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Surrogate decision maker

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https://www.readbyqxmd.com/read/28322634/end-of-life-decision-support-in-the-icu
#1
Grant Pignatiello, Ronald L Hickman, Breanna Hetland
Determining effective decision support strategies that enhance quality of end-of-life decision making in the intensive care unit is a research priority. This systematic review identified interventional studies describing the effectiveness of decision support interventions administered to critically ill patients or their surrogate decision makers. We conducted a systematic literature search using PubMed, CINAHL, and Cochrane. Our search returned 121 articles, 22 of which met the inclusion criteria. The search generated studies with significant heterogeneity in the types of interventions evaluated and varied patient and surrogate decision-maker outcomes, which limited the comparability of the studies...
November 1, 2016: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28283409/topics-in-practice-management-integrating-advance-care-planning-into-practice
#2
REVIEW
Laura E Dingfield, Joshua B Kayser
Advanced respiratory diseases progress over time and often lead to death. As their condition worsens, patients may lose medical decision making ability. Advance care planning (ACP) is a process in which patients receive information about their diagnosis and prognosis; discuss values, goals and fears; articulate preferences about life-sustaining treatments and end-of-life care; and appoint a surrogate medical decision maker. This process may result in written documentation of patient preferences, or appointment of a health care power of attorney (HCPOA)...
March 7, 2017: Chest
https://www.readbyqxmd.com/read/28278611/specific-words-and-experience-matter-to-surrogates-when-making-end-of-life-decisions
#3
Dawn E Fairlie
This grant funded preliminary study investigated the relationship between end-of-life terminologies and decisional conflict in surrogate decision makers using a convenience sample of 234 adults aged 50 and older. Participants were randomized into two groups; each received a survey packet that varied only in the use of the words "Do Not Resuscitate (DNR)" and "Allow Natural Death (AND)." The Decisional Conflict Scale (DCS) was administered and demographic data were collected. No difference was found in the total DCS scores based on the AND and DNR versions...
February 17, 2017: Health Communication
https://www.readbyqxmd.com/read/28265798/the-role-of-a-hospital-ethics-consultation-service-in-decision-making-for-unrepresented-patients
#4
Andrew M Courtwright, Joshua Abrams, Ellen M Robinson
Despite increased calls for hospital ethics committees to serve as default decision-makers about life-sustaining treatment (LST) for unrepresented patients who lack decision-making capacity or a surrogate decision-maker and whose wishes regarding medical care are not known, little is known about how committees currently function in these cases. This was a retrospective cohort study of all ethics committee consultations involving decision-making about LST for unrepresented patients at a large academic hospital from 2007 to 2013...
March 6, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28235413/presumed-consent-licenses-and-limits-inferred-from-the-case-of-geriatric-hip-fractures
#5
Joseph Bernstein, Drake LeBrun, Duncan MacCourt, Jaimo Ahn
BACKGROUND: Hip fractures are common and serious injuries in the geriatric population. Obtaining informed consent for surgery in geriatric patients can be difficult due to the high prevalence of comorbid cognitive impairment. Given that virtually all patients with hip fractures eventually undergo surgery, and given that delays in surgery are associated with increased mortality, we argue that there are select instances in which it may be ethically permissible, and indeed clinically preferable, to initiate surgical treatment in cognitively impaired patients under the doctrine of presumed consent...
February 24, 2017: BMC Medical Ethics
https://www.readbyqxmd.com/read/28187812/family-discussions-on-life-sustaining-interventions-in-neurocritical-care
#6
REVIEW
M M Adil, D Larriviere
Approximately 20% of all deaths in the USA occur in the intensive care unit (ICU) and the majority of ICU deaths involves decision of de-escalation of life-sustaining interventions. Life-sustaining interventions may include intubation and mechanical ventilation, artificial nutrition and hydration, antibiotic treatment, brain surgery, or vasoactive support. Decision making about goals of care can be defined as an end-of-life communication and the decision-making process between a clinician and a patient (or a surrogate decision maker if the patient is incapable) in an institutional setting to establish a plan of care...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28157753/discussing-life-sustaining-therapy-with-surrogate-decision-makers
#7
David Y Hwang
Clinicians caring for patients with severe stroke in intensive care units often grapple with requests from surrogate decision makers for life-prolonging treatment that members of the care team may believe to be futile. An example is a surrogate decision maker's request to place a tracheostomy and feeding tube in a patient who, in the clinical judgment of the neurocritical care team, is very unlikely to recover interactive capacity. This article presents a case, discusses definitions of medical futility, and summarizes recommended steps for mediating conflict regarding potentially inappropriate treatment...
February 2017: Continuum: Lifelong Learning in Neurology
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
#8
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/28074576/decisions-and-authority
#9
Gregory E Kaebnick
This issue of the Hastings Center Report (January-February 2017) features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers' authority when the surrogates' judgments about a patient's treatment conflict with the physicians'. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient-even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma...
January 2017: Hastings Center Report
https://www.readbyqxmd.com/read/28057703/advance-directives-and-end-of-life-care-among-nursing-home-residents-receiving-maintenance-dialysis
#10
Manjula Kurella Tamura, Maria E Montez-Rath, Yoshio N Hall, Ronit Katz, Ann M O'Hare
BACKGROUND AND OBJECTIVES: Little is known about the relation between the content of advance directives and downstream treatment decisions among patients receiving maintenance dialysis. In this study, we determined the prevalence of advance directives specifying treatment limitations and/or surrogate decision-makers in the last year of life and their association with end-of-life care among nursing home residents. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using national data from 2006 to 2007, we compared the content of advance directives among 30,716 nursing home residents receiving dialysis to 30,825 nursing home residents with other serious illnesses during the year before death...
March 7, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28012054/licensing-surrogate-decision-makers
#11
Philip M Rosoff
As medical technology continues to improve, more people will live longer lives with multiple chronic illnesses with increasing cumulative debilitation, including cognitive dysfunction. Combined with the aging of society in most developed countries, an ever-growing number of patients will require surrogate decision-makers. While advance care planning by patients still capable of expressing their preferences about medical interventions and end-of-life care can improve the quality and accuracy of surrogate decisions, this is often not the case, not infrequently leading to demands for ineffective, inappropriate and prolonged interventions...
December 23, 2016: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28001141/cases-from-the-cleveland-clinic-foundation-what-s-knowledge-got-to-do-with-it-ethics-epistemology-and-intractable-conflicts-in-the-medical-setting
#12
Bryan Kibbe, Paul J Ford
This article utilizes the case of Ms H. to examine the contrasting ways that surrogate decision makers move from simply hearing information about the patient to actually knowing and understanding the patient's medical condition. The focus of the case is on a family's request to actually see the patient's wounds instead of being told about the wounds, and the role of clinical ethicists in facilitating this request. We argue that clinical ethicists have an important role to play in the work of converting information into knowledge and that this can serve as a valuable way forward in the midst of seemingly intractable conflicts in the medical setting...
2016: Journal of Clinical Ethics
https://www.readbyqxmd.com/read/27935747/treatment-decision-making-capacity-in-children-and-adolescents-hospitalized-for-an-acute-mental-disorder-the-role-of-cognitive-functioning-and-psychiatric-symptoms
#13
Gabriele Mandarelli, Ugo Sabatello, Elisa Lapponi, Giulia Pace, Mauro Ferrara, Stefano Ferracuti
OBJECTIVE: This study was conducted to assess treatment decision-making capacity (TDMC) in a child and adolescent psychiatric sample and to verify possible associations between TDMC, psychiatric symptom severity, and cognitive functioning. METHODS: Twenty-two consecutively recruited patients hospitalized for an acute mental disorder, aged 11-18 years, underwent measurement of TDMC by the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). The MacCAT-T interview focused on patients' current treatment, which comprised second-generation antipsychotics (45...
December 9, 2016: Journal of Child and Adolescent Psychopharmacology
https://www.readbyqxmd.com/read/27916308/a-multi-attribute-methodology-for-the-prioritisation-of-oil-contaminated-sites-in-the-niger-delta
#14
Kabari Sam, Frédéric Coulon, George Prpich
The Ogoniland region of the Niger Delta contains a vast number of sites contaminated with petroleum hydrocarbons that originated from Nigeria's active oil sector. The United Nations Environment Programme (UNEP) reported on this widespread contamination in 2011, however, wide-scale action to clean-up these sites has yet to be initiated. A challenge for decision makers responsible for the clean-up of these sites has been the prioritisation of sites to enable appropriate allocation of scarce resources. In this study, a risk-based multi-criteria decision analysis framework was used to prioritise high-risk sites contaminated with petroleum hydrocarbons in the Ogoniland region of Nigeria...
February 1, 2017: Science of the Total Environment
https://www.readbyqxmd.com/read/27911489/palliative-care-interventions-in-advanced-dementia
#15
REVIEW
Edel Murphy, Katherine Froggatt, Sheelah Connolly, Eamon O'Shea, Elizabeth L Sampson, Dympna Casey, Declan Devane
BACKGROUND: Dementia is a chronic, progressive and ultimately fatal neurodegenerative disease. Advanced dementia is characterised by profound cognitive impairment, inability to communicate verbally and complete functional dependence. Usual care of people with advanced dementia is not underpinned universally by a palliative approach. Palliative care has focused traditionally on care of people with cancer but for more than a decade, there have been increased calls worldwide to extend palliative care services to include all people with life-limiting illnesses in need of specialist care, including people with dementia...
December 2, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27907968/palliative-care-practice-in-neurocritical-care
#16
Andrea K Knies, David Y Hwang
Many neurocritically ill patients and their families have high amounts of palliative care needs. Multiple professional societies relevant to neurocritical care have released consensus statements on meeting palliative care needs in neuroscience intensive care units. In this review, the authors discuss the ongoing debate regarding what model of palliative care delivery is optimal, focus on the process of shared decision making during goals-of-care discussions, and briefly comment on transitions from intensive care to comfort care...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27906720/decisions-regarding-forgoing-life-sustaining-treatments
#17
Gail A Van Norman
PURPOSE OF REVIEW: Decisions to forego life-sustaining treatments are complex, and disagreements between physicians and patients occur. This review discusses recent findings regarding what factors influence physicians and patients or their surrogates in these decisions and considers whether futility arguments regarding life-sustaining treatments should be abandoned. RECENT FINDINGS: Cardiopulmonary resuscitation is one paradigm in the literature for studying end-of-life decision-making...
April 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/27876636/concordance-between-veterans-self-report-and-documentation-of-surrogate-decision-makers-implications-for-quality-measurement
#18
Kimberly K Garner, Patricia Dubbert, Shelly Lensing, Dennis H Sullivan
CONTEXT: The Measuring What Matters 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 Measuring What Matters 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...
January 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27874181/ags-position-statement-making-medical-treatment-decisions-for-unbefriended-older-adults
#19
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/the-experience-of-surrogate-decision-makers-on-being-approached-for-consent-for-patient-participation-in-research-a-multicenter-study
#20
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 exists regarding patient prognosis, and critical illnesses are often associated with appreciable morbidity and mortality. OBJECTIVES: We aimed to describe the experiences of surrogate decision makers (SDMs) in being approached for consent for critically ill patients to participate in research. METHODS: A multicenter, qualitative study involving semistructured interviews with 26 SDMs, who provided or declined surrogate consent for research participation, at 5 Canadian centers nested within a multicenter observational study of research recruitment practices...
February 2017: Annals of the American Thoracic Society
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