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End of life communication

Vikram Khanna, Kashish Khanna, Maddur Srinivas
A day-old neonate presented with bowel obstruction and an abdominal mass. Exploratory laparotomy revealed complete tubular midgut duplication from duodeno-jejunal junction up to terminal ileum which was communicating with the ileum distally. At the proximal end, another 5×5 cm duplication cyst was identified and excised. Postoperatively, complaints were relieved. During follow-up, 99m-Tc-pertechnetate-SPECT scan showed ectopic gastric mucosa in lower abdomen and in the right hemithorax. CECT-chest showed a 3×3 cm foregut duplication cyst, but there were no respiratory symptoms...
March 15, 2018: BMJ Case Reports
Ellen McCreedy, Lacey Loomer, Jennifer A Palmer, Susan L Mitchell, Angelo Volandes, Vincent Mor
OBJECTIVES: Federally mandated assessments of nursing home (NH) residents drive individualized care planning. Residents with cognitive impairment may not be able to meaningfully communicate their care needs and preferences during this process-a gap that may be partially addressed by involving surrogates. We describe the prevalence of family participation in the care planning process for long-stay NH residents with varying degrees of cognitive impairment. DESIGN: Retrospective study using administrative data made available as part of an ongoing pragmatic cluster randomized controlled trial...
March 10, 2018: Journal of the American Medical Directors Association
Lindsay J Blazin, Cherilyn Cecchini, Catherine Habashy, Erica C Kaye, Justin N Baker
Effective communication is essential to the practice of pediatric oncology. Clear and empathic delivery of diagnostic and prognostic information positively impacts the ways in which patients and families cope. Honest, compassionate discussions regarding goals of care and hopes for patients approaching end of life can provide healing when other therapies have failed. Effective communication and the positive relationships it fosters also can provide comfort to families grieving the loss of a child. A robust body of evidence demonstrates the benefits of optimal communication for patients, families, and healthcare providers...
March 11, 2018: Children
Han-Lin Chi, Janine Cataldo, Evelyn Y Ho, Roberta S Rehm
BACKGROUND: Health-care providers (HCPs) find facilitating end-of-life (EOL) care discussions challenging, especially with patients whose ethnicities differ from their own. Currently, there is little guidance on how to initiate and facilitate such discussions with older Chinese Americans (≥55 years) and their families. OBJECTIVE: To explore communication strategies for HCPs to initiate EOL care discussions with older Chinese Americans in the San Francisco Bay Area...
January 1, 2018: American Journal of Hospice & Palliative Care
Phillip M Pifer, Mark K Farrugia, Malcolm D Mattes
BACKGROUND: Early palliative/supportive care (PSC) consultation and advance care planning (ACP) improve outcomes for patients with incurable cancer. However, PSC is underutilized in the United States. OBJECTIVE: To examine philosophical differences among PSC, radiation oncology (RO), and medical oncology (MO) physicians in order to understand barriers to early PSC referral. DESIGN: An electronic survey collected views of a nationwide cohort of health-care professionals regarding ACP and end-of-life care...
January 1, 2018: American Journal of Hospice & Palliative Care
Madison B Smith, Tamara G R Macieira, Michael D Bumbach, Susan J Garbutt, Sandra W Citty, Anita Stephen, Margaret Ansell, Toni L Glover, Gail Keenan
OBJECTIVES: To present the findings of a systematic review on the use of simulation-based learning experiences (SBLEs) to teach communication skills to nursing students and clinicians who provide palliative and end-of-life care to patients and their families. BACKGROUND: Palliative care communication skills are fundamental to providing holistic patient care. Since nurses have the greatest amount of direct exposure to patients, building such communication competencies is essential...
January 1, 2018: American Journal of Hospice & Palliative Care
Keith M Swetz, Arif H Kamal
Palliative care prioritizes symptom management and quality of life throughout the course of serious illness. Regardless of whether care is inpatient or outpatient, primary or subspecialty, a solid understanding of the basics of effective communication, symptom management, and end-of-life care is crucial. This article reviews these essentials and provides an overview of current evidence to support patient-centered palliative care.
March 6, 2018: Annals of Internal Medicine
Nicolino Ambrosino, Michele Vitacca
Background: Progress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients...
2018: Multidisciplinary Respiratory Medicine
Bob Woods, Laura O'Philbin, Emma M Farrell, Aimee E Spector, Martin Orrell
BACKGROUND: This updated Cochrane Review of reminiscence therapy (RT) for dementia was first published in 1998, and last updated in 2005. RT involves the discussion of memories and past experiences with other people using tangible prompts such as photographs or music to evoke memories and stimulate conversation. RT is implemented widely in a range of settings using a variety of formats. OBJECTIVES: To assess the effects of RT on people living with dementia and their carers, taking into account differences in its implementation, including setting (care home, community) and modality (group, individual)...
March 1, 2018: Cochrane Database of Systematic Reviews
Bo Van den Bulcke, Ruth Piers, Hanne Irene Jensen, Johan Malmgren, Victoria Metaxa, Anna K Reyners, Michael Darmon, Katerina Rusinova, Daniel Talmor, Anne-Pascale Meert, Laura Cancelliere, Làszló Zubek, Paolo Maia, Andrej Michalsen, Johan Decruyenaere, Erwin J O Kompanje, Elie Azoulay, Reitske Meganck, Ariëlla Van de Sompel, Stijn Vansteelandt, Peter Vlerick, Stijn Vanheule, Dominique D Benoit
BACKGROUND: Literature depicts differences in ethical decision-making (EDM) between countries and intensive care units (ICU). OBJECTIVES: To better conceptualise EDM climate in the ICU and to validate a tool to assess EDM climates. METHODS: Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting of 35 statements. This Ethical Decision-Making Climate Questionnaire (EDMCQ) was developed to capture three EDM domains in healthcare: interdisciplinary collaboration and communication; leadership by physicians; and ethical environment...
February 23, 2018: BMJ Quality & Safety
Ilona Fridman, Paul A Glare, Stacy Stabler, Andrew S Epstein, Alison Wiesenthal, Thomas W Leblanc, E Tory Higgins
BACKGROUND: Negative attitudes toward hospice care might prevent patients with cancer from discussing and choosing hospice as they approach end of life. When making a decision, people often naturally focus on either expected benefits or avoidance of harm. Behavioral research demonstrated that framing information in an incongruent manner with patients' underlying motivational focus reduces their negative attitudes toward a disliked option. OBJECTIVE: Our study tests this communication technique with cancer patients, aiming to reduce negative attitudes toward a potentially beneficial but often-disliked option: hospice care...
February 20, 2018: Journal of Pain and Symptom Management
Lynda Appleton, Helen Poole, Christine Wall
AIMS: To explore how cancer services may positively promote and support patients' well-being throughout treatment. Specifically to identify components of care that are important to patients and meet their needs BACKGROUND: Patients commonly experience stress and uncertainty during their cancer journey which can have a negative impact on their psychological health and quality of life. Comparatively, little is known about how patients may experience positive well-being during their treatment experience...
February 23, 2018: Journal of Advanced Nursing
Rowan H Harwood, Veronika van der Wardt, Sarah E Goldberg, Fiona Kearney, Pip Logan, Vicky Hood-Moore, Vicky Booth, Jennie E Hancox, Tahir Masud, Zoe Hoare, Andrew Brand, Rhiannon Tudor Edwards, Carys Jones, Roshan das Nair, Kristian Pollock, Maureen Godfrey, John R F Gladman, Kavita Vedhara, Helen Smith, Martin Orrell
Background: People with dementia progressively lose abilities and are prone to falling. Exercise- and activity-based interventions hold the prospect of increasing abilities, reducing falls, and slowing decline in cognition. Current falls prevention approaches are poorly suited to people with dementia, however, and are of uncertain effectiveness. We used multiple sources, and a co-production approach, to develop a new intervention, which we will evaluate in a feasibility randomised controlled trial (RCT), with embedded adherence, process and economic analyses...
2018: Pilot and Feasibility Studies
Anniek D Masman, Monique van Dijk, Joost van Rosmalen, Frans P M Baar, Dick Tibboel, Anneke A Boerlage
BACKGROUND: In palliative care, administration of opioids is often indispensable for pain treatment. Pain assessment may help recognize pain and guide treatment in non-communicative patients. In the Netherlands the Rotterdam Elderly Pain Observation Scale (REPOS) is recommended to this aim, but not yet validated. Therefore the objective of this study was to validate the REPOS in non-communicative or unconscious end-of-life patients. METHODS: In this observational study, the primary researcher applied the REPOS, while both the researcher and a nurse applied the Numeric Rating Scale (NRS)...
February 21, 2018: BMC Palliative Care
Suzanne K Chambers, Melissa K Hyde, Kirstyn Laurie, Melissa Legg, Mark Frydenberg, Ian D Davis, Anthony Lowe, Jeff Dunn
OBJECTIVE: To explore men's lived experience of advanced prostate cancer (PCa) and preferences for support. DESIGN: Cross-sectional qualitative study applying open-ended surveys and interviews conducted between June and November 2016. Interviews audio-recorded and transcribed verbatim and analysed from an interpretive phenomenological perspective. SETTING: Australia, nation-wide. PARTICIPANTS: 39 men diagnosed with advanced PCa (metastatic or castration-resistant biochemical regression) were surveyed with 28 men subsequently completing a semistructured in depth telephone interview...
February 17, 2018: BMJ Open
Ma Luisa Marván, Luis F Oñate-Ocaña, Patricio Santillán-Doherty, Asunción Álvarez-Del Río
OBJECTIVE: To explore the views of nurses on death in their practice, and their perception about physicians' actions dealing with terminally ill patients. MATERIALS AND METHODS: Two hundred ninety-five nurses with experience caring for terminally ill patients responded to a questionnaire developed for this study. RESULTS: The majority of participants considered that terminally ill patients should know about their prognosis. Although nearly all nurses said that when a patient brings up the subject and they talk with the patient about death, several of the nurses find it difficult to establish a relationship with these patients...
November 2017: Salud Pública de México
Consuela-Mădălina Gheorghe, Iuliana-Raluca Gheorghe, Victor Lorin Purcărea
Introduction. The importance of experience in marketing grew, as the concept itself is very personal and difficult to measure. Experience turns out to be complicated but once placed in a context it gets significant features. As the health care competitive environment increases, marketers are looking for new and effective methods of engaging consumers by using experiential marketing strategies. Moreover, little is known about the consumers' perceptions related to ophthalmologic services. Aim. The objective of this paper was to measure the consumer's perception of experiential marketing in the Romanian private ophthalmologic services by using structural equation modeling...
July 2017: Romanian Journal of Ophthalmology
Megan Lippe, Bailey Johnson, Stephanie Barger Mohr, Kyle Rhoads Kraemer
To provide adequate care, students from all health-care professions require education regarding palliative and end-of-life (EOL) care prior to entering professional practice. In particular, students need proper training to be equal members of interprofessional teams providing palliative and EOL care. However, limited information is currently available about the effectiveness of educational interventions relating to palliative and EOL care. Thus, an assessment of educational interventions to utilize in providing this education is warranted...
January 1, 2018: American Journal of Hospice & Palliative Care
Mark Schweda, Anna Kögel, Claudia Bartels, Jens Wiltfang, Anja Schneider, Silke Schicktanz
BACKGROUND: Biomarker-supported testing for preclinical and prodromal Alzheimer's disease (AD) finds its way into clinical practice. Professional attitudes and practices regarding disclosure and ethical issues are controversial in many countries. OBJECTIVES: Against this background, the objective was to survey the actual practice and the attitudes of physicians in German hospitals and memory clinics in order to explore possible practical insecurities and ethical concerns...
2018: Journal of Alzheimer's Disease: JAD
Catherine Millington-Sanders
Proactive, shared decision making between key professionals and sensitive communication with patients, and those important to them, can never be overestimated. Projected annual deaths in England and Wales are set to rise, highlighting the increasing need for high quality palliative and end-of-life care. The Royal College of General Practitioners and Marie Curie have worked in partnership to develop the Daffodil Standards, an evidenced-based, structured approach for practices using quality improvement methodology to help improve care for patients at an advanced stage of serious illness or approaching end of life...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
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