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1.
East Mediterr Health J ; 25(11): 791-797, 2019 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-31782515

RESUMO

Background: Advance directives towards end of life decisions are seldom used among Arabs. Aims: This study aimed at investigating advance care preferences among a sample of Arab patients. Method: This cross-sectional study was undertaken over the period March 2012-March 2013 on a sample of 300 patients with chronic illness in King Fahad National Guard Hospital, Riyadh, a major tertiary care hospital in Saudi Arabia. Results: Mean age of patients in the study was 48.7 years (standard deviation 16.4). There were 104 patients on haemodialysis, 73 with advanced malignancy, 81 with chronic liver disease and 35 with chronic respiratory disease. More than 80% of the respondents felt that the physician should make the decision about cardiopulmonary resuscitation. Over 60% wished to remain at home when their condition deteriorated to impending death. There were no significant correlations between the patients' end of life decision preferences and religiosity, quality of life, disease duration, or other demographic characteristics. Conclusion: Despite a significant lack of knowledge among our participants regarding resuscitation, a majority of patients with chronic illness were willing to discuss the options and were capable of making advance directive plans regarding their health status.


Assuntos
Diretivas Antecipadas/psicologia , Reanimação Cardiopulmonar/psicologia , Preferência do Paciente , Assistência Terminal/psicologia , Adulto , Idoso , Doença Crônica , Estudos Transversais , Tomada de Decisões , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Papel do Médico , Qualidade de Vida , Arábia Saudita , Fatores Socioeconômicos
2.
South Med J ; 112(10): 531-534, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31583413

RESUMO

OBJECTIVES: Many older adult patients want to be treated aggressively for reversible conditions, even when their current quality of life is limited; however, most standard living wills focus on the very end of life and provide little guidance to acute care providers (ACPs) should their older adult patient be admitted with a potentially treatable acute condition and temporarily lose capacity. We developed what we believe is a more informational and directive living will for this population. We sought to determine whether ACPs would find our pilot living will more helpful when caring for their older adult patients. METHODS: Convenience sample of members of the Society of Hospital Medicine (SHM). Respondents were asked to compare the pilot living will with their state form and then answer five attitudinal questions. RESULTS: In total, 125 providers from 39 states completed the survey: 86% indicated that the pilot living will better helped them understand their patients' general end-of-life preferences, 87.5% indicated the pilot living will would be more helpful in making specific treatment decisions for their patients, and 85% indicated the pilot living will would better facilitate end-of-life discussions with surrogates. CONCLUSIONS: Our results suggest that it is possible to design a functional advanced directive that better reflects the wishes of the older adult patient who wants to be treated aggressively in selected clinical situations. By more clearly defining these wishes, acute providers (eg, hospitalists, intensivists) can make more informed, patient-centered recommendations to surrogates.


Assuntos
Diretivas Antecipadas/psicologia , Estado Terminal , Tomada de Decisões , Testamentos Quanto à Vida/legislação & jurisprudência , Preferência do Paciente , Qualidade de Vida , Idoso , Feminino , Humanos , Masculino
3.
Int J Ment Health Nurs ; 28(6): 1296-1305, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31361087

RESUMO

Advance directives allow users of mental health services to make statements for their future care. In New Zealand, use of advance directives is supported by the Health and Disability Commissioner and was identified in the 2012 Blueprint as a key mechanism for service users to advocate for responses they find most helpful. This study used a qualitative descriptive methodology involving focus groups to explore the perceptions of service users, whanau and peer support workers concerning advance directives. Thematic analysis revealed certain belief patterns about what should or could be included in an advance directive, and about how and with whom one should be created. It revealed generally positive perceptions about how they can uphold service users' right to have preferences considered, to plan flexibly around dynamic needs, and about their value and utility. We conclude that advance directives can support services users' expressions of their preferences for care, but they need to be supported by clinicians if they are to realize this potential. Our findings can also inform service provision in New Zealand, and the planned reform of mental health legislation.


Assuntos
Diretivas Antecipadas , Transtornos Mentais/terapia , Adulto , Diretivas Antecipadas/psicologia , Idoso , Atitude Frente a Saúde , Feminino , Grupos Focais , Humanos , Masculino , Transtornos Mentais/psicologia , Serviços de Saúde Mental , Pessoa de Meia-Idade , Nova Zelândia , Grupo Associado , Adulto Jovem
4.
Pan Afr Med J ; 32: 64, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31223356

RESUMO

Introduction: Advanced directives enable the planning of care and support services independent of the older person's ability to make the decision. There is a paucity of information regarding the views and preferences regarding advanced directives and other end of life issues among older persons in low and middle-income countries such as Nigeria. The study aimed to explore the knowledge, attitude and belief of older persons regarding decision making surrounding end of life and advance directives. Methods: Data were collected through focus group discussions at a monthly social gathering of outpatients in a geriatric center in Oyo State, Nigeria. Discussions were audiotaped, transcribed and analyzed manually using a thematic approach. Results: Respondents' knowledge about the end of life care and advanced directives as prescribed in high income settings were sparse and did not include choices about treatment options or any medical directives. The predominant perceptions among the participants bordered mainly on the arrangements for place of death, burial and property sharing. Participants listed in order of preference the major decision makers in the advanced directive process mainly, the oldest male child, religious leaders and legal practitioners. Conclusion: Our findings imply the need for improving knowledge and awareness about the benefits of advanced directives among older persons with a focus on opportunities for their active participation.


Assuntos
Diretivas Antecipadas/psicologia , Atitude Frente a Morte , Conhecimentos, Atitudes e Prática em Saúde , Assistência Terminal/psicologia , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Percepção
5.
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
6.
Am J Hosp Palliat Care ; 36(11): 980-992, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31122037

RESUMO

BACKGROUND: End-of-life (EOL) care for Latinos with chronic illness is a critically important problem. Latinos with chronic illness suffer worse health outcomes and poorer quality of care due to various issues occurring in care delivery systems. Latinos are less likely than non-Hispanic whites to prepare an advance directive (AD) for health-care decision-making that impacts treatment decisions for when EOL is near. Advance care planning (ACP) interventions tailored specifically for Latinos have rarely been implemented. OBJECTIVE: The primary aim examines whether a motivational interviewing (MI) intervention increased rates of AD documentation among older Latinos. The secondary aim was to examine whether MI improved communication with providers and family members. METHODS: We pilot tested a randomized controlled trial with older Latinos >50 years with one or more chronic illnesses, including cancer. Participants were randomly assigned to usual care (UC) receiving ACP education alone versus treatment (TX), which received ACP education, plus MI counseling including interactive decisional support, emotional support, and barrier navigation. RESULTS: Results of logistic regression indicate TX group participants were significantly more likely to document an AD than UC, however were less ready to talk with health-care providers or family members. Those reporting navigational barriers for talking about dying is difficult showed a significant negative relationship for AD completion even with significant intervention effects. CONCLUSION: When using MI to motivate individuals toward ACP EOL conversations other factors are important to consider. Further research is needed, especially among Latinos to understand best practices for ACP education and counseling for EOL care.


Assuntos
Planejamento Antecipado de Cuidados , Diretivas Antecipadas/psicologia , Doença Crônica/psicologia , Hispano-Americanos/psicologia , Entrevista Motivacional/métodos , Assistência Terminal/psicologia , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Morte , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
7.
PLoS One ; 14(4): e0213938, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30978182

RESUMO

This study aimed to investigate physicians' and nurses' knowledge and attitudes toward advance directives (ADs) for cancer patients, which empower patients to take decisions on end-of-life needs if they lose their capacity to make medical decisions. A cross-sectional study was conducted using convenience sampling. The outcomes were responses to the knowledge and attitude questions, and the main outcome variables were the total scores for knowledge and attitudes toward ADs. This study included 281 physicians and nurses (60.5%). Most physicians were men (95, 80.5%), whereas most nurses were women (147, 86.5%). The mean (standard deviation; SD) total knowledge score was 6.8 (4.0) for physicians and 9.1 (3.0) for nurses (p < 0.001). There was a significant difference in the total knowledge score between nurses and physicians, with an adjusted mean difference of 1.54 (95% confidence interval [CI]; 0.08-2.97). Other significant independent predictors of knowledge of ADs were female sex (1.60, 95% CI; 0.27-3.13) and education level (master's versus bachelor's: 1.26, 95% CI; 0.30-2.33 and Ph.D. versus bachelor's: 2.22, 95% CI; 0.16-4.52). Nurses' attitudes appeared to be significantly more positive than those of physicians, and the mean total attitude score (SD) was 19.5 for nurses (6.2) and 15.1 (8.1) for physicians (p < 0.001). The adjusted mean difference (95% CI) for nurses versus physicians was 3.71 (0.57-6.98). All participants showed a high level of knowledge of ADs; however, nurses showed considerably more positive attitudes than physicians.


Assuntos
Diretivas Antecipadas/psicologia , Competência Clínica , Neoplasias/terapia , Enfermeiras e Enfermeiros/psicologia , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Humanos , Islamismo/psicologia , Masculino , Arábia Saudita , Adulto Jovem
8.
Am J Hosp Palliat Care ; 36(10): 893-899, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30913904

RESUMO

CONTEXT: This study aimed to evaluate the feasibility of an advance directive (AD) at the time of starting first-line palliative chemotherapy. We investigated changes in emotional distress, quality of life (QoL), and attitudes toward anticancer treatments between before and after AD. METHODS: Patients with advanced cancer who had just started palliative chemotherapy were prospectively enrolled. We assessed attitudes toward chemotherapy, Hospital Anxiety and Depression Scale (HADS), and European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ) before conducting the AD and subsequently performed the AD after the first cycle of chemotherapy. Follow-up evaluations using same parameters were performed in the next cycle visit. RESULTS: During the study period, 104 patients started palliative chemotherapy. Among them, 41 patients (11 with cognitive impairment at baseline, 14 with clinical deteriorations after the first cycle of chemotherapy, 6 with follow-up loss, 7 without proxy, 3 with protocol violations) were excluded, and the AD were recommended in the remaining 64 patients (proportion of AD recommendation: 62%). Among the 64 patients, 44 agreed to conduct the AD (proportion of AD consent: 69%). There were no significant changes before and after AD in terms of HADS and EORTC-QLQ. Attitudes regarding chemotherapy were also unchanged (P = .773). A total of 36 (82%) patients followed physician's recommendations, with the exception of 8 patients who terminated chemotherapy due to refusal or loss to follow-up. CONCLUSIONS: Considering our results showing no significant changes in depression and anxiety scores, QoL, and attitudes toward anticancer treatments after the AD, early integration of the AD at initiation of first-line palliative chemotherapy might be feasible.


Assuntos
Diretivas Antecipadas/psicologia , Saúde Mental , Neoplasias/psicologia , Cuidados Paliativos/psicologia , Idoso , Ansiedade/epidemiologia , Depressão/epidemiologia , Estudos de Viabilidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Qualidade de Vida , Estresse Psicológico/epidemiologia
9.
BMC Palliat Care ; 18(1): 25, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841925

RESUMO

BACKGROUND: Advance care planning (ACP) can offer benefits to patients and their families, especially when delivered in outpatient settings, but uptake remains low. Common barriers for health professionals include a perceived lack of time and adequate training, experience, and confidence in conducting ACP. Patient-reported barriers include a lack of awareness of ACP or discomfort initiating or engaging in discussions about end-of-life. METHODS: We aimed to explore patients' perspectives of an ACP intervention designed to address common barriers to uptake in the general practice setting. We provided training and support to doctors and general practice nurses (GPNs) to initiate and lead ACP discussions at their respective practices (2014 to 2015). Following the intervention, we conducted interviews with patients to explore their experience of engaging in ACP in the general practice setting. Thematic analysis was used to inductively code transcripts and identify key themes from semi-structured interviews with patients. RESULTS: Six major themes relating to patient experiences of GPN-facilitated ACP were identified: working through ideas, therapeutic relationship with nurses, significance of making wishes known, protecting family from burden, autonomy in decision-making, and challenges of family communication. The patients valued the opportunity to speak about issues that are important to them with the GPN who they found to be compassionate and caring. The patients felt that ACP would lead to significant benefits not only to themselves but also for their family. Despite encouragement to involve other family members, most patients attended the ACP discussions alone or as a couple; many did not see the relevance of their family being involved in the discussions. Some patients felt uncomfortable or reluctant in communicating the results of their discussion with their family. CONCLUSIONS: With adequate training and support, GPNs are able to initiate and facilitate ACP conversations with patients. Their involvement in ACP can have significant benefits for patients. Psychosocial and relational elements of care are critical to patient satisfaction. Our findings show that some patients may feel uncomfortable or reluctant to communicate the results of their ACP discussions with their family. A future larger study is required to verify the findings of this pilot study.


Assuntos
Diretivas Antecipadas/psicologia , Satisfação do Paciente , Pacientes/psicologia , Planejamento Antecipado de Cuidados/normas , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Medicina Geral/normas , Humanos , Masculino , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Apoio Social
10.
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
11.
Patient Educ Couns ; 102(6): 1067-1079, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30799141

RESUMO

OBJECTIVE: To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. METHOD: An integrative review of 93 studies, analysed according to their content themes. RESULTS: Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. CONCLUSIONS: There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. PRACTICE IMPLICATIONS: It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Diretivas Antecipadas/psicologia , Tomada de Decisões , Documentação , Armazenamento e Recuperação da Informação , Participação dos Interessados/psicologia , Humanos , Relações Profissional-Família , Relações Profissional-Paciente
12.
J Gerontol Nurs ; 45(1): 17-21, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30653233

RESUMO

The current study explored the perceptions of health care providers' use of electronic advance directive (AD) forms in the electronic health record (EHR). The Technology Acceptance Model (TAM) was used to guide the study. Of 165 surveys distributed, 151 participants (92%) responded. A moderately strong positive correlation was noted between perceived usefulness and actual system usage (r = 0.70, p < 0.0001). Perceived ease of use and actual system usage also had a moderately strong positive correlation (r = 0.70, p < 0.0001). In contrast, the strength of the relationship between behavioral intention to use and actual system usage was more modest (r = 0.22, p < 0.004). There was a statistically significant difference in actual system usage of electronic ADs across six departments (χ2[5] = 79.325, p < 0.001). The relationships among primary TAM constructs found in this research are largely consistent with previous TAM studies, with the exception of behavioral intention to use, which is slightly lower. These data suggest that health care providers' perceptions have great influence on the use of electronic ADs. [Journal of Gerontological Nursing, 45(1), 17-21.].


Assuntos
Diretivas Antecipadas/psicologia , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Registros Eletrônicos de Saúde , Pessoal de Saúde/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
14.
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
15.
Am J Hosp Palliat Care ; 36(6): 526-532, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30696253

RESUMO

BACKGROUND: Little is understood about the different ways patients complete advance directives (ADs), which is most commonly through lawyers and increasingly using websites. OBJECTIVE: To understand patients' perspectives on different approaches to facilitating AD completion, the value of legal regulation of ADs, and the use of a web-based platform to create an AD. DESIGN: Semi-structured interviews with patients. SETTING/PARTICIPANTS: We purposively sampled 25 patients at least 70 years of age or with a chronic disease from 2 internal medicine clinics. MEASUREMENTS: Interviews focused on experiences and perspectives creating ADs, including facilitation by lawyers, health-care professionals, and websites. Feedback on a website prototype was also obtained. Responses were analyzed with modified grounded theory until thematic saturation was achieved. RESULTS: Although a majority of participants with ADs had used lawyers, participants were ambivalent about the benefits of lawyer facilitation. Most valued both the medical perspective of a health-care professional and a lawyer's attention to legal requirements for AD validity. Participants had positive impressions of the web platform, but some were concerned about privacy with online storage. Trust emerged as an overarching theme, and participants valued legal regulation of ADs to ensure document authenticity and delivery of preference-concordant care. CONCLUSION: Efforts to improve documentation of care planning need to address the disparate methods by which participants complete ADs. Creating options that combine the perceived benefits of a legal approach with greater health professional involvement could appeal to participants. Privacy concerns may limit web use by some patients.


Assuntos
Diretivas Antecipadas/legislação & jurisprudência , Diretivas Antecipadas/psicologia , Internet , Pacientes/psicologia , Idoso , Idoso de 80 Anos ou mais , Confidencialidade , Tomada de Decisões , Feminino , Pessoal de Saúde/psicologia , Nível de Saúde , Humanos , Entrevistas como Assunto , Advogados/psicologia , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Confiança
16.
Ann Emerg Med ; 73(3): 294-301, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30503382

RESUMO

Physician Orders for Life-Sustaining Treatment forms convert patient wishes into physician orders to direct care patients receive near the end of life. Recent evidence of the challenges and opportunities for honoring patient end-of-life wishes in the emergency department (ED) is presented. The forms can be very helpful in directing whether cardiopulmonary resuscitation and intubation are desired in the first few minutes of a patient's presentation. After initial stabilization, understanding the intent of end-of-life orders and the scope of further interventions requires discussion with the patient or a surrogate. The emergency medicine provider must be committed both to honoring initial resuscitation orders and to the conversations required to narrow the gap between ED care and patient wishes so that people receive care best aligned with their wishes.


Assuntos
Cuidados para Prolongar a Vida , Preferência do Paciente , Ordens quanto à Conduta (Ética Médica) , Diretivas Antecipadas/legislação & jurisprudência , Diretivas Antecipadas/psicologia , Serviço Hospitalar de Emergência , Controle de Formulários e Registros/métodos , Humanos , Cuidados para Prolongar a Vida/legislação & jurisprudência , Cuidados para Prolongar a Vida/psicologia , Preferência do Paciente/legislação & jurisprudência , Preferência do Paciente/psicologia , Relações Médico-Paciente , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Ordens quanto à Conduta (Ética Médica)/psicologia
17.
Med Leg J ; 87(2): 97-99, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30489203

RESUMO

This case is of a suicide victim who purchased various drugs online using forged prescriptions after detailed research about the drugs to commit suicide. He left a suicide note giving details of his suicide methods and the reasons for it. He also denied any treatment and asked for euthanasia if he survived and remained in a vegetative state.


Assuntos
Diretivas Antecipadas/psicologia , Eutanásia/psicologia , Suicídio/psicologia , Redação , Overdose de Drogas/etiologia , Overdose de Drogas/psicologia , Humanos , Masculino , Adulto Jovem
18.
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
19.
BMJ Support Palliat Care ; 9(1): e22, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28935629

RESUMO

OBJECTIVES: To identify patient-reported paediatric advance care planning (pACP) needs of adolescents living with HIV and to examine the congruence with their family's perception of their needs. METHODS: A cross-sectional survey among six paediatric hospital-based outpatient HIV specialty clinics. Participants included 48 adolescent/family dyads (n=96 participants) within a larger study facilitating pACP. The main outcome measure was the Lyon Advance Care Planning Survey - Adolescent and Surrogate Versions-Revised. RESULTS: Adolescents' mean age was 18 years (range ≥14-<21); 54% male; 92% African-American; 27% with prior AIDS diagnosis. If dying, 92% believed in completing an advance directive; 85% preferred to die at home;88% knowing how to say good bye; 71% being off machines that extend life and 77% dying a natural death. Best timing for end-of-life (EOL) decisions was while healthy (38%), when first diagnosed (17%), when first sick from a life-threatening illness (4%), when first hospitalised (8%), if dying (4%) and all of the above (19%). Prevalence-adjusted bias-adjusted Kappa (PABAK) measured congruence in pACP needs within adolescent/family dyads. There was substantial congruence in that being free from pain (PABAK=0.83), and understanding your treatment choices (PABAK=0.92) were very important or important. There was discordance about being off machines that extend life (PABAK=0.08) and when is the best time to bring up EOL decisions (PABAK=0.32). CONCLUSIONS: Areas of discordance were associated with life-sustaining choices and when to have the EOL conversation. Targeted, adolescent/family-centred, evidence-based pACP interventions are needed to improve family understanding of youth's EOL wishes. TRIAL REGISTRATION NUMBER: NCT01289444; Results.


Assuntos
Planejamento Antecipado de Cuidados , Diretivas Antecipadas/psicologia , Família/psicologia , Infecções por HIV/psicologia , Assistência Terminal/psicologia , Adolescente , Comunicação , Estudos Transversais , Tomada de Decisões , Dissidências e Disputas , Feminino , HIV , Infecções por HIV/terapia , Humanos , Masculino , Relações Pais-Filho , Inquéritos e Questionários , Adulto Jovem
20.
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
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