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Decision making at the end of life

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https://www.readbyqxmd.com/read/28427472/optimising-conservative-management-of-chronic-low-back-pain-study-protocol-for-a-randomised-controlled-trial
#1
Katherine J Simson, Clint T Miller, Jon Ford, Andrew Hahne, Luana Main, Timo Rantalainen, Wei-Peng Teo, Megan Teychenne, David Connell, Guy Trudel, Guoyan Zheng, Gary Thickbroom, Daniel L Belavy
BACKGROUND: Lower back pain is a global health issue affecting approximately 80% of people at some stage in their life. The current literature suggests that any exercise is beneficial for reducing back pain. However, as pain is a subjective evaluation and physical deficits are evident in low back pain, using it as the sole outcome measure to evaluate superiority of an exercise protocol for low back pain treatment is insufficient. The overarching goal of the current clinical trial is to implement two common, conservative intervention approaches and examine their impact on deficits in chronic low back pain...
April 20, 2017: Trials
https://www.readbyqxmd.com/read/28426540/family-functioning-predicts-end-of-life-care-quality-in-patients-with-cancer-multicenter-prospective-cohort-study
#2
Myung Kyung Lee, Young Ho Yun
BACKGROUND: Treating patients with cancer within a family setting is the accepted standard of care and a hallmark of end-of-life (EoL) quality of care (QoC). OBJECTIVE: The aim of this study was to determine whether family caregiver functioning predicts EoL QoC received by terminally ill patients with cancer. METHODS: Family caregivers of terminally ill patients with cancer (n = 264) were enrolled from oncology inpatient and outpatient units of 12 large hospitals located in different regions throughout South Korea...
April 20, 2017: Cancer Nursing
https://www.readbyqxmd.com/read/28420191/designing-effective-interactions-for-concordance-around-end-of-life-care-decisions-lessons-from-hospice-admission-nurses
#3
Carey Candrian, Channing Tate, Kirsten Broadfoot, Alexandra Tsantes, Daniel Matlock, Jean Kutner
Near the end of life, hospice care reduces symptom-related distress and hospitalizations while improving caregiving outcomes. However, it takes time for a person to gain a sufficient understanding of hospice and decide to enroll. This decision is influenced by knowledge of hospice and its services, emotion and fear, cultural and religious beliefs, and an individual's acceptance of diagnosis. Hospice admission interactions, a key influence in shaping decisions regarding hospice care, happen particularly late in the illness trajectory and are often complex, unpredictable, and highly variable...
April 18, 2017: Behavioral Sciences
https://www.readbyqxmd.com/read/28419505/assisted-dying-disability
#4
Christopher A Riddle
This article explores at least two dominant critiques of assisted dying from a disability rights perspective. In spite of these critiques, I conclude that assisted dying ought to be permissible. I arrive at the conclusion that if we respect and value people with disabilities, we ought to permit assisted dying. I do so in the following manner. First, I examine recent changes in legislation that have occurred since the Royal Society of Canada Expert Panel on End-of-Life Decision-Making report, published in this journal...
April 17, 2017: Bioethics
https://www.readbyqxmd.com/read/28416655/economic-inequality-increases-risk-taking
#5
B Keith Payne, Jazmin L Brown-Iannuzzi, Jason W Hannay
Rising income inequality is a global trend. Increased income inequality has been associated with higher rates of crime, greater consumer debt, and poorer health outcomes. The mechanisms linking inequality to poor outcomes among individuals are poorly understood. This research tested a behavioral account linking inequality to individual decision making. In three experiments (n = 811), we found that higher inequality in the outcomes of an economic game led participants to take greater risks to try to achieve higher outcomes...
April 17, 2017: Proceedings of the National Academy of Sciences of the United States of America
https://www.readbyqxmd.com/read/28414849/-the-rights-of-the-dying-the-refusal-of-medical-treatments-in-argentine-courts
#6
Juan Pedro Alonso
This paper addresses the judicialization of end of life medical decision-making, as part of the advance of the justice system in the regulation of medical practice and the rise of recognition of patient autonomy. The article analyzes, from a sociological standpoint, legal decisions regarding treatment refusal at the end of life produced by the Argentine courts between 1975 and 2015. Based on a qualitative design, 38 sentences collected from jurisprudential databases using key terms were analyzed. First, judicialized cases during the period are described; these are characterized by a high proportion of claims presented by health institutions, a pro-treatment bias in the legal actions requested, and a high percentage of unnecessary litigation in the absence of conflicts or in situations that do not require court intervention...
July 2016: Salud Colectiva
https://www.readbyqxmd.com/read/28399022/palliative-and-end-of-life-care-in-nephrology-moving-from-observations-to-interventions
#7
Nwamaka D Eneanya, Michael K Paasche-Orlow, Angelo Volandes
PURPOSE OF REVIEW: In comparison with patients who have other serious illnesses, patients with advanced kidney disease have a higher rate of intensive care utilization at the end of life and receive palliative care less frequently. Consensus and clinical practice guidelines have therefore recommended the incorporation of palliative care earlier in the disease trajectory. This review summarizes recent literature on this aspect of care and will highlight future directions for patient-centered care within palliative nephrology...
April 8, 2017: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/28387570/seeking-and-accepting-u-s-clergy-theological-and-moral-perspectives-informing-decision-making-at-the-end-of-life
#8
Justin J Sanders, Vinca Chow, Andrea C Enzinger, Tai-Chung Lam, Patrick T Smith, Rebecca Quiñones, Andrew Baccari, Sarah Philbrick, Gloria White-Hammond, John Peteet, Tracy A Balboni, Michael J Balboni
BACKGROUND: People with serious illness frequently rely on religion/spirituality to cope with their diagnosis, with potentially positive and negative consequences. Clergy are uniquely positioned to help patients consider medical decisions at or near the end of life within a religious/spiritual framework. OBJECTIVE: We aimed to examine clergy knowledge of end-of-life (EOL) care and beliefs about the role of faith in EOL decision making for patients with serious illness...
April 7, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28379955/preferences-for-care-towards-the-end-of-life-when-decision-making-capacity-may-be-impaired-a-large-scale-cross-sectional-survey-of-public-attitudes-in-great-britain-and-the-united-states
#9
Gemma Clarke, Elizabeth Fistein, Anthony Holland, Matthew Barclay, Pia Theimann, Stephen Barclay
BACKGROUND: There is continuing public debate about treatment preferences at the end of life, and the acceptability and legal status of treatments that sustain or end life. However, most surveys use binary yes/no measures, and little is known about preferences in neurological disease when decision-making capacity is lost, as most studies focus on cancer. This study investigates changes in public preferences for care towards the end of life, with a focus on measures to sustain or end life...
2017: PloS One
https://www.readbyqxmd.com/read/28375994/translating-research-to-practice-providing-critically-ill-children-the-opportunity-to-go-home-or-to-hospice-for-end-of-life-care
#10
Harriett Nelson, Sandra Mott
BACKGROUND: A freestanding quaternary pediatric hospital in New England has been facilitating parents' requests to take their child home or to a hospice facility from an Intensive Care Unit at end of life for the withdrawal of life sustaining measures for the past 16 years. However, knowledge of the aftermath of this decision was very limited. Before responding to a growing interest in making this service more available, an exploratory study was done to learn about the parents' perceptions of the experience over time...
May 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28365248/parent-distress-and-the-decision-to-have-another-child-after-an-infant-s-death-in-the-nicu
#11
Madelaine C Keim, Christine A Fortney, Emily L Shultz, Adrien Winning, Cynthia A Gerhardt, Amy Baughcum
OBJECTIVE: To examine associations among parent perceptions of infant symptoms/suffering, parent distress, and decision making about having additional children after an infant's death in the NICU. DESIGN: Mixed-methods pilot study incorporating mailed surveys and qualitative interviews. SETTING: Midwestern Level IV regional referral NICU. PARTICIPANTS: Participants were 42 mothers and 27 fathers whose infants died in the NICU...
March 29, 2017: Journal of Obstetric, Gynecologic, and Neonatal Nursing: JOGNN
https://www.readbyqxmd.com/read/28360253/to-dialyse-or-delay-a-qualitative-study-of-older-new-zealanders-perceptions-and-experiences-of-decision-making-with-stage-5-chronic-kidney-disease
#12
Sarah Lovell, Robert J Walker, John B W Schollum, Mark R Marshall, Bronwen M McNoe, Sarah Derrett
BACKGROUND: Issues related to renal replacement therapy in elderly people with end stage kidney disease (ESKD) are complex. There is inadequate empirical data related to: decision-making by older populations, treatment experiences, implications of dialysis treatment and treatment modality on quality of life, and how these link to expectations of ageing. STUDY POPULATION: Participants for this study were selected from a larger quantitative study of dialysis and predialysis patients aged 65 years or older recruited from three nephrology services across New Zealand...
March 29, 2017: BMJ Open
https://www.readbyqxmd.com/read/28360015/health-related-quality-of-life-in-patients-with-locally-recurrent-or-metastatic-breast-cancer-treated-with-etirinotecan-pegol-versus-treatment-of-physician-s-choice-results-from-the-randomised-phase-iii-beacon-trial
#13
Chris Twelves, Javier Cortés, Joyce O'Shaughnessy, Ahmad Awada, Edith A Perez, Seock-Ah Im, Patricia Gómez-Pardo, Lee S Schwartzberg, Véronique Diéras, Denise A Yardley, David A Potter, Audrey Mailliez, Alvaro Moreno-Aspitia, Jin-Seok Ahn, Carol Zhao, Ute Hoch, Mary Tagliaferri, Alison L Hannah, Hope S Rugo
BACKGROUND: Health-related quality of life (HRQoL) enhances understanding of treatment effects that impact clinical decision-making. Although the primary end-point was not achieved, the BEACON (BrEAst Cancer Outcomes with NKTR-102) trial established etirinotecan pegol, a long-acting topoisomerase-1 (TOP1) inhibitor, as a promising therapeutic for patients with advanced/metastatic breast cancer (MBC) achieving clinically meaningful benefits in median overall survival (OS) for patients with stable brain metastases, with liver metastases or ≥ 2 sites of metastatic disease compared to treatment of physician's choice (TPC)...
March 27, 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28359288/termination-of-prehospital-resuscitative-efforts-a-study-of-documentation-on-ethical-considerations-at-the-scene
#14
Søren Mikkelsen, Caroline Schaffalitzky de Muckadell, Lars Grassmé Binderup, Hans Morten Lossius, Palle Toft, Annmarie Touborg Lassen
BACKGROUND: Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally...
March 31, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28355526/community-knowledge-of-law-at-the-end-of-life-availability-and-accessibility-of-web-based-resources
#15
Ben White, Lindy Willmott, Cheryl Tilse, Jill Wilson, Deborah Lawson, Angela Pearce, Jeffrey Dunn, Joanne F Aitken, Rachel Feeney, Stephanie Jowett
Objective The aim of the present study was to identify online resources community members may access to inform themselves about their legal duties and rights in end-of-life decision making.Methods Resource mapping identified online resources that members of the public in New South Wales, Victoria and Queensland are likely to identify, and assessed the ease or difficulty in locating them. Resources were then critically analysed for accessibility of language and format using the Patient Education Materials Assessment Tool (PEMAT)...
March 30, 2017: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/28345475/understanding-bladder-management-on-a-palliative-care-unit-a-grounded-theory-study
#16
Iris Gutmanis, Melissa Hay, Joshua Shadd, Janette Byrne, Sarah McCallum, Kristen Bishop, Patricia Whitfield, Cathy Faulds
BACKGROUND: Research regarding factors associated with nursing-initiated changes to bladder management at end-of-life is sparse. OBJECTIVES: To explore the process of Palliative Care Unit (PCU) nurses' approach to bladder management changes. METHODS: Nursing staff from one PCU in London, Canada were interviewed regarding bladder management care practices. A constructivist grounded theory was generated. RESULTS: Four interconnected themes emerged: humanity (compassionate support of patients); journey (making the most of a finite timeline); health condition (illness, functional decline); and context (orders, policies, supplies)...
March 16, 2017: International Journal of Palliative Nursing
https://www.readbyqxmd.com/read/28324205/levels-of-intervention-how-are-they-used-in-quebec-hospitals
#17
Marjolaine Frenette, Jocelyne Saint-Arnaud, Karim Serri
In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called "Levels of Intervention" (LOI). No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of patients who had died in three Quebec hospitals with a LOI ordered...
March 21, 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28314153/sewage-sludge-disposal-strategies-for-sustainable-development
#18
Małgorzata Kacprzak, Ewa Neczaj, Krzysztof Fijałkowski, Anna Grobelak, Anna Grosser, Małgorzata Worwag, Agnieszka Rorat, Helge Brattebo, Åsgeir Almås, Bal Ram Singh
The main objective of the present review is to compare the existing sewage sludge management solutions in terms of their environmental sustainability. The most commonly used strategies, that include treatment and disposal has been favored within the present state-of-art, considering existing legislation (at European and national level), characterization, ecotoxicology, waste management and actual routs used currently in particular European countries. Selected decision making tools, namely End-of-waste criteria and Life Cycle Assessment has been proposed in order to appropriately assess the possible environmental, economic and technical evaluation of different systems...
March 14, 2017: Environmental Research
https://www.readbyqxmd.com/read/28294479/understanding-advance-care-planning-within-the-south-asian-community
#19
Patricia D Biondo, Rashika Kalia, Rooh-Afza Khan, Nadia Asghar, Cyrene Banerjee, Debbie Boulton, Nancy Marlett, Svetlana Shklarov, Jessica E Simon
BACKGROUND: Advance care planning (ACP) is a process of reflection on and communication of a person's future health-care preferences. Evidence suggests visible minorities engage less in ACP. The South Asian ethnic group is the largest visible minority group in Canada, and information is needed to understand how ACP is perceived and how best to approach ACP within this diverse community. OBJECTIVE: To explore perspectives of South Asian community members towards ACP...
March 10, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28277859/impact-of-a-multivariate-serum-based-proteomic-test-on-physician-treatment-recommendations-for-advanced-non-small-cell-lung-cancer
#20
Wallace L Akerley, Alix M Arnaud, Bibas Reddy, Ray D Page
OBJECTIVE: The VeriStrat (1) (VS) test is intended to help guide treatment decisions for patients with advanced non-small-cell lung cancer (NSCLC) without an EGFR-sensitizing mutation, classifying patients into two categories. Patients classified as VSGood have a favorable prognosis and significant clinical response to EGFR tyrosine kinase inhibitors (TKIs). Patients classified as VSPoor have a less favorable prognosis and exhibit no significant response to EGFR-TKIs. The objective of this paper is to assess the real-world impact of VS test results on physicians' treatment recommendations including referrals for best supportive care (BSC)...
March 16, 2017: Current Medical Research and Opinion
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