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Decision making at the end of life

Fiona Ma MacCormick, Charlotte Emmett, Paul Paes, Julian C Hughes
BACKGROUND: Concerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking. AIM: To analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors. DESIGN: The data presented in this paper were collected as part of a wider research study of end-of-life care in an acute hospital setting...
March 9, 2018: Journal of Medical Ethics
Andrea Postier, Kris Catrine, Stacy Remke
Little is known about the role of pediatric palliative care (PPC) programs in providing support for home compassionate extubation (HCE) when families choose to spend their child's end of life at home. Two cases are presented that highlight the ways in which the involvement of PPC teams can help to make the option available, help ensure continuity of family-centered care between hospital and home, and promote the availability of psychosocial support for the child and their entire family, health care team members, and community...
March 7, 2018: Children
Caitlin Richardson-Royer, Imran Naqvi, Christopher Riffel, Lawrence Harvey, Domonique Smith, Dagmawe Ayalew, Nasim Motayar, Yaw Amoateng-Adjepong, Constantine A Manthous
Background: Previous studies have demonstrated that video of and scripted information about cardiopulmonary resuscitation (CPR) can be deployed during clinician-patient end-of-life discussions. Few studies, however, examine whether video adds to verbal information-sharing. We hypothesized that video augments script-only decision-making. Methods: Patients aged >65 years admitted to hospital wards were randomized to receive evidence-based information ("script") vs...
2018: International Journal of General Medicine
Simon M Cohen, Renee C Maciejewski, Manish A Shah, Kelly M Trevino, Megan J Shen, Paul K Maciejewski, Holly G Prigerson
Realistic illness understanding is essential to an advanced cancer patient's ability to make informed medical decisions at the end of life. This study sought to determine whether advanced cancer patients better understood the late stage of their cancer if an oncologist, compared to other members of the care team, was present to discuss their scan results. Data were derived from a multi-institutional, longitudinal cohort study of patients recruited between 2010 and 2015. Patients (n = 209) with late-stage cancers (metastatic cancers that progressed after at least one chemotherapy regimen) were interviewed before and after clinic visits in which scan results were discussed...
February 26, 2018: Cancer Medicine
Hans Ulrich Bucher, Sabine D Klein, Manya J Hendriks, Ruth Baumann-Hölzle, Thomas M Berger, Jürg C Streuli, Jean-Claude Fauchère
BACKGROUND: In the last 20 years, the chances for intact survival for extremely preterm infants have increased in high income countries. Decisions about withholding or withdrawing intensive care remain a major challenge in infants born at the limits of viability. Shared decision-making regarding these fragile infants between health care professionals and parents has become the preferred model today. However, there is an ongoing ethical debate on how decisions regarding life-sustaining treatment should be reached and who should have the final word when health care professionals and parents do not agree...
February 22, 2018: BMC Pediatrics
Kelsey Watt, Matthew P Kirschen, Joel A Friedlander
OBJECTIVES: Pediatric ethical consultation services (ECSs) have been proliferating at medical centers, with little data available on evaluating their implementation. The objective of this study was to evaluate the pediatric ECS and understand the ethical issues occurring within a single quaternary-level pediatric hospital. METHODS: A retrospective chart review of documented ethics consultations at a large pediatric hospital from November 2010 to November 2013 was performed and data was abstracted per the US Department of Veterans Affairs' Domains of Ethics in Health Care...
March 2018: Hospital Pediatrics
P Zaoui, T Hannedouche, C Combe
Type 2 diabetes has an increasing prevalence. Life expectancy is dominated by cardiovascular risk, which is the leading cause of death in these patients. Up to one third of diabetic patients will develop diabetic nephropathy related to micro-angiopathy. Renal impairment further increases cardiovascular risk. Reducing cardiovascular morbidity and mortality is a major public health issue, as well as early preventing and managing chronic kidney disease (CKD). Good glycemic control prevents the micro-vascular complications of the disease (retinopathy, nephropathy, etc...
June 2017: Néphrologie & Thérapeutique
Corinna Porteri
BACKGROUND: The proposal of the new criteria for the diagnosis of Alzheimer's disease (AD) based on biomarker data is making possible a diagnosis of AD at the mild cognitive impairment (MCI) or predementia/prodromal- stage. Given the present lack of effective treatments for AD, the opportunity for the individuals to personally take relevant decisions and plan for their future before and if cognitive deterioration occurs is one the main advantages of an early diagnosis. MAIN BODY: Advance directives are largely seen as an effective tool for planning medical care in the event the subject becomes incompetent...
February 20, 2018: BMC Medical Ethics
Katsiaryna Laryionava, Timo A Pfeil, Mareike Dietrich, Stella Reiter-Theil, Wolfgang Hiddemann, Eva C Winkler
BACKGROUND: Family members are important companions of severely ill patients with cancer. However, studies about the desirability and difficulties of integrating relatives in the decision-making process are rare in oncology. This qualitative study explores the family role in decisions to limit treatment near the end of life from the professionals' point of view. METHODS: Qualitative in-depth interviews were conducted with oncologists (n = 12) and nurses (n = 6) working at the Department of Hematology/Oncology at the University Hospital in Munich, Germany...
February 17, 2018: BMC Palliative Care
Yi Lin Lee, Yee Yian Ong, Sze Ying Thong, Shin Yi Ng
Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU). The practice of approaching end-of-life (EOL) care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU). The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process...
January 2018: Indian Journal of Palliative Care
Phil McEwan, Hayley Bennett Wilton, Albert C M Ong, Bjarne Ørskov, Richard Sandford, Francesco Scolari, Maria-Cristina V Cabrera, Gerd Walz, Karl O'Reilly, Paul Robinson
BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the leading inheritable cause of end-stage renal disease (ESRD); however, the natural course of disease progression is heterogeneous between patients. This study aimed to develop a natural history model of ADPKD that predicted progression rates and long-term outcomes in patients with differing baseline characteristics. METHODS: The ADPKD Outcomes Model (ADPKD-OM) was developed using available patient-level data from the placebo arm of the Tolvaptan Efficacy and Safety in Management of ADPKD and its Outcomes Study (TEMPO 3:4; ClinicalTrials...
February 13, 2018: BMC Nephrology
Catherine Millington-Sanders
Proactive, shared decision making between key professionals and sensitive communication with patients, and those important to them, can never be overestimated. Projected annual deaths in England and Wales are set to rise, highlighting the increasing need for high quality palliative and end-of-life care. The Royal College of General Practitioners and Marie Curie have worked in partnership to develop the Daffodil Standards, an evidenced-based, structured approach for practices using quality improvement methodology to help improve care for patients at an advanced stage of serious illness or approaching end of life...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Christopher E Gaw, Keith W Hamilton, Jeffrey S Gerber, Julia E Szymczak
BACKGROUND The decision to utilize antimicrobials in end-of-life situations is complex. Understanding the reasons why physicians prescribe antimicrobials in this patient population is important for informing the design of antimicrobial stewardship interventions. METHODS A 51-item survey containing both closed and open-ended questions on end-of-life antimicrobial use was administered to physicians affiliated with the University of Pennsylvania and Children's Hospital of Philadelphia from January through April 2017...
February 12, 2018: Infection Control and Hospital Epidemiology
Jhosselini Cardenas, Pamela Infante, Abel Infante, Elizabeth Chuang, Peter Selwyn
Hispanic Americans are among the fastest growing minority groups in the USA, and understanding their preferences for medical decision-making and information sharing is imperative to provide high quality end of life care. Studies exploring these decision control preferences (DCPs) are limited and found inconsistent results. (1) To measure DCPs of Hispanic patients in the Bronx. (2) To measure disclosure of information preferences of Hispanic patients in the Bronx. This is a cross-sectional survey. One hundred nineteen cancer patients who self-identified as Hispanic and were waiting at the oncology clinic at Montefiore Medical Center Cancer Center...
February 9, 2018: Journal of Cancer Education: the Official Journal of the American Association for Cancer Education
Emily Hammad Mrig, Karen Lutfey Spencer
A growing body of social science literature is devoted to describing processes of biomedicalization. The issue of biomedicalization is especially relevant for individuals suffering from end-stage cancer and hoping that aggressive end-of-life interventions, which are riddled with uncertainty around quantity or quality of life, will produce a 'cure'. To examine hospice underutilization among end-stage cancer patients, we apply the anthropological concept 'political economy of hope,' which describes how personal and collective 'hope' is associated with the political and economic structures that produce biomedicalization processes...
January 27, 2018: Social Science & Medicine
Jun Wan, Shiping Xu, Yinqiao Wu, Benyan Wu, Dezhong Joshua Liao, Ningzhi Xu, Gangshi Wang
Treatment and management of cancers in elderly patients require some special considerations. A better understanding of how cancers progress in those elderly patients who have not received any anticancer treatments could better help us in treating these patients and in making end-of-life decisions. Over the past years, we had encountered 57 elderly patients, aged 75 to 94 years (87.6 on average), with a cancer in the digestive system, who refused to accept anticancer treatment but who did receive the best available supportive and palliative care...
February 7, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Fyeza Hasan, Kevin Weingarten, Adam Rapoport, Eric Bouffet, Ute Bartels
The end-of-life management of children with diffuse intrinsic pontine glioma (DIPG) is challenging. Families cope with debilitating symptoms and make complex decisions regarding their child's care. However, there is little evidence guiding palliative care provision for these children. Our objective was to describe the dying trajectory of children with DIPG, their symptoms, the care they require and the end-of-life decisions made for them. This retrospective cohort study analyzed the end-of-life care of 41 consecutive patients with DIPG who died between January 2001 and June 2010...
February 3, 2018: Journal of Neuro-oncology
Clare MacMartin, Hannah C Wheat, Jason B Coe, Cindy L Adams
Nutritional changes recommended by veterinarians to clients can have a major role in animal-patient health. Although there is literature on best practices that can inform veterinary communication training, little is known specifically about how veterinarians communicate their recommendations to clients in real-life interactions. This study used the qualitative research method of conversation analysis to investigate the form and content of veterinarian-initiated proposals for long-term dietary change in canine and feline patients to further inform veterinary communication training...
February 2, 2018: Journal of Veterinary Medical Education
Tracy P George, Claire DeCristofaro, Pamela F Murphy, Corey R Remle
BACKGROUND: End-of-life decision making can be distressing for nursing students, and the purpose of this investigation was to assess undergraduate nursing students' knowledge, attitudes, and experiences with advance directives. METHOD: One hundred sixty-six Bachelor of Science in Nursing students at four different program levels were surveyed about their knowledge, personal and professional experience, and personal and professional attitudes regarding advance directives...
January 1, 2018: Journal of Nursing Education
Su-Ching Kuo, Pi-Ling Chou, Yu-Chien Liao, Yun-Fang Chen, Ju-Fen Cheng, Jia-Ling Sun
This study investigates the subjective experiences of terminal cancer patients who expedite their corneal donation decisions. The percentage of cancer patients who donate their corneas postmortem is low in Taiwan. The reasons are complex and needs further exploration. A qualitative design using content analysis was used. A semistructured interview approach was adopted to interview cancer patients recruited from a cancer ward in northern Taiwan. The study findings show that the factors contributing to an aversive preference of cancer patients included the necessity to consider the emotions of family members, traditional perceptions, religious reasons, disease, and no reason at all...
January 1, 2018: Omega
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