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Decision making at the end of life

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https://www.readbyqxmd.com/read/29135524/a-palliative-approach-for-heart-failure-end-of-life-care
#1
Jane Maciver, Heather J Ross
PURPOSE OF REVIEW: The current review discusses the integration of guideline and evidence-based palliative care into heart failure end-of-life (EOL) care. RECENT FINDINGS: North American and European heart failure societies recommend the integration of palliative care into heart failure programs. Advance care planning, shared decision-making, routine measurement of symptoms and quality of life and specialist palliative care at heart failure EOL are identified as key components to an effective heart failure palliative care program...
November 10, 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/29132946/an-interview-study-of-patient-and-caregiver-perspectives-on-advance-care-planning-in-esrd
#2
Marcus Sellars, Josephine M Clayton, Rachael L Morton, Tim Luckett, William Silvester, Lucy Spencer, Carol A Pollock, Rowan G Walker, Peter G Kerr, Allison Tong
BACKGROUND: Advance care planning (ACP) empowers patients to consider and communicate their current and future treatment goals. However, it can be an emotionally charged process for patients with kidney disease and their caregivers. This study aimed to describe the perspectives and attitudes of patients with end-stage renal disease (ESRD) and their caregivers toward ACP. STUDY DESIGN: Qualitative study. SETTING & PARTICIPANTS: Patients with ESRD (n=24) and their caregivers (n=15) aged 36 to 91 years at various stages of ACP ("not commenced," "in progress," or "completed") from 3 renal services...
November 10, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/29123355/economics-of-palliative-and-end-of-life-care-in-india-a-concept-paper
#3
Arunangshu Ghoshal, Anuja Damani, Naveen Salins, Jayita Deodhar, M A Muckaden
Only a few studies have assessed the economic outcomes of palliative care in India. The major areas of interest include hospice care, the process and structure of care, symptom management, and palliative chemotherapy compared to best supportive care. At present, there is no definite health-care system followed in India. Medical bankruptcy is common. In situations where patients bear most of the costs, medical decision-making might have significant implications on economics of health care. Game theory might help in deciphering the underlying complexities of decision-making when considered as a two person nonzero sum game...
October 2017: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29110738/what-can-we-learn-from-simulation-based-training-to-improve-skills-for-end-of-life-care-insights-from-a-national-project-in-israel
#4
Mayer Brezis, Yael Lahat, Meir Frankel, Alan Rubinov, Davina Bohm, Matan J Cohen, Meni Koslowsky, Orit Shalomson, Charles L Sprung, Henia Perry-Mezare, Rina Yahalom, Amitai Ziv
BACKGROUND: Simulation-based training improves residents' skills for end-of-life (EOL) care. In the field, staff providers play a significant role in handling those situations and in shaping practice by role modeling. We initiated an educational intervention to train healthcare providers for improved communication skills at EOL using simulation of sensitive encounters with patients and families. METHODS: Hospital physicians and nurses (n = 1324) attended simulation-based workshops (n = 100) in a national project to improve EOL care...
November 6, 2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/29110023/-modern-treatment-of-primary-biliary-cholangitis
#5
REVIEW
C P Strassburg
For nearly 30 years ursodeoxycholic acid (UDCA) represented the only pharmacological treatment option available for primary biliary cholangitis (PBC). This changed at the end of 2016 when obeticholic acid was licensed in Europe for PBC patients not responding to UDCA. Novel treatment concepts involving the modulation of nuclear receptor signaling in cholestatic and other liver diseases have led to a host of new potential options, studies and drug candidates for the treatment of PBC. The analysis of large multinational cohorts has additionally confirmed the effectiveness of UDCA in slowing PBC progression, and has led to the development of new definitions for the risk assessment of PBC patients under therapy, which will be an asset for clinical decision making...
November 6, 2017: Der Internist
https://www.readbyqxmd.com/read/29105683/-palliative-care-in-the-intensive-cardiac-care-unit-a-new-competence-for-the-cardiac-intensivist
#6
Massimo Romanò, Roberta Bertona, Federica Zorzoli, Rosvaldo Villani
Admissions to the intensive care unit at the end of life of patients with chronic non-malignant diseases are increasing. This involves the need for the development of palliative care culture and competence, also in the field of intensive cardiology. Palliative care should be implemented in the treatment of all patients with critical stages of disease, irrespective of prognosis, in order to improve the quality of care at the end of life.This review analyzes in detail the main clinical, ethical and communicational issues to move toward the introduction of basics of palliative care in cardiac intensive care units...
October 2017: Giornale Italiano di Cardiologia
https://www.readbyqxmd.com/read/29099667/redefining-the-therapeutic-objective-in-psoriatic-patients-candidates-for-biological-therapy
#7
G Carretero, L Puig, J M Carrascosa, L Ferrándiz, R Ruiz-Villaverde, P de la Cueva, I Belinchon, E Vilarrasa, R Del Rio, J L Sánchez-Carazo, A López-Ferrer, F Peral, S Armesto, N Eiris, J Mitxelena, J Vilar, M Ara, C Soria
The advances in psoriasis management currently allow achieving a good control of the disease. In particular, with the latest developed molecules, available evidence suggests that it is possible to pose an ambitious therapeutic goal, such as a Dermatology Life Quality Index 0/1, a Physician Global Assessment 0/1, or a Psoriasis Area and Severity Index 90/100 response. However, patients often fail to achieve the complete clearance of their cutaneous lesions or the improvement of disease factors that impair their quality of life...
November 3, 2017: Journal of Dermatological Treatment
https://www.readbyqxmd.com/read/29098205/better-minds-better-morals-a-procedural-guide-to-better-judgment
#8
G Owen Schaefer, Julian Savulescu
Making more moral decisions - an uncontroversial goal, if ever there was one. But how to go about it? In this article, we offer a practical guide on ways to promote good judgment in our personal and professional lives. We will do this not by outlining what the good life consists in or which values we should accept.Rather, we offer a theory of procedural reliability: a set of dimensions of thought that are generally conducive to good moral reasoning. At the end of the day, we all have to decide for ourselves what is good and bad, right and wrong...
2017: J Posthum Stud
https://www.readbyqxmd.com/read/29072148/patient-family-eol-communication-and-its-predictors-reports-from-caregivers-of-latino-patients-in-the-rural-u-s-mexico-border-region
#9
Eunjeong Ko, Jaehoon Lee, Carlos Ramirez, Denicka Lopez, Stephanie Martinez
OBJECTIVE: Family caregivers play an important role in end-of-life (EoL) decision making when the patient is unable to make his/her own decisions. While communication about EoL care between patients and family is perhaps a first step toward advance care planning (ACP)/EoL decisions, not every culture puts great value on open communication about this topic. The aims of the present study were to explore EoL communication and the aspects of communication among caregivers of Latino patients in the rural United States (U...
October 26, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29061178/intensive-procedure-preferences-at-the-end-of-life-eol-in-older-latino-adults-with-end-stage-renal-disease-esrd-on-dialysis
#10
Karla Gonzalez, Jesus G Ulloa, Gerardo Moreno, Oscar Echeverría, Keith Norris, Efrain Talamantes
BACKGROUND: Latinos in the U.S. are almost twice as likely to progress to End Stage Renal disease (ESRD) compared to non-Latino whites. Patients with ESRD on dialysis experience high morbidity, pre-mature mortality and receive intensive procedures at the end of life (EOL). This study explores intensive procedure preferences at the EOL in older Latino adults. METHODS: Seventy-three community-dwelling Spanish- and English-Speaking Latinos over the age of 60 with and without ESRD participated in this study...
October 23, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/29056563/impact-of-targeted-therapy-on-the-quality-of-end-of-life-care-for-patients-with-non-small-cell-lung-cancer-a-population-based-study-in-taiwan
#11
Hsin-Yun Tsai, Kuo-Piao Chung, Raymond Nien-Chen Kuo
CONTEXT: Targeted therapies with epidermal growth factor receptor tyrosine kinase inhibitors have been widely used in the treatment of advanced non-small cell lung cancer (NSCLC). However, little research has focused on the use of targeted therapies at the end-of-life (EOL). OBJECTIVES: This study investigated the determinants of receiving targeted therapy during the last month of life and how targeted therapies affect the quality of EOL care. METHODS: We conducted a retrospective population-based study using a cancer registry and National Health Insurance claims data among 42,678 Taiwanese NSCLC decedents in 2005-2012...
October 19, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29045355/complexity-of-chronic-conditions-impact-on-end-of-life-expense-trajectories-of-medicare-decedents
#12
Suzanne S Sullivan, Junxin Li, Yow-Wu Bill Wu, Sharon Hewner
OBJECTIVE: The aim of this study is to determine if the pattern of monthly medical expense can be used to identify individuals at risk of dying, thus supporting providers in proactively engaging in advanced care planning discussions. BACKGROUND: Identifying the right time to discuss end of life can be difficult. Improved predictive capacity has made it possible for nurse leaders to use large data sets to guide clinical decision making. METHODS: We examined the patterns of monthly medical expense of Medicare beneficiaries with life-limiting illness during the last 24 months of life using analysis of variance, t tests, and stepwise hierarchical linear modeling...
November 2017: Journal of Nursing Administration
https://www.readbyqxmd.com/read/29042081/peritoneal-dialysis-is-associated-with-better-cognitive-function-than-hemodialysis-over-a-one-year-course
#13
Denise Neumann, Wilfried Mau, Andreas Wienke, Matthias Girndt
Impaired cognitive functioning in patients with end-stage renal disease may reduce their capabilities to adhere to complex medical or dietary regimens and to fully participate in medical decisions. With decreasing renal function, cognitive abilities are likely to decline, with cognitive dysfunction improving after initiation of dialysis and even being generally reversible after successful renal transplantation. However, little is known about cognitive changes particularly regarding different treatment modalities...
October 14, 2017: Kidney International
https://www.readbyqxmd.com/read/29040427/what-is-the-end-of-life-period-trajectories-and-characterization-based-on-primary-caregiver-reports
#14
Jiska Cohen-Mansfield, Rinat Cohen, Michal Skornick-Bouchbinder, Shai Brill
BACKGROUND: As the population lives longer, end of life (EOL) is emerging as a distinct life phase, about which there is still limited understanding. Characterizing this important period is vital for clarifying issues regarding trajectory and decline at EOL and for health service planning on an institutional, communal, and societal level. In this paper we aim to characterize the EOL period, examining the duration and number of EOL stages, as well as the functional, attitudinal and emotional trajectories...
October 12, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/29040344/dilemmas-for-guardians-of-advanced-dementia-patients-regarding-tube-feeding
#15
Efrat Gil, Maayan Agmon, Ayal Hirsch, Miriam Ziv, Anna Zisberg
Background: advanced dementia is an incurable illness, its last stage marked by inability to eat. Tube feeding was deemed a helpful solution at this stage, but in recent years its inefficiency has been proved, and it is no longer practiced in many countries around the world. In Israel, however, the procedure is still accepted. In the gastroenterology department at the Bnai Zion Medical Center, a serious interaction is ongoing with patients' legal guardians, where detailed information is given about the inefficiency of the tube procedure...
October 13, 2017: Age and Ageing
https://www.readbyqxmd.com/read/29020932/difficult-conversations-australian-indigenous-patients-views-on-kidney-transplantation
#16
Jeannie Devitt, Kate Anderson, Joan Cunningham, Cilla Preece, Paul Snelling, Alan Cass
BACKGROUND: Indigenous Australians suffer a disproportionate burden of end stage kidney disease (ESKD) but are significantly less likely to receive a transplant. This study explores Indigenous ESKD patients' views on transplantation as a treatment option. METHODS: The Improving Access to Kidney Transplants (IMPAKT) research program investigated barriers to kidney transplantation for Indigenous Australians. An interview study, conducted in 2005-2006, elicited illness experience narratives from 146 Indigenous patients, including views on transplant...
October 11, 2017: BMC Nephrology
https://www.readbyqxmd.com/read/29020864/end-of-life-care-a-qualitative-study-comparing-the-views-of-people-with-dementia-and-family-carers
#17
Marie Poole, Claire Bamford, Emma McLellan, Richard P Lee, Catherine Exley, Julian C Hughes, Karen Harrison-Dening, Louise Robinson
BACKGROUND: In recent years, UK policy has increasingly recognised the importance of end-of-life care in dementia. While professional consensus on optimal palliative care in dementia has been reported, little is known about the perspectives of people with dementia and family carers. AIM: To compare the views of people with dementia and family carers of people with dementia (current and recently bereaved) on optimal end-of-life care. DESIGN: Qualitative interviews (32) and a focus group were conducted...
October 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/29020854/shared-decision-making-at-the-end-of-life-a-focus-group-study-exploring-the-perceptions-and-experiences-of-multi-disciplinary-healthcare-professionals-working-in-the-home-setting
#18
Paula Brogan, Felicity Hasson, Sonja McIlfatrick
BACKGROUND: Globally recommended in healthcare policy, Shared Decision-Making is also central to international policy promoting community palliative care. Yet realities of implementation by multi-disciplinary healthcare professionals who provide end-of-life care in the home are unclear. AIM: To explore multi-disciplinary healthcare professionals' perceptions and experiences of Shared Decision-Making at end of life in the home. DESIGN: Qualitative design using focus groups, transcribed verbatim and analysed thematically...
October 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28993286/spirit-trial-a-phase-iii-pragmatic-trial-of-an-advance-care-planning-intervention-in-esrd
#19
Mi-Kyung Song, Mark L Unruh, Amita Manatunga, Laura C Plantinga, Janice Lea, Manisha Jhamb, Abhijit V Kshirsagar, Sandra E Ward
Advance care planning (ACP) is a central tenet of dialysis care, but the vast majority of dialysis patients report never engaging in ACP discussions with their care providers. Over the last decade, we have developed and iteratively tested SPIRIT (Sharing Patient's Illness Representation to Increase Trust), a theory-based, patient- and family-centered advance care planning intervention. SPIRIT is a six-step, two-session, face-to-face intervention to promote cognitive and emotional preparation for end-of-life decision making for patients with ESRD and their surrogates...
October 6, 2017: Contemporary Clinical Trials
https://www.readbyqxmd.com/read/28993099/recognising-older-frail-patients-near-the-end-of-life-what-next
#20
Magnolia Cardona-Morrell, Ebony Lewis, Sanjay Suman, Cilla Haywood, Marcella Williams, Audrey-Anne Brousseau, Sally Greenaway, Ken Hillman, Elsa Dent
Frailty is a state of vulnerability resulting from cumulative decline in many physiological systems during a lifetime. It is progressive and considered largely irreversible, but its progression may be controlled and can be slowed down and its precursor -pre-frailty- can be treated with multidisciplinary intervention. The aim of this narrative review is to provide an overview of the different ways of measuring frailty in community settings, hospital, emergency, general practice and residential aged care; suggest occupational groups who can assess frailty in various services; discuss the feasibility of comprehensive geriatric assessments; and summarise current evidence of its management guidelines...
October 6, 2017: European Journal of Internal Medicine
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