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1.
BMC Palliat Care ; 22(1): 201, 2023 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-38097993

RESUMO

BACKGROUND: Hemodialysis holds the highest incidence and prevalence rate in Taiwan globally. However, the implementation of advance care planning (ACP), advance directives (AD), and patient self-determination acts (PSDA) remains limited. Our objective was to examine the current status of ACP, AD and PSDA and potential opportunities for enhancement. METHODS: We developed a novel questionnaire to assess individuals' knowledge, attitudes, and intentions regarding ACP, AD, and PSDA. We also collected baseline characteristics and additional inquiries for correlation analysis to identify potential factors. Student's t-test and Analysis of Variance were employed to assess significance. RESULTS: Initially, a cohort of 241 patients was initially considered for inclusion in this study. Subsequently, 135 patients agreed to participate in the questionnaire study, resulting in 129 valid questionnaires. Among these respondents, 76 were male (59.9%), and 53 were female (41.1%). Only 13.2% had signed AD. A significant portion (85.3%) indicated that they had not discussed their dialysis prognosis with healthcare providers. Additionally, a mere 14% engaged in conversations about life-threatening decisions. Ninety percent believed that healthcare providers had not furnished information about ACP, and only 30% had discussed such choices with their families. The findings revealed that the average standardized score for ACP and AD goals was 84.97, while the attitude towards PSDA received a standardized score of 69.94. The intention score stood at 69.52 in standardized terms. Potential candidates for ACP initiation included individuals aged 50 to 64, possessing at least a college education, being unmarried, and having no history of diabetes. CONCLUSION: Patients undergoing hemodialysis exhibited a significant knowledge gap concerning ACP, AD, and the PSDA. Notably, a substantial number of dialytic patients had not received adequate information on these subjects. Nevertheless, they displayed a positive attitude, and a considerable proportion expressed a willingness to sign AD. It is imperative for nephrologists to take an active role in initiating ACP discussions with patients from the very beginning.


Assuntos
Planejamento Antecipado de Cuidados , Patient Self-Determination Act , Estados Unidos , Humanos , Masculino , Feminino , Intenção , Conhecimentos, Atitudes e Prática em Saúde , Diretivas Antecipadas , Diálise Renal
2.
Artigo em Inglês | MEDLINE | ID: mdl-33020426

RESUMO

Previous research based on the trans-contextual model proposes that autonomous motivation in physical education (PE) is transferable to an out-of-school leisure-time (LT) context. However, only cross-sectional and unidirectional analyses have been conducted. The present study used a longitudinal design assessing N = 1681 students (M = 14.68 years) on two occasions, measuring the following constructs: perceived need for support in PE, motivational regulation during PE and LT, attitude, subjective norm, perceived behavioral control, intention, and physical activity behavior. Findings based on mixed effect models revealed that autonomy, competence, and relatedness support of the PE teacher were positively related to autonomous motivation. Moreover, similar motivational regulation types were found to significantly cross-lag across contexts. Through longitudinal mediation analyses, further support for the impact of autonomous motivation on physical activity, mediated by intention, attitude, and perceived behavioral control, was found. Suggestions for educational stakeholders regarding how to promote students' autonomous motivation are provided.


Assuntos
Exercício Físico/psicologia , Promoção da Saúde/métodos , Motivação , Educação Física e Treinamento/métodos , Estudantes/psicologia , Adolescente , Adulto , Atitude , Feminino , Humanos , Intenção , Atividades de Lazer/psicologia , Estudos Longitudinais , Masculino , Patient Self-Determination Act , Autonomia Pessoal , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
3.
Pediatrics ; 146(Suppl 1): S18-S24, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737228

RESUMO

With a few notable exceptions, adolescents do not possess the legal authority to provide consent for or refuse medical interventions. However, in some situations, the question arises regarding whether a mature minor should be permitted to make a life-altering medical decision that would be challenged if made by the minor's parent. In this article, I explore what we currently know about the adolescent brain and how that knowledge should frame our understanding of adolescent decision-making. The prevailing approach to determining when adolescents should have their decisions respected in the medical and legal context, an approach that is focused on establishing capacity under a traditional informed consent model, will be reviewed and critiqued. I will suggest that the traditional model is insufficient and explore the implications for the adolescent role in health care decision-making.


Assuntos
Desenvolvimento do Adolescente , Encéfalo/crescimento & desenvolvimento , Tomada de Decisão Clínica , Doença de Hodgkin/tratamento farmacológico , Consentimento Livre e Esclarecido/psicologia , Recusa do Paciente ao Tratamento/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Fatores Etários , Feminino , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Mães , Patient Self-Determination Act , Autonomia Pessoal , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
4.
Pediatrics ; 146(Suppl 1): S25-S32, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737229

RESUMO

In this article, I examine the role of minors' competence for medical decision-making in modern American law. The doctrine of parental consent remains the default legal and bioethical framework for health care decisions on behalf of children, complemented by a complex array of exceptions. Some of those exceptions vest decisional authority in the minors themselves. Yet, in American law, judgments of minors' competence do not typically trigger shifts in decision-making authority from adults to minors. Rather, minors' decisional capacity becomes relevant only after legislatures or courts determine that the default of parental discretion does not achieve important policy goals or protect implicated constitutional rights in a particular health care context and that those goals can best be achieved or rights best protected by authorizing capable minors to choose for themselves. It is at that point that psychological and neuroscientific evidence plays an important role in informing the legal inquiry as to whether minors whose health is at issue are legally competent to decide.


Assuntos
Tomada de Decisão Clínica , Competência Mental/legislação & jurisprudência , Menores de Idade/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Adolescente , Desenvolvimento do Adolescente , Criança , Desenvolvimento Infantil , Serviços de Saúde da Criança/legislação & jurisprudência , Educação Infantil , Proteção da Criança/legislação & jurisprudência , Direitos Civis , Tomada de Decisão Clínica/ética , Família , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Competência Mental/normas , Menores de Idade/psicologia , Relações Pais-Filho , Consentimento dos Pais/ética , Patient Self-Determination Act , Autonomia Pessoal , Procurador/legislação & jurisprudência , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
5.
Pediatrics ; 146(Suppl 1): S33-S41, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737230

RESUMO

Cases of adolescents in organ failure who refuse solid organ transplant are not common, but several have been discussed in the media in the United States and the United Kingdom. Using the framework developed by Buchanan and Brock for surrogate decision-making, I examine what role the adolescent should morally play when deciding about therapy for life-threatening conditions. I argue that the greater the efficacy of treatment, the less voice the adolescent (and the parent) should have. I then consider how refusals of highly effective transplant cases are similar to and different from refusals of other lifesaving therapies (eg, chemotherapy for leukemia), which is more commonly discussed in the media and medical literature. I examine whether organ scarcity and the need for lifelong immunosuppression justify differences in whether the state intervenes when an adolescent and his or her parents refuse a transplant. I argue that the state, as parens patriae, has an obligation to provide the social supports needed for a successful transplant and follow-up treatment plan, although family refusals may be permissible when the transplant is experimental or of low efficacy because of comorbidities or other factors. I conclude by discussing the need to limit media coverage of pediatric treatment refusals.


Assuntos
Temas Bioéticos , Meios de Comunicação de Massa/ética , Transplante de Órgãos/ética , Consentimento dos Pais/ética , Recusa do Paciente ao Tratamento/ética , Adolescente , Família , Feminino , Humanos , Consentimento Informado por Menores/ética , Consentimento Informado por Menores/legislação & jurisprudência , Masculino , Transplante de Órgãos/legislação & jurisprudência , Consentimento dos Pais/legislação & jurisprudência , Participação do Paciente , Patient Self-Determination Act , Ética Baseada em Princípios , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Gêmeos Monozigóticos , Reino Unido , Estados Unidos
6.
HEC Forum ; 29(4): 303-311, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28534181

RESUMO

The Patient Self Determination Act (PSDA) of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient's preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity (DMC). In general, patients are presumed to have DMC. A patient's DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders.


Assuntos
Tomada de Decisões , Leucemia Linfoide/psicologia , Ordens quanto à Conduta (Ética Médica)/ética , Pensamento , Idoso de 80 Anos ou mais , Comunicação , Humanos , Leucemia Linfoide/complicações , Masculino , Patient Self-Determination Act , Ordens quanto à Conduta (Ética Médica)/legislação & jurisprudência , Estados Unidos
8.
J Am Acad Psychiatry Law ; 43(2): 210-7, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26071511

RESUMO

The cognitive and behavioral changes that can be observed in the neurodegenerative terminal disease amyotrophic lateral sclerosis (ALS), once characterized as purely a motor neuron disease, have become increasingly recognized over the past century. Detecting cognitive deficits earlier and identifying continued changes at regular intervals can lead to improved care, proactive treatments, and earlier discussions about end-of-life wishes. Although medical decisional capacity is required for every treatment decision made, its importance becomes paramount when making decisions on complex medical treatments that will invariably and significantly affect quality of life or life itself. In this review, we conducted a critical analysis of the evidence-based literature on the cognitive and behavioral impairments in ALS that can compromise medical decisional capacity. We review specific ALS-related clinical scenarios in which decisional capacity is of utmost importance and discuss a practical framework for cognitive and behavioral assessment that can be routinely and efficiently used, while being mindful of the confounding factors associated with ALS. Finally, we review models for preserving patient choices that can be used in patients with ALS to help safeguard autonomy and retain dignity toward the end of life.


Assuntos
Esclerose Lateral Amiotrófica/diagnóstico , Esclerose Lateral Amiotrófica/psicologia , Tomada de Decisões , Competência Mental/legislação & jurisprudência , Técnicas de Observação do Comportamento , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Patient Self-Determination Act , Estados Unidos
10.
Nervenarzt ; 85(11): 1419-31, 2014 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-25388831

RESUMO

Respect for patient self-determination is a central ethical principle of medical care. Every person has the right to make decisions regarding his or her health autonomously, even if these decisions appear irrational to third parties. Free and informed consent is the necessary prerequisite for every diagnostic and therapeutic procedure. A patient's ability for self-determination is one requirement for valid consent. In illness, the ability for self-determination may be limited or absent in individual cases. An ethical dilemma arises if severely ill patients who are unable to make autonomous decisions put their health at significant risk and refuse medical procedures in this situation. While non-treatment can be severely detrimental to health, forced procedures can result in traumatization and can damage the relationship of trust between the doctor and patient. The dilemma is intensified in cases of danger to others. In these difficult situations doctors, therapists and nursing staff require ethical guidance for the professional conduct. The primary objective thereby is to avoid coercion. For this purpose recommendations for medical practice are formulated that can reduce the use of forced procedures (e.g. de-escalation procedures, communication competency, clinical ethics counseling, treatment agreements and patient living wills) or if they are unavoidable, that allow them to be conducted in an ethically and legally appropriate way. Further and continued education must pay greater attention to this ethical objective; therefore, for ethical reasons adequate personnel, spatial and structural are vital in hospitals.


Assuntos
Hospitais Psiquiátricos/ética , Competência Mental/legislação & jurisprudência , Pessoas Mentalmente Doentes/legislação & jurisprudência , Participação do Paciente/legislação & jurisprudência , Patient Self-Determination Act/ética , Autonomia Pessoal , Alemanha , Humanos , Guias de Prática Clínica como Assunto , Psiquiatria/ética , Psiquiatria/normas , Estados Unidos
11.
J Christ Nurs ; 31(4): 220-5; quiz 226-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25296485

RESUMO

Despite increasing age, most older Americans do not have Advance Health Care Directives (AHCDs) while healthcare providers report limited knowledge for teaching about AHCDs. This article offers a history of AHCDs, explores one method for assessing AHCD knowledge using the Knowledge-Attitudinal-Experimental Survey on Advance Directives (KAESAD), and utilizes adult learning theory to develop an AHCD educational in-service for nurses. AHCD information and resources are provided.


Assuntos
Diretivas Antecipadas/legislação & jurisprudência , Educação Continuada em Enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Testamentos Quanto à Vida/legislação & jurisprudência , Papel do Profissional de Enfermagem , Assistência Terminal/legislação & jurisprudência , Adulto , Diretivas Antecipadas/história , Idoso , Coleta de Dados , História do Século XX , História do Século XXI , Humanos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar , Educação de Pacientes como Assunto , Patient Self-Determination Act , Inquéritos e Questionários , Estados Unidos
13.
J Palliat Med ; 17(3): 282-7, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24325558

RESUMO

BACKGROUND: Respecting Choices® is a program designed and verified to improve advance care planning, yet it has not been tested in racially/ethnically diverse communities. Research has shown racial/ethnic minorities are less likely to have advance directives (ADs). OBJECTIVE: To determine whether Respecting Choices® would improve AD prevalence and utilization in a racially and ethnically diverse community. METHODS: The study design was that of a retrospective chart review. Subjects were all decedents from 2005 to 2010 (n=732) in a 300-bed Midwestern metropolitan hospital. Prevalence was assessed by the presence of an AD in the chart. Utilization was measured by the consistency of wishes expressed in an AD and treatment received ("No CPR," "No Feeding Tube," "No Antibiotics," "No Ventilator," "Comfort Care," and "Terminal Extubation"). Average treatment effect using regression analysis and matching on covariates was used for analysis of Respecting Choices® on AD prevalence. Proportional difference tests were used to compare consistency of wishes by race/ethnicity before and after Respecting Choices®. RESULTS: The prevalence of ADs increased significantly for racial and ethnic minorities after the implementation of Respecting Choices®: from 25.8% to 38.4% (p=0.011). The increase in AD prevalence for whites following Respecting Choices® was only marginal (46.7% to 47.3%; p=0.648), and the overall prevalence of ADs did not significantly change (35.9% to 42.9%; p=0.069). Consistency was high (74% to 96%) for all orders, and there were no significant differences following implementation of Respecting Choices® or between whites and racial and ethnic minorities. CONCLUSIONS: The prevalence of ADs increased after Respecting Choices® was initiated in a racially and ethnically diverse community.


Assuntos
Diretivas Antecipadas , Comportamento de Escolha , Cuidados Paliativos , Relações Profissional-Paciente , Diretivas Antecipadas/etnologia , Diretivas Antecipadas/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Urbanos , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Patient Self-Determination Act , Estudos Retrospectivos , Estados Unidos
15.
J Clin Ethics ; 24(2): 156-67, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23923815

RESUMO

This issue's "legal briefing" column covers recent legal developments involving the Patient Self-Determination Act (PSDA). Enacted in the wake of the U.S. Supreme Court's Cruzan decision in 1990, the PSDA remains a seminal event in the development of U.S. bioethics public policy, but the PSDA has long been criticized as inadequate and ineffective. Finally, recent legislative and regulatory changes promise to revitalize and rejuvenate it. The PSDA has been the subject of recent articles in The Journal of clinical ethics.' I categorize new legal developments concerning the PSDA into the following eight sections: (1) Background and history (2) Rules and requirements (3) Criticism and challenges (4) Failed efforts to amend the PSDA (5) Personalize your Care Act of 2013 (6) New regulations (7) New regulatory guidance (8) Expanded enforcement.


Assuntos
Diretivas Antecipadas/legislação & jurisprudência , Participação do Paciente , Patient Self-Determination Act , Humanos , Testamentos Quanto à Vida/legislação & jurisprudência , Estados Unidos
17.
Am J Crit Care ; 21(5): 311-20, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22941703

RESUMO

BACKGROUND: The Patient Self-Determination Act of 1990 mandates that hospitals reimbursed by Medicare and Medicaid inform each patient about the patient's right to a natural death. OBJECTIVE: To describe and explore implementation of the Patient Self-Determination Act in a critical care setting. The goal was to assess patients' understanding of advance directives. METHODS: In a semistructured cross-sectional study, all eligible patients 18 years or older admitted to the cardiac intensive care unit at Duke University Medical Center, Durham, North Carolina, were assessed. Each patient was asked the standard question required by the Patient Self-Determination Act-Do you have an advance directive?-and 3 open-ended questions to ascertain the patient's understanding of advance directives. RESULTS: The sample consisted of 505 patients with a mean age of 61.9 years (SD, 14.8), 37.8% (n = 191) were women, and 68.5% (n = 346) were white. Most patients (64.4%; n = 325) did not have an advance directive before admission to the unit. Of the patients who initially declined the opportunity to complete an advance directive (n = 213), 33.8% (n = 72) said they did not understand the question when initially asked and therefore just said no. CONCLUSIONS: Current practice meets the requirement of the Patient Self-Determination Act for documentation of patients' right to a natural death. However, simply asking Do you have an advance directive? does not elicit an accurate reflection of a patient's understanding of advance directives.


Assuntos
Diretivas Antecipadas , Unidades de Cuidados Coronarianos , Fatores Etários , Comorbidade , Estudos Transversais , Família , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Satisfação do Paciente , Patient Self-Determination Act , Procurador , Grupos Raciais , Estados Unidos
20.
J Gerontol Nurs ; 37(5): 15-9, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21485982

RESUMO

Older adults have a legally recognized right to determine and control the health care they receive and are legally presumed to possess the capacity necessary to make health care decisions. However, older adults are at major risk for life-threatening and serious health problems leading to a loss of their capacity to make end-of-life and other health care decisions. Advance care planning is a process that enables older adults to specify who they want to act as a surrogate decision maker and what decisions they want made for them in the event of incapacitation. Geriatric nurses can play a significant role in promoting advance care planning and the use of legal tools for such planning.


Assuntos
Planejamento Antecipado de Cuidados , Tomada de Decisões , Idoso , Humanos , Papel do Profissional de Enfermagem , Patient Self-Determination Act , Estados Unidos
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