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Decision making at the end of life

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https://www.readbyqxmd.com/read/27921276/relationship-between-physician-adjudicated-adverse-events-and-patient-reported-health-related-quality-of-life-in-a-phase-ii-clinical-trial-nct01143402-of-patients-with-metastatic-uveal-melanoma
#1
Thomas M Atkinson, Jennifer L Hay, Alexander Shoushtari, Yuelin Li, Daniel J Paucar, Sloane C Smith, Ragini R Kudchadkar, Austin Doyle, Jeffrey A Sosman, Jorge Fernando Quevedo, Mohammed M Milhem, Anthony M Joshua, Gerald P Linette, Thomas F Gajewski, Jose Lutzky, David H Lawson, Christopher D Lao, Patrick J Flynn, Mark R Albertini, Takami Sato, Karl Lewis, Brian Marr, David H Abramson, Mark Andrew Dickson, Gary K Schwartz, Richard D Carvajal
PURPOSE: Clinical trials commonly use physician-adjudicated adverse event (AE) assessment via the common terminology criteria for adverse events (CTCAE) for decision-making. Patient-reported health-related quality of life (HRQoL) data are becoming more frequent in oncology; however, the relationship between physician-adjudicated AE assessment and HRQoL is understudied. METHODS: Data from a phase II trial (clinicaltrials.gov identifier: NCT01143402) where patients with metastatic uveal melanoma were randomized to receive selumetinib, an oral MEK inhibitor, or chemotherapy were analyzed...
December 5, 2016: Journal of Cancer Research and Clinical Oncology
https://www.readbyqxmd.com/read/27920549/management-of-hypoglycemia-in-nondiabetic-palliative-care-patients-a-prognosis-based-approach
#2
REVIEW
Victor C Kok, Ping-Hsueh Lee
Hypoglycemia due to underlying terminal illness in nondiabetic end-of-life patients receiving palliative care has not been fully studied. For example, we do not have adequate information on the frequency of spontaneous hypoglycemia in patients as occurs during the different stages of palliative care. Depending on the case-mix nature of the palliative care ward, at least 2% of palliative care patients may develop hypoglycemia near the end of life when the remaining life expectancy counts down in days. As many as 25%-60% of these patients will neither have autonomic response nor have neuroglycopenic symptoms during a hypoglycemic episode...
2016: Palliative Care
https://www.readbyqxmd.com/read/27912108/encouraging-early-discussion-of-life-expectancy-and-end-of-life-care-a-randomised-controlled-trial-of-a-nurse-led-communication-support-program-for-patients-and-caregivers
#3
Adam Walczak, Phyllis N Butow, Martin H N Tattersall, Patricia M Davidson, Jane Young, Ronald M Epstein, Daniel S J Costa, Josephine M Clayton
BACKGROUND: Patients are often not given the information needed to understand their prognosis and make informed treatment choices, with many consequently experiencing less than optimal care and quality-of-life at end-of-life. OBJECTIVES: To evaluate the efficacy of a nurse-facilitated communication support program for patients with advanced, incurable cancer to assist them in discussing prognosis and end-of-life care. DESIGN: A parallel-group randomised controlled trial design was used...
October 21, 2016: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/27898175/interventions-for-promoting-participation-in-shared-decision-making-for-children-with-cancer
#4
REVIEW
Imelda Coyne, Dónal P O'Mathúna, Faith Gibson, Linda Shields, Edith Leclercq, Greg Sheaf
BACKGROUND: This is an update of the Cochrane systematic review of shared decision-making (SMD) making published in 2013. Children's rights to have their views heard in matters that affect their lives are now well established since the publication of the UN Convention treaty (1989). Children with cancer generally prefer to be involved in decision-making and consider it important that they have the opportunity to take part in decision-making concerning their health care, even in end-of-life decisions...
November 29, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27890302/-facilitators-and-barriers-regarding-end-of-life-care-at-nursing-homes-a-focus-group-study
#5
María Remedios Sánchez-García, Marina Moreno-Rodríguez, César Hueso-Montoro, Concepción Campos-Calderón, Ana Varella-Safont, Rafael Montoya-Juárez
AIM: To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. DESIGN: Descriptive qualitative research with phenomenological orientation, through content analysis. PLACEMENT: Nursing Homes at Primary Care District in Granada (Spain). PARTICIPANTS: Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care...
November 24, 2016: Atencion Primaria
https://www.readbyqxmd.com/read/27878797/choosing-wisely-at-the-end-of-life-the-crucial-role-of-medical-indication
#6
Gian Domenico Borasio, Ralf J Jox
At the end of life, several treatments are administered routinely that lack medical indication and may cause significant harm to patients. Examples include artificial hydration and oxygen therapy in the dying phase, as well as enteral nutrition in advanced dementia. Medical indication is defined as the appropriateness of a therapeutic or diagnostic measure in the patient's concrete clinical situation, in light of the best available evidence. The decision about the absence or presence of a medical indication is a core competence of physicians...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27872409/complexity-analysis-of-decision-making-in-the-critically-ill
#7
Barbara J Daly, Sara L Douglas, Elizabeth O'Toole, James Rowbottom, Alan Hoffer, Amy R Lipson, Christopher Burant
RATIONALE: Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. OBJECTIVE: To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness...
November 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27867525/barriers-to-goals-of-care-discussions-with-hospitalized-patients-with-advanced-heart-failure-feasibility-and-performance-of-a-novel-questionnaire
#8
Natasha Aleksova, Catherine Demers, Patricia H Strachan, Jane MacIver, James Downar, Robert Fowler, Daren K Heyland, Heather J Ross, John J You
AIMS: Good end-of-life communication and decision-making are important to patients with advanced heart failure (HF) and their families, but their needs remain unmet. In this pilot study, we describe the feasibility and performance of a novel questionnaire aimed at identifying barriers and solutions to improve communication and decision-making about goals of care for hospitalized patients with advanced HF. METHODS: We distributed questionnaires to staff cardiologists, cardiology trainees, and cardiology nurses who provide care for HF patients at a Canadian teaching hospital...
December 2016: ESC Heart Failure
https://www.readbyqxmd.com/read/27864564/hierarchical-structure-and-importance-of-patients-reasons-for-treatment-choices-in-knee-and-hip-osteoarthritis-a-concept-mapping-study
#9
Ellen M H Selten, Rinie Geenen, Willemijn H van der Laan, Roelien G van der Meulen-Dilling, Henk J Schers, Marc W Nijhof, Cornelia H M van den Ende, Johanna E Vriezekolk
OBJECTIVES: To improve patients' use of conservative treatment options of hip and knee OA, in-depth understanding of reasons underlying patients' treatment choices is required. The current study adopted a concept mapping method to thematically structure and prioritize reasons for treatment choice in knee and hip OA from a patients' perspective. METHODS: Multiple reasons for treatment choices were previously identified using in-depth interviews. In consensus meetings, experts derived 51 representative reasons from the interviews...
November 17, 2016: Rheumatology
https://www.readbyqxmd.com/read/27864126/the-use-of-life-sustaining-procedures-in-the-last-month-of-life-is-associated-with-more-depressive-symptoms-in-surviving-spouses
#10
Katherine A Ornstein, Melissa D Aldridge, Melissa M Garrido, Rebecca Gorges, Evan Bollens-Lund, Albert L Siu, Kenneth M Langa, Amy S Kelley
CONTEXT: Family caregivers of individuals with serious illness who undergo intensive life-sustaining medical procedures at the end of life may be at risk of negative consequences including depression. OBJECTIVE: To determine the association between patients' use of life-sustaining procedures at the end of life and depressive symptoms in their surviving spouses. METHODS: We used data from the Health and Retirement Study, a longitudinal survey of U...
November 15, 2016: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27860038/-i-m-worried-about-getting-water-in-the-holes-in-my-head-a-phenomenological-psychology-case-study-of-the-experience-of-undergoing-deep-brain-stimulation-surgery-for-parkinson-s-disease
#11
Virginia Eatough, Karen Shaw
OBJECTIVES: Deep brain stimulation (DBS) is a form of biotechnological surgery which has had considerable success for the motor improvement of Parkinson's disease and related disorders. Paradoxically, this observed motor improvement is not matched with improved psychosocial adjustment. This study contributes to a small but growing body of research aiming to understand this paradox. We conclude by discussing these aspects from a phenomenological and health psychology understanding of decision-making, human affectivity, and embodiment...
November 17, 2016: British Journal of Health Psychology
https://www.readbyqxmd.com/read/27856490/prevalence-and-contents-of-advance-directives-of-patients-with-esrd-receiving-dialysis
#12
Molly A Feely, Daniel Hildebrandt, Jithinraj Edakkanambeth Varayil, Paul S Mueller
BACKGROUND AND OBJECTIVES: ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life. Advance directives are intended to give providers and surrogates instruction on managing medical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis...
November 17, 2016: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/27854287/caregiving-and-its-resulting-effects-the-care-study-to-evaluate-the-effects-of-caregiving-on-caregivers-of-patients-with-advanced-cancer-in-singapore
#13
Cheryl Kai Ting Chua, Jun Tian Wu, Yin Yee Wong, Limin Qu, Yung Ying Tan, Patricia Soek Hui Neo, Grace Suyin Pang
Informal caregivers (IC) are key to enabling home deaths, where preferred, at the end-of-life. Significant morbidity from advanced cancer can make caregiving burdensome. However, knowledge about the nature of the caregiving burden for caregivers in Singapore is limited. Hence, the key objective in this study was to examine the impact of the caregiving burden on quality of life (QOL), mental health and work capacity among local ICs. Eligible English-speaking ICs of hospitalized advanced cancer patients were recruited through non-random sampling...
November 15, 2016: Cancers
https://www.readbyqxmd.com/read/27852819/factors-influencing-advance-care-planning-among-older-adults-in-two-socioeconomically-diverse-living-communities
#14
Jennifer L Tripken, Cathy Elrod, Susan Bills
BACKGROUND/OBJECTIVES: Advance care planning (ACP) is an iterative, complex, and dynamic process of discussion, decision-making, and documentation about end-of-life care. The extent to which this process takes place in older adults in diverse socioeconomic settings is not well documented. The aim of this study was to assess the knowledge, attitudes, and beliefs about ACP among older adults in two socioeconomically diverse settings to identify the individual and contextual factors that influence behaviors regarding end-of-life care...
November 15, 2016: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/27852711/angioplasty-and-stenting-for-patients-with-symptomatic-intracranial-atherosclerosis-study-protocol-of-a-randomised-controlled-trial
#15
Xiao-Ping Cui, Min Lin, Jun-Shan Mu, Jian-Xin Ye, Wen-Qing He, Mao-Lin Fu, Hua Li, Jia-Yang Fang, Feng-Feng Shen, Hang Lin
INTRODUCTION: Whether adding percutaneous transluminal angioplasty and stenting (PTAS) to background medical treatment is effective for decreasing the incidence of stroke or death in patients with symptomatic intracranial atherosclerosis (ICAS) is still controversial. We perform a randomised controlled trial to examine the effectiveness and safety of an improved PTAS procedure for patients with ICAS. METHODS AND ANALYSIS: A randomised controlled trial will be conducted in three hospitals in China...
November 15, 2016: BMJ Open
https://www.readbyqxmd.com/read/27834803/advance-care-planning-in-glioblastoma-patients
#16
REVIEW
Lara Fritz, Linda Dirven, Jaap C Reijneveld, Johan A F Koekkoek, Anne M Stiggelbout, H Roeline W Pasman, Martin J B Taphoorn
Despite multimodal treatment with surgery, radiotherapy and chemotherapy, glioblastoma is an incurable disease with a poor prognosis. During the disease course, glioblastoma patients may experience progressive neurological deficits, symptoms of increased intracranial pressure such as drowsiness and headache, incontinence, seizures and progressive cognitive dysfunction. These patients not only have cancer, but also a progressive brain disease. This may seriously interfere with their ability to make their own decisions regarding treatment...
November 8, 2016: Cancers
https://www.readbyqxmd.com/read/27822458/advance-care-planning-in-patients-with-primary-malignant-brain-tumors-a-systematic-review
#17
REVIEW
Krystal Song, Bhasker Amatya, Catherine Voutier, Fary Khan
Advance care planning (ACP) is a process of reflection and communication of a person's future health care preferences, and has been shown to improve end-of-life (EOL) care for patients. The aim of this systematic review is to present an evidence-based overview of ACP in patients with primary malignant brain tumors (pmBT). A comprehensive literature search was conducted using medical and health science electronic databases (PubMed, Cochrane, Embase, MEDLINE, ProQuest, Social Care Online, Scopus, and Web of Science) up to July 2016...
2016: Frontiers in Oncology
https://www.readbyqxmd.com/read/27821714/end-of-life-care-a-scoping-review-of-experiences-of-advance-care-planning-for-people-with-dementia
#18
Kerry Jones, Giles Birchley, Richard Huxtable, Linda Clare, Tony Walter, Jeremy Dixon
Despite increasing attention given to dementia by international governments and policy makers, the focus of end of life care has been on the dying trajectory of malignant disease. People with severe dementia have complex physical and psychological needs, yet the disease is not always recognised as terminal. Advance Care Planning involving people with dementia and their families can provide opportunities to discuss and later, initiate timely palliative care.We conducted a scoping review of studies exploring decisions associated with the EoLC of people with dementia...
November 7, 2016: Dementia
https://www.readbyqxmd.com/read/27821105/interventions-and-decision-making-at-the-end-of-life-the-effect-of-establishing-the-terminal-illness-situation
#19
C Campos-Calderón, R Montoya-Juárez, C Hueso-Montoro, E Hernández-López, F Ojeda-Virto, M P García-Caro
BACKGROUND: Many 'routine' interventions performed in hospital rooms have repercussions for the comfort of the patient, and the decision to perform them should depend on whether the patient is identified as in a terminal phase. The aim of this study is to analyse the health interventions performed and decisions made in the last days of life in patients with advanced oncological and non-oncological illness to ascertain whether identifying the patient's terminal illness situation has any effect on these decisions...
November 7, 2016: BMC Palliative Care
https://www.readbyqxmd.com/read/27807085/-i-ll-be-in-a-safe-place-a-qualitative-study-of-the-decisions-taken-by-people-with-advanced-cancer-to-seek-emergency-department-care
#20
Lesley A Henson, Irene J Higginson, Barbara A Daveson, Clare Ellis-Smith, Jonathan Koffman, Myfanwy Morgan, Wei Gao
OBJECTIVE: To explore the decisions of people with advanced cancer and their caregivers to seek emergency department (ED) care, and understand the issues that influence the decision-making process. DESIGN: Cross-sectional qualitative study incorporating semistructured patient and caregiver interviews. METHODS: Between December 2014 and July 2015, semistructured interviews were conducted with 18 people with advanced cancer, all of whom had recently attended the ED of a large university teaching hospital located in south-east London; and six of their caregivers...
November 2, 2016: BMJ Open
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