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barriers to end of life discussions

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https://www.readbyqxmd.com/read/28697736/end-of-life-perceptions-among-physicians-in-intensive-care-units-managed-by-anesthesiologists-in-germany-a-survey-about-structure-current-implementation-and-deficits
#1
Manfred Weiss, Andrej Michalsen, Anke Toenjes, Franz Porzsolt, Thomas Bein, Marc Theisen, Alexander Brinkmann, Heinrich Groesdonk, Christian Putensen, Friedhelm Bach, Dietrich Henzler
BACKGROUND: Structural aspects and current practice about end-of-life (EOL) decisions in German intensive care units (ICUs) managed by anesthesiologists are unknown. A survey among intensive care anesthesiologists has been conducted to explore current practice, barriers and opinions on EOL decisions in ICU. METHODS: In November 2015, all members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthesiologists (BDA) were asked to participate in an online survey to rate the presence or absence and the importance of 50 items...
July 11, 2017: BMC Anesthesiology
https://www.readbyqxmd.com/read/28675025/experiences-and-opinions-related-to-end-of-life-discussion-from-oncologists-and-resident-physicians-perspectives
#2
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/28664445/pediatric-cardiology-provider-attitudes-about-palliative-care-a-multicenter-survey-study
#3
Emily Morell Balkin, James N Kirkpatrick, Beth Kaufman, Keith M Swetz, Lynn A Sleeper, Joanne Wolfe, Elizabeth D Blume
While availability of palliative care consultation for children with advanced heart disease increases, little is known about cardiologist attitudes towards palliative care. We sought to describe perspectives of cardiologists regarding palliative care and to characterize their perceived competence in palliative care concepts. A cross-sectional survey of pediatric cardiologists and cardiac surgeons from 19 pediatric medical centers was performed. Overall response rate was 31% (183/589). Respondents had a median of 18 years of experience since medical school (range 2-49) and most practiced at academic centers (91%)...
June 29, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28654821/table%C3%A2-talk-how-mothers-and-adolescents-across-socioeconomic-status-discuss-food
#4
Priya Fielding-Singh, Jennifer Wang
This article reports findings from a qualitative study of food practices among families of differing socioeconomic circumstances. Using in-depth interviews from sixty-two families in the San Francisco Bay Area in 2015-2016, we find socioeconomic differences in how mothers and adolescents talk about food. Across SES, mothers and adolescents engage in discussions about healthy eating. However, these conversations are more commonplace and embedded within high-SES family life than among low-SES families. Beyond conversations about 1) healthy eating, the topics of 2) food quality and 3) price are discussed to varying degrees across SES...
June 15, 2017: Social Science & Medicine
https://www.readbyqxmd.com/read/28639084/early-palliative-care-for-patients-with-hematologic-malignancies-is-it-really-so-difficult-to-achieve
#5
REVIEW
Thomas W LeBlanc, Eric J Roeland, Areej El-Jawahri
Evidence points to many benefits of "early palliative care," the provision of specialist palliative care services upstream from the end of life, to improve patients' quality of life while living with a serious illness. Yet most trials of early palliative care have not included patients with hematologic malignancies. Unfortunately, patients with hematologic malignancies are also known to have substantial illness burden, poor quality of life, and aggressive care at the end of life, including a greater likelihood of dying in the hospital, receiving chemotherapy at the end of life, and low hospice utilization, compared to patients with solid tumors...
June 21, 2017: Current Hematologic Malignancy Reports
https://www.readbyqxmd.com/read/28630131/-it-s-a-hard-conversation-to-have-healthcare-professionals-views-concerning-advance-care-discussions-with-young-people-affected-by-life-limiting-neuromuscular-diseases-an-interview-study
#6
Andy Hiscock, Stephen Barclay
OBJECTIVE: Life-limiting neuromuscular disease, such as some of the muscular dystrophies, are often diagnosed in early childhood: when death comes, commonly in the second or third decade of life, patients rarely have advance care plans in place or documented end-of-life care preferences. There is very limited literature concerning the discussions about end-of-life plans healthcare professionals have with young people affected by life-limiting neuromuscular diseases. The aim of this study was to investigate the views and experiences of healthcare professionals concerning having discussions about advance care plans and end-of-life care with teenagers and young adult patients affected by life-limiting neuromuscular diseases...
June 19, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28592468/improving-health-care-provider-communication-in-end-of-life-decision-making
#7
Tracey Wilson, Cathy Haut, Bimbola Akintade
Critical care providers are responsible for many aspects of patient care, primarily focusing on preserving life. However, nearly 40% of patients who are admitted to an adult critical care unit will not survive. Initiating a conversation about end-of-life decision-making is a daunting task. Often, health care providers are not trained, experienced, or comfortable facilitating these conversations. This article describes a quality improvement project that identified current views on end-of-life communication in the intensive care unit and potential barriers that obstruct open discussion, and offering strategies for improvement...
2017: AACN Advanced Critical Care
https://www.readbyqxmd.com/read/28546901/macrophages-as-effectors-of-acute-and-chronic-allograft-injury
#8
Yianzhu Liu, Malgorzata Kloc, Xian C Li
Organ transplants give a second chance of life to patients with end-stage organ failure. However, the immuno-logical barriers prove to be very challenging to overcome and graft rejection remains a major hurdle to long-term transplant survival. For decades, adaptive immunity has been the focus of studies, primarily based on the belief that T cells are necessary and sufficient for rejection. With better-developed immunosuppressive drugs and protocols that effectively control adaptive cells, innate immune cells have emerged as key effector cells in triggering graft injury and have therefore attracted much recent attention...
December 2016: Current Transplantation Reports
https://www.readbyqxmd.com/read/28544056/exploring-the-knowledge-attitudes-and-needs-of-advance-care-planning-in-older-chinese-australians
#9
S S Yap, K Chen, K M Detering, S A Fraser
AIMS AND OBJECTIVES: The purpose of this study was to identify factors that influence the engagement of Chinese-Australians with advance care planning (ACP). BACKGROUND: Despite the benefits of ACP there is a low prevalence of ACP in the Chinese-Australian community. Reasons for this are often cited as cultural considerations and taboos surrounding future medical planning and death, however, other logistical factors may also be important. DESIGN: This qualitative study used a thematic analysis grounded theory approach to explore facilitators and barriers to engagement in ACP...
May 23, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28462236/palliative-and-end-of-life-care-conversations-in-copd-a-systematic-literature-review
#10
REVIEW
Nuno Tavares, Nikki Jarrett, Katherine Hunt, Tom Wilkinson
Chronic obstructive pulmonary disease (COPD) is a chronic life-limiting disorder characterised by persistent airflow obstruction and progressive breathlessness. Discussions/conversations between patients and clinicians ensure palliative care plans are grounded in patients' preferences. This systematic review aimed to explore what is known about palliative care conversations between clinicians and COPD patients. A comprehensive search of all major healthcare-related databases and websites was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
April 2017: ERJ Open Research
https://www.readbyqxmd.com/read/28417132/awareness-and-attitudes-of-community-dwelling-individuals-in-singapore-towards-participating-in-advance-care-planning
#11
Qin Xiang Ng, Tricia Zl Kuah, Germaine Jm Loo, Wilbert Hh Ho, Norbert L Wagner, Judy Gk Sng, Grace Mj Yang, Bee Choo Tai
INTRODUCTION: Advance care planning (ACP) is an important aspect of end-of-life care that has been shown to improve patient autonomy in decision-making and reduce stress for surviving family members. Given the rapidly ageing population in Singapore, a greater emphasis on end-of-life care planning is needed. This study therefore sought to examine the awareness and attitudes of the general Singaporean community towards participating in ACP, which are not known hitherto. MATERIALS AND METHODS: A 24-item interviewer-administered questionnaire was constructed and administered via door-to-door survey amongst community-dwelling residents living in Housing and Development Board (HDB) flats across Singapore, selected via a two-stage stratified random sampling...
March 2017: Annals of the Academy of Medicine, Singapore
https://www.readbyqxmd.com/read/28384309/-if-i-had-stayed-back-home-i-would-not-be-alive-any-more%C3%A2-exploring-end-of-life-preferences-in-patients-with-migration-background
#12
Piret Paal, Johannes Bükki
BACKGROUND: In patients with life-limiting conditions and a history of migration, a higher risk of not dying at home and limited access to palliative care services has been reported. AIM: To explore the views and end-of-life preferences of patients with a migration history in Germany and to identify migration specific themes. DESIGN: Two-armed study using Kaufmann's 'understanding interview' ('focused interview') method and grounded theory approach...
2017: PloS One
https://www.readbyqxmd.com/read/28345473/exploring-end-of-life-care-for-south-asian-kidney-patients-interviewer-reflections
#13
Emma Wilkinson, Muhammad Waqar, Balbir Gill, Pina Hoque, Champa Jetha, Kulwinder Kaur Bola, Riffat Mahmood, Sultan Mahmood, Rita Saujani, Gurch Randhawa
The reduction of inequalities in access to quality care has been a central tenet of UK health policy. Ethnic minorities may experience additional inequalities because of language and other cultural barriers. This article reports interviewer reflections of conducting interviews with South Asian kidney patients about their experiences of end-of-life care. It explores themes which emerged from the analysis of a focus group held with eight bilingual research interviewers. The relevance of these themes to understanding inequalities and access to end-of-life care is discussed; together with the potential for the research process to contribute to service improvement...
March 16, 2017: International Journal of Palliative Nursing
https://www.readbyqxmd.com/read/28329829/-end-of-life-care-i-m-not-going-to-worry-about-that-yet-health-literacy-gaps-and-end-of-life-planning-among-elderly-dialysis-patients
#14
Keren Ladin, Katie Buttafarro, Emily Hahn, Susan Koch-Weser, Daniel E Weiner
Purpose: Between 2000 and 2012, the incident dialysis population in the United States increased by nearly 60%, most sharply among adults 75 years and older. End-of-life (EOL) conversations among dialysis patients are associated with better patient-centered outcomes and lower use of aggressive interventions in the last month of life. This study examined how health literacy may affect engagement, comprehension, and satisfaction with EOL conversations among elderly dialysis patients. Design and Methods: Qualitative/descriptive study with semi-structured interviews about health literacy, EOL conversations, and goals of care with 31 elderly dialysis patients at 2 centers in Boston...
March 10, 2017: Gerontologist
https://www.readbyqxmd.com/read/28294479/understanding-advance-care-planning-within-the-south-asian-community
#15
Patricia D Biondo, Rashika Kalia, Rooh-Afza Khan, Nadia Asghar, Cyrene Banerjee, Debbie Boulton, Nancy Marlett, Svetlana Shklarov, Jessica E Simon
BACKGROUND: Advance care planning (ACP) is a process of reflection on and communication of a person's future health-care preferences. Evidence suggests visible minorities engage less in ACP. The South Asian ethnic group is the largest visible minority group in Canada, and information is needed to understand how ACP is perceived and how best to approach ACP within this diverse community. OBJECTIVE: To explore perspectives of South Asian community members towards ACP...
March 10, 2017: Health Expectations: An International Journal of Public Participation in Health Care and Health Policy
https://www.readbyqxmd.com/read/28283409/integrating-advance-care-planning-into-practice
#16
REVIEW
Laura E Dingfield, Joshua B Kayser
Advanced respiratory diseases progress over time and often lead to death. As the condition worsens, patients may lose medical decision-making ability. Advance care planning (ACP) is a process in which patients receive information about their diagnosis and prognosis; discuss values, goals, and fears; articulate preferences about life-sustaining treatments and end-of-life care; and appoint a surrogate medical decision maker. This process may result in written documentation of patient preferences or the appointment of a health-care power of attorney (HCPOA)...
June 2017: Chest
https://www.readbyqxmd.com/read/28160875/understanding-palliative-care-and-hospice-a%C3%A2-review-for-primary-care-providers
#17
REVIEW
Mary K Buss, Laura K Rock, Ellen P McCarthy
Palliative care provides invaluable clinical management and support for patients and their families. For most people, palliative care is not provided by hospice and palliative medicine specialists, but rather by their primary care providers. The recognition of hospice and palliative medicine as its own medical subspecialty in 2006 highlighted the importance of palliative care to the practice of medicine, yet many health care professionals harbor misconceptions about palliative care, which may be a barrier to ensuring that the palliative care needs of their patients are identified and met in a timely fashion...
February 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28156656/systematic-review-of-interventions-to-facilitate-advance-care-planning-acp-in-cancer-patients
#18
Hao-Wen Sim, Camilla Zimmermann, Monika K Krzyzanowska
21 Background: ACP refers to the process of consideration, documentation and communication of preferences for future care. ACP is crucial for patients (pts) with advanced cancer as it can guide substitute decision makers (SDM) and health care providers (HCP) to align care with preferences, thus improving quality of end-of-life care. METHODS: We performed a systematic review of MEDLINE, EMBASE, CINAHL, PsycINFO and Cochrane (Systematic Review and Clinical Trial) databases (1995 to 2015) to identify interventions that facilitate ACP for cancer pts (documentation or discussion of advance directives, SDM or code status)...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156561/a-qualitative-investigation-of-mindfulness-practice-to-support-advance-care-planning-acp
#19
Ann H Cottingham, Kathleen A Beck-Coon, Paul R Helft
15 Background: Despite ongoing attempts to increase ACP in the U.S, a national longitudinal study of patients with cancer found no significant change in participation in end-of-life (EOL) discussions or living will completion between 2000-2012. A key barrier to ACP includes emotional discomfort talking about EOL care preferences. Mindfulness practices facilitate emotional regulation through present-centered awareness and non-reactive coping. In this pilot, an intervention combining mindfulness training, mindful communication skill development, and information about ACP was hypothesized to increase ACP in patients with cancer...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152705/value-in-cancer-care-regional-initiative-to-improve-care-through-data-reporting-and-interventions
#20
Teah Hoopes, Lotte Steuten, Veena Shankaran, Bernardo Goulart, Gary H Lyman, Thomas David Brown, Eric Y Chen, Ted Conklin, John M Corman, Matt Lonergan, Daniel Lessler, Renato Martins, Csaba Mera, John Whitelaw Rieke, Elie P Saikaly, Julie C Smith, F Marc Stewart, Richard Whitten, Scott David Ramsey
34 Background: In the context of many initiatives aimed at measuring quality and value in cancer care, the Hutchinson Institute for Cancer Outcomes Research (HICOR), partnered with community members to launch a regional, stakeholder-driven initiative to define and report value metrics for cancer care for Washington State. Region-wide Summits were held in 2014 and 2015. Participants included local healthcare delivery organizations, patient advocacy groups, payers, and policymakers. The 2014 Summit identified priority metrics; these metrics were reported at the 2015 Summit...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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