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Advance care planning, end of life

Kip Waite, Jane Rhule, David Bush, Barry Meisenberg
We undertook a retrospective review of a subset of expired patients at our community hospital to evaluate end-of-life care patterns and the use of advanced care planning tools among patients who died in the hospital. These 162 expired patients fell into 1 of the 3 diagnosis-related groups of cardiac, respiratory, or infectious disease. Seventy-nine percent of patients arrived to the hospital with no requested limitations in the extent of resuscitative efforts, even though 98% of all patients had major or extreme severity of illness and risk of mortality scores...
October 11, 2016: American Journal of Hospice & Palliative Care
Kaisa Rajala, Juho T Lehto, M Saarinen, E Sutinen, T Saarto, M Myllärniemi
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease with median survival from 2 to 7 years. Palliative care is an important part of patients´ care as lung transplantation is not an option for the majority of patients. The aim of this study was to describe treatment practices, decision-making and symptoms during end-of-life care of IPF patients. METHODS: We identified 59 deceased patients from a national prospective IPF cohort study (FinnishIPF) and analyzed retrospectively their health care documentation during the 6 months that preceded death...
October 12, 2016: BMC Palliative Care
F J Erbguth, L Erbguth
End-of-life decisions in neurology have repeatedly given occasion for controversies. Often these are based on lack of knowledge of the juridical and ethical framework conditions. This review describes the juridical-ethical basis for the implementation and continuation, and for withholding and withdrawal of life-sustaining measures, in particular, the significance of medical indication and patient's will. The different forms of assisted dying ("Sterbehilfe"), namely homicide by request, assisted suicide, palliative symptom relief and treatment withdrawal are characterized...
September 2016: Deutsche Medizinische Wochenschrift
Emma Beecham, Linda Oostendorp, Joanna Crocker, Paula Kelly, Andrew Dinsdale, June Hemsley, Jessica Russell, Louise Jones, Myra Bluebond-Langner
BACKGROUND: Early engagement in advance care planning (ACP) is seen as fundamental for ensuring the highest standard of care for children and young people with a life-limiting condition (LLC). However, most families have little knowledge or experience of ACP. OBJECTIVE: To investigate how parents of children and young people with LLCs approach and experience ACP. METHODS: Open-ended, semi-structured interviews were conducted with parents of 18 children; nine children who were currently receiving palliative care services, and nine children who had received palliative care and died...
September 26, 2016: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
Alice Travers, Vanessa Taylor
INTRODUCTION: Improving end of life care is a national imperative. Unsatisfactory care persists particularly in acute hospitals, with shortcomings, variability in communication and advance care planning identified as fundamental issues. This review explored the literature to identify what is known about the barriers to initiating end-of-life conversations with patients from the perspective of doctors and nurses in the acute hospital setting. METHOD: Six electronic databases were searched for potentially relevant records published between 2008 and 2015...
September 2, 2016: International Journal of Palliative Nursing
Lauren Jodi Van Scoy, Jean M Reading, Allison M Scott, Cynthia Chuang, Benjamin H Levi, Michael J Green
CONTEXT: Substantive discussions between loved ones are necessary for effective advance care planning. Although multiple tools are currently in use for promoting conversations, the content and clinical relevance of the conversations they stimulate is unknown. OBJECTIVE: To describe the content and clinical relevance of conversations that occur during a nonfacilitated end-of-life conversation game. METHODS: Using convenience sampling, we scheduled adult volunteers to participate in an end-of-life conversation game (2-6 individuals per game; n = 68)...
September 17, 2016: Journal of Pain and Symptom Management
Mila Petrova, Julia Riley, Julian Abel, Stephen Barclay
BACKGROUND: Electronic Palliative Care Coordination Systems (EPaCCS) are England's pre-eminent initiative in enabling advance care planning and improved communication and coordination at the end of life. EPaCCS have been under development for 8 years after being proposed, as Locality Registers, in the 2008 End of Life Care Strategy for England. EPaCCS are electronic registers or tools and processes for sharing data which aim to enable access to information about dying patients. Striking outcomes have been reported around EPaCCS, such as 77...
September 16, 2016: BMJ Supportive & Palliative Care
Ciara McGlade, Edel Daly, Joan McCarthy, Nicola Cornally, Elizabeth Weathers, Rónán O'Caoimh, D William Molloy
BACKGROUND: A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. RESEARCH AIM: To identify challenges in implementing the 'Let Me Decide' advance care planning programme in long-term-care. RESEARCH DESIGN: This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families...
September 16, 2016: Nursing Ethics
Sean M Bagshaw, Dawn Opgenorth, Melissa Potestio, Stephanie E Hastings, Shelanne L Hepp, Elaine Gilfoyle, David McKinlay, Paul Boucher, Michael Meier, Jeanna Parsons-Leigh, R T Noel Gibney, David A Zygun, Henry T Stelfox
OBJECTIVES: Discrepancy in the supply-demand relationship for critical care services precipitates a strain on ICU capacity. Strain can lead to suboptimal quality of care and burnout among providers and contribute to inefficient health resource utilization. We engaged interprofessional healthcare providers to explore their perceptions of the sources, impact, and strategies to manage capacity strain. DESIGN: Qualitative study using a conventional thematic analysis...
September 15, 2016: Critical Care Medicine
Timothy F Platts-Mills, Natalie L Richmond, Eric M LeFebvre, Sowmya A Mangipudi, Allison G Hollowell, Debbie Travers, Kevin Biese, Laura C Hanson, Angelo E Volandes
INTRODUCTION: Increasing advance care planning (ACP) among older adults is a national priority. Documentation of ACP in the electronic health record (EHR) is particularly important during emergency care. OBJECTIVE: We sought to characterize completion and availability of ACP among a subset of older patients at an academic emergency department (ED) with an integrated EHR. METHODS: In this cross-sectional study, patients were eligible if aged ≥80 years or aged 65-79 with ≥1 indicator of high risk for short-term mortality...
September 13, 2016: Journal of Palliative Medicine
Naomi George, Jennifer Kryworuchko, Katherine M Hunold, Kei Ouchi, Amy Berman, Rebecca Wright, Corita Grudzen, Olga Kovalerchik, Eric M LeFebvre, Rachel A Lindor, Tammie Quest, Terri A Schmidt, Tamara Sussman, Amy Vandenbroucke, Angelo E Volandes, Timothy F Platts-Mills
BACKGROUND: Little is known about the optimal use of shared decision making (SDM) to guide palliative and end-of-life decisions in the emergency department (ED). OBJECTIVE: To convene a working group to develop a set of research questions that, when answered, will substantially advance the ability of clinicians to use SDM to guide palliative and end-of-life care decisions in the ED. METHODS: Participants were identified based on expertise in emergency, palliative, or geriatrics care, policy, or patient-advocacy and spanned physician, nursing, social work, legal, and patient perspectives...
September 9, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Seok Ohr, Sarah Jeong, Peter Saul
AIMS: To explore specific cultural and religious beliefs and values concerning death and dying, truth telling, and advance care planning (ACP), and the preferences for end-of-life (EOL) care among older persons from culturally and linguistically diverse (CALD) backgrounds. BACKGROUND: Whilst literature indicates that culture impacts on EOL decision making significantly, there is limited evidence on the topic. DESIGN: A cross-sectional survey...
September 7, 2016: Journal of Clinical Nursing
Caroline Bähler, Andri Signorell, Oliver Reich
BACKGROUND: Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society. AIM: We aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population...
2016: PloS One
Huei-Wern Shen, Nidhi Khosla
Advance care planning (ACP) increases the likelihood patients will receive end-of-life care that is congruent with their preferences and lowers stress among both patients and caregivers. Previous efforts to increase ACP have mainly focused on information provision in the very late stage of life. This study examines whether a relationship exists between volunteering and ACP, and whether this relationship is associated with social support. The sample comprises 877 individuals who were aged 55+ in 2008, and were deceased before 2010...
September 3, 2016: Journal of Gerontological Social Work
Richard B L Lim
Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline...
October 2016: Therapeutic Advances in Respiratory Disease
Jeanine Yonashiro-Cho, Sarah Cote, Susan Enguidanos
Although advance care planning (ACP) is associated with better care at the end of life, better quality of death, and less psychological distress in survivors, ethnic disparities in ACP completion rates have been documented and may be attributable to lack of knowledge about ACP or differences in cultural values and preferences. Despite rapid increases in the size of the Asian-American population, little is known about ACP preferences of Chinese Americans. The purpose of this study is to explore the knowledge, attitudes, and preferences of older Chinese Americans toward ACP...
September 2016: Journal of the American Geriatrics Society
Charlene Weir, Cherie Brunker, Jorie Butler, Mark A Supiano
This paper evaluates the role of facilitation in the successful implementation of Computerized Decision Support (CDS). Facilitation processes include education, specialized computerized decision support, and work process reengineering. These techniques, as well as modeling and feedback enhance self-efficacy, which we propose is one of the factors that mediate the effectiveness of any CDS. In this study, outpatient clinics implemented quality improvement (QI) projects focused on improving geriatric care. Quality Improvement is the systematic process of improving quality through continuous measurement and targeted actions...
August 28, 2016: Journal of Biomedical Informatics
Jason Lambden, Baohui Zhang, Robert Friedlander, Holly G Prigerson
BACKGROUND: Oncologists are often reluctant to discuss life-expectancy estimates with their patients because of concerns about their inaccuracy and limited evidence regarding benefits. OBJECTIVE: Determine oncologist accuracy in predicting their advanced cancer patients' life expectancy and correlates associated with accuracy. DESIGN: Multicenter prospective, longitudinal study of patients with advanced cancer, assessed once at baseline and followed to death...
August 30, 2016: Journal of Palliative Medicine
Deborah E Meyers, Sarah J Goodlin
Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan...
September 2016: Canadian Journal of Cardiology
Georg Bollig, Jan Henrik Rosland, Eva Gjengedal, Gerda Schmidt, Arnd T May, Andreas Heller
BACKGROUND: There are many existing ethical challenges in nursing homes. Although different methods and approaches to discussing the ethical challenges have been established, systematic ethics work is not yet a standard in all nursing homes. The aim of the present study was to explore ethical challenges and approaches to implementing systematic ethics work in nursing homes. METHODS: Data from five institutions in Austria, Germany and Norway were collected, and a mixed-methods two-tiered study approach was chosen...
August 26, 2016: Scandinavian Journal of Caring Sciences
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