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decision critical surrogate

M M Adil, D Larriviere
Approximately 20% of all deaths in the USA occur in the intensive care unit (ICU) and the majority of ICU deaths involves decision of de-escalation of life-sustaining interventions. Life-sustaining interventions may include intubation and mechanical ventilation, artificial nutrition and hydration, antibiotic treatment, brain surgery, or vasoactive support. Decision making about goals of care can be defined as an end-of-life communication and the decision-making process between a clinician and a patient (or a surrogate decision maker if the patient is incapable) in an institutional setting to establish a plan of care...
2017: Handbook of Clinical Neurology
Helen Cliffe, Chirag Patel, Robin Prestwich, Andrew Scarsbrook
Radiation therapy is a common component of curative cancer treatment. However, there is a significant incidence of treatment failure. In these cases salvage surgical options are sometimes appropriate. Accurate assessment of response and early recognition of treatment success or failure is therefore critical to guide treatment decisions and impacts on survival and the morbidity of treatment. Traditionally, treatment response has depended upon anatomical measurement of disease. However, this may not correlate well with the presence of disease, especially after radiotherapy...
December 23, 2016: British Journal of Radiology
Ellen C Meltzer, Natalia S Ivascu, Meredith Stark, Alexander V Orfanos, Cathleen A Acres, Paul J Christos, Thomas Mangione, Joseph J Fins
OBJECTIVE: Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians' attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus...
2016: Journal of Clinical Ethics
Katalin Bognar, John A Romley, Jay P Bae, James Murray, Jacquelyn W Chou, Darius N Lakdawalla
Approval of new drugs is increasingly reliant on "surrogate endpoints," which correlate with but imperfectly predict clinical benefits. Proponents argue surrogate endpoints allow for faster approval, but critics charge they provide inadequate evidence. We develop an economic framework that addresses the value of improvement in the predictive power, or "quality," of surrogate endpoints, and clarifies how quality can influence decisions by regulators, payers, and manufacturers. For example, the framework shows how lower-quality surrogates lead to greater misalignment of incentives between payers and regulators, resulting in more drugs that are approved for use but not covered by payers...
December 11, 2016: Journal of Health Economics
Barbara J Daly, Sara L Douglas, Elizabeth O'Toole, James Rowbottom, Alan Hoffer, Amy R Lipson, Christopher Burant
RATIONALE: Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. OBJECTIVE: To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness...
November 20, 2016: Journal of Intensive Care Medicine
Karen E A Burns, Clara Juando Prats, Maria Maione, Mary Lanceta, Celia Zubrinich, Lianne Jeffs, Orla M Smith
RATIONALE: Recruitment in critical care research differs from other contexts in important ways: patients lack decision-making capacity, uncertainty exists regarding patient prognosis, and critical illnesses are often associated with appreciable morbidity and mortality. OBJECTIVES: We aimed to describe the experiences of surrogate decision makers (SDMs) in being approached for consent for critically ill patients to participate in research. METHODS: A multicenter, qualitative study involving semistructured interviews with 26 SDMs, who provided or declined surrogate consent for research participation, at 5 Canadian centers nested within a multicenter observational study of research recruitment practices...
February 2017: Annals of the American Thoracic Society
Jorie M Butler, Eliotte L Hirshberg, Ramona O Hopkins, Emily L Wilson, James F Orme, Sarah J Beesley, Kathryn Kuttler, Samuel M Brown
OBJECTIVE: The Intensive Care Unit (ICU) is a stressful environment for families of critically ill patients and these individuals are at risk to develop persistent psychological morbidity. Our study objective was to identify individual differences in coping with stress and information presentation preferences of respondents exposed to a simulated ICU experience. METHODS: Participants were recruited from a university and two community populations. Participants completed questionnaires that measured demographic information and characteristics that may be relevant to an individual's ICU experience...
2016: PloS One
Catharine M Sturgeon, Stuart Sprague, Alison Almond, Etienne Cavalier, William D Fraser, Alicia Schimnich-Algeciras, Ravinder Singh, Jean-Claude Souberbielle, Hubert W Vesper
Parathyroid hormone (PTH) measurement in serum or plasma is a necessary tool for the exploration of calcium/phosphorus disorders, and is widely used as a surrogate marker to assess skeletal and mineral disorders associated with chronic kidney disease (CKD), referred to as CKD-bone mineral disorders (CKD-BMD). CKD currently affects >10% of the adult population in the United States and represents a major health issue worldwide. Disturbances in mineral metabolism and fractures in CKD patients are associated with increased morbidity and mortality...
October 13, 2016: Clinica Chimica Acta; International Journal of Clinical Chemistry
Daniela J Lamas, Robert L Owens, R Nicholas Nace, Anthony F Massaro, Nathan J Pertsch, Jonathon Gass, Rachelle E Bernacki, Susan D Block
OBJECTIVE: Chronically critically ill patients have recurrent infections, organ dysfunction, and at least half die within 1 year. They are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting. Our objective was to explore the understanding and expectations and goals of these patients and surrogates. DESIGN: We conducted semi-structured interviews with chronically critically ill long-term acute care hospital patients or surrogates...
September 14, 2016: Critical Care Medicine
Sean M Ronnekleiv-Kelly, Richard A Burkhart, Timothy M Pawlik
Metastatic disease ultimately occurs in approximately 50-70% of patients presenting with colorectal cancer. In patients with advanced disease, there is significant variability in individual patient outcomes. To improve understanding of tumor behavior, markers such as KRAS and BRAF mutation status are increasingly utilized. Additionally, newer surrogates of tumor biology, such as telomerase activity and the prevalence of circulating tumor cells and circulating tumor DNA, have generated increasing interest due to clinical potential...
September 2016: Surgical Oncology
Alexander A Kon, Eric K Shepard, Nneka O Sederstrom, Sandra M Swoboda, Mary Faith Marshall, Barbara Birriel, Fred Rincon
OBJECTIVES: The Society of Critical Care Medicine and four other major critical care organizations have endorsed a seven-step process to resolve disagreements about potentially inappropriate treatments. The multiorganization statement (entitled: An official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units) provides examples of potentially inappropriate treatments; however, no clear definition is provided...
September 2016: Critical Care Medicine
Shannon S Carson, Christopher E Cox, Sylvan Wallenstein, Laura C Hanson, Marion Danis, James A Tulsky, Emily Chai, Judith E Nelson
IMPORTANCE: Family caregivers of patients with chronic critical illness experience significant psychological distress. OBJECTIVE: To determine whether family informational and emotional support meetings led by palliative care clinicians improve family anxiety and depression. DESIGN, SETTING, AND PARTICIPANTS: A multicenter randomized clinical trial conducted from October 2010 through November 2014 in 4 medical intensive care units (ICUs). Adult patients (aged ≥21 years) requiring 7 days of mechanical ventilation were randomized and their family surrogate decision makers were enrolled in the study...
July 5, 2016: JAMA: the Journal of the American Medical Association
Douglas B White
No abstract text is available yet for this article.
July 5, 2016: JAMA: the Journal of the American Medical Association
Jillian L Gustin, David P Way, Sharla Wells-Di Gregorio, Jennifer W McCallister
RATIONALE: Fellows in pulmonary and critical care medicine are required to show competency in facilitating family meetings for critically ill patients. There are many assessment measures available for evaluating physician-patient communication (e.g., the SEGUE Framework [Set the stage, Elicit information, Give information, Understand the patient's perspective, End the encounter]) and some designed for family meetings. However, no validated measure exists that is specifically designed to assess communication skills during family meetings with surrogate decision makers in intensive care settings...
August 2016: Annals of the American Thoracic Society
Stacy Y Chu, David Y Hwang
Accurate outcome prognostication is critical to the management of patients with primary or spontaneous intracerebral hemorrhage (ICH). Prognostication may guide the decision to pursue aggressive acute management or to plan proper goals of care for patients who will likely suffer long-term severe disability. In particular, early predictions of poor outcome for ICH patients routinely influence discussions with surrogate decision makers to pursue do-not-resuscitate orders or comfort care, practices that may often be appropriate, but that are at risk for self-fulfilling prophecies...
June 2016: Seminars in Neurology
Douglas B White, Natalie Ernecoff, Praewpannarai Buddadhumaruk, Seoyeon Hong, Lisa Weissfeld, J Randall Curtis, John M Luce, Bernard Lo
IMPORTANCE: Misperceptions about prognosis by individuals making decisions for incapacitated critically ill patients (surrogates) are common and often attributed to poor comprehension of medical information. OBJECTIVE: To determine the prevalence of and factors related to physician-surrogate discordance about prognosis in intensive care units (ICUs). DESIGN, SETTING, AND PARTICIPANTS: Mixed-methods study comprising quantitative surveys and qualitative interviews conducted in 4 ICUs at a major US medical center involving surrogate decision makers and physicians caring for patients at high risk of death from January 4, 2005, to July 10, 2009...
May 17, 2016: JAMA: the Journal of the American Medical Association
Barbara E Bierer, Rebecca Li, Mark Barnes, Ida Sim
Sharing clinical trial data is critical in order to inform clinical and regulatory decision making and honor trial participants who put themselves at risk to advance science. A recent Institute of Medicine (IOM) report argues that availability of deidentified (anonymized) patient-level data from..
June 23, 2016: New England Journal of Medicine
Craig M Dale, Tasnim Sinuff, Laurie J Morrison, Eyal Golan, Damon C Scales
RATIONALE: Early withdrawal of life-sustaining therapy contributes to the majority of deaths following out-of-hospital cardiac arrest (OHCA), despite current recommendations for delayed neurological prognostication (≥72 h) after treatment with targeted temperature management. Little is known about clinicians' experiences of early withdrawal of life support decisions in patients with OHCA. OBJECTIVES: To explore clinicians' experiences and perceptions of early withdrawal of life support decisions and barriers to guideline-concordant neurological prognostication in comatose survivors of OHCA treated with targeted temperature management...
July 2016: Annals of the American Thoracic Society
Kimberly A Fisher, Sumera Ahmad, Madeline Jackson, Kathleen M Mazor
OBJECTIVE: To describe surrogate decision makers' (SDMs) perspectives on preventable breakdowns in care among critically ill patients. METHODS: We screened 70 SDMs of critically ill patients for those who identified a preventable breakdown in care, defined as an event where the SDM believes something "went wrong", that could have been prevented, and resulted in harm. In-depth interviews were conducted with SDMs who identified an eligible event. RESULTS: 32 of 70 participants (46%) identified at least one preventable breakdown in care, with a total of 75 discrete events...
October 2016: Patient Education and Counseling
Jean-Philippe Rigaud, Grégoire Moutel, Corinne Quesnel, Jean-Pierre Eraldi, François Bougerol, Arnaud Pavon, Jean-Pierre Quenot
BACKGROUND: Many critically ill patients are incapable of receiving information or expressing their own opinion on treatment decisions due to the severity of their disease, or because they are under sedation. French legislation requires that when a physician proposes further tests or treatment for a patient, this proposal should be accompanied by clear and honest information that is appropriate in view of the circumstances and the patient's state of health, and the physician must obtain the patient's consent before proceeding...
June 2016: Anaesthesia, Critical Care & Pain Medicine
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