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end of life decision making

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https://www.readbyqxmd.com/read/28732071/the-ideas-about-advanced-life-support-and-affecting-factors-at-the-end-stage-of-life-in-a-hospital-in-turkey
#1
Turgay Albayrak, İrfan Şencan, Ömer Akça, Esra Meltem Koç, Hilal Aksoy, Selim Ünsal, İskender Bülbül, Adem Bahadır, İsmail Kasım, Rabia Kahveci, Adem Özkara
BACKGROUND: The participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. "Advanced directives" is one of the examples for the participation in decisions for the treatment. AIM: We wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions...
2017: PloS One
https://www.readbyqxmd.com/read/28726731/the-use-of-imaging-in-the-prediction-and-assessment-of-cancer-treatment-toxicity
#2
REVIEW
Hossein Jadvar
Multimodal imaging is commonly used in the management of patients with cancer. Imaging plays pivotal roles in the diagnosis, initial staging, treatment response assessment, restaging after treatment and the prognosis of many cancers. Indeed, it is difficult to imagine modern precision cancer care without the use of multimodal molecular imaging, which is advancing at a rapid pace with innovative developments in imaging sciences and an improved understanding of the complex biology of cancer. Cancer therapy often leads to undesirable toxicity, which can range from an asymptomatic subclinical state to severe end organ damage and even death...
July 20, 2017: Diagnostics
https://www.readbyqxmd.com/read/28725839/nursing-strategies-for-engaging-families-of-older-immigrants-hospitalized-for-end-of-life-care-an-australian-study
#3
Megan-Jane Johnstone, Alison M Hutchinson, Helen Rawson, Bernice Redley
BACKGROUND: Engaging with families of older non-English-speaking background (NESB) immigrants hospitalized for end-of-life (EOL) care can be challenging, especially when their cultures, lifeways, and family decision-making processes are unfamiliar to the nurses caring for them. Despite the recognized importance of family engagement when providing EOL care, the issue of ethnic minority family engagement has received little attention in the field. AIM: To explore and describe the strategies nurses use to facilitate engagement with families of older immigrant NESB patients hospitalized for EOL care...
September 2016: Journal of patient experience
https://www.readbyqxmd.com/read/28725289/amnestic-mci-patients-perspectives-toward-disclosure-of-amyloid-pet-results-in-a-research-context
#4
Gwendolien Vanderschaeghe, Jolien Schaeverbeke, Rik Vandenberghe, Kris Dierickx
BACKGROUND: Researchers currently are not obligated to share individual research results (IRR) with participants. This non-disclosure policy has been challenged on the basis of participants' rights to be aware and in control of their personal medical information. Here, we determined how patients view disclosure of research PET results of brain amyloid and why they believe it is advantageous or disadvantageous to disclose. METHOD: As a part of a larger diagnostic trial, we conducted semi-structured interviews with patients with amnestic Mild Cognitive Impairment (aMCI)...
2017: Neuroethics
https://www.readbyqxmd.com/read/28721432/influence-of-age-on-decision-making-process-to-limit-or-withdraw-life-sustaining-treatment-in-the-intensive-care-unit-a-single-center-prospective-observational-study
#5
G Ducos, O Mathe, L Balardy, S Lozano, M Kurrek, J Ruiz, B Riu-Poulenc, O Fourcade, S Silva, V Minville
BACKGROUND: The increasing age in the industrialized countries places significant demands on intensive care unit (ICU) resources and this triggers debates about end-of-life care for the elderly. OBJECTIVES: We sought to determine the impact of age on the decision-making process to limit or withdraw life-sustaining treatment (DWLST) in an ICU in France. We hypothesized that there are differences in the decision-making process for young and old patients. DESIGN, SETTING, PARTICIPANTS: We prospectively studied end-of-life decision-making for all consecutive admissions (n=390) to a tertiary care university ICU in Toulouse, France over a period of 11 months between January and October 2011...
2017: Journal of Frailty & Aging
https://www.readbyqxmd.com/read/28714644/-dialysis-implementation-in-elderly-patients-a-difficult-clinical-choice
#6
Silesia Da Graca, Patrick Saudan
Prevalence of elderly patients with end-stage kidney disease has increased. Implementation of dialysis does not offer a clear advantage in terms of life expectancy and quality of life compared to a conservative treatment in these patients, especially in emergency and in those with severe comorbidities. The choice between dialysis and supportive care should be based on a shared decision-making process between the patient, his family and the caregivers.
February 22, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28712987/the-tailored-study-a-randomized-controlled-trial-to-improve-surrogate-decision-making
#7
Daniel P Sulmasy, Mark T Hughes, Gayane Yenokyan, Joan Kub, Peter B Terry, Alan B Astrow, Julie A Johnson, Grace Ho, Marie T Nolan
CONTEXT: Patients with terminal illnesses often require surrogate decision makers. Prior research has demonstrated high surrogate stress, and that despite standards promoting substituted judgment, most patients do not want their surrogates to make pure substituted judgments for them. It is not known how best to help loved ones fulfill the surrogate role. OBJECTIVES: To test the effectiveness of an intervention to help surrogate decision makers. METHODS: 166 patients (41% with ALS and 59% with gastrointestinal cancers) and their surrogates at 2 university medical centers were randomized to an intensive nurse-directed discussion of the end of life Decision Control Preferences of the patient (TAILORED) or a discussion of nutrition (CONTROL); 163 completed baseline interviews and underwent the intervention...
July 13, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28708740/experiences-of-substitute-decision-makers-in-making-decisions-for-older-persons-diagnosed-with-major-neurocognitive-disorder-at-end-of-life-a-qualitative-systematic-review-protocol
#8
Sarah J Cresp, Susan F Lee, Cheryle Moss
The objective of this systematic review is to identify and synthesize the best available qualitative evidence on how substitute decision makers (SDMs) are affected by and experience making decisions at end of life (EOL) for older persons diagnosed with major neurocognitive disorder (major NCD) (dementia). Addressing the objective will provide an understanding of SDMs' experiences of making decisions for older persons diagnosed with major NCD at EOL, in order to tailor supportive education and interventions and potentially decrease inopportune outcomes...
July 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28708342/-admission-to-intensive-care-of-palliative-care-patients-the-stakes-and-factors-influencing-the-decision
#9
Monica Escher, Mathieu Nendaz, Bara Ricou
Palliative care patients have limited prospects of survival and the benefit of intensive care is uncertain. To make a decision there are considerations other than survival probabilities. Patients should receive appropriate care and be spared suffering. End of life in the intensive care unit has an impact on families, who may develop psychological problems or complicated grief. End of life care can be a source of conflicts and cause burnout in health providers. Finally, intensive care is an expensive resource, which must be fairly allocated...
February 1, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28695561/medical-challenges-at-the-end-of-the-first-ten-decades-of-life
#10
Thomas Münzer
Demographic changes worldwide challenge the healthcare system. Advanced age is associated with a number of biological alterations that, together with concomitant comorbidities, increase the risk for functional decline by inducing functional disintegration. In this concept frailty and sarcopenia play an important role. Consequently the preservation of muscle mass and function are prominent targets of medicine in old age. In order to professionally care for persons in their last years of life several other factors influencing medical decisions regarding diagnostic and treatments are important...
July 11, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28687135/advance-care-planning-within-survivorship-care-plans-for-older-cancer-survivors-a-systematic-review
#11
REVIEW
Rónán O'Caoimh, Nicola Cornally, Ronan O'Sullivan, Ruth Hally, Elizabeth Weathers, Amanda H Lavan, Tara Kearns, Alice Coffey, Ciara McGlade, D William Molloy
Advances in the medical treatment of cancer have increased the number of survivors, particularly among older adults, who now represent the majority of these. Survivorship care plans (SCPs) are documents that cancer patients receive summarising their care, usually at the end of treatment but preferably from initial diagnosis. These may increase patient satisfaction and represent an opportunity to initiate preventative strategies and address future care needs. Advance care planning (ACP), incorporating advance healthcare decision-making, including formal written directives, increases satisfaction and end-of-life care...
June 23, 2017: Maturitas
https://www.readbyqxmd.com/read/28686046/the-challenges-of-dysphagia-in-treating-motor-neurone-disease
#12
Siobhan Vesey
Motor neurone disease (MND) is a relatively rare degenerative disorder. Its impacts are manifested in progressive loss of motor function and often accompanied by wider non-motor changes. Swallowing and speech abilities are frequently severely impaired. Effective management of dysphagia (swallowing difficulty) symptoms and nutritional care requires a holistic multidisciplinary approach. Care must be patient focused, facilitate patient decision making, and support planning towards end of life care. This article discusses the challenges of providing effective nutritional care to people living with motor neurone disease who have dysphagia...
July 1, 2017: British Journal of Community Nursing
https://www.readbyqxmd.com/read/28684551/transitions-in-prognostic-awareness-among-terminally-ill-cancer-patients-in-their-last-6-months-of-life-examined-by-multi-state-markov-modeling
#13
Chen Hsiu Chen, Fur-Hsing Wen, Ming-Mo Hou, Chia-Hsun Hsieh, Wen-Chi Chou, Jen-Shi Chen, Wen-Cheng Chang, Siew Tzuh Tang
BACKGROUND: Developing accurate prognostic awareness, a cornerstone of preference-based end-of-life (EOL) care decision-making, is a dynamic process involving more prognostic-awareness states than knowing or not knowing. Understanding the transition probabilities and time spent in each prognostic-awareness state can help clinicians identify trigger points for facilitating transitions toward accurate prognostic awareness. We examined transition probabilities in distinct prognostic-awareness states between consecutive time points in 247 cancer patients' last 6 months and estimated the time spent in each state...
July 6, 2017: Oncologist
https://www.readbyqxmd.com/read/28680279/palliative-care-as-a-public-health-issue-understanding-disparities-in-access-to-palliative-care-for-the-homeless-population-living-in-toronto-based-on-a-policy-analysis
#14
REVIEW
B Henry, N Dosani, L Huynh, N Amirault
Even in a developed country such as Canada, there are disparities in just access to adequate health care-and, more specifically, palliative care. That inequality is most notable in an underserved group such as the homeless population. Even the word "homeless" has become both a negative descriptor and a stereotype in our society. We posit that the provision of hospice palliative care is structured on several problematic assumptions: an expectation that patients will have an informal support network (family and friends), a stable and secure residence, a predictive terminal illness trajectory, and reasonable access to health care...
June 2017: Current Oncology
https://www.readbyqxmd.com/read/28679812/challenges-in-understanding-and-respecting-patients-preferences
#15
Amber E Barnato
The Institute of Medicine's report on Dying in America called for honoring treatment preferences near the end of life for seriously ill patients. To achieve this objective, the report recommended that patients, their family members, other loved ones, and providers engage in shared decision making about current and future treatment decisions (that is, advance care planning). Yet decision science research suggests that preferences are objectively difficult to specify for complex contingencies and subjectively difficult to specify for unfamiliar choices...
July 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28677220/a-qualitative-study-of-factors-in-nurses-and-physicians-decision-making-related-to-family-presence-during-resuscitation
#16
Renee Twibell, Debra Siela, Cheryl Riwitis, Alexis Neal, Nicole Waters
AIMS AND OBJECTIVES: To explore the similarities and differences in factors that influence nurses' and physicians' decision-making related to family presence during resuscitation. BACKGROUND: Despite the growing acceptance of family presence during resuscitation worldwide, health care professionals continue to debate the risks and benefits of family presence. Since many hospitals lack a policy to guide family presence during resuscitation, decisions are negotiated by resuscitation teams, families and patients in crisis situations...
July 5, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28676498/health-and-death-literacy-and-cultural-diversity-insights-from-hospital-employed-interpreters
#17
Barbara Hayes, Anne Marie Fabri, Maria Coperchini, Rafatullah Parkar, Zoe Austin-Crowe
OBJECTIVES: 001225The aim of this qualitative study is to better understand, through the experiences and insights of hospital interpreters, how people from culturally and linguistic diverse (CALD) communities might respond to advance care planning (ACP) and end-of-life discussions. METHODS: Hospital interpreters from five Melbourne metropolitan health services were recruited for in-depth semi-structured interviews that explored the question, 'What can be learnt from hospital interpreters about cultural issues related to ACP and end-of-life decision-making?' Thirty-nine interpreters, representing 22 language groups, were interviewed...
July 4, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28676293/attitudes-toward-advance-directives-among-patients-and-their-family-members-in-china
#18
Lin Kang, Xiao-Hong Liu, Jing Zhang, Pei-Yan Shan, Jie-Ping Wang, Ping Zhong, Xiao-Hong Du, Yu-Feng Du, Bao-Cheng Yu, Nan Wei, Hui-Ling Lou, Ou Bian, Huai-Hong Chen, Fan Lin, Hong-Lian Zhou, Wen He, Huai-Cong Long, Lu-Rong Hong, Hui Su, Jun-Nan Yang, Yong-Liang Jiang, Ye Shi, Jing Ning, Fang Liang, Zhong Wang, Ting Gong, Ming-Lei Zhu, Xiao-Hong Ning, Zhi-Jun Chen, Liang-Kung Chen
OBJECTIVES: Chinese people are generally unfamiliar with the concept of advance care planning or advance directives (ACP/ADs), which raises dilemmas in life-support choice and can even affect clinical decision making. To understand and address the issues involved better, we investigated the awareness of ACP/ADs in China, as well as people's attitudes toward medical autonomy and end-of-life care. DESIGN: A multicenter cross-sectional survey, conducted from August 1 to December 31, 2016...
July 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28675025/experiences-and-opinions-related-to-end-of-life-discussion-from-oncologists-and-resident-physicians-perspectives
#19
Su-Jin Koh, Shinmi Kim, JinShil Kim, Bhumsuk Keam, Dae Seog Heo, Kyung Hee Lee, Bong-Seog Kim, Jee Hy Kim, Hye Jung Chang, Sun Kyung Baek
Purpose: The aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care. Materials and Methods: A survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t-test, and the Chi-square test were performed for the analyses...
July 3, 2017: Cancer Research and Treatment: Official Journal of Korean Cancer Association
https://www.readbyqxmd.com/read/28670652/decision-making-in-advanced-heart-failure-bench-bedside-practice-and-policy
#20
REVIEW
Daniel D Matlock, William C McGuire, Molly Magid, Larry Allen
This is an exciting time for patient-centered care. The window of opportunity appears to be open for the medical culture to accept the importance of the patients' values, goals and preferences in guiding medical decisions. Heart failure guidelines are changing to include language around shared decision making for major procedures and end-of-life care. However, while the cultural norms appear to be moving in this direction, the science regarding how to best deliver patient centered care (basic, clinical, delivery, and policy) is still developing...
July 3, 2017: Heart Failure Reviews
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