the mental ability of individuals to be responsible for their decisions and actions. A variety of instruments can be used to assess DMC. If it is determined that a patient lacks DMC, clinicians have an ethical obligation to seek out a surrogate decision-maker...
May 2018: FP Essentials
https://www.readbyqxmd.com/read/29699709/endocrine-surgery-in-the-geriatric-population
#3
REVIEW
John Benjamin McIntire, Susan McCammon, Eric R Mong
Age must be a factor when considering endocrine surgery. Age itself is a risk factor for complications after thyroidectomy, specifically pulmonary, infectious, and cardiac complications. For this reason, in patients with nodular thyroid disease or thyroid microcarcinoma, length of observation must be measured against age and surgical risk. Outcomes of thyroid surgery in geriatric patients can be improved with several measures, including careful preoperative risk stratification based on comorbidities and frailty...
April 23, 2018: Otolaryngologic Clinics of North America
https://www.readbyqxmd.com/read/29697329/responding-to-those-who-hope-for-a-miracle-practices-for-clinical-bioethicists
#4
Trevor M Bibler, Myrick C Shinall, Devan Stahl
Significant challenges arise for clinical care teams when a patient or surrogate decision-maker hopes a miracle will occur. This article answers the question, "How should clinical bioethicists respond when a medical decision-maker uses the hope for a miracle to orient her medical decisions?" We argue the ethicist must first understand the complexity of the miracle-invocation. To this end, we provide a taxonomy of miracle-invocations that assist the ethicist in analyzing the invocator's conceptions of God, community, and self...
May 2018: American Journal of Bioethics: AJOB
https://www.readbyqxmd.com/read/29682768/combining-conversation-analysis-and-event-sequencing-to-study-health-communication
#5
Kristen E Pecanac
Good communication is essential in patient-centered care. The purpose of this paper is to describe conversation analysis and event sequencing and explain how integrating these methods strengthened the analysis in a study of communication between clinicians and surrogate decision makers in an intensive care unit. Conversation analysis was first used to determine how clinicians introduced the need for decision-making regarding life-sustaining treatment and how surrogate decision makers responded. Event sequence analysis then was used to determine the transitional probability (probability of one event leading to another in the interaction) that a given type of clinician introduction would lead to surrogate resistance or alignment...
April 23, 2018: Research in Nursing & Health
https://www.readbyqxmd.com/read/29665095/enteral-nutrition-and-dementia-integrating-ethics
#6
Denise Baird Schwartz
This narrative review highlights topics related to feeding patients with dementia, including the use of ethical principles and legal precedents; specifies guidelines and practice recommendations; provides an option to assist in applying the recommendations, such as comfort feedings instead of enteral nutrition; promotes the use of early advance care planning to achieve medical therapies based on an individual's wishes; and provides 3 case studies to demonstrate the clinical application of the information presented in the article...
April 17, 2018: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/29649031/low-level-of-vegetative-state-after-traumatic-brain-injury-in-a-swiss-academic-hospital
#7
Federica Stretti, Stephanie Klinzing, Ulrike Ehlers, Peter Steiger, Reto Schuepbach, Tanja Krones, Giovanna Brandi
BACKGROUND: No standards exist regarding decision making for comatose patients, especially concerning life-saving treatments. The aim of this retrospective, single-center study was to analyze outcomes and the decision-making process at the end of life (EOL) in patients with traumatic brain injury (TBI) in a Swiss academic tertiary care hospital. METHODS: Consecutive admissions to the surgical intensive care unit (ICU) with stays of at least 48 hours between January 1, 2012 and June 30, 2015 in patients with moderate to severe TBI and with fatality within 6 months after trauma were included...
April 11, 2018: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/29617766/narrative-interest-standard-a-novel-approach-to-surrogate-decision-making-for-people-with-dementia
#8
James M Wilkins
Dementia is a common neurodegenerative process that can significantly impair decision-making capacity as the disease progresses. When a person is found to lack capacity to make a decision, a surrogate decision-maker is generally sought to aid in decision-making. Typical bases for surrogate decision-making include the substituted judgment standard and the best interest standard. Given the heterogeneous and progressive course of dementia, however, these standards for surrogate decision-making are often insufficient in providing guidance for the decision-making for a person with dementia, escalating the likelihood of conflict in these decisions...
June 17, 2017: Gerontologist
https://www.readbyqxmd.com/read/29608789/advance-care-planning-in-frail-older-adults-a-cluster-randomized-controlled-trial
#9
Anouk Overbeek, Ida J Korfage, Lea J Jabbarian, Pascalle Billekens, Bernard J Hammes, Suzanne Polinder, Johan Severijnen, Siebe J Swart, Frederika E Witkamp, Agnes van der Heide, Judith A C Rietjens
OBJECTIVES: To determine the effectiveness of advance care planning (ACP) in frail older adults. DESIGN: Cluster randomized controlled trial. SETTING: Residential care homes in the Netherlands (N=16). PARTICIPANTS: Care home residents and community-dwelling adults receiving home care (N=201; n=101 intervention; n=100 control). Participants were 75 years and older, frail, and capable of consenting to participation. INTERVENTION: Adjusted Respecting Choices ACP program...
April 2, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29608394/surrogate-decision-makers-perspectives-on-family-members-prognosis-after-intracerebral-hemorrhage
#10
Darin B Zahuranec, Renee R Anspach, Meghan E Roney, Andrea Fuhrel-Forbis, Daniel M Connochie, Emily P Chen, Bradford B Thompson, Panayiotis N Varelas, Lewis B Morgenstern, Angela Fagerlin
BACKGROUND: Surrogate communication with providers about prognosis in the setting of acute critical illness can impact both patient treatment decisions and surrogate outcomes. OBJECTIVES: To examine surrogate decision maker perspectives on provider prognostic communication after intracerebral hemorrhage (ICH). DESIGN: Semistructured interviews were conducted and analyzed qualitatively for key themes. SETTING/SUBJECTS: Surrogate decision makers for individuals admitted with ICH were enrolled from five acute care hospitals...
April 2, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29587711/a-review-of-paper-based-advance-care-planning-aids
#11
John F P Bridges, Thomas Lynch, Anne L R Schuster, Norah L Crossnohere, Katherine Clegg Smith, Rebecca A Aslakson
BACKGROUND: Advance care planning (ACP) aids can help prepare patients, family members, and physicians for in-the-moment medical decision-making. We wished to describe the content and approach of paper-based ACP aids in order to characterize existing aids and inform the development of a new ACP aid. METHODS: Paper-based ACP aids were identified through an environmental scan and screened for eligibility. ACP conceptual frameworks and data were gathered via stakeholder engagement and used to inform the coding framework that two investigators used to independently code each aid...
March 27, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29579506/a-preliminary-psychometric-evaluation-of-the-eight-item-cognitive-load-scale
#12
Grant A Pignatiello, Emily Tsivitse, Ronald L Hickman
AIM: The aim of this article is to report the psychometric properties of the eight-item cognitive load scale. BACKGROUND: According to cognitive load theory, the formatting and delivery of healthcare education influences the degree to which patients and/or family members can engage their working memory systems for learning. However, despite its relevance, cognitive load has not yet been evaluated among surrogate decision makers exposed to electronic decision support for healthcare decisions...
April 2018: Applied Nursing Research: ANR
https://www.readbyqxmd.com/read/29566541/advance-care-planning-for-people-with-dementia-ordinary-everyday-conversations
#13
Kay de Vries, Jenny Drury-Ruddlesden
Advance care planning for people with dementia has become a focus of dementia care policies in developed countries. In New Zealand, the framework for dementia care relies on the person with dementia having a level of competence to enable them to participate in the planning process. For people with dementia, it may be too late to initiate these discussions in terms of decision-making capacity. Consequently, decisions about end-of-life care for people with dementia are typically made by a family member who acts as a surrogate decision maker on behalf of the person with dementia...
January 1, 2018: Dementia
https://www.readbyqxmd.com/read/29564855/-the-intentions-affecting-the-medical-decision-making-behavior-of-surrogate-decision-makers-of-critically-ill-patients-and-related-factors
#14
Szu-Huei Su, Li-Min Wu
BACKGROUND: The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. PURPOSE: To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. METHODS: A cross-sectional, correlation study design was used...
April 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29550975/the-voice-is-as-mighty-as-the-pen-integrating-conversations-into-advance-care-planning
#15
Kunal Bailoor, Leslie H Kamil, Ed Goldman, Laura M Napiewocki, Denise Winiarski, Christian J Vercler, Andrew G Shuman
Advance care planning allows patients to articulate preferences for their medical treatment, lifestyle, and surrogate decision-makers in order to anticipate and mitigate their potential loss of decision-making capacity. Written advance directives are often emphasized in this regard. While these directives contain important information, there are several barriers to consider: veracity and accuracy of surrogate decision-makers in making choices consistent with the substituted judgement standard, state-to-state variability in regulations, literacy issues, lack of access to legal resources, lack of understanding of medical options, and cultural disparities...
March 17, 2018: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/29496535/refractory-schizophrenia-attempted-suicide-and-withdrawal-of-life-support-a-clinical-ethics-case-report
#16
Cory Taylor, Jamie C Fertal, Solomon Liao
BACKGROUND: Withdrawal of life support for an individual with refractory schizophrenia after attempted suicide remains controversial. Discussion regarding prognosis of mental illness and the distinction between somatic and mental illness brings out many ethical issues. This article will examine the role and weight of severe persistent mental illness in the withdrawal of life support after attempted suicide. CASE DESCRIPTION: A 30-year-old gentleman with deafness and schizophrenia was admitted with multiple self-inflicted visceral stab wounds...
February 26, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29485530/nontraditional-surrogate-decision-makers-for-hospitalized-older-adults
#17
Amber R Comer, James E Slaven, Annie Montz, Emily Burke, Lev Inger, Alexia Torke
BACKGROUND: Without advanced preparation of legal documents, state law determines who may serve as a surrogate decision maker for patients in hospitals. OBJECTIVES: To examine the relationship characteristics associated with traditional versus nontraditional health care surrogates who are making medical decisions for patients in hospitals. RESEARCH DESIGN: Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study...
April 2018: Medical Care
https://www.readbyqxmd.com/read/29462004/how-surrogate-decision-makers-for-patients-with-chronic-critical-illness-perceive-and-carry-out-their-role
#18
Lingsheng Li, Judith E Nelson, Laura C Hanson, Christopher E Cox, Shannon S Carson, Emily J Chai, Kristine L Keller, James A Tulsky, Marion Danis
OBJECTIVES: Family members commonly make medical decision for patients with chronic critical illness. This study examines how family members approach this decision-making role in real time. DESIGN: Qualitative analysis of interviews with family members in the intervention arm of a randomized controlled communication trial. SETTINGS: Medical ICUs at four U.S. hospitals. PARTICIPANTS: Family members of patients with chronic critical illness (adults mechanically ventilated for ≥ 7 d and expected to remain ventilated and survive for ≥ 72 hr) who participated in the active arm of a communication intervention study...
May 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29457244/the-different-moral-bases-of-patient-and-surrogate-decision-making
#19
Daniel Brudney
My topic is a problem with our practice of surrogate decision-making in health care, namely, the problem of the surrogate who is not doing her job-the surrogate who cannot be reached or the surrogate who seems to refuse to understand or to be unable to understand the clinical situation. The analysis raises a question about the surrogate who simply disagrees with the medical team. One might think that such a surrogate is doing her job-the team just doesn't like how she is doing it. My analysis raises the question of whether (or perhaps when) she should be overridden...
January 2018: Hastings Center Report
https://www.readbyqxmd.com/read/29457239/patient-care-to-public-health-to-synthetic-biology
#20
EDITORIAL
(no author information available yet)
The January-February 2018 issue of the Hastings Center Report includes pieces addressing patient care concerns that lie at the original core of bioethics and pieces that reflect the field's growing breadth. Among the pieces getting at the original core is an article by philosopher Daniel Brudney on the moral values underpinning surrogate decision-making. The article and the two commentaries that follow it contribute to the debate on the moral authority of surrogate decision-makers. Several items in the issue take up matters of public health and health policy...
January 2018: Hastings Center Report
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