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Surrogate decision maker

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https://www.readbyqxmd.com/read/27876636/concordance-between-veterans-self-report-and-documentation-of-surrogate-decision-makers-implications-for-quality-measurement
#1
Kimberly K Garner, Patricia Dubbert, Shelly Lensing, Dennis H Sullivan
CONTEXT: The Measuring What Matters (MWM) initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. OBJECTIVES: To better understand the potential implementation of this MWM quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker...
November 19, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27874181/ags-position-statement-making-medical-treatment-decisions-for-unbefriended-older-adults
#2
Timothy W Farrell, Eric Widera, Lisa Rosenberg, Craig D Rubin, Aanand D Naik, Ursula Braun, Alexia Torke, Ina Li, Caroline Vitale, Joseph Shega
In this position statement, we define unbefriended older adults as patients who: (1) lack decisional capacity to provide informed consent to the medical treatment at hand; (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so; and (3) lack family, friends or a legally authorized surrogate to assist in the medical decision-making process. Given the vulnerable nature of this population, clinicians, health care teams, ethics committees and other stakeholders working with unbefriended older adults must be diligent when formulating treatment decisions on their behalf...
November 22, 2016: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/27849142/a-multicenter-study-of-surrogate-decision-makers-experiences-in-being-approached-for-consent-for-patient-participation-in-research
#3
Karen E A Burns, Clara Juando Prats, Maria Maione, Mary Lanceta, Celia Zubrinich, Lianne Jeffs, Orla M Smith
RATIONALE: Recruitment in critical care research differs from other contexts in important ways: patients lack decision-making capacity, uncertainty exits regarding patient's prognosis, and critical illnesses are often associated with appreciable morbidity and mortality. OBJECTIVES: We aimed to describe surrogate decision makers (SDMs) experiences in being approached for consent for critically ill patients to participate in research. METHODS: A multicenter qualitative study involving 26 SDMs at 5 Canadian centers nested within a multicenter observational study of research recruitment practices...
November 16, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27780889/decision-making-on-behalf-of-people-living-with-dementia-how-do-surrogates-decision-makers-decide
#4
Deirdre Fetherstonhaugh, Linda McAuliffe, Michael Bauer, Chris Shanley
BACKGROUND: For people living with dementia, the capacity to make important decisions about themselves diminishes as their condition advances. As a result, important decisions (affecting lifestyle, medical treatment and end of life) become the responsibility of someone else, as the surrogate decision-maker. This study investigated how surrogate decision-makers make important decisions on behalf of a person living with dementia. METHODS: Semi-structured interviews were conducted with 34 family members who had formally or informally taken on the role of surrogate decision-maker...
October 25, 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27776894/end-of-life-euthanasia-and-assisted-suicide-an-update-on-the-situation-in-france
#5
R Aubry
On February 2, 2016, the French parliament adopted legislation creating new rights for the terminally ill. The text modifies and reinforces the rights of patients to end-of-life care and strengthens the status of surrogate decision makers. Under the new regulations, advance directives become legally binding though not unenforceable. Two types of advance directives are distinguished depending on whether the person is suffering or not from a serious illness when drafting them. The attending physician must abide by the patient's advance directives except in three situations: there is a life-threatening emergency; the directives are manifestly inappropriate; the directives are not compatible with the patient's medical condition...
October 21, 2016: Revue Neurologique
https://www.readbyqxmd.com/read/27676259/economic-feasibility-of-staffing-the-intensive-care-unit-with-a-communication-facilitator
#6
Nita Khandelwal, David Benkeser, Norma B Coe, Ruth A Engelberg, J Randall Curtis
RATIONALE: In the intensive care unit (ICU), complex decision-making by clinicians and families requires good communication to ensure care is consistent with patients' values and goals. OBJECTIVES: Assess the economic feasibility of staffing ICUs with a communication facilitator. METHODS: Data from a randomized trial of an "ICU communication facilitator" linked to hospital financial records; eligible patients (n=135) were admitted to the ICU at a single hospital with predicted mortality ≥30% and a surrogate decision maker...
September 27, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27647483/financial-surrogate-decision-making-lessons-from-applied-experimental-philosophy
#7
Adam Feltz
An estimated 1 in 4 elderly Americans need a surrogate to make decisions at least once in their lives. With an aging population, that number is almost certainly going to increase. This paper focuses on financial surrogate decision making. To illustrate some of the empirical and moral implications associated with financial surrogate decision making, two experiments suggest that default choice settings can predictably influence some surrogate financial decision making. Experiment 1 suggested that when making hypothetical financial decisions, surrogates tended to stay with default settings (OR = 4...
2016: Spanish Journal of Psychology
https://www.readbyqxmd.com/read/27632675/opening-the-door-the-experience-of-chronic-critical-illness-in-a-long-term-acute-care-hospital
#8
Daniela J Lamas, Robert L Owens, R Nicholas Nace, Anthony F Massaro, Nathan J Pertsch, Jonathon Gass, Rachelle E Bernacki, Susan D Block
OBJECTIVE: Chronically critically ill patients have recurrent infections, organ dysfunction, and at least half die within 1 year. They are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting. Our objective was to explore the understanding and expectations and goals of these patients and surrogates. DESIGN: We conducted semi-structured interviews with chronically critically ill long-term acute care hospital patients or surrogates...
September 14, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27618273/storytelling-in-the-early-bereavement-period-to-reduce-emotional-distress-among-surrogates-involved-in-a-decision-to-limit-life-support-in-the-icu-a-pilot-feasibility-trial
#9
Amber E Barnato, Yael Schenker, Greer Tiver, Mary Amanda Dew, Robert M Arnold, Eduardo R Nunez, Charles F Reynolds
OBJECTIVES: Surrogate decision makers involved in decisions to limit life support for an incapacitated patient in the ICU have high rates of adverse emotional health outcomes distinct from normal processes of grief and bereavement. Narrative self-disclosure (storytelling) reduces emotional distress after other traumatic experiences. We sought to assess the feasibility, acceptability, and tolerability of storytelling among bereaved surrogates involved in a decision to limit life support in the ICU...
September 9, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27613411/islamic-perspectives-on-clinical-intervention-near-the-end-of-life-we-can-but-must-we
#10
Aasim I Padela, Omar Qureshi
The ever-increasing technological advances of modern medicine have increased physicians' capacity to carry out a wide array of clinical interventions near the end-of-life. These new procedures have resulted in new "types" of living where a patient's cognitive functions are severely diminished although many physiological functions remain active. In this biomedical context, patients, surrogate decision-makers, and clinicians all struggle with decisions about what clinical interventions to pursue and when therapeutic intent should be replaced with palliative goals of care...
September 9, 2016: Medicine, Health Care, and Philosophy
https://www.readbyqxmd.com/read/27573590/parental-perception-of-self-empowerment-in-pediatric-pharmacogenetic-testing-the-reactions-of-parents-to-the-communication-of-actual-and-hypothetical-cyp2d6-test-results
#11
Sarah Adelsperger, Cynthia A Prows, Melanie F Myers, Cassandra L Perry, Ariel Chandler, Ingrid A Holm, John A Lynch
Concerns about the ethical and social implications of genetics persist as more applications of genetic and genomic technology have become available. Pediatric testing for genetic influences on response to opioids like codeine is one area of application. We interviewed parents of children enrolled in a mixed-methods study following the communication of actual or hypothetical results for CYP2D6, which impacts opioid response. Forty-one parents of children naive to opioids and 42 parents of children previously exposed to opioids participated in qualitative interviews...
August 30, 2016: Health Communication
https://www.readbyqxmd.com/read/27525995/defining-futile-and-potentially-inappropriate-interventions-a-policy-statement-from-the-society-of-critical-care-medicine-ethics-committee
#12
Alexander A Kon, Eric K Shepard, Nneka O Sederstrom, Sandra M Swoboda, Mary Faith Marshall, Barbara Birriel, Fred Rincon
OBJECTIVES: The Society of Critical Care Medicine and four other major critical care organizations have endorsed a seven-step process to resolve disagreements about potentially inappropriate treatments. The multiorganization statement (entitled: An official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units) provides examples of potentially inappropriate treatments; however, no clear definition is provided...
September 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27513360/dimensions-and-role-specific-mediators-of-surrogate-trust-in-the-icu
#13
Paul J Hutchison, Katie McLaughlin, Tom Corbridge, Kelly N Michelson, Linda Emanuel, Peter H S Sporn, Megan Crowley-Matoka
OBJECTIVE: In the ICU, discussions between clinicians and surrogate decision makers are often accompanied by conflict about a patient's prognosis or care plan. Trust plays a role in limiting conflict, but little is known about the determinants of trust in the ICU. We sought to identify the dimensions of trust and clinician behaviors conducive to trust formation in the ICU. DESIGN: Prospective qualitative study. SETTING: Medical ICU of a major urban university hospital...
August 10, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27500269/standardized-outcomes-in-nephrology-transplantation-a-global-initiative-to-develop-a-core-outcome-set-for-trials-in-kidney-transplantation
#14
Allison Tong, Klemens Budde, John Gill, Michelle A Josephson, Lorna Marson, Timothy L Pruett, Peter P Reese, David Rosenbloom, Lionel Rostaing, Anthony N Warrens, Germaine Wong, Jonathan C Craig, Sally Crowe, Tess Harris, Brenda Hemmelgarn, Braden Manns, Peter Tugwell, Wim Van Biesen, David C Wheeler, Wolfgang C Winkelmayer, Nicole Evangelidis, Benedicte Sautenet, Martin Howell, Jeremy R Chapman
BACKGROUND: Although advances in treatment have dramatically improved short-term graft survival and acute rejection in kidney transplant recipients, long-term graft outcomes have not substantially improved. Transplant recipients also have a considerably increased risk of cancer, cardiovascular disease, diabetes, and infection, which all contribute to appreciable morbidity and premature mortality. Many trials in kidney transplantation are short-term, frequently use unvalidated surrogate endpoints, outcomes of uncertain relevance to patients and clinicians, and do not consistently measure and report key outcomes like death, graft loss, graft function, and adverse effects of therapy...
June 2016: Transplantation Direct
https://www.readbyqxmd.com/read/27457661/advance-care-planning-for-haemodialysis-patients
#15
REVIEW
Chi Eung Danforn Lim, Rachel W C Ng, Nga Chong Lisa Cheng, Maria Cigolini, Cannas Kwok, Frank Brennan
BACKGROUND: End-stage kidney disease (ESKD) is a chronic, debilitative and progressive illness that may need interventions such as dialysis, transplantation, dietary and fluid restrictions. Most patients with ESKD will require renal replacement therapy, such as kidney transplantation or maintenance dialysis. Advance care planning traditionally encompass instructions via living wills, and concern patient preferences about interventions such as cardiopulmonary resuscitation and feeding tubes, or circumstances around assigning surrogate decision makers...
July 26, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27417862/-i-am-not-interested-in-talking-with-you
#16
Adam Peña, Trevor Bibler
Mr. M is an eighty-five-year-old who presented to the hospital with congestive heart failure exacerbation, pneumonia, altered mental status, and sepsis. A physician determines that he lacks capacity, and the team in the intensive care unit looks to the patient's daughter, Celia, as his surrogate decision-maker because she is named as an agent in his medical power of attorney form. While in the ICU, Mr. M suffers acute respiratory distress secondary to pneumonia and thus requires intubation. Celia accepts several life-sustaining interventions, but she sporadically refuses other medically indicated therapies...
July 2016: Hastings Center Report
https://www.readbyqxmd.com/read/27416980/the-ethics-of-deprescribing-in-older-adults
#17
Emily Reeve, Petra Denig, Sarah N Hilmer, Ruud Ter Meulen
Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics (beneficence, non-maleficence, autonomy, and justice) that may guide medical practitioners' prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier to deprescribing...
July 14, 2016: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/27380343/effect-of-palliative-care-led-meetings-for-families-of-patients-with-chronic-critical-illness-a-randomized-clinical-trial
#18
RANDOMIZED CONTROLLED TRIAL
Shannon S Carson, Christopher E Cox, Sylvan Wallenstein, Laura C Hanson, Marion Danis, James A Tulsky, Emily Chai, Judith E Nelson
IMPORTANCE: Family caregivers of patients with chronic critical illness experience significant psychological distress. OBJECTIVE: To determine whether family informational and emotional support meetings led by palliative care clinicians improve family anxiety and depression. DESIGN, SETTING, AND PARTICIPANTS: A multicenter randomized clinical trial conducted from October 2010 through November 2014 in 4 medical intensive care units (ICUs). Adult patients (aged ≥21 years) requiring 7 days of mechanical ventilation were randomized and their family surrogate decision makers were enrolled in the study...
July 5, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27380340/strategies-to-support-surrogate-decision-makers-of-patients-with-chronic-critical-illness-the-search-continues
#19
EDITORIAL
Douglas B White
No abstract text is available yet for this article.
July 5, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27329251/relative-effectiveness-assessments-of-oncology-medicines-for-pricing-and-reimbursement-decisions-in-european-countries
#20
S Kleijnen, I Lipska, T Leonardo Alves, K Meijboom, A Elsada, V Vervölgyi, A d'Andon, A Timoney, H G Leufkens, A De Boer, W G Goettsch
BACKGROUND: There is a debate on the added clinical value of new, expensive, anticancer treatments. Among European decision makers, the relevance of commonly used end points in trials, especially overall survival (OS), progression-free survival (PFS) and quality of life (QoL), varies, leading to the available evidence being valued differently. This research studies the extent to which the value of end points for cancer medicines differs among European decision makers. METHODS: We compared guidelines and relative effectiveness assessments (REAs) of medicines for pricing or reimbursement decisions in England, France, Germany, The Netherlands, Poland, and Scotland...
September 2016: Annals of Oncology: Official Journal of the European Society for Medical Oncology
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