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Decision making at the end of life

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https://www.readbyqxmd.com/read/28923833/nephrology-provider-prognostic-perceptions-and-care-delivered-to-older-adults-with-advanced-kidney-disease
#1
Huzaifah Salat, Andrei Javier, Edward D Siew, Rocio Figueroa, Loren Lipworth, Edmond Kabagambe, Aihua Bian, Thomas G Stewart, Maie H El-Sourady, Mohana Karlekar, Cesar Y Cardona, T Alp Ikizler, Khaled Abdel-Kader
BACKGROUND AND OBJECTIVES: Prognostic uncertainty is one barrier that impedes providers in engaging patients with CKD in shared decision making and advance care planning. The surprise question has been shown to identify patients at increased risk of dying. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In our prospective observational study, 488 patients ≥60 years of age with CKD stage 4 or 5 were enrolled. Binary surprise question (i.e., "Would you be surprised if this patient died in the next 12 months?") responses were recorded, and dialysis planning preferences, presence of advance care planning documentation, and care preceding death were abstracted...
September 18, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28919539/the-nexus-between-the-documentation-of-end-of-life-wishes-and-awareness-of-dying-a-model-for-research-education-and-care
#2
Deborah P Waldrop, Jacqueline M McGinley, Brian Clemency
The convergence of medical treatment that can extend life with written medical orders that make it possible to refuse such treatment brings the differential dynamics of contemporary end-of-life decision-making into sharp focus. Communication between families and clinicians can be confusing, uncertain and pressured when death is imminent. These situations create distress that ultimately influences the end-of-life experience for people who are dying and those who care for them. This paper presents the analysis of the decisional dynamics that emerge from the intersection of the patient-family-provider awareness that death is near with the presence or absence of documentation of expressed wishes for end-of-life care...
September 14, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28918408/effectiveness-cost-utility-and-implementation-of-a-decision-aid-for-patients-with-localised-prostate-cancer-and-their-partners-study-protocol-of-a-stepped-wedge-cluster-randomised-controlled-trial
#3
Hoda H M Al-Itejawi, Cornelia F van Uden-Kraan, Peter M van de Ven, Veerle M H Coupé, André N Vis, Jakko A Nieuwenhuijzen, Jeroen A van Moorselaar, Irma M Verdonck-de Leeuw
INTRODUCTION: Patient decision aids (PDAs) have been developed to help patients make an informed choice for a treatment option. Despite proven benefits, structural implementation falls short of expectations. The present study aims to assess the effectiveness and cost-utility of the PDA among newly diagnosed patients with localised prostate cancer and their partners, alongside implementation of the PDA in routine care. METHODS/ANALYSIS: A stepped-wedge cluster randomised trial will be conducted...
September 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28901283/a-systematic-review-of-religious-beliefs-about-major-end-of-life-issues-in-the-five-major-world-religions
#4
Rajshekhar Chakraborty, Areej R El-Jawahri, Mark R Litzow, Karen L Syrjala, Aric D Parnes, Shahrukh K Hashmi
OBJECTIVE: The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). METHOD: This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus...
October 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28865869/homing-in-on-the-social-systems-level-influences-on-overly-aggressive-treatments-at-the-end-of-life
#5
Elizabeth Dzeng, Daniel Dohan, J Randall Curtis, Thomas J Smith, Alessandra Colaianni, Christine Ritchie
CONTEXT: The American medical system is programmed to a default setting of aggressive care for the terminally ill. Institutional norms of decision-making have been shown to promote high intensity care, regardless of consistency with patient preferences. There are myriad factors at a system, clinician, surrogate, and patient level that drive the culture of overly aggressive treatments in American hospitals. OBJECTIVE: To understand physician perspective of the ways systems-level factors influence patient, physician, and surrogate perceptions and consequent behavior...
August 30, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28859644/predictive-value-of-c-reactive-protein-in-patients-treated-with-sunitinib-for-metastatic-clear-cell-renal-cell-carcinoma
#6
Martin Pilskog, Christian Beisland, Lars A Akslen, Leif Bostad, Åse Haug, Daniel Heinrich, Karin M Hjelle, Oddbjørn Straume
BACKGROUND: Sunitinib has become mainstay first line treatment for patients with metastatic renal clear cell carcinoma (mRCC). Still, useful predictive markers of response are lacking and urgently needed for clinical decision making. METHODS: In the present study we investigated the predictive value of standard serum markers as well as clinical markers, including C-reactive protein (CRP), Neutrophil to Lymphocyte ratio (NLR) and early hypertension (eHTN) in an unselected prospective patient population treated with sunitinib for mRCC...
August 31, 2017: BMC Urology
https://www.readbyqxmd.com/read/28844985/pediatric-advance-care-planning-pacp-for-teens-with-cancer-and-their-families-design-of-a-dyadic-longitudinal-rcct
#7
Katherine B Curtin, Anne E Watson, Jichuan Wang, Obianuju C Okonkwo, Maureen E Lyon
Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to their children about end of life (EOL) care, yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating the efficacy of FAmily CEntered disease-specific advance care planning (ACP) for teens with cancer (FACE-TC)...
August 24, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28837010/second-medical-opinions-in-end-of-life-disputes-in-critical-care-an-ethics-based-approach
#8
Sally Bean, Phil Shin, Blair Henry, Brian H Cuthbertson
Requests for a second medical opinion (SMO) by patients or substitute decision-makers (SDMs) can arise during end-of-life disputes in critical care. Such disagreements between patients or SDMs and physicians often pertain to specific elements of the decision-making process related to withholding or withdrawing of life-sustaining treatments. When these disputes occur in the critical care setting in Canada, practicalities and policy barriers prevent an SDM from obtaining an SMO without support from healthcare providers; moreover, in a majority of these cases the SDM will require the facilitation of a physician who is often the same individual with whom they are in conflict...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28829694/identifying-and-managing-undue-influence-from-family-members-in-end-of-life-decisions-for-patients-with-advanced-cancer
#9
Francis X Baker, Colleen M Gallagher
Undue influence from family members of patients with advanced cancer remains a serious ethical problem in end-of-life decision making. Despite the wealth of articles discussing the problem of undue influence, little has been written by way of practical guidance to help clinicians identify and effectively manage situations of undue influence. This article briefly lays out how to identify and manage situations of undue influence sensitively and effectively. We explain how undue influence may present itself in the clinic and distinguish it from ethically permissible expressions of relational autonomy...
August 22, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28827369/discordance-between-patients-stated-values-and-treatment-preferences-for-end-of-life-care-results-of-a-multicentre-survey
#10
Daren K Heyland, Rebecca Heyland, Peter Dodek, John J You, Tasnim Sinuff, Tim Hiebert, Xuran Jiang, Andrew G Day
BACKGROUND: Medical orders for the use of life-supports should be informed by patients' values and treatment preferences. The purpose of this study was to explore the internal consistency of patients' (or their family members') stated values, and the relationship between these values and expressed preferences. METHODS: We conducted a prospective study in 12 acute care hospitals in Canada. We administered a questionnaire to elderly patients and their family members about their values related to end-of-life (EOL) care, treatment preferences and decisional conflict...
September 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28816094/theories-of-health-care-decision-making-at-the-end-of-life-a-meta-ethnography
#11
Kyounghae Kim, Katherine Heinze, Jiayun Xu, Melissa Kurtz, Hyunjeong Park, Megan Foradori, Marie T Nolan
The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015...
August 1, 2017: Western Journal of Nursing Research
https://www.readbyqxmd.com/read/28815814/supporting-end-of-life-decision-making-case-studies-of-relational-closeness-in-supported-decision-making-for-people-with-severe-or-profound-intellectual-disability
#12
Joanne Watson, Erin Wilson, Nick Hagiliassis
BACKGROUND: The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions. METHODS: Five people with severe or profound intellectual disability's experiences of supported decision making were examined...
August 16, 2017: Journal of Applied Research in Intellectual Disabilities: JARID
https://www.readbyqxmd.com/read/28814131/what-factors-influence-women-s-perceptions-of-their-systemic-recurrence-risk-after-breast-cancer-treatment
#13
Kamaria L Lee, Nancy K Janz, Brian J Zikmund-Fisher, Reshma Jagsi, Lauren P Wallner, Allison W Kurian, Steven J Katz, Paul Abrahamse, Sarah T Hawley
BACKGROUND: Breast cancer patients' misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. Little is known about how women derive their risk estimates. METHODS: Using Los Angeles and Georgia's SEER registries (2014-2015), a random sample of early-stage breast cancer patients was sent surveys about 2 to 3 months after surgery ( N = 3930; RR, 68%). We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample ( N = 1,754)...
August 1, 2017: Medical Decision Making: An International Journal of the Society for Medical Decision Making
https://www.readbyqxmd.com/read/28805170/perspectives-of-patients-close-relatives-nurses-and-physicians-on-end-of-life-medication-management
#14
Marianne K Dees, Eric C T Geijteman, Wim J M Dekkers, Bregje A A Huisman, Roberto S G M Perez, Lia van Zuylen, Agnes van der Heide, Evert van Leeuwen
OBJECTIVE: Our aim was to gain insight into the perspectives of patients, close relatives, nurses, and physicians on medication management for patients with a life expectancy of less than 3 months. METHOD: We conducted an empirical multicenter study with a qualitative approach, including in-depth interviews with patients, relatives, nurses, specialists, and general practitioners (GPs). We used the constant comparative method and ATLAS.ti (v. 7.1) software for our analysis...
August 14, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28804862/oncological-patients-in-the-intensive-care-unit-prognosis-decision-making-therapies-and-end-of-life-care
#15
Ewelina Biskup, Fengfeng Cai, Marcus Vetter, Stephan Marsch
The effectiveness of intensive care unit (ICU) care for cancer patients remains controversial. Advances in antitumour and supportive care led to major improvements in outcomes of oncological patients in the ICU. Improved cancer therapies and supportive management of organ dysfunctions have contributed to improved survival rates. As a consequence, the number of cancer patients requiring ICU admission is rising. Frequently, cancer patients have a poor performance status and are vulnerable. It is a heterogeneous population, where the nature and curability of the neoplasm and the severity of critical illness cause a plethora of issues about ICU admissions...
August 14, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28781022/determinants-of-last-line-treatment-in-metastatic-breast-cancer
#16
Marika Cinausero, Lorenzo Gerratana, Elisa De Carlo, Donatella Iacono, Marta Bonotto, Valentina Fanotto, Vanessa Buoro, Debora Basile, Maria Grazia Vitale, Karim Rihawi, Gianpiero Fasola, Fabio Puglisi
BACKGROUND: In metastatic breast cancer (MBC) patients, the identification of factors helping clinicians in the choice between active therapy versus best supportive care is needed clinically. The aim of the present study was to identify the clinicopathologic factors that could improve the prognostic valuation of MBC patients and clinical decision-making at the end of life. PATIENTS AND METHODS: The present study analyzed data from a retrospective series of 522 MBC patients treated at the oncology department (University Hospital of Udine) from January 2004 to June 2014...
July 14, 2017: Clinical Breast Cancer
https://www.readbyqxmd.com/read/28777113/family-satisfaction-with-end-of-life-care-in-the-intensive-care-unit-a-systematic-review-of-the-literature
#17
Susan DeSanto-Madeya, Parissa Safizadeh
BACKGROUND: Assessment of family satisfaction after the death of a loved one in the intensive care unit (ICU) provides a way to determine whether quality end-of-life care was received by the patient and family. The purpose of this systematic review was to explore the factors associated with family satisfaction with end-of-life care in the ICU. METHODS: A systematic literature review was conducted using electronic databases CINAHL, MEDLINE, EMBASE, and PsychINFO...
September 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28776144/-validation-of-medical-ethical-decisions-at-the-bedside-by-the-autopsy-experience-of-the-ethics-committee-at-the-stuttgart-clinic
#18
REVIEW
A Bosse, C Schupp
BACKGROUND: Ethics consultations in a clinical setting can be challenging, specifically with respect to limiting therapeutic interventions in terminally ill patients. Some decisions will even be controversial. OBJECTIVE: Can a clinical autopsy be used to confirm the recommendations given by the ethics committee, i. e. limitation of therapy to palliative care? MATERIAL AND METHODS: We report an exemplary case of a patient with endocarditis and subsequent septic cerebral infarction...
August 3, 2017: Der Pathologe
https://www.readbyqxmd.com/read/28775217/end-of-life-services-for-older-people-in-residential-care-homes-in-hong-kong
#19
REVIEW
J K Luk
Good end-of-life care is needed for older people living in residential care homes with advanced irreversible chronic medical illnesses and cancers. At present, the usual practice of residential care homes is to send older residents to acute hospitals when they are unwell, and some residents will die in hospital. Dying in hospital without choice for older people may not be in alignment with the principle of 'good death'. There are many barriers for older people to die in the place of their choice, particularly in a residential care home...
August 4, 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28760834/validation-of-quality-indicators-for-end-of-life-communication-results-of-a-multicentre-survey
#20
MULTICENTER STUDY
Daren K Heyland, Peter Dodek, John J You, Tasnim Sinuff, Tim Hiebert, Carolyn Tayler, Xuran Jiang, Jessica Simon, James Downar
BACKGROUND: The lack of validated quality indicators is a major barrier to improving end-of-life communication and decision-making. We sought to show the feasibility of and provide initial validation for a set of quality indicators related to end-of-life communication and decision-making. METHODS: We administered a questionnaire to patients and their family members in 12 hospitals and asked them about advance care planning and goals-of-care discussions. Responses were used to calculate a quality indicator score...
July 31, 2017: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
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