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1.
Arch Gerontol Geriatr ; 86: 103955, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31561064

RESUMO

BACKGROUND: Increased awareness of the clinical course of nursing home residents with advanced dementia and advance care planning (ACP) has become the cornerstone of good palliative care. OBJECTIVE: The aim of our study is to describe changes in ACP in the form of physician treatment orders (PTOs), symptom prevalence and possible burdensome interventions among nursing home (NH) residents who died between 2004-2009 and 2010-2013 METHODS: Retrospective study RESULTS: The number of PTOs regarding forgoing antibiotics or parenteral antibiotics, forgoing artificial nutrition or hydration or forgoing hospitalisation doubled between 2004-2009 and 2010-2013 (38.1% vs. 64.9%, p < 0.001; 40.0% vs. 81.7%, p < 0.001; 28.1% vs. 69.5%, p < 0.001, respectively). PTOs were also done significantly earlier in 2010-2013 than in 2004-2009. The prevalence of distressing symptoms and possible burdensome interventions remained unchanged, although the prevalence of consistency with the PTOs was high. CONCLUSION: Despite the increased number of PTOs, this had little effect on symptom prevalence and possible burdensome interventions experienced by NH residents in the last days of life.


Assuntos
Planejamento Antecipado de Cuidados/tendências , Diretivas Antecipadas/estatística & dados numéricos , Demência/terapia , Casas de Saúde/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Morte , Demência/mortalidade , Demência/psicologia , Feminino , Finlândia/epidemiologia , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Hospitalização , Humanos , Masculino , Prevalência , Estudos Retrospectivos
2.
BMC Palliat Care ; 18(1): 84, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640677

RESUMO

BACKGROUND: "End of life" is a difficult topic of conversation in East Asian cultures, even among patients and doctors who share a good rapport. In 2016, the Hospice, Palliative Care, and Life-Sustaining Treatment Decision-Making Act, which took the form of "Physician Orders for Life-Sustaining Treatment," was introduced in South Korea. This study was conducted to investigate the completion rate of Physician Orders for Life-Sustaining Treatment in patients with advanced cancer on the active recommendation of physicians, as well as patients' general attitudes toward end-of-life care. METHODS: We conducted a preliminary, cross-sectional descriptive survey on patients with advanced cancer. A total of 101 patients with advanced solid cancer agreed to participate in the study. The primary endpoint was the rate of completion of Physician Orders for Life-Sustaining Treatment based on a doctor's suggestion. Written interviews were conducted to understand the perceptions and factors influencing patients' decisions. RESULTS: Of the 101 patients, 72 (71.3%) agreed to prepare Physician Orders for Life-Sustaining Treatment. Patients who had an educational level of high school or higher were more likely to agree to complete Physician Orders for Life-Sustaining Treatment documentation as compared to the lower educational status group. More than half of the respondents who completed Physician Orders for Life-Sustaining Treatment documentation reported that they had more than a fair understanding of "life-sustaining care" or "Physician Orders for Life-Sustaining Treatment." Participants' reasons for Physician Orders for Life-Sustaining Treatment completion were diverse. CONCLUSIONS: We found that highly educated patients, who understood the concept behind the policy well, tended to accept Physician Orders for Life-Sustaining Treatment without hesitation. Better education, information shared through the media, and conversations with health care providers might improve understanding of Physician Orders for Life-Sustaining Treatment in patients with cancer.


Assuntos
Diretivas Antecipadas/estatística & dados numéricos , Neoplasias/terapia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Ordens quanto à Conduta (Ética Médica) , Inquéritos e Questionários , Cooperação e Adesão ao Tratamento/psicologia
3.
Med. paliat ; 26(3): 227-235, jul.-sept. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190247

RESUMO

OBJETIVO: Describir el conocimiento del personal sanitario de servicios implicados en el manejo de enfermos paliativos en situación avanzada, sobre el Documento de Voluntades Anticipadas (DVA) y su Registro Nacional. Conocer cómo valoran su uso y si lo consultan habitualmente. MATERIAL Y MÉTODO: Estudio multicéntrico, transversal descriptivo, mediante cuestionario anónimo cumplimentado por personal médico y de enfermería en tres centros hospitalarios. Se recogieron un total de 160 cuestionarios correspondientes a 58 médicos y 102 enfermeros, pertenecientes a Servicios de Urgencias (SU), Oncología, Unidades de Hospitalización a Domicilio (HaD) y Hospital de Día. El cuestionario constaba de 14 preguntas tipo test de respuesta única, además de las variables demográficas y laborales pertinentes para el estudio. RESULTADOS: Las medias de edad de la muestra fueron de 42 ± 9 años, y la experiencia profesional de 17 ± 9,3 años. El 83,1 % de los encuestados afirmaron conocer el DVA y el 53,7 % que sabrían cumplimentarlo, pero solo un 8,1 % de ellos contestaron correctamente a la pregunta de dónde localizar dicho documento. El 92,5 % de los encuestados no lo consultan nunca. Los dos encuestados que afirmaban consultarlo habitualmente, no supieron localizarlo. CONCLUSIONES: Existe un desconocimiento generalizado del DVA, siendo este independiente tanto de la categoría profesional como de los años de experiencia o del servicio en el que se trabaja. Incluso en los casos que dicen conocerlo, sus respuestas no corroboran tal afirmación


OBJECTIVE: To describe the knowledge healthcare providers at the units involved in the management of advanced palliatiave care patients have of the advance directives document (ADD). To find out how do they value its use, and whether they check it out regularly. MATERIAL AND METHODS: A multicenter, cross-sectional, descriptive study using an anonymous questionnaire to be completed by doctors and nurses in three hospitals. A total of 160 questionnaires were collected from 58 doctors and 102 nurses working at emergency rooms (ERs), oncology departments, home hospitalization units (HHUs), and day hospital services. Questionnaires included 14 multiple choice questions with only one valid option, and also collected the demographic and labor variables required by the study. RESULTS: Mean age in the sample was 42 ± 9 years, and professional experience was 17 ± 9.3 years. Among responders, 83.1 % claimed knowledge of the ADD, and 53.7 % said they could complete it, but only 8.1 % knew where to find it; 92.5 % of respondents never consult it. The two respondents who claimed they usually checked it out were eventually unable to locate it. CONCLUSIONS: Lack of knowledge about ADDs and their related National Registry is widespread, and occurs regardless of professional category or years of experience. Even in providers who claim awareness of this document the answers provided belie it


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Planejamento Antecipado de Cuidados , Diretivas Antecipadas/estatística & dados numéricos , Serviços Hospitalares de Assistência Domiciliar , Hospital Dia/organização & administração , Serviços Médicos de Emergência , Pessoal de Saúde/educação , Estudos Transversais , Inquéritos e Questionários
4.
Gac Med Mex ; 155(2): 149-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056615

RESUMO

Introduction: Concepts related to end-of-life decisions, such as euthanasia, palliative care, advance directives and therapeutic obstinacy, are poorly understood by the general population, which, when facing a terminal situation, is not prepared to choose the best option. Objective: Pilot study (n = 544) to find out what the open population understands about terms used in end-of-life situations in four cities of the Mexican Republic. Method: Survey via Internet with 18 questions about different terms. It was a descriptive, cross-sectional study. Statistical analysis was carried out. Results: People older than 18 years who were not engaged in health-related professional activities were selected. Conclusions: Most terms related to end-of-life decisions were found not to be interesting to or understood by a part of the population. The least recognized term was therapeutic obstinacy (62.8%), and the most widely known, palliative care (91%); there was confusion between the terms euthanasia and assisted suicide (47.8%). Age and education level had more influence in the results, than other demographic variables.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Cuidados Paliativos/psicologia , Assistência Terminal/psicologia , Adolescente , Adulto , Diretivas Antecipadas/psicologia , Diretivas Antecipadas/estatística & dados numéricos , Fatores Etários , Idoso , Estudos Transversais , Escolaridade , Eutanásia/psicologia , Eutanásia/estatística & dados numéricos , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Projetos Piloto , Suicídio Assistido/psicologia , Suicídio Assistido/estatística & dados numéricos , Inquéritos e Questionários , Assistência Terminal/estatística & dados numéricos , Adulto Jovem
5.
Cancer Res Treat ; 51(4): 1632-1638, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30999720

RESUMO

PURPOSE: Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice. Materials and Methods: Patients with terminal cancer, age ≥ 20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians' or patients' barriers were also collected. RESULTS: From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians' barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients' denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients' barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%). CONCLUSION: One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.


Assuntos
Diretivas Antecipadas/estatística & dados numéricos , Neoplasias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Negação em Psicologia , Estudos de Viabilidade , Feminino , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Estudos Prospectivos , Ordens quanto à Conduta (Ética Médica) , Assistência Terminal , Adulto Jovem
6.
J Trauma Acute Care Surg ; 87(1): 153-160, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31033897

RESUMO

BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) forms are portable medical orders documenting patient treatment preferences in an acute health decline. It is unclear how these forms are used in the management of elderly trauma patients. METHODS: Patients 65 years and older presenting to a Level I trauma center were identified between 2012 and 2017. Hospital trauma registry and medical records were used to identify a preinjury POLST and its acknowledgment by providers within 24 hours of arrival. A 1:1 propensity score matched sample was used to evaluate clinical outcomes based on the presence of a POLST limiting interventions with p less than 0.05 deemed significant. RESULTS: There were 3,342 elderly trauma patients identified. One hundred ninety-two (6%) had a POLST identified by the institutional trauma registry dated before the injury. Do not attempt resuscitation (DNR) was listed in 154 patients (80%), and 79% desired to avoid the intensive care unit (ICU) with limited (54%) or comfort measures only (CMO, 25%). One hundred seven (76%) of admitted POLST DNR patients had a DNR code status for the majority of their admission. 59 (58%) of the limited and 29 (60%) of the comfort measures only patients were admitted to the ICU. Acknowledgment of a preinjury POLST or code status was explicitly documented in 110 cases (57%). Propensity score analysis yielded a comparison sample of 288 patients. In the matched comparison, an acknowledged POLST with limitations was associated with a shorter ICU stay (1.7 vs. 2.8 days, p = 0.008) but there was no difference in ICU admission (58% vs. 61%, p = 0.69), total length of stay (3.8 days vs. 4.8 days, p = 0.08), or in-hospital mortality (13% vs. 8%, p = 0.2). CONCLUSION: Limited provider acknowledgment of preinjury medical directives necessitates protocol development for the management of frail elderly trauma patients. When acknowledged, patients with a POLST limiting interventions had fewer ICU days without increased in-hospital mortality compared with similarly injured elderly patients. LEVEL OF EVIDENCE: Care Management, level IV.


Assuntos
Diretivas Antecipadas/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pontuação de Propensão , Ordens quanto à Conduta (Ética Médica) , Estudos Retrospectivos , Resultado do Tratamento , Ferimentos e Lesões/epidemiologia
8.
Appl Nurs Res ; 46: 8-15, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30853079

RESUMO

BACKGROUND: The current debate regarding decision-making at the End-of-Life (EoL) is increasing remarkably and has spread all over the world. However, literature has paid little attention to describe choice's differences in EoL care between healthcare professionals and general public. OBJECTIVES: The aim of this study was to explore the difference between choices in EoL care made by healthcare professionals and those of the general public within the Italian context. SETTING AND PARTICIPANTS: In 2017, an Italian widespread survey was conducted using a snowball sampling. A total of 2038 participants completed the survey, 55.64% of which were the general public. RESULTS: The main differences related to specific EoL choices made by healthcare professionals and the general public. In particular, healthcare professionals were more likely to avoid cardiopulmonary resuscitation and mechanical forms of breathing in terminal-stage conditions, and they were also more likely to be favorable towards the use of opioids to avoid suffering. Overall, healthcare professionals were also more likely to make a choice rather than express a 'not sure' answer. CONCLUSION: The higher percentage of participants in the general public group that chose 'not sure' highlighted the importance of addressing and enhancing people's self-awareness. More cross-national investigation should help to frame the understanding of the choice's differences in EoL care between healthcare professionals and general public.


Assuntos
Diretivas Antecipadas/psicologia , Atitude do Pessoal de Saúde , Atitude Frente a Morte , Tomada de Decisões , Pessoal de Saúde/psicologia , Pacientes/psicologia , Assistência Terminal/psicologia , Adulto , Diretivas Antecipadas/estatística & dados numéricos , Estudos Transversais , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Inquéritos e Questionários , Assistência Terminal/estatística & dados numéricos
9.
Intern Med J ; 49(10): 1261-1267, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30785233

RESUMO

BACKGROUND: The community prevalence of advance care directives (ACD) is low despite known benefits of advance care planning for patients, families and health professionals. AIM: To determine the community prevalence of instructional and appointing ACD in New South Wales, Victoria and Queensland and factors associated with completion of these documents. METHODS: A telephone survey of adults living in New South Wales, Victoria and Queensland (n = 1175) about completion of instructional ACD (making their own decisions about future healthcare) and appointing ACD (appointing another to decide). Quota sampling occurred based on population size by state, gender and age, with oversampling in smaller jurisdictions (Victoria and Queensland). RESULTS: Overall response rate was 33%. Six per cent of respondents reported completing an instructional ACD while 12% reported completing an appointing ACD. Female gender, higher educational level, personal experience of a major health scare and being widowed were significant predictors of completing an instructional ACD. Older age, higher educational level and being widowed were significant predictors of completing an appointing ACD. CONCLUSIONS: Despite long-standing efforts to increase advance care planning, community prevalence of ACD remains low, particularly for instructional ACD. This study found some different predictors for instructional ACD compared with appointing ACD, and also a potential role for experiential factors in triggering uptake. These findings suggest supplementing general community awareness campaigns with more nuanced and targeted efforts to improve ACD completion.


Assuntos
Diretivas Antecipadas/estatística & dados numéricos , Adolescente , Adulto , Tomada de Decisões , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , New South Wales/epidemiologia , Prevalência , Queensland/epidemiologia , Inquéritos e Questionários , Telefone , Vitória/epidemiologia , Adulto Jovem
10.
J Palliat Care ; 34(3): 189-196, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30808249

RESUMO

BACKGROUND: Advance directives are statements that allow a person to express his or her wishes for medical treatment in advance of needing it or to appoint someone else if they are unable to do so. OBJECTIVES: To estimate the prevalence of decedents having a documented advance directive (AD) and a signed enduring power of attorney (SPoA) and to determine the degrees to which characteristics of decedents and their informant and the care the decedent received were predictive of the decedents having a documented AD and a SPoA. METHODS: A population-based mortality follow-back survey was conducted in Nova Scotia, Canada. Informants who were knowledgeable of a decedents' death were invited to participate in a telephone interview based on the After-Death Bereaved Family Member Interview. Regression analyses were used to assess factors that were predictive of having an AD or SPoA. RESULTS: Overall, 56.3% of decedents had a documented AD, and 67.6% had an SPoA. Significant predictors of a decedent having a documented AD were their age, where they received the majority of their end-of-life care, whether they received specialized palliative care, whether they were aware they were dying, and the informant's age. Significant factors in predicting whether a person had a SPoA were whether the decedent received specialized palliative care, where they received the majority of their care, and the age and education level of their informant. CONCLUSION: These results may be used to better target and tailor future efforts to promote use of AD and SPoA.


Assuntos
Diretivas Antecipadas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Nova Escócia , Inquéritos e Questionários
11.
Artigo em Inglês | MEDLINE | ID: mdl-30696082

RESUMO

Advance directives (AD) can be used for the communication of healthcare decisions that may be required in the future when individuals have lost their capacity to make such decisions. The aim of this study is to examine the prevalence, perception, and predictors of AD completion in the Hong Kong general population with a diverse culture. Through random-digit dialing, a population-based telephone survey was conducted with participants aged 18 or above. Socio-demographic characteristics, self-perception and health status, prevalence of AD, and perceptions related to AD were assessed. The acceptance on completing AD was measured by the summed score on the level of agreement in making AD. In total, 2002 participants completed the survey, with only 0.5% having made AD. However, the majority of those who had heard about AD had made or intended to make AD (80.2%). Multivariable regression analysis showed that being religious, being optimistic, and agreeing to respect patients' wishes are independently associated with higher AD acceptance. Being a student is associated with lower AD acceptance. The extremely low completion rate of AD, but high acceptance of AD urges for more active promotion of AD to the public and education on end-of-life care among university students.


Assuntos
Diretivas Antecipadas/psicologia , Diretivas Antecipadas/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Vigilância da População/métodos , Assistência Terminal/psicologia , Assistência Terminal/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Prevalência , Análise de Regressão , Inquéritos e Questionários
12.
Am J Hosp Palliat Care ; 36(5): 402-407, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30477311

RESUMO

CONTEXT:: Completion of advance directives (ADs) enhances the likelihood of receiving goal-concordant treatments near the end of life. Previous research on community samples have shown that completion of ADs is less common in lower socioeconomic status demographic group; there is a paucity of such research in patients with cancer. OBJECTIVES:: To study the effect of income and education on the completion of ADs. HYPOTHESIS:: Patients with cancer having lower incomes and education levels would be less likely to report completing ADs. METHODS:: We conducted cross-sectional analyses of data provided by patients (n = 265) enrolled in the Values and Options in Cancer Care clinical trial. Patients with advanced cancer reported whether they had (1) completed a living will or (2) designated a health-care proxy. Response options for both questions were yes (scored 1), no (scored 0), and unsure (scored 0). We studied the association of lower household income (≤US$20 000) and education level (never attended college) with AD scores. RESULTS:: Patients with lower annual incomes had lower AD scores (estimate -0.44; confidence intervals [CI]: -0.71 to -0.16, P = .001); the association between higher educational attainment (some college or more) and completion of ADs was not statistically significant (estimate 0.04, CI: -0.16 to 0.24, P = .70). CONCLUSION:: Interventions to promote completion of ADs among lower income patients with serious illnesses are needed.


Assuntos
Diretivas Antecipadas/estatística & dados numéricos , Escolaridade , Renda/estatística & dados numéricos , Neoplasias/epidemiologia , Fatores Etários , Idoso , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
13.
Hosp Pract (1995) ; 47(1): 28-33, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30328723

RESUMO

BACKGROUND: There has been little published research regarding the implementation of healthcare power of attorney (HCPOA) documents prior to elective surgery. OBJECTIVES: This study aims to determine the prevalence of HCPOA documents incorporated into the electronic medical records (EMR) of patients undergoing elective surgery at four healthcare institutions. A secondary aim is to examine for correlations between HCPOA document implementation and demographic and preoperative clinical predictors. METHODS: A retrospective chart review was performed in 2012 on 500 consecutive adult patients undergoing elective surgery that required general anesthesia at four medical centers. A descriptive analysis and multivariate logistic regression analysis were performed to examine for associations between HCPOA implementation and hospital site, age, gender, ASA score, marital status, body mass index, insurance type, and zip code. RESULTS: Of 1723 charts reviewed, only 382 had a HCPOA document implemented within the EMR at the time of surgery with significant variance between hospital sites. Female sex, a widowed marital status, and an ASA score greater than 2 were significantly associated with having a HCPOA implemented in the EMR, while BMI, insurance type, and socioeconomic status based on zip code did not significantly correlate with the rate of HCPOA documentation. CONCLUSIONS: Less than a quarter (22.2%) of patients undergoing elective surgery requiring general anesthesia had a HCPOA document appropriately identified despite the known morbidity and mortality risks. The mere presence of EMR systems, palliative care consultation teams, and preoperative care teams are likely insufficient in ensuring appropriate surrogate documentation prior to elective surgery.


Assuntos
Diretivas Antecipadas/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Procurador/estatística & dados numéricos , Tomada de Decisões , Humanos , Relações Médico-Paciente , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos
14.
Rev Med Interne ; 40(3): 145-150, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-29804875

RESUMO

INTRODUCTION: In France, Leonetti and Claeys-Leonetti laws relating to patients' rights and end-of-life practice have introduced the advance healthcare directives (ADs). Although family doctor's role is important in initiating discussions regarding AD, hospital healthcare professionals should also be concerned by the health care planning laws. METHODS: A descriptive, quantitative and qualitative study was conducted in Paris Saint-Joseph hospital to evaluate the knowledge of nursing personnel regarding ADs. Among healthcare professionals present on 02/06/2016 and agreeing to participate, 50 non-medical caregivers and 50 doctors were randomly selected and took part in this survey. Three trainee lawyers conducted interviews, recorded and anonymized them. The Nvivo software analyzed the qualitative part of the results. RESULTS: Only 10% of healthcare professionals knew these legal and ethical issues in health care. Most caregivers were not in favor of informing all patients admitted to a hospital (hospitalized patients or patients received consultations). For 44%, only hospitalized end-of-life patients should be informed about ADs. For 76% of the people questioned, family doctor has a unique position to guide the patient on the preparation and registration of living wills. In hospital stay, the nurse was proposed by 52% of the staff as the preferred caregiver for AD communication, as part of an interdisciplinary healthcare team approach. Finally, the clear majority of caregivers (85%), called for discussions and documentation about ADs, and end-of-life training. CONCLUSION: Advance directives remain poorly known in the hospital, 12 years after the first Leonetti law. The attitude of professionals about ADs is not homogenous but interest for the subject is obvious in the vast majority of caregivers. The results of this survey highlighted that discussions and documentation about ADs as well as training on end-of-life patient care are essential.


Assuntos
Diretivas Antecipadas , Atitude do Pessoal de Saúde , Hospitalização , Pacientes , Prática Profissional , Adulto , Diretivas Antecipadas/ética , Diretivas Antecipadas/psicologia , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Atitude , Feminino , França/epidemiologia , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Direitos do Paciente/ética , Pacientes/psicologia , Papel do Médico/psicologia , Prática Profissional/ética , Prática Profissional/normas , Prática Profissional/estatística & dados numéricos , Adulto Jovem
15.
J Appl Gerontol ; 38(4): 572-591, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-28380721

RESUMO

Hospice is underutilized in the United States, and many patients enroll for short periods of times. The purpose of this cross-sectional study was to identify significant predictors of intentions to use hospice in community-dwelling older adults. The Theory of Planned Behavior informed the selection of predictors. Data were collected from 146 White older adults ( M age = 69.5; 69% females). Multiple linear regression analyses showed that higher hospice knowledge, normative beliefs that support hospice utilization, higher perceived control to use hospice, and preferences for end-of-life care that favor comfort and quality of life over living as long as possible were significant predictors of intentions to use hospice. In spite of being a sample of mostly highly educated older adults, almost half did not know about funding for hospice. These results provide better understanding of where to focus interventions to educate older adults about hospice, ideally in advance of a crisis.


Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Modelos Lineares , Masculino , Medicare , Pessoa de Meia-Idade , Preferência do Paciente/psicologia , Religião , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos
16.
BMJ Support Palliat Care ; 9(3): 267-270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29572344

RESUMO

OBJECTIVES: The aim of this evaluation is to describe the components and results of urgent care planning in Coordinate My Care (CMC), a digital clinical service for patients with life-limiting illness, for use if a patient is unable to make or express choices. Ceiling of treatment (CoT) plans were created detailing where the patient would like to receive their care and how aggressive medical interventions should be. METHODS: A retrospective service evaluation was completed of all CMC records created between December 2015 and September 2016 (n=6854). CMC records were divided into two cohorts: those with a CoT plan and those without. The factors associated with these cohorts were reviewed including age, diagnosis, resuscitation status and preferences for place of death (PPD). Analysis of the non-mandatory free text section was carried out. RESULTS: Two-thirds of patients had recorded decisions about CoT. Regardless of which CoT option was chosen, for most patients, PPD was home or care home. Patients with a CoT plan were more likely to have a documented resuscitation status. Patients with a CoT were more likely to die in their PPD (82%vs71%, OR 1.79, p<0.0001). A higher proportion of patients with a CoT decision died outside hospital. CONCLUSION: This analysis demonstrates that a substantial proportion of patients are willing to engage in urgent care planning. Three facets of urgent care planning identified include PPD, CoT and resuscitation status.


Assuntos
Planejamento Antecipado de Cuidados/estatística & dados numéricos , Diretivas Antecipadas/estatística & dados numéricos , Estado Terminal/mortalidade , Assistência Terminal/estatística & dados numéricos , Diretivas Antecipadas/psicologia , Idoso de 80 Anos ou mais , Estado Terminal/psicologia , Tomada de Decisões , Assistência à Saúde , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Assistência Terminal/métodos , Assistência Terminal/psicologia
17.
Am J Hosp Palliat Care ; 36(1): 24-27, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30071753

RESUMO

PURPOSE:: Advance care planning (ACP) is theorized to benefit both the patient and their family when end of life is near as well as earlier in the course of serious illness. However, ACP remains underutilized, and little is known about the nature of ACP documentation in geriatrics practices. The study investigated the prevalence and nature of ACP documentation within a geriatric primary care clinic. METHODS:: A retrospective chart review was conducted on a randomly selected sample of electronic medical record (EMR) charts. The sample consisted of patients aged 65 and older who were seen in the clinic from January 1, 2015, to December 31, 2016. Charts were reviewed for ACP documentation and data regarding age, gender, race, religion, comorbidities (end-stage renal disease, congestive heart failure, cancer, and dementia), recent hospitalizations, and visit type. RESULTS:: Ninety-eight charts were reviewed (n = 98). Nine patients (9.18%) had an advance directive (AD) or power of attorney (POA) available within their EMR. Twenty-five patients (25.5%) had provider notes documenting that they have an AD, POA, or preferred health-care decision maker; however, no documents were available. The remaining 64 (65.3%) patients had no evidence of ACP documentation within their EMR. Age was the only demographic variable associated with completion of an AD ( P = .038). DISCUSSION:: The rate of ACP documentation (34.6%) was lower than the average among US adults aged 65 and over (45.6%); further, most patients with ACP documentation did not have an AD or POA on file. The authors plan to reevaluate ACP statistics in the same office following a future intervention.


Assuntos
Planejamento Antecipado de Cuidados/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Diretivas Antecipadas/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Comorbidade , Documentação , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Atenção Primária à Saúde , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos
18.
J Emerg Med ; 56(2): 145-152, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30527561

RESUMO

BACKGROUND: Early integration of palliative care from the emergency department (ED) is an underutilized care modality with potential benefits, but few studies have identified who is appropriate for such care. OBJECTIVE: Our hypothesis is that patients aged 65 years or older who present to the ED as level I Emergency Severity Index from a long-term care (LTC) facility have high resource utilization and mortality and may benefit from early palliative care involvement. METHODS: We performed a retrospective chart review of patients aged 65 years or older who arrived in the ED of an academic suburban southeastern level I trauma center from an LTC facility and triaged as level I priority. The ED course, hospital course, and final outcomes were analyzed. RESULTS: Of the 198 patients studied, 54% were deceased 30 days after discharge, with only 29.8% alive at 12 months. Admitted patients had a median hospital length of stay of 5 days and 73% required intensive care. Formal palliative care intervention was provided in 40.4%, occuring a median of 4 days into hospitalization and leading to 85% downgrading their advanced directive wishes, and discharge occuring a median of 1 day later. Few formal palliative care interventions occurred in the ED (9.1%). CONCLUSIONS: Elderly patients from LTC facilities presenting with severe acute illness have high mortality and seldom receive early palliative care. Introduction of palliative care has the ability to change the course of treatment in this vulnerable population and should be considered early in the hospitalization and, where available, be initiated in the ED.


Assuntos
Diretivas Antecipadas/estatística & dados numéricos , Geriatria/métodos , Cuidados Paliativos/métodos , Triagem/classificação , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/organização & administração , Feminino , Geriatria/normas , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/normas , Masculino , Cuidados Paliativos/normas , Estudos Retrospectivos , Índice de Gravidade de Doença , Triagem/estatística & dados numéricos
19.
Mayo Clin Proc ; 93(12): 1720-1727, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30522592

RESUMO

OBJECTIVE: To characterize the end-of-life care of all international patients who died at a global destination medical center from January 1, 2005, through December 31, 2015. PATIENTS AND METHODS: We performed a retrospective review of all adult international patients who died at a global destination medical center from January 1, 2005, through December 31, 2015. RESULTS: Eighty-two international patients from 25 countries and 5 continents died during the study period (median age, 59.5 years; 59% male). Of the study cohort, 11% (n=9) completed an advance directive, 61% (n=50) died in the intensive care unit, 26% (n=21) had a full code order at the time of death, and 73% (n=19 of 26) receiving cardiopulmonary resuscitation did not survive the resuscitation process. CONCLUSION: Seriously ill international patients who travel to receive health care in the United States face many barriers to receiving high-quality end-of-life care. Seriously ill international patients are coming to the United States in increasing numbers, and little is known about their end-of-life care. There are many unique needs in the care of this complex patient population, and further research is needed to understand how to provide high-quality end-of-life care to these patients.


Assuntos
Turismo Médico/estatística & dados numéricos , Assistência Terminal/normas , Adulto , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Assistência à Saúde Culturalmente Competente/normas , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/normas , Cuidados Paliativos/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
20.
Natl Health Stat Report ; (117): 1-8, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30248019

RESUMO

This report describes the percentage of adult day services centers (ADSCs) that typically maintain documentation of participants' advance directives by region and center characteristics. Further, among ADSCs that maintain documentation, this report describes the percentage of participants with advance directives by region and center characteristics.


Assuntos
Centros-Dia de Assistência à Saúde para Adultos , Diretivas Antecipadas , Tomada de Decisões , Diretivas Antecipadas/estatística & dados numéricos , Documentação , Registros Eletrônicos de Saúde , Pesquisas sobre Serviços de Saúde , Humanos , Medicaid , Pessoa de Meia-Idade , Estados Unidos
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