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end of life decision making

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https://www.readbyqxmd.com/read/28532225/pneumonia-in-nursing-home-patients-with-advanced-dementia-decisions-intravenous-rehydration-therapy-and-discomfort
#1
Jenny T van der Steen, Paola Di Giulio, Fabrizio Giunco, Massimo Monti, Simona Gentile, Daniele Villani, Silvia Finetti, Francesca Pettenati, Lorena Charrier, Franco Toscani
BACKGROUND: Comfort may be an appropriate goal in advanced dementia. Longitudinal studies on physician decision-making and discomfort assessed by direct observation are rare, and intravenous rehydration therapy is controversial. METHODS: To assess treatment decisions and discomfort in patients with advanced dementia and pneumonia and to compare by intravenous rehydration therapy, we used data from the observational multicenter Italian End of Life Observatory-Prospective Study On DEmentia patients Care...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28530141/decisions-around-long-term-ventilation-for-children-perspectives-of-directors-of-pediatric-home-ventilation-programs
#2
Jeffrey D Edwards, Marilyn C Morris, Judith E Nelson, Howard B Panitch, Rachel L Miller
RATIONALE: The decision of whether to initiate or forgo long-term ventilation for children with life-limiting conditions can be complex and impactful. Providers are responsible for helping families to understand the consequences of their options and guiding them through shared decision-making, but little has been published on how to do this. OBJECTIVES: To assess how directors of pediatric home ventilation programs facilitate shared decision-making with families facing decisions of whether to initiate or forgo long-term ventilation for their children with life-limiting conditions...
May 21, 2017: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/28506865/protocol-driven-neurological-prognostication-and-withdrawal-of-life-sustaining-therapy-after-cardiac-arrest-and-targeted-temperature-management
#3
Irina Dragancea, Matthew P Wise, Nawaf Al-Subaie, Julius Cranshaw, Hans Friberg, Guy Glover, Tommaso Pellis, Rebecca Rylance, Andrew Walden, Niklas Nielsen, Tobias Cronberg
BACKGROUND: Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the Targeted Temperature Management (TTM) trial...
May 12, 2017: Resuscitation
https://www.readbyqxmd.com/read/28504894/preventing-burdensome-transitions-of-nursing-home-residents-with-advanced-dementia-it-s-more-than-advance-directives
#4
Ruth Palan Lopez, Susan L Mitchell, Jane L Givens
BACKGROUND: Although a palliative approach to care is recommended for people with advanced dementia, many nursing home (NH) residents with dementia experience burdensome interventions such as hospital transfers at the end of life. OBJECTIVE: The goal of this study was to examine how decisions to transfer NH residents with advanced dementia are made, from the perspective of NH nurses and physicians. METHODS: A qualitative, descriptive method was used...
May 15, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28504892/palliative-care-interventions-before-left-ventricular-assist-device-implantation-in-both-bridge-to-transplant-and-destination-therapy
#5
Shunichi Nakagawa, Melana Yuzefpolskaya, Paolo C Colombo, Yoshifumi Naka, Craig D Blinderman
BACKGROUND: The optimal level of palliative care (PC) involvement in left ventricular assist device (LVAD) therapy has yet to be determined. OBJECTIVE: Describe the feasibility of PC intervention to elucidate patients' goals and values in LVAD therapy in both destination therapy (DT) and bridge to transplant (BTT). DESIGN: Single center, prospective, single-arm study. SETTING/SUBJECTS: All patients who received mandatory PC consultation, using a semistructured script, before LVAD implantation (PreVAD evaluation)...
May 15, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28500122/navigating-the-benefits-and-burdens-of-life-saving-treatment-in-severely-decompensated-cirrhosis-an-illustrative-multisourced-narrative
#6
Philip Berry, Kuldeep Cheent, Heather Lewis, Marcus Peck
Severely decompensated cirrhosis presents major challenges in terms of balancing the benefits and burdens of life-extending treatment. Using accounts and interviews with a patient, her mother, consultant hepatologists and a consultant intensivist, this article explores the decision making around a 43-year-old woman with alcoholic liver disease who died after 100 days in a hospital. Particular focus is given to decisions on escalation, recognition of futility, distress associated with therapy and how messages given during end-of-life discussions are processed...
May 12, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28494653/patterns-and-yearly-time-trends-in-the-use-of-radiation-therapy-during-the-last-30-days-of-life-among-patients-with-metastatic-rectal-cancer-in-the-united-states-from-2004-to-2012
#7
Adan Z Becerra, Christian P Probst, Fergal J Fleming, Zhaomin Xu, Christopher T Aquina, Carla F Justiniano, Courtney I Boodry, Alex A Swanger, Katia Noyes, Alan W Katz, John R Monson, Todd A Jusko
PURPOSE: Although radiation therapy (RT) can provide palliative benefits for patients with metastatic rectal cancer, its role at the end of life remains unclear. The objective of this study was to assess sociodemographic and clinical factors associated with the use of RT during the last 30 days of life and to evaluate yearly time trends in RT utilization among stage IV patients with rectal cancer. METHODS: The 2004 to 2012 National Cancer DataBase was queried for patients with metastatic rectal cancer who had a documented death during follow-up...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/28486892/cardiopulmonary-resuscitation-from-the-patient-s-perspective
#8
S Wee, Z Y Chang, Y H Lau, Yky Wong, Cym Ong
With increasing emphasis on patient autonomy, patients are encouraged to be more involved in end-of-life issues, including the use of extraordinary efforts to prolong their lives. Being able to make anticipatory decisions is seen to promote autonomy, empower patients and optimise patient care. To facilitate shared decision-making, patients need to have a clear and accurate understanding of cardiopulmonary resuscitation (CPR). This study aims to understand the knowledge and perspectives of the local community regarding resuscitation options and end-of-life decision-making and to explore ways to improve the quality of end-of-life discussions...
May 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28486693/oncologists-views-on-the-importance-of-general-practitioners-for-cancer-patients-a-qualitative-interview-study-from-germany
#9
Jennifer Engler, Insa Kone, Christine Holmberg, Walter Baumann, Andrea Siebenhofer, Corina Güthlin
Background.: Integrated cancer care requires cooperation between specialists and general practitioners (GPs). Mutual understanding of each other's tasks and responsibilities is essential if cooperation is to be successful. While GPs' opinions about oncologists have been addressed in previous studies, less is known about oncologists' views on the role of GPs' in cancer care, especially with regard to GPs' patient-centred, communication-based tasks. Objective.: To assess oncologists' views on the importance of GPs for cancer patients...
May 9, 2017: Family Practice
https://www.readbyqxmd.com/read/28484927/ethical-and-legal-considerations-in-the-management-of-an-unbefriended-patient-in-a-vegetative-state
#10
Alexandra Lloyd-Smith Sequeira, Ariane Lewis
BACKGROUND: Patients without surrogates are referred to as "unbefriended." Because these patients do not have representatives to assist with medical decision-making, patient autonomy and self-determination, fundamental concepts of American healthcare, are jeopardized. METHODS: We present a case of an unbefriended patient in a vegetative state and discuss the ethical and legal complications associated with management of unbefriended patients. RESULTS: An unbefriended patient was admitted to our hospital with a cardiac arrest in the setting of an intracerebral hemorrhage...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28482856/the-impact-of-the-inpatient-practice-of-continuous-deep-sedation-until-death-on-healthcare-professionals-emotional-well-being-a-systematic-review
#11
Sarah Ziegler, Hannes Merker, Margareta Schmid, Milo A Puhan
BACKGROUND: The practice of continuous deep sedation is a challenging clinical intervention with demanding clinical and ethical decision-making. Though current research indicates that healthcare professionals' involvement in such decisions is associated with emotional stress, little is known about sedation-related emotional burden. This study aims to systematically review the evidence on the impact of the inpatient practice of continuous deep sedation until death on healthcare professionals' emotional well-being...
May 8, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28481607/engagement-in-steps-of-advance-health-care-planning-by-homeless-veterans
#12
Patricia M Dubbert, Kimberly K Garner, Shelly Lensing, J Glen White, Dennis H Sullivan
Communicating health care preferences in advance, so that wishes can be honored if the person becomes unable to participate in decision-making, is especially important for vulnerable populations such as homeless veterans. Hospitals are required to inform patients of their rights to document their preferences, but completion rates for advance directives are low. Conceptualizing advance health care planning as a series of health behavior steps emphasizing communication is recommended for improving engagement in advance health care planning...
May 2017: Psychological Services
https://www.readbyqxmd.com/read/28480126/the-life-process-of-children-who-survived-the-manjil-earthquake-a-decaying-or-renewing-process
#13
Abbas Shamsalinia, Fatemeh Ghaffari, Nahid Dehghan-Nayeri, Sarieh Poortaghi
INTRODUCTION: Among earthquake survivors, children are more vulnerable than other age groups due to their exposure to harrowing scenes of devastation as well as their drastically new living situations that result from an earthquake disaster. The life process of children survivors undergoes many different changes that are affected by a wide range of factors. Understanding the life process of these children may lead to effective outcomes and interventions. In addition, observing children survivors establishes knowledge and understanding of the challenges that correspond with earthquake disasters...
April 4, 2017: PLoS Currents
https://www.readbyqxmd.com/read/28479121/ethical-considerations-and-palliative-care-in-patients-with-amyotrophic-lateral-sclerosis-a-review
#14
REVIEW
V Danel-Brunaud, L Touzet, L Chevalier, C Moreau, D Devos, S Vandolaeghe, L Defebvre
Amyotrophic lateral sclerosis (ALS) is not a curable disease, but it is treatable. By definition, much of the care provided to ALS patients is palliative, even though active life-sustaining strategies are available to prolong survival. Healthcare professionals must develop communication skills that help patients cope with the inexorable progression of the disease and the inevitability of death. Symptomatic treatments as well as respiratory insufficiency and nutritional life-sustaining therapies must be regularly evaluated as the disease progresses, without losing sight of the burden placed on the patient's non-professional caregivers...
May 4, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28478847/the-preoperative-reaction-and-decision-making-process-regarding-colostomy-surgery-among-chinese-rectal-cancer-patients
#15
Jun-E Zhang, Frances Kam Yuet Wong, Mei-Chun Zheng
PURPOSE: Patients with rectal cancer have issues in adjusting to their permanent colostomy after surgery, and support is required to help them resume normal life. However, few studies have explored the experience and factors that affect a patient's decision-making and maladjustment prior to colostomy surgery. The aim of this study was to explore the experience of rectal cancer patients who have to undergo colostomy surgery. METHOD: A descriptive, qualitative design was used...
June 2017: European Journal of Oncology Nursing: the Official Journal of European Oncology Nursing Society
https://www.readbyqxmd.com/read/28477205/-advance-directives-in-clinical-practice-living-will-healthcare-power-of-attorney-and-care-directive
#16
J Hack, B Buecking, C L Lopez, S Ruchholtz, C A Kühne
In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e...
May 5, 2017: Zeitschrift Für Rheumatologie
https://www.readbyqxmd.com/read/28476218/-bioethics-in-end-of-life-decisions-in-neonatology-unresolved-issues
#17
Juan Arnaez, Juan Carlos Tejedor, Sonia Caserío, María Teresa Montes, María Teresa Moral, Javier González de Dios, Alfredo García-Alix
This document is the result of previous work carried out by different expert groups and submitted to multidisciplinary debate at a Conference about controversial, deficient, or new aspects in the field of neonatal palliative care, such as: 1) the deliberative decision-making process, 2) hospital and domiciliary palliative care, 3) donation after controlled cardiac death, and 4) moral stress in professionals. The most relevant conclusions were: the need to instruct professionals in bioethics and in the deliberative method to facilitate thorough and reasonable decision-making; the lack of development in the field of perinatal palliative care and domiciliary palliative care in hospitals that attend newborns; the need to provide neonatal units with resources that help train professionals in communication skills and in the management of moral distress, as well as delineate operational procedure and guidelines for neonatal organ donation...
May 2, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28473036/ethical-analysis-of-withdrawing-total-artificial-heart-support
#18
Erin S DeMartino, Sara E Wordingham, John M Stulak, Barry A Boilson, Kayla R Fuechtmann, Nausheen Singh, Daniel P Sulmasy, Octavio E Pajaro, Paul S Mueller
OBJECTIVES: To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. PATIENTS AND METHODS: We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed...
May 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28471764/palliative-care-in-surgery-defining-the-research-priorities
#19
Elizabeth J Lilley, Zara Cooper, Margaret L Schwarze, Anne C Mosenthal
OBJECTIVE: To describe the existing science of palliative care in surgery within three priority areas and expose specific gaps within the field. BACKGROUND: Given the acute and often life-limiting nature of surgical illness, as well as the potential for treatment to induce further suffering, surgical patients have considerable palliative care needs. Yet these patients are less likely to receive palliative care than their medical counterparts and palliative care consultations often occur when death is imminent, reflecting poor quality end-of-life care...
May 3, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28467581/can-we-make-an-early-do-not-resuscitate-decision-in-severe-burn-patients
#20
Yücel Yüce, Hakan Ahmet Acar, Kutlu Hakan Erkal, Erhan Tuncay
BACKGROUND: The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. METHODS: Between January 2009 and December 2014, 29 patients (3...
March 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
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