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HEC Forum ; 24(2): 99-114, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22302457


CONTEXT: Established in 1997, Summa Health System's Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been unclear. OBJECTIVES: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. METHODS: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. RESULTS: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133-62); (2) changes in top two reasons for EC consult requests from 'Family opposed to withdrawing life-sustaining treatment (LST)' and 'Patient capacity in question' to 'Futility' and 'Physician opposed to providing LST'; (3) changes in top two recommendations given by the EC from 'Emotional Support for Patient/Family' and 'Initiate DNR Order' to 'Comfort Care' and 'Withdraw Treatment.' Overall, 88% of recommendations were followed. CONCLUSION: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined.

Comités de Ética Clínica , Ética Médica , Derivación y Consulta/ética , Anciano , Comités de Ética Clínica/organización & administración , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/ética , Derivación y Consulta/estadística & datos numéricos , Cuidado Terminal
J Pain Symptom Manage ; 39(1): 76-87, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19892511


CONTEXT: Unlike primary care physicians in the U.S., it is only recently that Hungarian primary care physicians have had the educational resources for providing end-of-life care and the availability of hospice services as part of the Hungarian health care system. OBJECTIVES: The aim of this study was to assess, compare, and contrast beliefs and practices of end-of-life care held by primary care physicians practicing in selected regions of the United States and Hungary. METHODS: A 22-item questionnaire, written in English, translated to Hungarian, and pilot tested in both countries, was mailed to 339 Hungarian and 330 U.S. physicians, with response rates of 54% and 48%, respectively. Descriptive and bivariate analyses were conducted to compare the samples. RESULTS: Over half of U.S. physicians indicated they were quite knowledgeable about hospice care and rated currently available services for the terminally ill as exceptionally good, compared to less than 10% of Hungarian physicians. The physicians' differing beliefs that discussing a terminal prognosis fosters a sense of hopelessness is consistent with disclosure beliefs and practices. The majority of U.S. physicians believe it is the patients' right to know and always tell them when the diagnosis is terminal. Hungarian physicians (44%) believe that the patient's right to know is balanced by the physician's judgment of the patient's best interest, and an additional 40% disclose only if asked. CONCLUSION: These results illustrate some of the important differences in physicians' beliefs about the care of terminally ill patients between the two countries and can be used to guide medical education and practice.

Actitud del Personal de Salud , Actitud Frente a la Muerte , Cuidados Paliativos/psicología , Cuidado Terminal/psicología , Comparación Transcultural , Conocimientos, Actitudes y Práctica en Salud , Cuidados Paliativos al Final de la Vida , Hospitales para Enfermos Terminales , Humanos , Hungría , Relaciones Médico-Paciente , Médicos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Relaciones Profesional-Familia , Encuestas y Cuestionarios , Estados Unidos