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Advance care planning, end of life

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https://www.readbyqxmd.com/read/28095941/preparation-for-the-end-of-life-and-life-completion-during-late-stage-lung-cancer-an-exploratory-analysis
#1
Gail Adorno, Cara Wallace
OBJECTIVE: Our aim was to explore preparation for the end of life (EoL) and life closure among persons with advanced metastatic lung cancer. Understanding quality of life through the lens of preparation and completion is important since the trajectory of lung cancer can be relatively short, often leading to application of cancer-directed therapies near death without the opportunity for advance planning or palliative care. Clinical research is needed to understand the kinds of distress specific to older adults with advanced lung cancer that are amendable to palliative care interventions...
January 18, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/28093312/palliative-medicine-and-preparedness-planning-for-patients-receiving-left-ventricular-assist-device-as-destination-therapy-challenges-to-measuring-impact-and-change-in-institutional-culture
#2
Brandon P Verdoorn, Angela J Luckhardt, Sara E Wordingham, Shannon M Dunlay, Keith M Swetz
CONTEXT: While left ventricular assist devices as destination therapy (DT-LVAD) can improve survival, quality of life, and functional capacity in well-selected patients with advanced heart failure, there remain unique challenges to providing quality end-of-life care in this population. Palliative care involvement is universally recommended, but how to best operationalize this care and measure success is unknown. OBJECTIVES: To characterize the process of preparedness planning (PP) for patients receiving DT-LVAD at our institution and better understand opportunities for quality improvement or procedural transferability...
January 13, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28086861/managing-shades-of-grey-a-focus-group-study-exploring-community-dwellers-views-on-advance-care-planning-in-older-people
#3
Natasha Michael, Clare O'Callaghan, Emma Sayers
BACKGROUND: Community-dwelling consumers of healthcare are increasing, many aging with life-limiting conditions and deteriorating cognition. However, few have had advance care planning discussions or completed documentation to ensure future care preferences are acted upon. This study examines the awareness, attitudes, and experiences of advance care planning amongst older people and unrelated offspring/caregivers of older people residing in the community. METHODS: Qualitative descriptive research, which included focus groups with older people (55+ years) and older people's offspring/caregivers living in an Australian city and surrounding rural region...
January 13, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28062341/implementation-and-impact-of-patient-lay-navigator-led-advance-care-planning-conversations
#4
Gabrielle B Rocque, J Nicholas Dionne-Odom, Chao-Hui Sylvia Huang, Soumya J Niranjan, Courtney P Williams, Bradford E Jackson, Karina I Halilova, Kelly M Kenzik, Kerri S Bevis, Audrey S Wallace, Nedra Lisovicz, Richard A Taylor, Maria Pisu, Edward E Partridge, Linda A Briggs, Elizabeth A Kvale
CONTEXT: Advance care planning (ACP) improves alignment between patient preferences for life-sustaining treatment and care received at end of life (EOL). OBJECTIVES: To evaluate implementation of lay navigator-led ACP. METHODS: A convergent, parallel mixed-methods design was employed to evaluate implementation of navigator-led ACP across 12 cancer centers. Data collection included: (1) electronic navigation records, (2) navigator surveys (n=45), (3) claims-based patient outcomes (n=820), and (4) semi-structured navigator interviews (n=26)...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28062337/using-laboratory-test-results-at-hospital-admission-to-predict-short-term-survival-in-critically-ill-patients-with-metastatic-or-advanced-cancer
#5
Lee Cheng, Alma Y DeJesus, Maria A Rodriguez
CONTEXT: Accurately estimating the life expectancy of critically ill patients with metastatic or advanced cancer is a crucial step in planning appropriate palliative or supportive care. OBJECTIVE: We evaluated the results of laboratory tests performed within 2 days of hospital admission to predict the likelihood of death within 14 days. METHODS: We retrospectively selected patients 18 years or older with metastatic or advanced cancer who were admitted to intensive care units or palliative and supportive care services in our hospital...
January 3, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28038509/engaging-college-undergraduates-in-advance-care-planning
#6
Sara Sanders, Erin L Robinson
Advance care planning (ACP) is a critical part of long-term health-care planning, as no one knows when the ability to make personal medical decisions may be impaired. Many assume ACP is only necessary for older adults or those with life-threatening health conditions; however, there are growing discussions about healthy, young adults also engaging in ACP, as they too suffer from unexpected medical events that limit their ability to make medical decisions. The current study examined the reactions of college students following the completion of their advance care plans and then sharing these plans with friends and family...
February 2017: Omega
https://www.readbyqxmd.com/read/28028678/the-effect-of-advance-directive-completion-on-hospital-care-among-chronically-homeless-persons-a-prospective-cohort-study
#7
Alexander K Leung, Matthew J To, Linh Luong, Zahra Syavash Vahabi, Victor L Gonçalves, John Song, Stephen W Hwang
Advance care planning is relevant for homeless individuals because they experience high rates of morbidity and mortality. The impact of advance directive interventions on hospital care of homeless individuals has not been studied. The objective of this study was to determine if homeless individuals who complete an advance directive through a shelter-based intervention are more likely to have information from their advance directive documented and used during subsequent hospitalizations. The advance directive included preferences for life-sustaining treatments, resuscitation, and substitute decision maker(s)...
December 27, 2016: Journal of Urban Health: Bulletin of the New York Academy of Medicine
https://www.readbyqxmd.com/read/28028278/-feasibility-study-of-a-one-day-educational-program-to-train-advance-care-planning-facilitators-acpfs-in-regional-areas
#8
Mitsunori Nishikawa, Hisayuki Miura, Sanae Oya, Tomonari Kato, Hiroyuki Nagae, Yoshiyuki Osada, Tetsuya Watanabe, Sachiko Matsuoka, Yasuro Otsuka, Mie Yamaguchi, Kazuko Watanabe, Katsutoshi Kito, Hatsue Ooi, Naoko Suzuki
Promoting advance care planning in regional areas is important. Education For Implementing End-of-Life Discussion(EFIELD) is a two-day educational program for Advance Care Planning Facilitators(ACPFs)developed by the National Center for Geriatrics and Gerontology. Unfortunately, some trainers experience difficulties implementing the content of the program, and some trainees feel the program is too long for implementation in many regional areas. The purpose of the research is to clarify the feasibility of ACPFs education using a one-day program in regional areas...
December 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
https://www.readbyqxmd.com/read/28012054/licensing-surrogate-decision-makers
#9
Philip M Rosoff
As medical technology continues to improve, more people will live longer lives with multiple chronic illnesses with increasing cumulative debilitation, including cognitive dysfunction. Combined with the aging of society in most developed countries, an ever-growing number of patients will require surrogate decision-makers. While advance care planning by patients still capable of expressing their preferences about medical interventions and end-of-life care can improve the quality and accuracy of surrogate decisions, this is often not the case, not infrequently leading to demands for ineffective, inappropriate and prolonged interventions...
December 23, 2016: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28009643/palliative-care-and-chronic-obstructive-pulmonary-disease-where-the-lines-meet
#10
Sarah E Harrington, Elizabeth Rogers, Megan Davis
PURPOSE OF REVIEW: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is expected to increase as the population ages. Patients have a high symptom burden, low healthcare quality of life, and unmet needs at the end of life. This review highlights specific palliative care needs of patients with advanced COPD and opportunities to integrate palliative care into standard practice. RECENT FINDINGS: There are many barriers to providing integrated palliative care in COPD, including difficulty with prognostication, communication barriers surrounding advance care planning, and lack of access to specialty palliative care...
December 21, 2016: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/28007621/instability-of-willingness-to-accept-life-sustaining-treatments-of-patients-with-advanced-chronic-organ-failure-during-one-year
#11
Carmen H M Houben, Martijn A Spruit, Jos M G A Schols, Emiel F M Wouters, Daisy J A Janssen
BACKGROUND: For optimal end-of-life decision-making, it is important to understand the stability of patients' treatment preferences. The aim of this article is to examine stability of willingness to accept life-sustaining treatments during one-year follow-up in Dutch patients with advanced chronic organ failure. In addition, we want to explore the association between willingness to accept high-burden treatment and preferences for cardiopulmonary resuscitation (CPR) and mechanical ventilation (MV)...
December 19, 2016: Chest
https://www.readbyqxmd.com/read/27989399/the-long-term-impact-of-an-end-of-life-communication-intervention-among-veterans-with-copd
#12
Lynn F Reinke, Laura C Feemster, Jennifer McDowell, Eric Gunnink, Erica V Tartaglione, Edmunds Udris, J Randall Curtis, David H Au
OBJECTIVE: To assess if an end-of-life communication intervention with patients with COPD led to higher long-term documentation of advance care planning discussions at the end-of-life. BACKGROUND: We previously demonstrated that providing clinicians a patient-specific feedback form about patients' communication preferences improved the occurrence and quality of clinician communication about end-of-life care. METHODS: Among those individuals enrolled in the intervention study (2004-2007) who had died during the follow-up period (up to 2013), we assessed if patients in the intervention arm had more goals of care discussions and formal advance directives completed as compared to controls...
January 2017: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/27987411/preconditions-for-successful-advance-care-planning-in-nursing-homes-a-systematic-review
#13
REVIEW
Joni Gilissen, Lara Pivodic, Tinne Smets, Chris Gastmans, Robert Vander Stichele, Luc Deliens, Lieve Van den Block
OBJECTIVES: There is growing evidence of the potential effectiveness of advance care planning. Yet important knowledge gaps remain regarding the preconditions for successful implementation of advance care planning in the nursing home setting. We aim to identify the preconditions related to successful advance care planning in the nursing home setting. By specifying those, we would be able to make well-founded choices for the future design and planning of advance care planning intervention programs...
December 8, 2016: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/27976624/palliative-care-for-dementia-patients
#14
France Hirot
Dementia is a life-limiting disease without curative treatments but the data suggest that advanced dementia is not viewed as a terminal diagnosis by physicians. Although symptoms of dementia and cancer patients are similar, palliative care is less frequently proposed for dementia patients. However, professionals and family members of demented patients strongly favor comfort care for end-stage dementia. To improve the patients' relief near the end of life, advance care planning with patients and their proxies should be encouraged...
December 1, 2016: GĂ©riatrie et Psychologie Neuropsychiatrie du Vieillissement
https://www.readbyqxmd.com/read/27943487/a-comparison-of-attitudes-toward-length-and-quality-of-life-between-community-dwelling-older-adults-and-patients-with-advanced-cancer
#15
Chetna Malhotra, Ling Xiang, Semra Ozdemir, Ravindran Kanesvaran, Noreen Chan, Eric Andrew Finkelstein
OBJECTIVE: Applying prospect theory to end-of-life (EOL) decision-making, we hypothesize that community dwelling older adults (CDOAs) will be relatively less inclined towards extending length over improving quality of life compared to patients. We also hypothesize that differences in relative inclination for length over quality of life between the two groups will decrease with advancing age. METHODS: We tested these hypotheses by administering the Quality-Quantity questionnaire to 1067 CDOAs and 320 stage IV cancer patients and applying a linear regression model to assess whether relative inclination for length over quality of life, as estimated by the questionnaire, differed between CDOAs and patients after controlling for differences in socio-demographic characteristics...
December 10, 2016: Psycho-oncology
https://www.readbyqxmd.com/read/27927735/-just-let-me-go-end-of-life-planning-among-ojibwe-elders
#16
Mary Kate Dennis, Karla T Washington
PURPOSE OF THE STUDY: Although advance care planning (ACP) is designed to promote person-centered end-of-life care, the principles underpinning it are at odds with the values and norms of many American Indian/Alaska Native (AI/AN) communities, contributing to low rates of ACP among AI/AN elders. The purpose of this study was to explore the apparent tension between Western approaches to end-of-life care, including its emphasis on ACP, and the expectations and wishes of one community of AI elders, in hopes of informing more culturally appropriate approaches to planning for end-of-life care...
December 7, 2016: Gerontologist
https://www.readbyqxmd.com/read/27916344/advance-care-discussions-with-young-people-affected-by-life-limiting-neuromuscular-diseases-a-systematic-literature-review-and-narrative-synthesis
#17
Andy Hiscock, Isla Kuhn, Stephen Barclay
End of life care policy in the UK advocates open discussions between health professionals and patients as the end of life approaches. Despite well documented understanding of the progression of life-limiting neuromuscular diseases, the majority of patients affected by such conditions die without a formal end of life plan in place. We performed a systematic review to investigate conversations regarding end of life care between healthcare professionals and younger adult patients with life-limiting neuromuscular diseases...
November 21, 2016: Neuromuscular Disorders: NMD
https://www.readbyqxmd.com/read/27915265/the-ethics-of-unilateral-implantable-cardioverter-defibrillators-and-cardiac-resynchronization-therapy-with-defibrillator-deactivation-patient-perspectives
#18
Margaret Daeschler, Ralph J Verdino, James N Kirkpatrick
AIMS: Decisions about deactivation of implantable cardioverter defibrillators (ICDs) are complicated. Unilateral do-not-resuscitate (DNR) orders (against patient/family wishes) have been ethically justified in cases of medical futility. Unilateral deactivation of ICDs may be seen as a logical extension of a unilateral DNR order. However, the ethical implications of unilateral ICD deactivation have not been explored. METHODS AND RESULTS: Sixty patients who had an ICD or cardiac resynchronization therapy with defibrillator (CRT-D) were interviewed at a quaternary medical centre outpatient electrophysiology practice...
December 2, 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/27911489/palliative-care-interventions-in-advanced-dementia
#19
REVIEW
Edel Murphy, Katherine Froggatt, Sheelah Connolly, Eamon O'Shea, Elizabeth L Sampson, Dympna Casey, Declan Devane
BACKGROUND: Dementia is a chronic, progressive and ultimately fatal neurodegenerative disease. Advanced dementia is characterised by profound cognitive impairment, inability to communicate verbally and complete functional dependence. Usual care of people with advanced dementia is not underpinned universally by a palliative approach. Palliative care has focused traditionally on care of people with cancer but for more than a decade, there have been increased calls worldwide to extend palliative care services to include all people with life-limiting illnesses in need of specialist care, including people with dementia...
2, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27909034/advance-care-planning-in-patients-with-incurable-cancer-study-protocol-for-a-randomised-controlled-trial
#20
Stephanie Johnson, Josephine Clayton, Phyllis N Butow, William Silvester, Karen Detering, Jane Hall, Belinda E Kiely, Jonathon Cebon, Stephen Clarke, Melanie L Bell, Martin Stockler, Phillip Beale, Martin H N Tattersall
INTRODUCTION: There is limited evidence documenting the effectiveness of Advance Care Planning (ACP) in cancer care. The present randomised trial is designed to evaluate whether the administration of formal ACP improves compliance with patients' end-of-life (EOL) wishes and patient and family satisfaction with care. METHODS AND ANALYSIS: A randomised control trial in eight oncology centres across New South Wales and Victoria, Australia, is designed to assess the efficacy of a formal ACP intervention for patients with cancer...
December 1, 2016: BMJ Open
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