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Decision making at the end of life

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https://www.readbyqxmd.com/read/29327100/-provision-of-palliative-care-for-people-with-advanced-dementia
#1
REVIEW
J Diehl-Schmid, L Riedl, U Rüsing, J Hartmann, M Bertok, C Levin, J Hamann, M Arcand, S Lorenzl, B Feddersen, R J Jox
As a result of a literature-based expert process, this review provides an overview about the principles of palliative care for people with advanced dementia that are relevant for clinical practice. In particular, the indications, impact and aims of palliative care for advanced dementia are described. Life-prolonging measures and management of symptoms at the end of life are discussed. Furthermore, the overview focuses on the legal basis of decision making.
January 11, 2018: Der Nervenarzt
https://www.readbyqxmd.com/read/29310641/health-services-research-in-patients-with-breast-cancer-camiss-prospective-study-protocol-for-an-observational-prospective-study
#2
Susana García-Gutierrez, Miren Orive, Cristina Sarasqueta, Maria Jose Legarreta, Nerea Gonzalez, Maximino Redondo, Amado Rivero, Pedro Serrano-Aguilar, Xavier Castells, Jose Maria Quintana, Maria Sala
BACKGROUND: Though breast cancer remains a major health problem, there is a lack of information on health care provided to patients with this disease and associated costs. In addition, there is a need to update and validate risk stratification tools in Spain. Our purpose is to evaluate the health services provided for breast cancer in Spain, from screening and diagnosis to treatment and prognosis. METHODS: Prospective cohort study involving 13 hospitals in Spain with a follow-up period of up to 5 years after diagnostic biopsy...
January 8, 2018: BMC Cancer
https://www.readbyqxmd.com/read/29301555/improving-partnerships-with-family-members-of-icu-patients-study-protocol-for-a-randomized-controlled-trial
#3
Daren K Heyland, Judy Davidson, Yoanna Skrobik, Amanda Roze des Ordons, Lauren J Van Scoy, Andrew G Day, Virginia Vandall-Walker, Andrea P Marshall
BACKGROUND: Over the last decade, health care delivery has shifted to partnering with patients and their families to improve health and quality of care, and to lower costs. Partnering with family members (FMs) of critically ill patients who lack capacity is particularly important for improving experiences and outcomes for both patients and FMs. How best to apply such partnering strategies, however, is yet unknown. The IMPACT trial will evaluate two interventions that enable partnerships with families of critically ill patients, each in a distinct content area, but similar in that they empower and support FMs...
January 4, 2018: Trials
https://www.readbyqxmd.com/read/29298626/systemic-anticancer-therapy-in-the-last-30-days-of-life-retrospective-audit-from-an-australian-regional-cancer-centre
#4
Peter J Gilbar, Ian McPherson, Genevieve G Aisthorpe, Srinivas Kondalsamy-Chennakes
Background Cessation of chemotherapy at an appropriate time is an important component of good quality palliative care. Published studies looking at administration of chemotherapy at the end of life vary widely. Objective To retrospectively determine the rate of death occurring within 14 and 30 days of chemotherapy and use this to benchmark against other cancer centres as a quality of care measure. Method All adult patients who received systemic anticancer therapy for solid tumours and haematological malignancies at an Australian Regional Cancer Centre between 2011 and 2015 were included...
January 1, 2018: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/29297900/-talking-about-unspeakable-insights-from-patient-centered-medicine-to-palliative-paternalism
#5
Silvia Maria Luisa Del Negro, Lidia Borghi, Daris Ferrari, Elena Vegni
The literature highlights the importance of involving the patient as a partner of care, using a patient-centered approach aimed at improving a process of share decision-making. However, there are clinical situations in which a shared decision-making process is difficult and its actual achievement is even more complex, as in the case of end-of-life decisions, in which a decision about death is a tremendous weight for both patients and their caregivers. In such situations, we wonder what kind of position physicians should assume in order to be patient-centered but also to reduce the patient suffering...
December 2017: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29297392/summary-findings-from-a-mixed-methods-study-on-identifying-and-responding-to-maternal-and-newborn-illness-in-seven-countries-implications-for-programs
#6
Danielle Charlet, Allisyn C Moran, Supriya Madhavan
BACKGROUND: There is a lack of systematic information documenting recognition of potentially life-threatening complications and decisions to seek care, as well as reaching care and the specific steps in that process. In response to this gap in knowledge, a multi-country mixed methods study was conducted to illuminate the dynamics driving Delays 1 and 2 across seven countries for maternal and newborn illness and death. METHODS: A common protocol and tools were developed, adapted by each of seven study teams depending on their local context (Ethiopia, India, Indonesia, Nigeria, Tanzania, Uganda, and Nepal)...
December 21, 2017: Journal of Health, Population, and Nutrition
https://www.readbyqxmd.com/read/29291585/quality-of-dying-and-death-in-the-icu-the-euroq2-project
#7
Rik T Gerritsen, Hanne Irene Jensen, Matty Koopmans, J Randall Curtis, Lois Downey, Jose G M Hofhuis, Ruth A Engelberg, Peter E Spronk, Jan G Zijlstra
PURPOSE: Knowledge of families' perspective of quality of intensive care unit (ICU) care is important, especially with regard to end-of-life (EOL) care. Adaptation of the US-developed "Quality of dying and death questionnaire" (QODD) to a European setting is lacking. The primary aim of this study is to examine the euroQODD's usability and its assessments of EOL care in a cohort of Danish and Dutch family members. METHODS: Family members of patients dying in an ICU after a stay of at least 48h were sent the euroQODD three weeks after the patient died...
December 26, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29288287/a-contemporary-paradigm-integrating-spirituality-in-advance-care-planning
#8
Katie Lutz, Stefan R Rowniak, Prabjot Sandhu
In the 25 years since advance care planning first drew the attention of the national healthcare and legal systems, gains in the rate of advance care directive completion have been negligible despite the effort of researchers, ethicists, and lawmakers. With the benefit of sophisticated healthcare technology, patients are living longer. Despite the benefits of increased longevity, it is widely acknowledged that enough has not been done to adequately address end-of-life care decisions at the crossroads between medical futility and quality of life...
December 29, 2017: Journal of Religion and Health
https://www.readbyqxmd.com/read/29287691/protocol-for-the-assessment-of-patient-capacity-to-make-end-of-life-treatment-decisions
#9
Richard B Stuart, Stephen Thielke
Patients' right to decide what happens to their bodies, especially around the end of life, is enshrined in legislation across the world, but questions often arise about whether a patient is capable of meaningfully participating in such decisions. Because of uncertainties about capacity, care providers and administrative agencies often must decide whether to honor, or even to elicit, patients' wishes. General decision-making capacity has been well studied, but few clear protocols exist for ascertaining capacity at the end of life...
December 26, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/29283867/the-impact-of-public-health-awareness-campaigns-on-the-awareness-and-quality-of-palliative-care
#10
Jane Seymour
OBJECTIVE: The right to health includes a right of access to good quality palliative care, but inequalities persist. Raising awareness is a key plank of the public health approach to palliative care, but involves consideration of subjects most of us prefer not to address. This review addresses the question: "do public health awareness campaigns effectively improve the awareness and quality of palliative care"? BACKGROUND: The evidence shows that public awareness campaigns can improve awareness of palliative care and probably improve quality of care, but there is a lack of evidence about the latter...
January 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29261591/examining-racial-disparities-in-the-time-to-withdrawal-of-life-sustaining-treatment-in-trauma
#11
Melissa A Hornor, James P Byrne, Kathryn E Engelhardt, Avery B Nathens
INTRODUCTION: Racial disparities in medical treatment for seriously injured patients across the spectrum of care are well established, but racial disparities in end of life decision-making practices have not been well described. When time from admission to time to withdrawal of life-sustaining treatment (WLST) increases, so does the potential for ineffective care, healthcare resource loss, and patient and family suffering. We sought to determine the existence and extent of racial disparities in late WLST after severe injury...
December 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29258492/oncology-nurses-perceptions-of-obstacles-and-role-at-the-end-of-life-care-cross-sectional-survey
#12
Aurelija Blaževičienė, Jamesetta A Newland, Vilija Čivinskienė, Renea L Beckstrand
BACKGROUND: Major obstacles exist in the care of patients at the end of life: lack of time, poor or inadequate communication, and lack of knowledge in providing care. Three possible nursing roles in care decision-making were investigated: Information Broker, Supporter, and Advocate. The purpose of this study was to examine obstacles faced by oncology nurses in providing end-of-life (EOL) care and to examine roles of nurses in providing care. METHODS: A descriptive, cross-sectional, correlational design was applied...
December 19, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29240011/fecal-calprotectin-test-performed-at-home-a-prospective-study-of-pediatric-patients-with-inflammatory-bowel-disease
#13
Maija Piekkala, Henrik Alfthan, Laura Merras-Salmio, Anne Puustinen Wikström, Kaarina Heiskanen, Tytti Jaakkola, Paula Klemetti, Martti Färkkilä, Kaija-Leena Kolho
OBJECTIVES: Measuring fecal calprotectin (FC) in a laboratory is time-consuming and that is why home tests have been developed. We studied the use of an FC home test in pediatric patients with inflammatory bowel disease (PIBD) in real-life settings. METHODS: The patients were asked to perform the IBDoc® FC home test monthly for six months and to report their clinical disease activity at testing. However, clinical decision-making was guided by routine FC enzyme-linked immunosorbent assay (ELISA) for patients with raised IBDoc® values...
December 12, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/29221845/characterizing-the-role-of-u-s-surgeons-in-the-provision-of-palliative-care-a-systematic-review-and-mixed-methods-meta-synthesis
#14
REVIEW
Pasithorn A Suwanabol, Arielle E Kanters, Ari C Reichstein, Lauren M Wancata, Lesly A Dossett, Emily B Rivet, Maria J Silveira, Arden M Morris
CONTEXT: The provision of palliative care varies appropriately by clinical factors such as patient age and severity of disease, but also varies by provider practice and specialty. Surgical patients are persistently less likely to receive palliative care than their medical counterparts for reasons that aren't clear. OBJECTIVES: We sought to characterize surgeon-specific determinants of palliative care in seriously-ill and dying patients. METHODS: We performed a systematic review of the literature focused on surgery and palliative care within PubMed, CINHAL, EMBASE, Scopus, and Ovid Medline databases from January 1, 2000 through December 31, 2016 according to PRISMA guidelines...
December 5, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29199905/potentially-inappropriate-medication-in-primary-care-at-the-end-of-life-a-mixed-method-study
#15
Peter Pype, Fien Mertens, Fleur Helewaut, Bert D'Hulster, An De Sutter
CONTEXT: Polypharmacy results in adverse drug interactions, high pill burden, and medication costs. Stopping or diminishing potentially inappropriate medication (PIM), is complex . Data on the use of PIM in a primary care context are scarce and deprescribing barriers for general practitioners (GP) are underexplored. OBJECTIVE: Describing the use of PIM in primary care at the end of life, and exploring the barriers for GPs to deprescribe. METHODS: Retrospective chart review of 210 consecutive patients referred to a palliative home care service and semi-structured interviews with 11 GPs...
December 4, 2017: Acta Clinica Belgica
https://www.readbyqxmd.com/read/29191724/moral-distress-at-the-end-of-a-life-when-family-and-clinicians-do-not-agree-on-implantable-cardioverter-defibrillator-deactivation
#16
Jill M Steiner, Kristen K Patton, Jordan M Prutkin, James N Kirkpatrick
A 63-year-old man with end-stage ischemic cardiomyopathy presented with incessant ventricular tachycardia. He had been hospitalized multiple times in the past year for severe heart failure. As he approached end of life and was regularly receiving defibrillator shocks, his care team recommended deactivation of his implantable cardioverter-defibrillator. However, his family did not wish to allow deactivation, reporting a religious obligation to prolong his life, regardless of the risk of suffering. The patient was unable to adequately participate in the decision-making process...
November 28, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29191185/compassionate-collaborative-care-an-integrative-review-of-quality-indicators-in-end-of-life-care
#17
Kathryn Pfaff, Adelais Markaki
BACKGROUND: Compassion and collaborative practice are individually associated with high quality healthcare. When combined in a compassionate collaborative care (CCC) practice framework, they are reported to improve health, strengthen care provision, and control health costs. Little is known about how to integrate and measure CCC, yet it is fundamentally applied in palliative and end-of-life care settings. This study aimed to identify quality indicators of CCC by systematically reviewing and synthesizing the current state of the palliative and end-of-life care literature...
December 1, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29191183/an-economic-model-of-advance-care-planning-in-australia-a-cost-effective-way-to-respect-patient-choice
#18
Kim-Huong Nguyen, Marcus Sellars, Meera Agar, Sue Kurrle, Adele Kelly, Tracy Comans
BACKGROUND: Advance care planning (ACP) is a process of planning for future health and personal care. A person's values and preferences are made known so that they can guide decision making at a future time when that person cannot make or communicate his or her decisions. This is particularly relevant for people with dementia because their ability to make decisions progressively deteriorates over time. This study aims to evaluate the cost-effectiveness of delivering a nationwide ACP program within the Australian primary care setting...
December 1, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/29179708/comparing-doctors-legal-compliance-across-three-australian-states-for-decisions-whether-to-withhold-or-withdraw-life-sustaining-medical-treatment-does-different-law-lead-to-different-decisions
#19
Ben P White, Lindy Willmott, Colleen Cartwright, Malcolm Parker, Gail Williams, Juliet Davis
BACKGROUND: Law purports to regulate end-of-life care but its role in decision-making by doctors is not clear. This paper, which is part of a three-year study into the role of law in medical practice at the end of life, investigates whether law affects doctors' decision-making. In particular, it considers whether the fact that the law differs across Australia's three largest states - New South Wales (NSW), Victoria and Queensland - leads to doctors making different decisions about withholding and withdrawing life-sustaining treatment from adults who lack capacity...
November 28, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/29173831/an-exploration-of-medical-emergency-team-intervention-at-the-end-of-life-for-people-with-advanced-cancer
#20
Christine Brown, Allison Drosdowsky, Meinir Krishnasamy
PURPOSE: Recent advances in cancer therapies offer survival benefit when cure is no longer possible. The contribution of the Medical Emergency Teams (METs) in the context of advancing disease has received little empirical consideration. This study set out to explore MET intervention at the end of life for people with advanced cancer in an Australian comprehensive cancer centre, and its impact on quality of death. METHOD: A retrospective medical chart review was undertaken to explore MET response for people with advanced (incurable) cancer nearing end of life...
December 2017: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
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