WorldWideScience

Sample records for end-of-life irradiation performance

  1. Accuracy and Reliability in the Prediction of End-of-Life Performance of Solar Generators

    Science.gov (United States)

    Rapp, Etienne

    2008-09-01

    The end-of-life power analysis of solar arrays is calculated using a combination of arithmetic and root square sums of loss factors. These loss factors are sometimes linked to degradations, sometimes linked to uncertainties. The uncertainties of the degradations are taken into account considering contractual "worst cases". This paper will put the first stones for a move "metrological" evaluation of the probable performance associated with a standard uncertainty. The turn from silicon to triple junction solar cells induces some changes in the degradation parameters of solar arrays: * The triple junction cells are more sensitive to UV darkening than silicon ones. * The cell voltage is higher and the current is lower. Then the cell strings are shorter, and there are more strings in parallel. This induces some changes in the reliability analyses and risk management. * The failure modes and failure rates of these cells have to be compared and discussed. We try to define improved rules to design solar arrays for end of life performance, for a better knowledge of the margins and a better reliability.

  2. Scope Definition on End-of-Life Chain Performance Assessment: Recycling Rate and French E-Waste Chain Case Study

    OpenAIRE

    ARDUIN, Rachel Horta; LEAL, Jorge Martinez; GRIMAUD, Guilhem; CHARBUILLET, Carole; Pompidou, Stéphane; LARATTE, Bertrand; PERRY, Nicolas

    2017-01-01

    International audience; Efficiency indicators have been frequently used to assess end-of-life chain performance. While legislations give a standard definition, sometimes stakeholders redefine them to fit their own scopes and objectives. It is therefore necessary to fully understand the indicators calculation scope in order to accurately interpret the results during a decision-making process. This work discusses the influence of scope definition when establishing performance rates using the Fr...

  3. End of Life Issues

    Science.gov (United States)

    Planning for the end of life can be difficult. But by deciding what end-of-life care best suits your needs when you are healthy, you can ... right choices when the time comes. End-of-life planning usually includes making choices about the following: ...

  4. Multi-Criteria Evaluation of End-of-Life Vehicles’ Dismantling Scenarios with Respect to Technical Performance and Sustainability Issues

    Directory of Open Access Journals (Sweden)

    Alexis Schmid

    2016-12-01

    Full Text Available Three scenarios of dismantling and shredding operations of end-of-life vehicles (ELVs were compared in this study with respect to technical and sustainability criteria, according to the level of dismantling applied to the vehicles. The scenarios differed from each other in the extent of the dismantling operations. They were implemented experimentally at the industrial scale on representative samples of 120 vehicles. The data collected from the monitoring of the experimental campaigns were used as feed data for the multi-criteria analysis of the scenarios using the PROMETHEE method. Nine criteria of evaluation were selected, namely global warming, local environmental impacts, tropospheric ozone production, ecotoxicity, operational costs, investment costs, occupational risks, employability, and technical performance. The medium-level dismantling scenario was identified as the best scenario with respect to the criteria of evaluation. This scenario included the steps of depollution, followed by the removal of easily accessible and identifiable plastics and glasses. Reasonable changes in the ponderation of the evaluation criteria did not significantly affect the ranking.

  5. Performance of the Family Satisfaction with the End-of-Life Care (FAMCARE) measure in an ethnically diverse cohort: psychometric analyses using item response theory.

    Science.gov (United States)

    Teresi, Jeanne A; Ornstein, Katherine; Ocepek-Welikson, Katja; Ramirez, Mildred; Siu, Albert

    2014-02-01

    The Family Satisfaction with End-of-Life Care (FAMCARE) has been used widely among caregivers to individuals with cancer. The aim of this study was to evaluate the psychometric properties of this measure using item response theory (IRT). The analytic sample was comprised of caregivers to 1,983 patients with advanced cancer. Among the patients, 56 % were females, with mean age 59.9 years (s.d. = 11.8), 20 % were non-Hispanic Black. The majority were family members either living with (44 %) or not living with (35 %) the patient. Factor analyses and IRT were used to examine the dimensionality, information, and reliability of the FAMCARE. Although a bi-factor model fit the data slightly better than did a unidimensional model, the loadings on the group factors were very low. Thus, a unidimensional model appears to provide adequate representation for the item set. The reliability estimates, calculated along the satisfaction (theta) continuum, were adequate (>0.80) for all levels of theta for which subjects had scores. Examination of the category response functions from IRT showed overlap in the lower categories with little unique information provided; moreover, the categories were not observed to be interval. Based on these analyses, a three-response category format was recommended: very satisfied, satisfied, and not satisfied. Most information was provided in the range indicative of either dissatisfaction or high satisfaction. These analyses support the use of fewer response categories and provide item parameters that form a basis for developing shorter-form scales. Such a revision has the potential to reduce respondent burden.

  6. Pharmacotherapy at the end-of-life.

    LENUS (Irish Health Repository)

    O'Mahony, Denis

    2011-07-01

    Older people reaching end-of-life status are particularly at risk from inter-related adverse effects of pharmacotherapy, including polypharmacy, inappropriate medications and adverse drug events. These adverse effects of pharmacotherapy may be highly detrimental, as well as highly expensive. End-of-life pharmacotherapy is sometimes perceived to be complex and challenging, probably unnecessarily. This relates in part to the poorly developed evidence base and lack of high-quality research in this area. In this article, we deal with some of the key issues relating to pharmacotherapy in end-of-life patients, namely (i) the guiding principles of drug selection, (ii) the main drugs and drug classes that are best avoided, (iii) the benefits of \\'oligopharmacy\\' (i.e. deliberate avoidance of polypharmacy) in end-of-life patients.

  7. Environmental assessment of end-of-life textiles in Denmark

    DEFF Research Database (Denmark)

    Koligkioni, Athina; Parajuly, Keshav; Sørensen, Birgitte Lilholt

    2017-01-01

    The European Union is on its way to a circular economy through eco-design, waste prevention, reuse and recycling of products and materials. This study analyzes the environmental effects of end-of-life textile management in Denmark. First, a Mass Flow Analysis was performed for textile flows from...

  8. End-of-life care: improving quality of life at the end of life.

    Science.gov (United States)

    Eues, Stephanie K

    2007-01-01

    The purpose of this article is to identify barriers and interventions that influence quality of life at the end of life. PRIMARY PRACTICE SETTINGS(S): Primary care, acute inpatient care, case management, and end-of-life care settings. Death and dying affects the whole family, not just the individual who is dying. Early identification and recognition of end-of-life care choices heavily influence the quality of life an individual experiences during the dying process. Unfortunately, delaying end-of-life care plans is common. Over the years, the social structure and family structure have changed leaving many patients and families searching for viable end-of-life care options. Advancements in technology have affected the way medical professionals approach the end of life making a difficult decision for patients and families even more difficult by offering medical interventions that may not be necessary. To steer end-of-life care toward evidence-based practice standards, there needs to be additional research on the effectiveness of the various types of care available. Because case managers are often on the front lines of communicating and arranging end-of-life care, case managers need a clearer understanding of end-of-life care choices and how to communicate these choices to patients and families. The hospice and palliative care movements have been instrumental in increasing the understanding of end-of-life care and in providing patients alternatives to dying in the hospital. * Only 25% of patients eligible for hospice actually enter hospice programs.* The average time spent in hospice is 3 weeks.* The most significant barrier in coordinating and providing end-of-life care is inadequate communication.* Early discussion of prognosis and end-of-life care options helps facilitate earlier entry into hospice and palliative care programs.* The nursing profession needs additional research to determine the effectiveness of the various types of end-of-life care available and

  9. End-of-life decisions: Christian perspectives.

    Science.gov (United States)

    Stempsey, William E

    1997-12-01

    While legal rights to make medical treatment decisions at the end of one's life have been recognized by the courts, particular religious traditions put axiological and metaphysical meat on the bare bones of legal rights. Mere legal rights do not capture the full reality, meaning and importance of death. End-of-life decisions reflect not only the meaning we find in dying, but also the meaning we have found in living. The Christian religions bring particular understandings of the vision of life as a gift from God, human responsibility for stewardship of that life, the wholeness of the person, and the importance of the dying process in preparing spiritually for life beyond earthly life, to bear on end-of-life decisions.

  10. Consent and end of life decisions

    OpenAIRE

    Harris, John

    2003-01-01

    This paper discusses the role of consent in decision making generally and its role in end of life decisions in particular. It outlines a conception of autonomy which explains and justifies the role of consent in decision making and criticises some misapplications of the idea of consent, particular the role of fictitious or "proxy" consents. Where the inevitable outcome of a decision must be that a human individual will die and where that individual is a person who can consent, then that decis...

  11. End-of-life practices in the Netherlands under the Euthanasia Act

    NARCIS (Netherlands)

    A. van der Heide (Agnes); B.D. Onwuteaka-Philipsen (Bregje); M.L. Rurup (Mette); H.M. Buiting (Hilde); J.J.M. van Delden (Johannes); J.E. Hanssen-de Wolf (Johanna); A.J.G.M. Janssen; H.R. Pasman (Roeline); J.A.C. Rietjens (Judith); C.J.M. Prins (Cornelis); I.M. Keij-Deerenberg (Ingeborg); J.K.M. Gevers (Joseph); P.J. van der Maas (Paul); G. van der Wal (Gerrit)

    2007-01-01

    textabstractBACKGROUND: In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. METHODS:

  12. DESIGN CONSIDERATIONS UPON PRODUCT END-OF-LIFE OPTIONS

    Directory of Open Access Journals (Sweden)

    BARSAN Lucian

    2016-11-01

    Full Text Available The paper presents some considerations about the necessity of evaluating the environmental impact of a product during its entire life. The present situation (economic, social and ecologic imposes solutions to reduce this impact as a result of an analysis performed during all stages of the life cycle. This paper focuses on design solutions with consequences in the last stage, the end-of-life. Reusing products, with, or without remanufacturing and recycling the materials from products that cannot be reused represent some options analysed in this paper. The end-of-life options should be known even from the beginning of the design process and should be included as design objectives or, at least as constrictions. Considering them as human needs would naturally include them in the requirements list.

  13. End of Life: A Family Narrative

    Directory of Open Access Journals (Sweden)

    Helen K. Black

    2011-01-01

    Full Text Available This paper is based on ethnographic research that examines family reaction to an elderly husband and father's end of life. From a group of 30 families in our study (family defined as a widow aged 70 and over and two adult biological children between the ages of 40 and 60, we offer an extreme case example of family bereavement. We report our findings through the open-ended responses of a widow and two children who were interviewed ten months after the death of the husband and father. Three general themes emerged: (1 how the family imputes meaning to the end of life, (2 changes in the roles of family members, and (3 the family's ways of coping with the death, particularly through their belief system. A key finding is that the meaning family members find in their loved one's death is tied to the context of his death (how and where he died, their perception of his quality of life as a whole, and their philosophical, religious, and spiritual beliefs about life, death, and the afterlife that are already in place.

  14. End of Life: A Family Narrative

    Science.gov (United States)

    Black, Helen K.; Moss, Miriam S.; Rubinstein, Robert L.; Moss, Sidney Z.

    2011-01-01

    This paper is based on ethnographic research that examines family reaction to an elderly husband and father's end of life. From a group of 30 families in our study (family defined as a widow aged 70 and over and two adult biological children between the ages of 40 and 60), we offer an extreme case example of family bereavement. We report our findings through the open-ended responses of a widow and two children who were interviewed ten months after the death of the husband and father. Three general themes emerged: (1) how the family imputes meaning to the end of life, (2) changes in the roles of family members, and (3) the family's ways of coping with the death, particularly through their belief system. A key finding is that the meaning family members find in their loved one's death is tied to the context of his death (how and where he died), their perception of his quality of life as a whole, and their philosophical, religious, and spiritual beliefs about life, death, and the afterlife that are already in place. PMID:21629740

  15. Video Eases End-of-Life Care Discussions

    Science.gov (United States)

    Patients with advanced cancer who watched a video that depicts options for end-of-life care were more certain of their end-of-life decision making than patients who only listened to a verbal narrative.

  16. Describing Spirituality at the End of Life.

    Science.gov (United States)

    Stephenson, Pam Shockey; Berry, Devon M

    2015-09-01

    Spirituality is salient to persons nearing the end of life (EOL). Unfortunately, researchers have not been able to agree on a universal definition of spirituality reducing the effectiveness of spiritual research. To advance spiritual knowledge and build an evidence base, researchers must develop creative ways to describe spirituality as it cannot be explicitly defined. A literature review was conducted to determine the common attributes that comprise the essence of spirituality, thereby creating a common ground on which to base spiritual research. Forty original research articles (2002 to 2012) focusing on EOL and including spiritual definitions/descriptions were reviewed. Analysis identified five attributes that most commonly described the essence of spirituality, including meaning, beliefs, connecting, self-transcendence, and value. © The Author(s) 2014.

  17. Pricing end-of-life components

    Science.gov (United States)

    Vadde, Srikanth; Kamarthi, Sagar V.; Gupta, Surendra M.

    2005-11-01

    The main objective of a product recovery facility (PRF) is to disassemble end-of-life (EOL) products and sell the reclaimed components for reuse and recovered materials in second-hand markets. Variability in the inflow of EOL products and fluctuation in demand for reusable components contribute to the volatility in inventory levels. To stay profitable the PRFs ought to manage their inventory by regulating the price appropriately to minimize holding costs. This work presents two deterministic pricing models for a PRF bounded by environmental regulations. In the first model, the demand is price dependent and in the second, the demand is both price and time dependent. The models are valid for single component with no inventory replenishment sale during the selling horizon . Numerical examples are presented to illustrate the models.

  18. Chemotherapy Use at the End of Life in Uganda.

    Science.gov (United States)

    Low, Daniel; Merkel, Emily C; Menon, Manoj; Lyman, Gary H; Ddungu, Henry; Namukwaya, Elizabeth; Leng, Mhoira; Casper, Corey

    2017-12-01

    Purpose Avoiding chemotherapy during the last 30 days of life has become a goal of cancer care in the United States and Europe, yet end-of-life chemotherapy administration remains a common practice worldwide. The purpose of this study was to determine the frequency of and factors predicting end-of-life chemotherapy administration in Uganda. Methods Retrospective chart review and surveys and interviews of providers were performed at the Uganda Cancer Institute (UCI), the only comprehensive cancer center in the area, which serves a catchment area of greater than 100 million people. All adult patients at the UCI with reported cancer deaths between January 1, 2014, and August 31, 2015 were included. All UCI physicians were offered a survey, and a subset of physicians were also individually interviewed. Results Three hundred ninety-two patients (65.9%) received chemotherapy. Age less than 55 years (odds ratio [OR], 2.30; P = .004), a cancer diagnosis greater than 60 days before death (OR, 9.13; P < .001), and a presenting Eastern Cooperative Oncology Group performance status of 0 to 2 (OR, 2.47; P = .001) were associated with the administration of chemotherapy. More than 45% of patients received chemotherapy in the last 30 days of life. No clinical factors were predictive of chemotherapy use in the last 30 days of life, although doctors reported using performance status, cancer stage, and tumor chemotherapy sensitivity to determine when to administer chemotherapy. Patient expectations and a lack of outcomes data were important nonclinical factors influencing chemotherapy administration. Conclusion Chemotherapy is administered to a high proportion of patients with terminal cancer in Uganda, raising concern about efficacy. Late presentation of cancer in Uganda complicates end-of-life chemotherapy recommendations, necessitating guidelines specific to sub-Saharan Africa.

  19. Consent and end of life decisions.

    Science.gov (United States)

    Harris, John

    2003-02-01

    This paper discusses the role of consent in decision making generally and its role in end of life decisions in particular. It outlines a conception of autonomy which explains and justifies the role of consent in decision making and criticises some misapplications of the idea of consent, particular the role of fictitious or "proxy" consents. Where the inevitable outcome of a decision must be that a human individual will die and where that individual is a person who can consent, then that decision is ethical if and only if the individual consents. In very rare and extreme cases such a decision will be ethical in the absence of consent where it would be massively cruel not to end life in order to prevent suffering which is in no other way preventable. Where, however, the human individual is not a person, as is the case with abortion, the death of infants like Mary (one of the conjoined twins in a case discussed in the paper), or in the very rare and extreme cases of those who have ceased to be persons like Tony Bland, such decisions are governed by the ethics of ending the lives of non-persons.

  20. Communication in palliative care: talking about the end of life, before the end of life.

    Science.gov (United States)

    Brighton, Lisa Jane; Bristowe, Katherine

    2016-08-01

    Increasing evidence demonstrates the benefits of early end-of-life care discussions with patients with life-threatening illness and their families. However, these conversations often do not occur. This review explores some of the many barriers faced by clinicians in relation to end-of-life care discussions, including prognostic uncertainty, fear of causing distress, navigating patient readiness and feeling unprepared for these conversations. The value of core clinical communication skills, potential strategies for improvement and areas for future research are also discussed. It is essential that clinicians offer patients facing life-threatening illness, and those close to them, the opportunity to discuss end-of-life issues in line with their information and decision-making preferences. With a growing and ageing global population, supporting both generalist and specialist providers of palliative care in this task is key. With careful preparation, fears of undertaking these discussions should not be a barrier to initiating them. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. Institutional disposition and management of end-of-life electronics.

    Science.gov (United States)

    Babbitt, Callie W; Williams, Eric; Kahhat, Ramzy

    2011-06-15

    Institutions both public and private face a challenge to develop policies to manage purchase, use, and disposal of electronics. Environmental considerations play an increasing role in addition to traditional factors of cost, performance and security. Characterizing current disposition practices for end-of-life electronics is a key step in developing policies that prevent negative environmental and health impacts while maximizing potential for positive social and economic benefits though reuse. To provide a baseline, we develop the first characterization of quantity, value, disposition, and flows of end-of-life electronics at a major U.S. educational institution. Results of the empirical study indicate that most end-of-first-life electronics were resold through public auction to individuals and small companies who refurbish working equipment for resale or sell unusable products for reclamation of scrap metal. Desktop and laptop computers sold for refurbishing and resale averaged U.S. $20-100 per unit, with computers sold directly to individuals for reuse reaching $250-350 per unit. This detailed assessment was coupled with a benchmarking survey of end-of-life electronics management practices at other U.S. universities. Survey results indicate that while auctions are still commonplace, an increasing number of institutions are responding to environmental concerns by creating partnerships with local recycling and resale entities and mandating domestic recycling. We use the analyses of current disposition practices as input to discuss institutional strategies for managing electronics. One key issue is the tension between benefits of used equipment sales, in terms of income for the institution and increased reuse for society, and the environmental risks because of unknown downstream practices.

  2. Quality end-of-life care: A global perspective

    Directory of Open Access Journals (Sweden)

    Singer Peter A

    2002-07-01

    Full Text Available Abstract Background Quality end-of-life care has emerged as an important concept in industrialized countries. Discussion We argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of the number of people it affects, directly and indirectly, in terms of the well being of loved ones, and the large-scale, population based nature of some possible interventions. It is a health systems problem because one of its main features is the need for better information on quality end-of-life care. We examine the context of end-of-life care, including the epidemiology of death and cross-cultural considerations. Although there are examples of success, we could not identify systematic data on capacity for delivering quality end-of-life care in developing countries. We also address a possible objection to improving end-of-life care in developing countries; many deaths are preventable and reduction of avoidable deaths should be the focus of attention. Conclusions We make three recommendations: (1 reinforce the recasting of quality end-of-life care as a global public health and health systems problem; (2 strengthen capacity to deliver quality end-of-life care; and (3 develop improved strategies to acquire information about the quality of end-of-life care.

  3. Quality end-of-life care: A global perspective.

    Science.gov (United States)

    Singer, Peter A; Bowman, Kerry W

    2002-07-25

    BACKGROUND: Quality end-of-life care has emerged as an important concept in industrialized countries. DISCUSSION: We argue quality end-of-life care should be seen as a global public health and health systems problem. It is a global problem because 85 % of the 56 million deaths worldwide that occur annually are in developing countries. It is a public health problem because of the number of people it affects, directly and indirectly, in terms of the well being of loved ones, and the large-scale, population based nature of some possible interventions. It is a health systems problem because one of its main features is the need for better information on quality end-of-life care. We examine the context of end-of-life care, including the epidemiology of death and cross-cultural considerations. Although there are examples of success, we could not identify systematic data on capacity for delivering quality end-of-life care in developing countries. We also address a possible objection to improving end-of-life care in developing countries; many deaths are preventable and reduction of avoidable deaths should be the focus of attention. CONCLUSIONS: We make three recommendations: (1) reinforce the recasting of quality end-of-life care as a global public health and health systems problem; (2) strengthen capacity to deliver quality end-of-life care; and (3) develop improved strategies to acquire information about the quality of end-of-life care.

  4. Ethics at the End of Life: A Teaching Tool

    Science.gov (United States)

    Wallace, Cara L.; Thielman, Kara J.; Cimino, Andrea N.; Rueda, Heidi L. Adams

    2017-01-01

    Social workers rarely receive education and training in the areas of grief, bereavement, and death and dying, which may lead to difficulties in compassionately and ethically addressing concerns in end-of-life or grief-related contexts. This article presents actual and potential outcomes from three challenging end-of-life case studies using…

  5. End of life care simulation: a review of the literature.

    Science.gov (United States)

    Gillan, Pauline C; Jeong, Sarah; van der Riet, Pamela J

    2014-05-01

    Simulation is an evolving pedagogical approach to teaching in many undergraduate nursing curricula, however, there is little published literature on end of life care simulation as an effective means of teaching nursing students about end of life care. To examine available literature on end of life care simulation. An extensive literature search on end of life care simulation in the undergraduate nursing curriculum was conducted in CINAHL, Mosby's Index, Cochrane Database, Scopus, Eric via Proquest, and Medline. 6 research articles and 10 descriptive articles published between 2009 and 2013 that met the selection criteria are included in the review. Findings of these 16 articles are reported under 4 main themes: 1) Increased knowledge of end of life care through 'experiential learning'; 2) Impact of family presence on student learning; 3) the Debriefing imperative, and 4) Methodological issues raised from studies. The findings of the studies reviewed support end of life care simulation as a strong and viable pedagogical approach to learning for its positive effects on knowledge acquisition, communication skills, self-confidence, student satisfaction and level of engagement in learning. However, the important factors including psychological safety of students and the costs involved require careful consideration. Research on the use of simulation in nursing is still in its infancy, further research using various research designs is required to adequately explore the issues surrounding end of life care simulation. © 2013.

  6. Use of opioids and sedatives at End-of-Life

    Directory of Open Access Journals (Sweden)

    Shin Wei Sim

    2014-01-01

    Full Text Available Despite their proven efficacy and safety, opioid and sedative use for palliation in patients afflicted with cancer in Singapore have been shown to be a fraction of that in other countries. This paper explores the various psychosocial and system-related factors that appear to propagate this conservative approach to care in what is largely a western-influenced care practice. A search for publications relating to sedative and opioid usage in Asia was performed on PubMed, Google, Google Scholar, World Health Organization, and Singapore′s government agency websites using search terms such as "opioids," "sedatives," "palliation," "end-of-life-care," "pain management," "palliative care," "cancer pain," "Asia," "Singapore," and "morphine." Findings were classified into three broad groups - system-related, physician-related, and patient-related factors. A cautious medico-legal climate, shortage of physicians trained in palliative care, and lack of instruments for symptom assessment of patients at the end of life contribute to system-related barriers. Physician-related barriers include delayed access to palliative care due to late referrals, knowledge deficits in non-palliative medicine physicians, and sub-optimal care provided by palliative physicians. Patients′ under-reporting of symptoms and fear of addiction, tolerance, and side effects of opioids and sedatives may lead to conservative opioid use in palliative care as well. System-related, physician-related, and patient-related factors play crucial roles in steering the management of palliative patients. Addressing and increasing the awareness of these factors may help ensure patients receive adequate relief and control of distressing symptoms.

  7. End of life and beyond as hidden curriculum.

    Science.gov (United States)

    Condon, Barbara Backer; Grimsley, Catherine; Kelley, Teresa; Nissen, Mary Kay

    2014-01-01

    End-of-life experiences are unique. Most can vividly recall feelings during those times. Governing boards in the United States attempt to guide nursing faculty regarding end of life curriculum. Yet, the beliefs of faculty members arising from those unique experiences can alter the tone and message of what students are actually taught--often surfacing as hidden curriculum. In this column the authors discuss hidden curriculum while presenting the beliefs regarding end of life, of four nursing faculty members from a single university. Heightened awareness and respect for the beliefs of all faculty members within any university setting is imperative in decreasing the development of hidden curriculum.

  8. Palliative and end of life care for people with dementia.

    Science.gov (United States)

    Harrison Dening, Karen

    2016-02-03

    Dementia is a life-limiting condition that is largely a disease of ageing. However, older people in general, and older people with dementia in particular, have not always had equal access to effective palliative and end of life care. As a result, people with dementia at the end of life often receive aggressive and burdensome interventions, or inadequate assessment and management of their symptoms. Patterns in how people with dementia experience and present symptoms as they near the end of life can indicate when the goals of care should change and a palliative approach should be adopted.

  9. A new measure for end of life planning, preparation, and preferences in Huntington disease: HDQLIFE end of life planning.

    Science.gov (United States)

    Carlozzi, Noelle E; Hahn, E A; Frank, S A; Perlmutter, J S; Downing, N D; McCormack, M K; Barton, S; Nance, M A; Schilling, S G

    2018-01-01

    Huntington disease is a fatal inherited neurodegenerative disease. Because the end result of Huntington disease is death due to Huntington disease-related causes, there is a need for better understanding and caring for individuals at their end of life. The purpose of this study was to develop a new measure to evaluate end of life planning. We conducted qualitative focus groups, solicited expert input, and completed a literature review to develop a 16-item measure to evaluate important aspects of end of life planning for Huntington disease. Item response theory and differential item functioning analyses were utilized to examine the psychometric properties of items; exploratory factor analysis was used to establish meaningful subscales. Participants included 508 individuals with pre-manifest or manifest Huntington disease. Item response theory supported the retention of all 16 items on the huntington disease quality of life ("HDQLIFE") end of life planning measure. Exploratory factor analysis supported a four-factor structure: legal planning, financial planning, preferences for hospice care, and preferences for conditions (locations, surroundings, etc.) at the time of death. Although a handful of items exhibited some evidence of differential item functioning, these items were retained due to their relevant clinical content. The final 16-item scale includes an overall total score and four subscale scores that reflect the different end of life planning constructs. The 16-item HDQLIFE end of life planning measure demonstrates adequate psychometric properties; it may be a useful tool for clinicians to clarify patients' preferences about end of life care.

  10. End-of-life planning activities: an integrated process.

    Science.gov (United States)

    Kelly, Christopher M; Masters, Julie L; DeViney, Stanley

    2013-07-01

    This study examined end-of-life planning and whether common characteristics predicted completion of these decisions. Participants in the Nebraska End-of-Life Survey were asked whether they had heard about or completed five plans: a health care power of attorney agreement, a living will, a last will and testament, funeral or burial preplanning, and organ and tissue donation. Logistic regression was used to identify predictors of these outcomes. Predictors of completing end-of-life plans, including funeral and burial preplanning, included older age, higher household income, and higher religiosity. This suggests that all of these decisions may be part of an integrated planning process at the end of life. Further, results from this study indicate that the role of religiosity, found in this study to predict both financial and health care planning, warrants further exploration.

  11. Intercultural differences and communication at the end of life.

    Science.gov (United States)

    Hallenbeck, J L

    2001-06-01

    Cross-cultural encounters at the end of life are common and can result in misunderstandings and conflicts. The primary care physician is ideally suited to facilitate communication that can promote understanding and conflict resolution.

  12. Uncharted terrain: preference construction at the end of life.

    Science.gov (United States)

    White, Mary T

    2014-01-01

    Respect for patients' self-determination has long been considered central to efforts to improve end-of-life care, yet efforts to promote advance directives or engage patients in end-of-life discussions are often unsuccessful. In this article, I contend that this is because the shared decision-making approach typically used in healthcare assumes patients' capacity to make rational choices, which is not always possible in end-of-life decisions. Drawing on decision theory, behavioral psychology, and related studies of end-of-life care, I present a growing body of evidence that suggests the novelty, complexity, and uncertainty of end-of-life circumstances make rational and stable preferences difficult to establish. I argue that an effective decision-making approach for the terminally ill must recognize and respond to the unique characteristics of end-of-life choices, including their nonrational dimensions. I conclude with a description of an initiative that appears to do so, resulting in increased patients' satisfaction. Copyright 2014 The Journal of Clinical Ethics. All rights reserved.

  13. Nursing homes and end-of-life care in Japan.

    Science.gov (United States)

    Ikegami, Naoki; Ikezaki, Sumie

    2013-10-01

    To describe end-of-life care in Japanese nursing homes by comparing facility and characteristics of residents dying in nursing homes with those who had been transferred and had died in hospitals, and by comparing the quality of end-of-life care with hospitals and with their respective counterparts in the United States. National sample of 653 nursing homes with responses from 371 (57%) on their facility characteristics, 241 (37%) on their resident characteristics, and 92 (14%) on the residents' quality of life. All 5 hospitals in a city 80 miles from Tokyo cooperated. Nursing home staff answered questionnaires on facility and resident characteristics. Resident level data were obtained from 1158. The questionnaire on the quality of care was responded to by 256 (63%) of the decedents' families in nursing homes and 205 (48%) in hospitals. Facility characteristics included items on physicians, nurse staffing, and the facility's end-of-life care policy. Resident characteristics included basic demographics, level of dementia, and resident's and family's preference for the site of death. The Toolkit was used to measure the quality of end-of-life care. The proportion of those dying within the nursing home was related to the facility's policy on end-of-life care and the family's preference. The quality of end-of-life care in nursing homes was generally better than in hospitals, and than in their respective counterparts in the United States. Financial incentives by the Japanese government to promote end-of-life care in nursing homes may have contributed to increasing the proportion of deaths within the facility. The quality of care in nursing homes was evaluated as being better than hospitals. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

  14. End-of-life decisions - some international comparisons.

    Science.gov (United States)

    Costello, Michael M; West, Daniel J; Ramirez, Bernardo

    2014-01-01

    Healthcare professionals often confront difficult issues in end-of-life care. Caregivers who question futile care and treatment can find themselves at odds with patients, family members and surrogates who stress patient autonomy. Many developed nations recognize hospital ethics committees as appropriate venues for discussion of end-of-life care, and palliative care initiatives in many hospitals play important roles in patient care at the end of life. As health systems worldwide confront diminishing resources and endless questioning on expenditures, the concept of medical futility has taken on increasing prominence. Medical professionals know intuitively that certain interventions near the end of life can neither extend life nor improve the quality of life remaining. In addition to medical futility, concerns about international economic pressures and enhanced recognition of patient autonomy lead to questions as to the appropriateness of withdrawing life-sustaining treatment, assisted suicide and euthanasia. While some appellate courts seem willing to entertain questions on the legal rights of patients to access certain end-of-life measures, legislative bodies appear reluctant to legalize assisted suicide and euthanasia.

  15. End-of-Life Care in Latin America

    Directory of Open Access Journals (Sweden)

    Enrique Soto-Perez-de-Celis

    2017-06-01

    Full Text Available Cancer has become a global pandemic with disproportionately higher mortality rates in low- and middle- income countries, where a large fraction of patients present in advanced stages and in need of end-of-life care. Globally, the number of adults needing end-of-life care is greater than 19 million, and up to 78% of these patients are living in low- and middle- income countries. In the Americas alone, more than one million people are in need of end-of-life care, placing an enormous burden on local health systems, which are often unprepared to meet the challenge presented by this complex patient population. In Latin America, cancer care is characterized by the presence of vast inequalities between and within countries, and the provision of end-of-life care is no exception. Disparities in access to advanced care planning, with a lack of provision of adequate palliative care and pain medication, are common in the region. These shortcomings are related in large part to inadequate or inappropriate legislation, lack of comprehensive national palliative care plans, insufficient infrastructure, lack of opportunities for clinical training, unreliable reporting of data, and cultural barriers. This report reviews the current status of end-of-life care in Latin America, focusing on identifying existing deficiencies and providing a framework for improvement.

  16. End-of-Life Care in Latin America

    Science.gov (United States)

    Soto-Perez-de-Celis, Enrique; Chavarri-Guerra, Yanin; Pastrana, Tania; Ruiz-Mendoza, Rossana; Bukowski, Alexandra

    2017-01-01

    Cancer has become a global pandemic with disproportionately higher mortality rates in low- and middle- income countries, where a large fraction of patients present in advanced stages and in need of end-of-life care. Globally, the number of adults needing end-of-life care is greater than 19 million, and up to 78% of these patients are living in low- and middle- income countries. In the Americas alone, more than one million people are in need of end-of-life care, placing an enormous burden on local health systems, which are often unprepared to meet the challenge presented by this complex patient population. In Latin America, cancer care is characterized by the presence of vast inequalities between and within countries, and the provision of end-of-life care is no exception. Disparities in access to advanced care planning, with a lack of provision of adequate palliative care and pain medication, are common in the region. These shortcomings are related in large part to inadequate or inappropriate legislation, lack of comprehensive national palliative care plans, insufficient infrastructure, lack of opportunities for clinical training, unreliable reporting of data, and cultural barriers. This report reviews the current status of end-of-life care in Latin America, focusing on identifying existing deficiencies and providing a framework for improvement. PMID:28717769

  17. Barriers of healthcare providers against end-of-life discussions with pediatric cancer patients.

    Science.gov (United States)

    Yoshida, Saran; Shimizu, Ken; Kobayashi, Mariko; Inoguchi, Hironobu; Oshima, Yoshio; Dotani, Chikako; Nakahara, Rika; Takahashi, Tomomi; Kato, Masashi

    2014-08-01

    End-of-life discussions with patients can be one of the most difficult and stressful tasks for the oncologist. However, little is known about the discussions that healthcare providers have with patients in such situations and the difficulties they face. The primary end points of this study were to describe the contents of end-of-life discussion in the pediatric setting and the barriers to end-of-life discussion for pediatric patients, as perceived by pediatric healthcare providers. Participants were 10 healthcare providers. Semi-structured interviews were conducted, and the KJ method was performed to analyze the data. We found 23 barriers against end-of-life discussion with pediatric cancer patients. These barriers were classified as follows: healthcare provider factors, patient factors, parent factors and institutional or cultural factors. In addition to barriers found in previous studies, some unique barriers were uncovered such as, 'Lack of confidence to face the patient after the discussion', 'Uncertain responsibility for treatment decision-making' and 'No compelling reason to discuss'. Healthcare providers actively discussed the purpose of treatment and the patients' wishes and concerns; however, they were reluctant to deal with the patients' own impending death and their estimated prognosis. End-of-life discussion with pediatric patients differs from that with adult patients. Further studies are required to analyze pediatric cases associated with end-of-life discussion and carefully discuss its adequacy, pros and cons. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Public, patient and carers' views on palliative and end-of-life care in India.

    Science.gov (United States)

    Ramasamy Venkatasalu, M; Sirala Jagadeesh, N; Elavally, S; Pappas, Y; Mhlanga, F; Pallipalayam Varatharajan, R

    2017-08-30

    To systematically review the existing evidence on the Indian public, patient and carers' perspectives on palliative and end-of-life care. With a growing population of terminally ill people across the world, there is also an increasing awareness among international health policy makers of the need to improve the quality of life for terminally ill patients. Understanding service users' (patients, family and public) perspectives is crucial in developing and sustaining successful community-centred palliative nursing policies and service models especially in countries like India with diverse population. An integrative review was performed on five databases, using hand searches of key journals and reference citation tracking for empirical studies published in English from 1990 to 2015. A thematic analysis framework was used to analyse and identify key themes. Analysis of the six eligible studies revealed five themes. Themes describe how social, economic, cultural, religious, spiritual and traditional factors influenced the palliative and end-of-life care perspectives and experiences among Indians. They also illustrated preferences relating to place of care, as well as benefits and challenges of family caregiving during the last days of life. Although we found minimal evidence on user perspectives, nurses need to aware of those unique components of context-specific palliative and end-of-life care practices in India - socioeconomic, cultural and religious factors - on their nursing encounters. Nurses need to advocate same in policy development to enable accessibility and utility of palliative and end-of-life care services, which are scant in India. Nurses can be central in gathering the contextual evidence that advocate users' perspectives to inform further studies and national palliative care policies in India. Emerging policies in nursing education need to focus on integrating family-centred palliative and end-of-life care within curricula, whereas nursing practice may

  19. End-of-life decisions in the intensive care unit

    DEFF Research Database (Denmark)

    Jensen, Hanne Irene

    2012-01-01

    Background When making end-of-life decisions in intensive care units, the different staff groups have different roles in the decision-making process and may not always assess the situation identically. Practice recommendations for withholding or withdrawing therapy state that decisions should...... (135) from 10 ICUs in the Region of Southern Denmark. Additionally the survey included primary physicians (146) from two regional ICUs. Subproject 4. Audit: Three interdisciplinary audits with the participation of 8 primary care physicians, 9 intensivists, and 12 nurses were conducted. Form and profit...... be interdisciplinary, but the literature shows that this is not always the case. Research on end-of-life issues in Danish ICUs is limited. Aim The aims of this thesis were to • Examine Danish practices regarding end-of-life decisions in the ICU. • Examine the opinions of nurses and physicians who work in Danish ICUs...

  20. Towards cultural competency in end-of-life communication training.

    Science.gov (United States)

    Lubimir, Karen T; Wen, Aida B

    2011-11-01

    To meet the needs of a more diverse population, a culturally sensitive approach to end-of-life communication is critical. This paper describes a unique communication workshop that introduces future physicians to the delivery of culturally responsive care for patients in palliative and end-of-life treatment. The workshop is embedded within the required fourth year medical student rotation in Geriatrics and Palliative Care. Using case-vignettes, role playing, and small group discussions, content areas include: breaking bad news, discussing advanced directives, and decisions regarding withdrawal or withholding of treatment. Post workshop student evaluations reveal an overwhelmingly favorable response to the curriculum, with high scores for overall quality of the workshop, practical value, and appropriateness for level of training. This workshop meets the goal for all graduating medical students to engage in culturally competent palliative and end of life patient care.

  1. Symptomatic Control in End-of-Life Patients

    Directory of Open Access Journals (Sweden)

    Mariana Alves

    2017-01-01

    Full Text Available End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention to basic concepts of control concerning refractory symptoms and palliative sedation.

  2. Symptomatic Control in End-of-Life Patients

    OpenAIRE

    Mariana Alves; Rita Abril; Isabel Galriça Neto

    2017-01-01

    End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention t...

  3. Symptomatic Control in End-of-Life Patients.

    Science.gov (United States)

    Alves, Mariana; Abril, Rita; Neto, Isabel Galriça

    2017-01-31

    End-of-life patients present a variety of symptoms that cause suffering for them and their respective families. Health professionals throughout their university, internship and medical careers are ill-prepared to manage and improve the quality of life of these patients. This article aims to provide basic skills in the symptomatic management of end-of-life patients, focusing in particular on the control of pain, dyspnoea, fatigue, nausea, vomiting and anorexia. It also aims to draw attention to basic concepts of control concerning refractory symptoms and palliative sedation.

  4. Conducting end-of-life research: strategies for success.

    Science.gov (United States)

    Kavanaugh, Karen L; Campbell, Margaret L

    2014-01-01

    Conducting studies at the end of life is often challenging for researchers due to the sensitive nature of the research, the vulnerability of the participants and the inherent methodological complexities. Methodological challenges include identifying and gaining access to eligible research participants, estimating the duration of patient survival time in the study, minimizing the potential burden of data collection, and attending to issues of consent and confidentiality. In this paper, the authors identify challenges when conducting end-of-life research and draw from collective research experiences to describe strategies to achieve success.

  5. Customer Differentiated End-of-Life Inventory Problem

    NARCIS (Netherlands)

    M. Pourakbar (Morteza); R. Dekker (Rommert)

    2011-01-01

    textabstractThis paper deals with the service parts end-of-life inventory problem in a circumstance that demands for service parts are differentiated. Customer differentiation might be due to criticality of the demand or based on various service contracts. In both cases, we model the problem as a

  6. Measuring End-of-Life Care Processes in Nursing Homes

    Science.gov (United States)

    Temkin-Greener, Helena; Zheng, Nan; Norton, Sally A.; Quill, Timothy; Ladwig, Susan; Veazie, Peter

    2009-01-01

    Purpose: The objectives of this study were to develop measures of end-of-life (EOL) care processes in nursing homes and to validate the instrument for measuring them. Design and Methods: A survey of directors of nursing was conducted in 608 eligible nursing homes in New York State. Responses were obtained from 313 (51.5% response rate) facilities.…

  7. Incorporating End-of-Life Issues into Psychology Courses.

    Science.gov (United States)

    Werth, James L., Jr.

    2002-01-01

    Discusses the reasons why teaching about the process of dying is relevant content for psychology courses. Offers suggestions for teaching about end-of-life issues in various courses on: (1) ethical, legal, and professional issues courses; (2) adult and life span development; (3) counseling diverse populations; and (4) assessment and diagnosis.…

  8. Palliative sedation at end of life - a systematic literature review.

    Science.gov (United States)

    Engström, Joakim; Bruno, Erik; Holm, Birgitta; Hellzén, Ove

    2007-02-01

    Palliative sedation at the end of life to handle unmanageable symptoms has been much debated. A systematic literature review in three phases including a content analysis of 15 articles published between the years 1990 and 2005 has been conducted. The aim was to describe the phenomenon of 'palliative sedation at the end of life' from a nursing perspective. The results can be summarised in three themes: 'Important factors leading to the patient receiving sedation at the end of life', 'Attitudes to palliative sedation at the end of life' and 'Nurses' experience of palliative sedation at the end of a patient's life'. Together, the themes show that palliative sedation is a phenomenon that could be described as sedation given to fewer than 40% of dying patients during their last 4 days of life. It is usually given because of the patient's pain, agitation and/or dyspnoea. Professionals usually have positive attitudes towards it and their view differs from that of the public's view regarding it as continuously deep sedation, whereas the public regards it as being close to euthanasia. Studies focusing on nursing care during palliative sedation are hard to find and this underlines the importance of further research in this area to elucidate the nurses' role during palliative sedation.

  9. Nurses' involvement in end-of-life decisions.

    NARCIS (Netherlands)

    Veer, A. de; Francke, A.; Poortvliet, E.P.

    2008-01-01

    In Dutch healthcare, patients and physicians are responsible for medical end-of-life decisions. These include nontreatment decisions, withholding or withdrawing parenteral hydration and nutrition where the patient can no longer drink or eat, relieving pain and other symptoms with drugs that might

  10. Intensive care nurses' experiences of end-of-life care.

    Science.gov (United States)

    Kisorio, Leah C; Langley, Gayle C

    2016-04-01

    To explore intensive care nurses' experiences of end-of-life care in adult intensive care units. An exploratory, descriptive qualitative approach was utilised. Purposive sampling method was used to select nurse participants (n=24) working at the selected intensive care units in the three academic affiliated, tertiary specialist hospitals in the Johannesburg and Pretoria regions, South Africa. Using a focus group guide, three focus group discussions were conducted. Data were analysed using the long-table approach (Krueger and Casey, 2000). Trustworthiness of the study was ensured by following the criteria set out by Lincoln and Guba (1985). Five major themes related to nurses' experiences of end-of-life care emerged. These included: "difficulties we experience", "discussion and decision making", "support for patients", "support for families" and "support for nurses". End-of-life care can be difficult and a challenging process. Nevertheless, this study has highlighted some of the interventions and support systems that could be incorporated for improved caring process. Whereas the dying patients and their families need to be continuously supported, critical care nurses too need to be taken care of for them to continue providing the best possible end-of-life care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Hospital at home: home-based end of life care

    Science.gov (United States)

    Shepperd, Sasha; Wee, Bee; Straus, Sharon E

    2014-01-01

    Background The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and patients with a terminal illness would prefer to receive end of life care at home. Objectives To determine if providing home-based end of life care reduces the likelihood of dying in hospital and what effect this has on patients’ symptoms, quality of life, health service costs and care givers compared with inpatient hospital or hospice care. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library) to October 2009, Ovid MED-LINE(R) 1950 to March 2011, EMBASE 1980 to October 2009, CINAHL 1982 to October 2009 and EconLit to October 2009. We checked the reference lists of articles identified for potentially relevant articles. Selection criteria Randomised controlled trials, interrupted time series or controlled before and after studies evaluating the effectiveness of home-based end of life care with inpatient hospital or hospice care for people aged 18 years and older. Data collection and analysis Two authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible we presented the data in narrative summary tables. Main results We included four trials in this review. Those receiving home-based end of life care were statistically significantly more likely to die at home compared with those receiving usual care (RR 1.33, 95% CI 1.14 to 1.55, P = 0.0002; Chi 2 = 1.72, df = 2, P = 0.42, I2 = 0% (three trials; N=652)). We detected no statistically significant differences for functional status (measured by the Barthel Index), psychological well-being or cognitive status, between patients receiving home-based end of life care compared with those receiving standard care (which

  12. Quality of life at the end of life

    Directory of Open Access Journals (Sweden)

    Downey Lois

    2007-08-01

    Full Text Available Abstract Background Little is known about self-perceived quality of life (QOL near the end of life, because such information is difficult to collect and to interpret. Here, we describe QOL in the weeks near death and determine correlates of QOL over time, with emphasis on accounting for death and missing data. Methods Data on QOL were collected approximately every week in an ongoing randomized trial involving persons at the end of life. We used these data to describe QOL in the 52 weeks after enrollment in the trial (prospective analysis, N = 115, and also in the 10 weeks just prior to death (retrospective analysis, N = 83. The analysis consisted of graphs and regressions that accounted explicitly for death and imputed missing data. Results QOL was better than expected until the final 3 weeks of life, when a terminal drop was observed. Gender, race, education, cancer, and baseline health status were not significantly related to the number of “weeks of good-quality life” (WQL during the study period. Persons younger than 60 had significantly higher WQL than older persons in the prospective analysis, but significantly lower WQL in the retrospective analysis. The retrospective results were somewhat sensitive to the imputation model. Conclusion In this exploratory study, QOL was better than expected in persons at the end of life, but special interventions may be needed for persons approaching a premature death, and also for the last 3 weeks of life. Our descriptions of the trajectory of QOL at the end of life may help other investigators to plan and analyze future studies of QOL. Methodology for dealing with death and the high amount of missing data in longitudinal studies at the end of life needs further investigation.

  13. Enabling occupation at the end of life: A literature review.

    Science.gov (United States)

    Mills, Katherine; Payne, Angela

    2015-12-01

    Occupation, or meaningful activity, can contribute to the well-being and quality of life of all individuals. It is thus a logical tautology that occupation should be enabled for those at the end of life. Our present review examines current provision of these processes by Occupational Therapist, who can be much-valued members of multidisciplinary palliative care teams. Following a literature search and critical selection, 10 global papers were identified examining occupation and occupational therapy at the end of life in the acute, hospice, and community environments. Universally, there appeared to be a dearth of therapists working in end-of-life care. Provision of palliative care in hospitals was found to be compensatory or rehabilitative. Hospice therapy emerged as pleasingly occupational, though the number of hospice places was disappointingly few. Community literature was sparse, so it proved challenging to draw definitive conclusions. Promising research refracted light on occupation at home; however, it also revealed stretched domiciliary services, where clients are not well informed about the potential scope of occupational therapy. A "good death" involving a quality end-of-life experience is the foundational goal overarching all therapy and medicine in the provision of palliative care. Arguably, an occupation-focused approach provided by therapists meets client needs to enable meaningful experiences in the limited time left to them. Current occupational therapy practice environments are not necessarily achieving these goals in commensurate fashion. There is a need to promote the role of occupational therapy and circumscribe what therapists can offer. Further research is necessitated across all environments and future funding for therapist positions in palliative teams. End-of-life care can be complex and challenging; however, therapists can facilitate fulfillment of client-centered occupational goals. In engaging with personally constructed nuances of meaning

  14. Pleurodesis for effusions in pediatric oncology patients at end of life

    Energy Technology Data Exchange (ETDEWEB)

    Hoffer, Fredric A. [St. Jude Children' s Research Hospital, Department of Radiological Sciences, Memphis, TN (United States); Children' s Hospital and Regional Medical Center, Department of Radiology, R-5438, Seattle, WA (United States); Hancock, Michael L.; Rai, Shesh N. [St. Jude Children' s Research Hospital, Department of Biostatistics, Memphis, TN (United States); Hinds, Pamela S. [St. Jude Children' s Research Hospital, Division of Nursing Research, Memphis, TN (United States); Oigbokie, Nikita [St. Jude Children' s Research Hospital, Department of Radiological Sciences, Memphis, TN (United States); Rao, Bhaskar [St. Jude Children' s Research Hospital, Department of Surgery, Memphis, TN (United States)

    2007-03-15

    Pleurodesis for end-of-life care has been used in adults for decades, but little is known about the usefulness of this technique in improving the quality of care for pediatric patients. To assess whether intractable pleural effusions in pediatric oncology patients at end of life could be sufficiently relieved by pleurodesis. Eleven pleurodeses were performed with doxycycline in seven pediatric cancer patients (age 3-21 years) with intractable pleural effusions at the end of life. Five patients had unilateral pleurodeses and two had a unilateral followed by bilateral pleurodeses. Respiratory rates decreased in all seven patients (P = 0.016) and aeration improved significantly after chest tube placement (P = 0.033). The chest tubes were placed a median of 1 day before pleurodesis. Eight of nine chest tubes (89%) were removed before discharge at a median of 3 days after pleurodesis. Pain secondary to the pleurodesis lasted 1 day or less. Improvement in the respiratory rate remained after pleurodesis and chest tube removal (P = 0.031). Five of seven patients (70%) were able to leave the hospital to return home. The five patients discharged lived 10 to 49 days (median 19 days) after discharge. Pediatric oncology patients with intractable effusions at end of life can have respiratory benefit from pleurodeses and, as a result, are more likely to return home for terminal care. (orig.)

  15. Potential for response bias in family surveys about end-of-life care in the ICU.

    Science.gov (United States)

    Kross, Erin K; Engelberg, Ruth A; Shannon, Sarah E; Curtis, J Randall

    2009-12-01

    After-death surveys are an important source of information about the quality of end-of-life care, but response rates generally are low. Our goal was to understand the potential for nonresponse bias in survey studies of family members after a patient's death in the hospital ICU by identifying differences in patient demographics and delivery of palliative care between patients whose families respond to a survey about end-of-life care and those whose families do not. We performed a cohort study of patients who died in the ICU at 14 hospitals. Surveys were mailed to family members 1 to 2 months after the patient's death. Chart abstraction was completed on all patients, assessing demographic characteristics and previously validated indicators of palliative care. Of the 2,016 surveys sent to families, 760 were returned, for a response rate of 38%. Patients whose family members returned the surveys were more likely to be white (88% vs 74%, respectively; p care, including medical record documentation of family present at death, involvement of spiritual care, and dying after a decision to limit life-sustaining therapies (p family members responded to a survey about end-of-life care were more likely to be white, older, and have indicators of palliative care documented in the medical record. Because these patients likely received higher quality palliative care, these findings suggest that the response bias in end-of-life care research is toward overestimating the quality of palliative care. ClinicalTrials.gov Identifier: NCT00685893.

  16. End-of-life care in pediatric neuro-oncology.

    Science.gov (United States)

    Vallero, Stefano Gabriele; Lijoi, Stefano; Bertin, Daniele; Pittana, Laura Stefania; Bellini, Simona; Rossi, Francesca; Peretta, Paola; Basso, Maria Eleonora; Fagioli, Franca

    2014-11-01

    The management of children with cancer during the end-of-life (EOL) period is often difficult and requires skilled medical professionals. Patients with tumors of the central nervous system (CNS) with relapse or disease progression might have additional needs because of the presence of unique issues, such as neurological impairment and altered consciousness. Very few reports specifically concerning the EOL period in pediatric neuro-oncology are available. Among all patients followed at our center during the EOL, we retrospectively analyzed data from 39 children and adolescents with brain tumors, in order to point out on their peculiar needs. Patients were followed-up for a median time of 20.1 months. Eighty-two percent were receiving only palliative therapy before death. Almost half the patients (44%) died at home, while 56% died in a hospital. Palliative sedation with midazolam was performed in 58% of cases; morphine was administered in 51.6% of cases. No patient had uncontrolled pain. The EOL in children with advanced CNS cancer is a period of active medical care. Patients may develop complex neurological symptoms and often require long hospitalization. We organized a network-based collaboration among the reference pediatric oncology center, other pediatric hospitals and domiciliary care personnel, with the aim to ameliorate the quality of care during the EOL period. In our cohort, palliative sedation was widely used while no patients died with uncontrolled pain. A precise process of data collection and a better sharing of knowledge are necessary in order to improve the management of such patients. © 2014 Wiley Periodicals, Inc.

  17. End-of-life practices in the Netherlands under the Euthanasia Act.

    Science.gov (United States)

    van der Heide, Agnes; Onwuteaka-Philipsen, Bregje D; Rurup, Mette L; Buiting, Hilde M; van Delden, Johannes J M; Hanssen-de Wolf, Johanna E; Janssen, Anke G J M; Pasman, H Roeline W; Rietjens, Judith A C; Prins, Cornelis J M; Deerenberg, Ingeborg M; Gevers, Joseph K M; van der Maas, Paul J; van der Wal, Gerrit

    2007-05-10

    In 2002, an act regulating the ending of life by a physician at the request of a patient with unbearable suffering came into effect in the Netherlands. In 2005, we performed a follow-up study of euthanasia, physician-assisted suicide, and other end-of-life practices. We mailed questionnaires to physicians attending 6860 deaths that were identified from death certificates. The response rate was 77.8%. In 2005, of all deaths in the Netherlands, 1.7% were the result of euthanasia and 0.1% were the result of physician-assisted suicide. These percentages were significantly lower than those in 2001, when 2.6% of all deaths resulted from euthanasia and 0.2% from assisted suicide. Of all deaths, 0.4% were the result of the ending of life without an explicit request by the patient. Continuous deep sedation was used in conjunction with possible hastening of death in 7.1% of all deaths in 2005, significantly increased from 5.6% in 2001. In 73.9% of all cases of euthanasia or assisted suicide in 2005, life was ended with the use of neuromuscular relaxants or barbiturates; opioids were used in 16.2% of cases. In 2005, 80.2% of all cases of euthanasia or assisted suicide were reported. Physicians were most likely to report their end-of-life practices if they considered them to be an act of euthanasia or assisted suicide, which was rarely true when opioids were used. The Dutch Euthanasia Act was followed by a modest decrease in the rates of euthanasia and physician-assisted suicide. The decrease may have resulted from the increased application of other end-of-life care interventions, such as palliative sedation. Copyright 2007 Massachusetts Medical Society.

  18. End-of-life care for neonates and infants: the experience and effects of a palliative care consultation service.

    Science.gov (United States)

    Pierucci, R L; Kirby, R S; Leuthner, S R

    2001-09-01

    Neonates and infants have the highest death rate in the pediatric population, yet there is a paucity of data about their end-of-life care and whether a palliative care service can have an impact on that care. The objective of this study was to describe end-of-life care for infants, including analysis of palliative care consultations conducted in this population. We hypothesized that the palliative care consultations performed had an impact on the infants' end-of-life care. A retrospective chart review using the "End of Life Chart Review" from the Center to Improve Care for the Dying was conducted. The participants were the patients at Children's Hospital of Wisconsin who died at palliative care consultations. The rate of consultations increased from 5% of the infant deaths in 1994 to 38% of the infant deaths in 1997. Infants of families that received consultations had fewer days in intensive care units, blood draws, central lines, feeding tubes, vasopressor and paralytic drug use, mechanical ventilation, cardiopulmonary resuscitation, and x-rays, and the families had more frequent referrals for chaplains and social services than families that did not have palliative care consultations. This study describes the end-of-life care that infants and their families received. Fewer medical procedures were performed, and more supportive services were provided to infants and families that had a palliative care consultation. This suggests that palliative care consultation may enhance end-of-life care for newborns.

  19. Doctors' learning experiences in end-of-life care

    DEFF Research Database (Denmark)

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti

    2017-01-01

    death could even be welcomed. Through challenging dialogues dealing with family members’ hope and trust, they learnt how to adjust words and decisions according to family and patient’s life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position......Background: Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life...... care. The aim of this study was to explore newly qualified doctors’ learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. Methods: House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped...

  20. End-of-life treatment decision making: American Indians' perspective.

    Science.gov (United States)

    Colclough, Yoshiko Yamashita; Brown, Gary M

    2014-08-01

    This study explored American Indians' end-of-life experiences in treatment decision making. Scarce knowledge about this population's perspective regarding end-of-life treatments has resulted in health care providers (HCPs) functioning at less than optimum levels. Using a community-based participatory research approach, open-ended interview data were collected and analyzed using a grounded theory method. Patient and family participants generally stated that the physicians made the treatment decisions for them, while HCPs believed that patients participated in informed autonomous treatment decision making. Both parties (HCPs and patients and families) were not aware of American Indian's psychological aspect that interfered with the exercise of the right of informed consent. This additional understanding would benefit them in order to result in ethically and legally sound practice of patient's autonomous treatment decision making. © The Author(s) 2013.

  1. REUSE OF AUTOMOTIVE COMPONENTS FROM DISMANTLED END OF LIFE VEHICLES

    Directory of Open Access Journals (Sweden)

    Piotr NOWAKOWSKI

    2013-12-01

    Full Text Available The problem of recycling end of life automotive vehicles is serious worldwide. It is one of the most important streams of waste in developed countries. It has big importance as recycling potential of raw materials content in automotive vehicles is valuable. Different parts and assemblies after dismantling can also be reused in vehicles where replacement of specific component is necessary. Reuse of the components should be taken into consideration in selecting the vehicles dismantling strategy. It also complies with European Union policy concerning end of life vehicles (ELV. In the paper it is presented systematic approach to dismantling strategies including disassembly oriented on further reuse of components. It is focused on decision making and possible benefits calculation from economic and environmental point of view.

  2. Measuring the quality of end-of-life care

    DEFF Research Database (Denmark)

    Ross, Lone; Neergaard, Mette Asbjoern; Petersen, Morten Aagaard

    2017-01-01

    BACKGROUND: The perspectives of patients and relatives are important in the improvement of the quality of health care. However, the quality of end-of-life care has not been systematically evaluated in Scandinavia. AIM: To develop or adapt and subsequently validate a questionnaire assessing....... RESULTS: Most of the important topics were covered by the Views of Informal Carers' Evaluation of Services-Short Form, but not all Danish settings (e.g. home care by a palliative team) were covered. These settings were added to the Views of Informal Carers' Evaluation of Services-Short Form, and a few...... the quality of end-of-life care in Denmark. The questionnaire was intended for bereaved relatives in order to assess the quality of care in the last 3 months of the patient's life and the circumstances surrounding death. DESIGN AND DATA SOURCES: Based on the literature and interviews with 15 bereaved...

  3. Ethical aspects of brain death and end-of-life

    Directory of Open Access Journals (Sweden)

    Gabriel Oselka

    Full Text Available Abstract Ethical issues surrounding brain death and end-of-life have not been afforded in Brazil the same attention as in many developed countries. There appears to be reluctance on the part of Brazilian doctors to limit or suspend procedures or treatment which prolongs life of patients in terminal phases of severe incurable illness, or to suspend the artificial means of supporting vegetative functions in cases of brain death outside the context of organ and tissue donation for transplant. Fears grounded in possible administrative (Regional Medical Councils or legal repercussions, as well as ambiguous interpretations of religious precepts, partially explain this reluctance which often results in unnecessary prolonging of patient suffering. A recent resolution by the Federal Medical Council on end-of-life may offer doctors some guidance and confidence in dealing with highly complex ethical situations.

  4. End of Life Issues in the Intensive Care Units

    OpenAIRE

    Datta, Rashmi; Chaturvedi, R.; Rudra, A.; Jaideep, C.N.

    2012-01-01

    A structured discussion of End-of-Life (EOL) issues is a relatively new phenomenon in India. Personal beliefs, cultural and religious influences, peer, family and societal pressures affect EOL decisions. Indian law does not provide sanction to contentious issues such as do-not-resuscitate (DNR) orders, living wills, and euthanasia. Finally, published data on EOL decisions in Indian ICUs is lacking. What is needed is a prospective determination of which patients will benefit from aggressive ma...

  5. [End-of-life support from a private practice nurse].

    Science.gov (United States)

    Lecointre, Brigitte

    2015-11-01

    Eighty-one per cent of people say they would prefer to die at home. Several elements contribute to improving end-of-life care at home: an evolving society, ethical questioning, legislative changes, new methods of organisation, specialised and interdisciplinary training. However, this remains difficult. The private practice nurse provides clinical support and plays a major role in this care. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. [ETHICAL CONFLICTS AT THE END OF LIFE FROM NURSE PERCEPTION].

    Science.gov (United States)

    Calvo Rodríguez, Begoña; Berdial Cabal, Ignacio

    2015-10-01

    Current medicine tends to dehumanize the end of life process, which contributes to generate certain ethical conflict to nurse staff The major scientific datadas research. The four main ethical conflicts detected are: decisions making, communicating information, futile treatments and hydration and artificial feeding. The nurses suffer moral distress with ethical conflicts by the obligation of safeguard the dignity and rights of their patients. The lack of training and experience to treat ethical problems contribute to increase nurse disconfort.

  7. The significance of end-of-life dreams and visions.

    Science.gov (United States)

    Grant, Pei; Wright, Scott; Depner, Rachel; Luczkiewicz, Debra

    End-of-life dreams and visions (ELDVs) have been well documented through history and across cultures. They appear to affect both dying people and their families deeply, and may be a source of profound meaning and comfort. The aims of the study were to; document hospice patients' ELDV experiences over time using a daily survey, examine the content and subjective significance of ELDVs, and relate the prevalence, content and significance of end-of-life experiences over time until death. Patients (n = 66) in a hospice inpatient unit, between January 2011 and July 2012, were interviewed daily. The interview contained closed questions about the content, frequency and level of comfort or distress of dreams and visions. Most participants reported at least one dream or vision and almost half of the dreams and visions occurred during sleep. Nearly all patients reported that their experience felt real. The most common content featured deceased friends and relatives, followed by living friends and relatives. As participants approached death, comforting dreams and visions of the deceased became more prevalent. End-of-life dreams and visions are commonly experienced during dying. These dreams and visions may be a profound source of potential meaning and comfort to the dying.

  8. End-of-life care: pathways and evidence.

    Science.gov (United States)

    Costantini, Massimo; Alquati, Sara; Di Leo, Silvia

    2014-12-01

    Studies in different countries and settings of care have reported the quality of care for the dying patients as suboptimal. Care pathways have been developed with the aim of ensuring that dying patients and their family members received by health professionals the most appropriate care. This review presents and discusses the evidence supporting the effectiveness of the end-of-life care pathways. Two Cochrane systematic reviews updated at June 2013 did not identify studies that met minimal criteria for inclusion. One randomized cluster trial aimed at assessing the effectiveness of the Liverpool Care Pathway in hospitalized cancer patients was subsequently published. The trial did not find a significant difference in the overall quality of care, the primary end-point, but two out of nine secondary outcomes - respect, dignity, and kindness, and control of breathlessness showed significant improvements. Afterwards, we did not find any other potentially eligible published study. The overall amount of evidence supporting the dissemination of end-of-life care pathways is rather poor. One negative randomized trial suggests the pathways have the potential to reduce the gap between hospital and hospices. Further research is needed to understand the potential benefit of end-of-life care pathways.

  9. A conceptual analysis of spirituality at the end of life.

    Science.gov (United States)

    Vachon, Mélanie; Fillion, Lise; Achille, Marie

    2009-01-01

    The definition of spirituality is the subject of endless debates in the empirical literature. This content analysis sought to: (1) exhaustively review the empirical literature on end-of-life spirituality to extract definitional elements of this concept and (2) elaborate on these definitional elements to create an integrative and inclusive definition of end-of-life spirituality based on the items retrieved. A search of the literature on spirituality published in the last 10 years was conducted via the the PsychINFO and MEDLINE databases. Seventy-one articles were selected based on specific inclusion criteria. A qualitative thematic analysis yielded 11 dimensions for the concept of end-of-life spirituality, namely: (1) meaning and purpose in life, (2) self-transcendence, (3) transcendence with a higher being, (4) feelings of communion and mutuality, (5) beliefs and faith, (6) hope, (7) attitude toward death, (8) appreciation of life, (9) reflection upon fundamental values, (10) the developmental nature of spirituality, and (11) its conscious aspect. The definition derived from this concept analysis, after being tested empirically, may be useful in informing the development of new measures of spirituality and new protocols to assess spirituality in clinical settings.

  10. Team Leadership and Cancer End-of-Life Decision Making.

    Science.gov (United States)

    Waldfogel, Julie M; Battle, Dena J; Rosen, Michael; Knight, Louise; Saiki, Catherine B; Nesbit, Suzanne A; Cooper, Rhonda S; Browner, Ilene S; Hoofring, Laura H; Billing, Lynn S; Dy, Sydney M

    2016-11-01

    End-of-life decision making in cancer can be a complicated process. Patients and families encounter multiple providers throughout their cancer care. When the efforts of these providers are not well coordinated in teams, opportunities for high-quality, longitudinal goals of care discussions can be missed. This article reviews the case of a 55-year-old man with lung cancer, illustrating the barriers and missed opportunities for end-of-life decision making in his care through the lens of team leadership, a key principle in the science of teams. The challenges demonstrated in this case reflect the importance of the four functions of team leadership: information search and structuring, information use in problem solving, managing personnel resources, and managing material resources. Engaging in shared leadership of these four functions can help care providers improve their interactions with patients and families concerning end-of-life care decision making. This shared leadership can also produce a cohesive care plan that benefits from the expertise of the range of available providers while reflecting patient needs and preferences. Clinicians and researchers should consider the roles of team leadership functions and shared leadership in improving patient care when developing and studying models of cancer care delivery.

  11. Integrating professional apprentices into an end-of-life course.

    Science.gov (United States)

    Hold, Judith L; Ward, Elizabeth N; Blake, Barbara J

    2014-02-01

    Nursing education faces several challenges in providing quality and meaningful education. Providing such an education is most important in teaching end-of-life care, as nurses are pivotal in helping patients to achieve a good death. A good death is often based on physical comfort, preparation for death, and completion of social and emotional tasks. Many obstacles hinder a patient's wishes about dying, including how nurses perceive their role in end-of-life care situations and knowing how to intervene on behalf of the patient. Therefore, nursing education needs to create meaningful and relevant learning experiences to enable future nurses to effectively care for the dying patient. To this endeavor, the Palliative and End-of-Life Care course described in this article integrated knowledge through the use of three professional apprenticeships: (a) acquiring and using knowledge and science (cognitive), (b) using clinical reasoning and skilled know-how (practice), and (c) ethical comportment and formation (moral reasoning). Copyright 2014, SLACK Incorporated.

  12. End-of Life Care and Barriers for Female Inmates

    Science.gov (United States)

    Loeb, Susan J.; Penrod, Janice; Hollenbeak, Christopher S.; Smith, Carol A.

    2011-01-01

    The number of female inmates is growing, and their average age is increasing. As a result, end-of-life care is situated in a highly restrictive environment with a focus on security rather than comfort. We describe the need for and potential barriers to humane care and provide care strategies that can be useful in a complex organizational system. Frontline workers such as nurses who understand the balance between care and control must promote change in the women’s prison system. PMID:21645114

  13. End-of-life care: legal and ethical considerations.

    Science.gov (United States)

    O'Keefe, Mary E; Crawford, Kate

    2002-05-01

    To prepare the oncology nurse, under the Patient Self-Determination Act, to analyze and discuss legal and ethical issues that may arise in the clinical area when end-of-life decisions are made. Nursing textbooks, scholarly articles, court cases, and internet publications. The dying patient has the right to die with dignity, respect, and the right treatment choices. Nurses need to understand how to implement the Patient Self-Determination Act regarding living wills, do not resuscitate orders, euthanasia, and whether or not to use feeding tubes.

  14. Social work involvement in end of life planning.

    Science.gov (United States)

    Heyman, Janna C; Gutheil, Irene A

    2006-01-01

    This cross sectional study examined the factors associated with social workers' involvement in end-of-life (EOL) planning using a random sample of NASW members in health and aging. Of the 390 social workers who worked in EOL planning, the majority were involved in health care proxy discussions and counseling with patients. Respondents tended to see barriers to proxy completion as client-related. However, some system barriers were correlated with overall involvement. Factors that predicted social workers' involvement with the health care proxy included age, attitudes, perceptions of barriers, and perceived physician support. Social workers need to attend to the systems in which they operate as well as to client concerns.

  15. Music therapy for end-of-life care.

    Science.gov (United States)

    Bradt, Joke; Dileo, Cheryl

    2010-01-20

    Music therapy in end-of-life care aims to improve a person's quality of life by helping relieve symptoms, addressing psychological needs, offering support, facilitating communication, and meeting spiritual needs. In addition, music therapists assist family and caregivers with coping, communication, and grief/bereavement. To examine effects of music therapy with standard care versus standard care alone or standard care combined with other therapies on psychological, physiological, and social responses in end-of-life care. We searched CENTRAL, MEDLINE, CINAHL, EMBASE, PSYCINFO, LILACS, CancerLit, Science Citation Index, www.musictherapyworld.de, CAIRSS for Music, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, and the National Research Register to September 2009. We handsearched music therapy journals and reference lists, and contacted experts to identify unpublished manuscripts. There was no language restriction. We included all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone or combined with other therapies in any care setting with a diagnosis of advanced life-limiting illness being treated with palliative intent and with a life expectancy of less than two years. Data were extracted, and methodological quality was assessed, independently by review authors. Additional information was sought from study authors when necessary. Results are presented using weighted mean differences for outcomes measured by the same scale and standardized mean differences for outcomes measured by different scales. Posttest scores were used. In cases of statistically significant baseline difference, we used change scores. Five studies (175 participants) were included. There is insufficient evidence of high quality to support the effect of music therapy on quality of life of people in end-of-life care. Given the limited number of studies and small sample sizes, more research is

  16. [Spiritual end of life domiciliary care: a bibliographic review].

    Science.gov (United States)

    Sierra García, Marta; Getino Canseco, María

    2013-09-01

    This article is a descriptive literature review on the topic of spirituality, in a palliative care aimed at adult patients with different pathologies that are in an advanced stage of the disease. We analyze the sociocultural construction of spirituality at the end of life in the domiciliary environment, relating it to the disease process, its terminality and death. We describe the attention of the palliative-nurses, caring for the spiritual needs from a holistic point of view. It has to be considered that if the palliative-nurses are aware of the spirituality of patients with terminal illness should have some established strategies in their efforts to provide spiritual comfort.

  17. End-of-life issues for aboriginal patients

    Science.gov (United States)

    Kelly, Len; Minty, Alana

    2007-01-01

    OBJECTIVE To understand some of the cross-cultural issues in providing palliative care to aboriginal patients. SOURCES OF INFORMATION MEDLINE (1966 to 2005), CINAHL, PsycINFO, Google Scholar, and the Aboriginal Health Collection at the University of Manitoba were searched. Studies were selected based on their focus on both general cross-cultural caregiving and, in particular, end-of-life decision making and treatment. Only 39 relevant articles were found, half of which were opinion pieces by experienced nonaboriginal professionals; 14 were qualitative research projects from nursing and anthropologic perspectives. MAIN MESSAGE All patients are unique. Some cultural differences might arise when providing palliative care to aboriginal patients, who value individual respect along with family and community. Involvement of family and community members in decision making around end-of-life issues is common. Aboriginal cultures often have different approaches to telling bad news and maintaining hope for patients. Use of interpreters and various communication styles add to the challenge. CONCLUSION Cultural differences exist between medical caregivers and aboriginal patients. These include different assumptions and expectations about how communication should occur, who should be involved, and the pace of decision making. Aboriginal patients might value indirect communication, use of silence, and sharing information and decision making with family and community members. PMID:17872874

  18. End-of-Life Decisions and Advanced Old Age

    Directory of Open Access Journals (Sweden)

    Stoyles

    2014-07-01

    Full Text Available Despite the fact that most people die in advanced old age, little attention is given to cases involving older people in debates about the moral and legal dimensions of end-of-life decision making. The purpose of this paper is to establish some of the ways our discussions should change as we pay attention to important factors influencing end-of-life decisions for people in advanced old age. Focusing on the prevalence of comorbidities and the likelihood that people in advanced old age will experience an extended period of declining function before death, I argue that our debates should be expanded to include greater consideration of how we want to live in the final stages of life. With this, I am arguing against the tendency to think that “end-of-life” decision making concerns only making decisions about when and how it is appropriate to terminate a person’s life. I argue, further, that we should move away from the medicalization of dying.

  19. Preferences for autonomy in end-of-life decision making in modern Korean society.

    Science.gov (United States)

    Kim, Su Hyun

    2015-03-01

    The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not. The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people. This study was a cross-sectional correlational study using a survey. Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses. The study was approved by the hospitals' directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants. A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income. Results of this study suggested the necessity for development of alternatives to a dominant traditional "family-centered" approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process. Healthcare providers need to examine not only patients' preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden. © The Author(s) 2014.

  20. Parent's Perspectives on the End-of-life Care of their Child with Cancer: Indian Perspective.

    Science.gov (United States)

    Latha, Sneha Magatha; Scott, Julius Xavier; Kumar, Satish; Kumar, Suresh M; Subramanian, Lalitha; Rajendran, Aruna

    2016-01-01

    Parents report that end-of-life decisions are the most difficult treatment-related decisions that they face during their child cancer experience. Research from the parent's perspective of the quality of end-of-life care of their cancer children is scarce, particularly in developing countries like India. This study aimed to identify the symptoms (medical/social/emotional) that most concerned parents at the end-of-life care of their cancer child and to identify the strategies parents found to be helpful during this period. We wanted to conduct this to focus on the parents perspectives on their cancer child's end-of-life care and to address the issues that could contribute to the comfort of the families witnessing their child's suffering. The study was conducted at Sri Ramachandra University, Chennai, a Tertiary Care Pediatric Hemato Oncology Unit. Parents who lost their child to cancer, treated in our institution were interviewed with a validated prepared questionnaire. Statistical analysis was performed using SAS statistical software package. Toward death, dullness (30%), irritability (30%), and withdrawn from surroundings (10%) were the most common symptoms encountered. About 30% of the children had fear to be alone. About 50% of the children had the fear of death. Pain, fatigue, loss of appetite were the main distressful symptoms that these children suffered from parents' perspective. Though the parents accepted that the child was treated for these symptoms, the symptom relief was seldom successful. The conclusion of the study was that at the end of their child's life, parents value obtaining adequate information and communication, being physically present with the child, preferred adequate pain management, social support, and empathic relationships by the health staff members.

  1. [End of life care difficulties in intensive care units. The nurses' perspective].

    Science.gov (United States)

    Velarde-García, Juan Francisco; Luengo-González, Raquel; González-Hervías, Raquel; González-Cervantes, Sergio; Álvarez-Embarba, Beatriz; Palacios-Ceña, Domingo

    To describe the difficulties perceived by nursing staff in the delivery of end-of-life care to critically ill patients within intensive care units (ICU). A descriptive phenomenological qualitative study was performed. A purposeful and snowball sampling of nursing staff with at least 1 year's previous experience working in an ICU was conducted. Twenty-two participants were enrolled. Data collection strategies included in-depth unstructured and semi-structured interviews and researcher's field notes. Data were analysed using the Giorgi proposal. Three themes were identified: academic-cultural barriers, related to the care orientation of the ICU and lack of training in end of life care; architectural-structural barriers, related to the lack of space and privacy for the patient and family in the last moments of life; and psycho-emotional barriers, related to the use of emotional detachment as a strategy applied by nursing staff. Nursing staff need proper training on end-of-life care through the use of guidelines or protocols and the development of coping strategies, in addition to a change in the organisation of the ICU dedicated to the terminal care of critically ill patients and family support. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Network modeling for reverse flows of end-of-life vehicles.

    Science.gov (United States)

    Ene, Seval; Öztürk, Nursel

    2015-04-01

    Product recovery operations are of critical importance for the automotive industry in complying with environmental regulations concerning end-of-life products management. Manufacturers must take responsibility for their products over the entire life cycle. In this context, there is a need for network design methods for effectively managing recovery operations and waste. The purpose of this study is to develop a mathematical programming model for managing reverse flows in end-of-life vehicles' recovery network. A reverse flow is the collection of used products from consumers and the transportation of these products for the purpose of recycling, reuse or disposal. The proposed model includes all operations in a product recovery and waste management network for used vehicles and reuse for vehicle parts such as collection, disassembly, refurbishing, processing (shredding), recycling, disposal and reuse of vehicle parts. The scope of the network model is to determine the numbers and locations of facilities in the network and the material flows between these facilities. The results show the performance of the model and its applicability for use in the planning of recovery operations in the automotive industry. The main objective of recovery and waste management is to maximize revenue and minimize pollution in end-of-life product operations. This study shows that with an accurate model, these activities may provide economic benefits and incentives in addition to protecting the environment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Using sieving and pretreatment to separate plastics during end-of-life vehicle recycling.

    Science.gov (United States)

    Stagner, Jacqueline A; Sagan, Barsha; Tam, Edwin Kl

    2013-09-01

    Plastics continue to be a challenge for recovering materials at the end-of-life for vehicles. However, it may be possible to improve the recovery of plastics by exploiting material characteristics, such as shape, or by altering their behavior, such as through temperature changes, in relation to recovery processes and handling. Samples of a 2009 Dodge Challenger front fascia were shredded in a laboratory-scale hammer mill shredder. A 2 × 2 factorial design study was performed to determine the effect of sample shape (flat versus curved) and sample temperature (room temperature versus cryogenic temperature) on the size of the particles exiting from the shredder. It was determined that sample shape does not affect the particle size; however, sample temperature does affect the particle size. At cryogenic temperatures, the distribution of particle sizes is much narrower than at room temperature. Having a more uniform particle size could make recovery of plastic particles, such as these more efficient during the recycling of end-of-life vehicles. Samples of Chrysler minivan headlights were also shredded at room temperature and at cryogenic temperatures. The size of the particles of the two different plastics in the headlights is statistically different both at room temperature and at cryogenic temperature, and the particles are distributed narrowly. The research suggests that incremental changes in end-of-life vehicle processing could be effective in aiding materials recovery.

  4. End-of-life care in nursing and care homes.

    Science.gov (United States)

    Percival, John; Johnson, Malcolm

    More than 70,000 people die each year in nursing and residential care homes, yet comparatively little attention has been paid to end-of-life care practice and its challenges in this setting. We conducted interviews and group discussions in 12 homes, involving 73 residents, 97 members of staff and 16 relatives. These revealed that personalised care, dignity and respect, making time, talking about death, relatives' roles, and staff support were priorities for all concerned. Training is vital in helping staff to engage sensitively, respectfully and creatively with dying residents. Staffing levels must be sufficient so staff can sit with residents and care in a way that is attuned to their personality, life history and wishes. relatives help to ensure a "civilised death".

  5. Examining End-of-Life Case Management: Systematic Review

    Directory of Open Access Journals (Sweden)

    Roger E. Thomas

    2014-01-01

    Full Text Available Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL case management identified 17 research articles, with content analysis revealing two themes: (a seeking to determine or establish the value of EOL case management and (b identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.

  6. End-of-life care: a philosophical or management problem?

    Science.gov (United States)

    Callahan, Daniel

    2011-01-01

    End-of-life care became an important issue in the late 1960s and early 1970s. It was in great part driven by complaints about the care of the dying: lack of patient autonomy, indifferent or insensitive physicians, and inadequate pain control. The main task of those who worked to improve the situation centered on changing each of those variables, assuming that would do the job. But it has worked to a moderate extent only and the problem is not fully solved. The main omission has been a failure to confront the medical enterprise itself, which believes in endless progress and conducts a war against death. Only a change in those underlying values can bring about further significant change. © 2011 American Society of Law, Medicine & Ethics, Inc.

  7. Working with children in end-of-life decision making.

    Science.gov (United States)

    Whitty-Rogers, Joanne; Alex, Marion; MacDonald, Cathy; Pierrynowski Gallant, Donna; Austin, Wendy

    2009-11-01

    Traditionally, physicians and parents made decisions about children's health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children - of diverse levels of cognitive development - are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children's 'best interest'. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.

  8. Accepting transitions: African Americans discuss end of life.

    Science.gov (United States)

    Yancu, Cecile N; Farmer, Deborah F; Graves, Mara J; Rhinehardt, April; Leahman, Dee

    2015-06-01

    African Americans typically underuse hospice care; this study explores their end of life attitudes. An iterative focus group strategy generated qualitative data using 4 baseline groups and 1 confirmatory focus group recruited from predominantly African American churches. Each group consisted of 8 to 14 adults. Investigators analyzed data for dominant themes, representatives from baseline groups returned to discuss the results. A total of 43 African Americans (male: 8 [18.6]; female: 35 [81.4]) participated in initial discussions, with 10 returning for follow-up. The prevailing theme was transitions; with life to death dominating discourse; other themes included curative to palliative care and acceptance of death as inevitable. Among African Americans, outreach efforts may be strengthened by reframing the dying process as the product of many transitions and reaching out to faith-based communities. © The Author(s) 2014.

  9. Narrative Medicine and Contemplative Care at the End of Life.

    Science.gov (United States)

    Lewis, Bradley

    2016-02-01

    Two important movements leading the way toward a new approach to healthcare are narrative medicine and contemplative care. Despite considerable common ground between these two movements, they have existed largely parallel to each other, with different literatures, different histories, different sub-communities, and different practitioners. This article works toward integration of narrative medicine and contemplative care through a philosophical exploration of key similarities and differences between them. I start with an overview of their similar diagnosis of healthcare's problems and then consider their related, but different, responses to these problems. Finally, I use the example of Margaret Edson's Pulitzer Prize winning drama W;t to highlight how these issues can play out at the end of life.

  10. International Space Station End-of-Life Probabilistic Risk Assessment

    Science.gov (United States)

    Duncan, Gary W.

    2014-01-01

    The International Space Station (ISS) end-of-life (EOL) cycle is currently scheduled for 2020, although there are ongoing efforts to extend ISS life cycle through 2028. The EOL for the ISS will require deorbiting the ISS. This will be the largest manmade object ever to be de-orbited therefore safely deorbiting the station will be a very complex problem. This process is being planned by NASA and its international partners. Numerous factors will need to be considered to accomplish this such as target corridors, orbits, altitude, drag, maneuvering capabilities etc. The ISS EOL Probabilistic Risk Assessment (PRA) will play a part in this process by estimating the reliability of the hardware supplying the maneuvering capabilities. The PRA will model the probability of failure of the systems supplying and controlling the thrust needed to aid in the de-orbit maneuvering.

  11. Ethical Dilemmas at the End of Life: Islamic Perspective.

    Science.gov (United States)

    Chamsi-Pasha, Hassan; Albar, Mohammed Ali

    2017-04-01

    Many Muslim patients and families are often reluctant to accept fatal diagnoses and prognoses. Not infrequently, aggressive therapy is sought by the patient or his/her family, to prolong the life of the patient at all costs. A series of searches were conducted of Medline databases published in English between January 2000 and January 2015 with the following Keywords: End-of-life, Ethics and Islam. Islamic law permits the withdrawal of futile treatment, including all kinds of life support, from terminally ill patients leaving death to take its natural course. However, such decision should only take place when the physicians are confident that death is inevitable. All interventions ensuring patient's comfort and dignity should be maintained. This topic is quite challenging for the health care providers of Muslim patients in the Western World.

  12. Occupational Variation in End-of-Life Care Intensity.

    Science.gov (United States)

    Hyder, Joseph A; Haring, R Sterling; Sturgeon, Daniel; Gazarian, Priscilla K; Jiang, Wei; Cooper, Zara; Lipsitz, Stuart R; Prigerson, Holly G; Weissman, Joel S

    2018-03-01

    End-of-life (EOL) care intensity is known to vary by secular and geographic patterns. US physicians receive less aggressive EOL care than the general population, presumably the result of preferences shaped by work-place experience with EOL care. We investigated occupation as a source of variation in EOL care intensity. Across 4 states, we identified 660 599, nonhealth maintenance organization Medicare beneficiaries aged ≥66 years who died between 2004 and 2011. Linking death certificates, we identified beneficiaries with prespecified occupations: nurses, farmers, clergy, mortuary workers, homemakers, first-responders, veterinary workers, teachers, accountants, and the general population. End-of-life care intensity over the last 6 months of life was assessed using 5 validated measures: (1) Medicare expenditures, rates of (2) hospice, (3) surgery, (4) intensive care, and (5) in-hospital death. Occupation was a source of large variation in EOL care intensity across all measures, before and after adjustment for sex, education, age-adjusted Charlson Comorbidity Index, race/ethnicity, and hospital referral region. For example, absolute and relative adjusted differences in expenditures were US$9991 and 42% of population mean expenditure ( P care intensity measures, teachers (5 of 5), homemakers (4 of 5), farmers (4 of 5), and clergy (3 of 5) demonstrated significantly less aggressive care. Mortuary workers had lower EOL care intensity (4 of 5) but small numbers limited statistical significance. Occupations with likely exposure to child development, death/bereavement, and naturalistic influences demonstrated lower EOL care intensity. These findings may inform patients and clinicians navigating choices around individual EOL care preferences.

  13. Important aspects of end-of-life care among veterans: implications for measurement and quality improvement.

    Science.gov (United States)

    Casarett, David; Pickard, Amy; Amos Bailey, F; Ritchie, Christine; Furman, Christian; Rosenfeld, Ken; Shreve, Scott; Shea, Judy A

    2008-02-01

    existing survey instruments. VA efforts to evaluate end-of-life care for veterans should not only measure common aspects of care (e.g., pain management), but also examine performance in areas that are more specific to the veteran population.

  14. Influence of physicians' life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries

    NARCIS (Netherlands)

    Cohen, J.; van Delden, J.; Mortier, F.; Lofmark, R.; Norup, M.; Cartwright, C.; Faisst, K.; Canova, C.; Onwuteaka-Philipsen, B.; Bilsen, J.

    2008-01-01

    Aim: To examine how physicians' life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making. Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and

  15. ["Dignity" at the end of life: ethical and deontologic reflections].

    Science.gov (United States)

    Mazzon, Davide

    2015-12-01

    Bioethical reflection is often raised to qualify medical treatment in relation to the concept of "dignity" of the human being. In philosophy, the concept of human dignity is used to refer to the intrinsic value of every human being but it has been framed in many different ways depending on the theoretical matrix we refer to. According to Christian principles, the dignity of human beings resides on their being created in the image and likeness of God: hence, the holiness of life for the believer and the condemnation of all means of action intended to anticipate death from suicide to euthanasia. On the contrary, according to the liberal tradition, human dignity is especially expressed in the autonomy of every human being. The Italian and the German Constitutions recall the value of human dignity. In the article 32 of the Italian Constitution, the concept of dignity is taken into account when stating the autonomy of the individual decision-making about health treatment. This is confirmed by the Code of Medical Ethics (2014): the right to self-determination and the right of patients to decide for themselves in accordance with their own life plans, are at the core of the concept of "human dignity". For this reason, doctors should support and encourage the full right of every patient to be considered as an autonomous person until the end of life, affirming his dignity. The acronym ABCD (airway, breathing, circulation, drugs) synthetises the essentials of intensive care procedures in life-threatening events. The same acronym should guide our behavior in promoting dignity in clinical settings. Attitude: moving away from our certainties, to better understand the real nature of the sick person we are approaching. Behavior: always be inspired by kindness and respect. Compassion, that is, deep awareness of the suffering, coupled with the desire to bring relief. Dialogue, being open to know the human being "behind" disease. This approach, developed by Chochinov and called

  16. Quality Indicators of End-of-Life Care in Patients With Cancer: What Rate Is Right?

    Science.gov (United States)

    Barbera, Lisa; Seow, Hsien; Sutradhar, Rinku; Chu, Anna; Burge, Fred; Fassbender, Konrad; McGrail, Kim; Lawson, Beverley; Liu, Ying; Pataky, Reka; Potapov, Alex

    2015-05-01

    To develop data-driven and achievable benchmark rates for end-of-life quality indicators using administrative data from four provinces in Canada. Indicators of end-of-life care were defined and measured using linked administrative data for 33 health regions across British Columbia, Alberta, Ontario, and Nova Scotia. These were emergency department use, intensive care unit admission, physician house calls and home care visits before death, and death in hospital. An empiric benchmark was defined using indicator rates from the top-ranked regions to include the top decile of patients overall. Funnel plots were used to graph each region's age- and sex-adjusted indicator rates along with the overall rate and 95% confidence limits. Rates varied approximately two- to four-fold across the regions, with physician house calls showing the greatest variation. Benchmark rates based on the top decile performers were emergency department use, 34%; intensive care unit admission, 2%; physician house calls, 34%; home care visits, 63%; and death in hospital, 38%. With the exception of intensive care unit admission, funnel plots demonstrated that overall indicator rates and their confidence limits were uniformly worse than benchmarks even after adjusting for age and sex. Few regions met the benchmark rates. There is significant variation in end-of-life quality indicators across regions in four provinces in Canada. Using this study's methods-deriving empiric benchmarks and funnel plots-regions can determine their relative performance with greater context that facilitates priority setting and resource deployment. Applying this study's methods can support quality improvement by decreasing variation and striving for a target. Copyright © 2015 by American Society of Clinical Oncology.

  17. End-of-life planning in a rural elderly cohort.

    Science.gov (United States)

    Ashcraft, Alyce S; Owen, Donna C

    2016-01-01

    Relationships between end-of-life (EOL) planning and demographic and health related variables for individuals living in three rural West Texas counties were examined using a prospective cohort study design. Project FRONTIER, a longitudinal community-based participatory research project, served as the database for this study. Abstracted data from 692 older adults focused on demographic variables, medical conditions, and EOL planning. EOL planning activities included completing a will (39%), a durable power of attorney (32%), advanced directives (14%), talking with family about EOL wishes (31%), and designating a decision maker (55%). The mean EOL Planning Index was 1.6 (SD = 2.58) with higher numbers indicating greater level of planning. Regression findings supported significantly higher levels of EOL planning influenced by age, education, non-Hispanic ethnicity, chronic disease, depression, and communication with family about nursing home placement. Aging rural adults and their healthcare providers would benefit from learning more about EOL planning. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. End of life care in hematology: still a challenging concern.

    Science.gov (United States)

    Niscola, Pasquale; Tendas, Andrea; Scaramucci, Laura; Giovannini, Marco

    2014-01-01

    The majority of patients with hematological malignancies (HM) may experience troublesome symptoms and complicating clinical syndromes throughout all phases of disease. Therefore, among the current concepts concerning the comprehensive management of hematological patients, palliative care should exert a more ever expanding role, in particular in the advanced phases of disease, as there are special clinical needs (such as blood transfusions and anti-infective treatments), presented by this peculiar category of cancer patients. However, reported experiences on advanced HM patients claimed a too intensive level of medical care during the last week of life for which the needs of future and collaborative researches in order to set a proper allocation of medical resources and the optimal end-of-life care in the hematologic setting are highly awaited. Indeed, the most important aspect of caring for these suffering patients is to ameliorate or restore their quality of life (QoL) though a highly humanized approach, whereas technological and pharmacological measures should be limited enough to control the symptoms burden and the several kinds of sufferance that may complicate the final phase of disease course.

  19. Spirituality and uncertainty at the end of life.

    Science.gov (United States)

    Stephenson, Pam Shockey; Berry, Devon M

    2014-01-01

    To examine the theoretical congruency between uncertainty and spirituality at the end of life (EOL). Relevant empirical and theoretical articles using the key words spirituality, uncertainty, terminal illness, and similar derivatives were drawn from the databases of CINAHL®, MEDLINE®, PsycINFO, and SocINDEX. Spirituality and uncertainty were compared for theoretical congruency based on five general categories: prevalence, temporality, interpretation, quality, and directionality. The categories were drawn from the uncertainty literature and looked at the ability of spirituality and uncertainty to contribute to or detract from health. This article presents an innovative way of viewing how spirituality is experienced at the EOL. The likelihood that uncertainty and spirituality can coexist as a simultaneous and even blended construct that influences the EOL is supported and warrants additional exploration. Health professionals must recognize the prevalence of spiritual uncertainty in the lives of their patients and understand the need to frequently assess for spiritual uncertainty. Specific recommendations are provided to guide professionals in addressing spiritual uncertainty with patients.

  20. End-of-life care at a community cancer center.

    Science.gov (United States)

    Cowall, David E; Yu, Bennett W; Heineken, Sandra L; Lewis, Elizabeth N; Chaudhry, Vishal; Daugherty, Joan M

    2012-07-01

    The evidence-based use of resources for cancer care at end of life (EOL) has the potential to relieve suffering, reduce health care costs, and extend life. Internal benchmarks need to be established within communities to achieve these goals. The purpose for this study was to evaluate data within our community to determine our EOL cancer practices. A random sample of 390 patients was obtained from the 942 cancer deaths in Wicomico County, Maryland, for calendar years 2004 to 2008. General demographic, clinical event, and survival data were obtained from that sample using cancer registry and hospice databases as well as manual medical record reviews. In addition, the intensity of EOL cancer care was assessed using previously proposed indicator benchmarks. The significance of potential relationships between variables was explored using χ(2) analyses. Mean age at death was 70 years; 52% of patients were male; 34% died as a result of lung cancer. Median survival from diagnosis to death was 8.4 months with hospice admission and 5.8 months without hospice (P = .11). Four of eight intensity-of-care indicators (ie, intensive care unit [ICU] admission within last month of life, > one hospitalization within last month of life, hospital death, and hospice referral < 3 days before death) all significantly exceeded the referenced benchmarks. Hospice versus nonhospice admissions were associated (P < .001) with ICU admissions (2% v 13%) and hospital deaths (2% v 54%). These data suggest opportunities to improve community cancer center EOL care.

  1. Hospital end-of-life care in haematological malignancies.

    Science.gov (United States)

    Beaussant, Yvan; Daguindau, Etienne; Chauchet, Adrien; Rochigneux, Philippe; Tournigand, Christophe; Aubry, Régis; Morin, Lucas

    2018-02-06

    To investigate patterns of care during the last months of life of hospitalised patients who died from different haematological malignancies. Nationwide register-based study, including all hospitalised adults ≥20 years who died from haematological malignancies in France in 2010-2013. Outcomes included use of invasive cancer treatments and referral to palliative care. Percentages are adjusted for sex and age using direct standardisation. Of 46 629 inpatients who died with haematological malignancies, 24.5% received chemotherapy during the last month before death, 48.5% received blood transfusion, 12.3% were under invasive ventilation and 18.1% died in intensive care units. We found important variations between haematological malignancies. The use of chemotherapy during the last month of life varied from 8.6% among patients with chronic myeloid leukaemia up to 30.1% among those with non-Hodgkin's lymphoma (Pcare units. A high proportion of patients who died from haematological malignancies receive specific treatments near the end of life. There is a need for a better and earlier integration of the palliative care approach in the standard practice of haematology. However, substantial variation according to the type of haematological malignancy suggests that the patients should not be considered as one homogeneous group. Implementation of palliative care should account for differences across haematological malignancies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. [Advance directives for end-of-life care].

    Science.gov (United States)

    Golan, Ofra G

    2009-04-01

    The provision of care for the dying patient confronts the caring team with very complex ethical dilemmas that doctors have no "medical" means to manage. Such decisions should be made according to the patient's will and preferences reflecting the value of life and the quality of life. However, many patients are not competent at this stage to decide or to express their wishes. Therefore, the Dying Patient Law of 2005, recognized advance expression of will through advance directives and power of attorney. Yet, there are many difficulties in the actual application of this idea. Dr. Shalev's article in this issue, to which this editorial relates, discusses the problems of communication between doctor and patient at the stage of preparing advance directives, and suggests a way to handle these deliberations. The Israeli law of 2005 provides some original solutions to other obstacles presented in the Literature as causing "the failure of the Living will". One resolution is the requirement that an explanation of the relevant medical information be given by a doctor or a nurse to the person who wishes to prepare written advance directives. This article suggests that the required explanation should be given within the framework of a discussion that simulates a process of informed consent for an unknown scenario at the end-of-life. Such discussions should be conducted as a dialogue, in which the doctor, first and foremost, Listens to the patient in order to clarify his/her worries and wishes, according to which specific medical orders can then be formulated.

  3. End of life issues in the intensive care units.

    Science.gov (United States)

    Datta, Rashmi; Chaturvedi, R; Rudra, A; Jaideep, C N

    2013-01-01

    A structured discussion of End-of-Life (EOL) issues is a relatively new phenomenon in India. Personal beliefs, cultural and religious influences, peer, family and societal pressures affect EOL decisions. Indian law does not provide sanction to contentious issues such as do-not-resuscitate (DNR) orders, living wills, and euthanasia. Finally, published data on EOL decisions in Indian ICUs is lacking. What is needed is a prospective determination of which patients will benefit from aggressive management and life-support. A consensus regarding the concept of Medical Futility is necessary to give impetus to further discussion on more advanced policies including ideas such as Managed Care to restrict unnecessary health care costs, euthanasia, the principle of withhold and/or withdraw, ethical and moral guidelines that would govern decisions regarding futile treatment, informed consent to EOL decisions and do-not-resuscitate orders. This review examines the above concepts as practiced worldwide and looks at some landmark judgments that have shaped current Indian policy, as well as raising talking points for possible legislative intervention in the field.

  4. Family involvement in end-of-life hospital care.

    Science.gov (United States)

    Tschann, Jeanne M; Kaufman, Sharon R; Micco, Guy P

    2003-06-01

    To examine whether the end-of-life treatment provided to hospitalized patients differed for those who had a family member present at death and those who did not. A retrospective cohort analysis. An urban community hospital. All 370 inpatients who died during a 1-year period. Medical records were examined for whether life-support treatments were provided or withdrawn, occurrence and timing of do-not-resuscitate (DNR) orders, and use of comfort measures such as narcotics and sedation. DNR orders were written for 85% of patients. For patients who had a DNR order written, the average time from the DNR order to death was 4.8 days. Only 26% of patients had one or more treatments withdrawn. Sixty-seven percent of patients received narcotics before death, and 22% received sedatives. Patients aged 75 and older and African Americans were less likely to have a family member present at death. After adjusting for age and ethnicity, patients who had a family member present at death were more likely to have DNR orders written, to have treatments withdrawn, and to receive narcotics before death. Patients with a family member present at death also had a shorter time to death after DNR orders were written. The presence of a family member at death appears to be an indirect measure of family involvement during patients' hospitalization. Family involvement before death may reduce the use of technology and increase the use of comfort care as patients die.

  5. 2016 AAHA/IAAHPC End-of-Life Care Guidelines.

    Science.gov (United States)

    Bishop, Gail; Cooney, Kathleen; Cox, Shea; Downing, Robin; Mitchener, Kathy; Shanan, Amir; Soares, Nancy; Stevens, Brenda; Wynn, Tammy

    End-of-life (EOL) care and decisionmaking embody the critical final stage in a pet's life and are as important and meaningful as the sum of the clinical care provided for all prior life stages. EOL care should focus on maximizing patient comfort and minimizing suffering while providing a collaborative and supportive partnership with the caregiver client. Timely, empathetic, and nonjudgmental communication is the hallmark of effective client support. Veterinarians should not allow an EOL patient to succumb to a natural death without considering the option of euthanasia and ensuring that other measures to alleviate discomfort and distress are in place. Animal hospice care addresses the patient's unique emotional and social needs as well as the physical needs traditionally treated in clinical practice. An EOL treatment plan should consist of client education; evaluating the caregiver's needs and goals for the pet; and a collaborative, personalized, written treatment plan involving the clinical staff and client. Primary care practices should have a dedicated team to implement palliative and hospice care for EOL patients. How the healthcare team responds to a client's grief after the loss of a pet can be a key factor in the client's continued loyalty to the practice. Referral to professional grief-support counseling can be a helpful option in this regard.

  6. Team-Based Models for End-of-Life Care: An Evidence-Based Analysis.

    Science.gov (United States)

    2014-01-01

    End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. Our objective was to determine whether an optimal team-based model of care exists for service delivery at end of life. In systematically reviewing such models, we considered their core components: team membership, services offered, modes of patient contact, and setting. A literature search was performed on October 14, 2013, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to October 14, 2013. Abstracts were reviewed by a single reviewer and full-text articles were obtained that met the inclusion criteria. Studies were included if they evaluated a team model of care compared with usual care in an end-of-life adult population. A team was defined as having at least 2 health care disciplines represented. Studies were limited to English publications. A meta-analysis was completed to obtain pooled effect estimates where data permitted. The GRADE quality of the evidence was evaluated. Our literature search located 10 randomized controlled trials which, among them, evaluated the following 6 team-based models of care: •hospital, direct contact •home, direct contact •home, indirect contact •comprehensive, indirect contact •comprehensive, direct contact •comprehensive, direct, and early contact Direct contact is when team members see the patient; indirect contact is when they advise another health care practitioner (e.g., a family doctor) who sees the patient. A "comprehensive" model is

  7. End-of-life care in two Norwegian nursing homes: family perceptions.

    Science.gov (United States)

    Kaarbø, Elsa

    2011-04-01

    The aim of this article is to report a study exploring experiences of relatives who have been present immediately prior to and after the death (in the last 72 hours) of a next-of-kin in a nursing home. The purpose of the study was to acquire research-based knowledge to improve practice. Globally, a growing number of older people, often with increased morbidity and complexity of conditions, require specialised nursing care, particularly at the end of life. Several international studies describe end-of-life care in nursing homes as insufficient, mainly owing to shortage of qualified staff and other essential resources. There are few studies in this field in Norway; none of them focus on the final days and hours of a patient's life from the perspective of their relatives. A mixed methods design was used. Data were collected through structured interviews with 50 relatives during Spring 2006 and analysed by SPSS version 14 and theme-based analysis. With a few exceptions, the quality of nursing care was considered professional and good. Care was described as supportive, individualised and based on patients' needs - in a safe atmosphere and supported by good relations between patients and nursing staff. Information and communication between staff and relatives, however, were described as unsystematic and casual. That some patients died alone became a source of distress for their relatives. Information and communication between staff and relatives need to be improved. There is need for change to avoid the situation where patients die in solitude. End-of-life care is performed at a time when patients and their relatives are at their most vulnerable. Nurses and other health workers need information, as this study suggests, to provide high-quality care to ease this situation. © 2010 Blackwell Publishing Ltd.

  8. Doctors' learning experiences in end-of-life care - a focus group study from nursing homes.

    Science.gov (United States)

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti; Schaufel, Margrethe Aase

    2017-01-31

    Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life care. The aim of this study was to explore newly qualified doctors' learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. House officers in nursing homes (n = 16) participated in three focus group interviews. Interviews were audiotaped and transcribed verbatim. Data were analysed with systematic text condensation. Lave & Wenger's theory about situated learning was used to support interpretations, focusing on how the newly qualified doctors gained knowledge of end-of-life care through participation in the nursing home's community of practice. Newly qualified doctors explained how nursing home staff's attitudes taught them how calmness and acceptance could be more appropriate than heroic action when death was imminent. Shifting focus from disease treatment to symptom relief was demanding, yet participants comprehended situations where death could even be welcomed. Through challenging dialogues dealing with family members' hope and trust, they learnt how to adjust words and decisions according to family and patient's life story. Interdisciplinary role models helped them balance uncertainty and competence in the intermediate position of being in charge while also needing surveillance. There is a considerable potential for training doctors in EOL care in nursing homes, which can be developed and integrated in medical education. This practice based learning arena offers newly qualified doctors close interaction with patients, relatives and nurses, teaching them to perform difficult dialogues, individualize medical decisions and balance their professional role in an interdisciplinary setting.

  9. Mental competence and surrogate decision-making towards the end of life.

    Science.gov (United States)

    Strätling, M; Scharf, V E; Schmucker, P

    2004-01-01

    German legislation demands that decisions about the treatment of mentally incompetent patients require an 'informed consent'. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person under his/her care. This includes 'end-of-life decisions'. Deviations from this procedure are only allowed in acute emergencies or cases of 'medical futility'. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical 'end of life-decisions' and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like the assessment of mental competence, the options for exercising patient self-determination via advance directives and durable powers of attorney, the improvement of palliative care facilities, the clarification of formal procedures for surrogate decision-making in health care and towards the end of life and the possibilities and their limitations of controlling these decision-making processes 'externally' (e.g., by Guardianship Courts or committees). The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction

  10. The effects of advance care planning on end-of-life care: a systematic review.

    Science.gov (United States)

    Brinkman-Stoppelenburg, Arianne; Rietjens, Judith A C; van der Heide, Agnes

    2014-09-01

    Advance care planning is the process of discussing and recording patient preferences concerning goals of care for patients who may lose capacity or communication ability in the future. Advance care planning could potentially improve end-of-life care, but the methods/tools used are varied and of uncertain benefit. Outcome measures used in existing studies are highly variable. To present an overview of studies on the effects of advance care planning and gain insight in the effectiveness of different types of advance care planning. Systematic review. We systematically searched PubMed, EMBASE and PsycINFO databases for experimental and observational studies on the effects of advance care planning published in 2000-2012. The search yielded 3571 papers, of which 113 were relevant for this review. For each study, the level of evidence was graded. Most studies were observational (95%), originated from the United States (81%) and were performed in hospitals (49%) or nursing homes (32%). Do-not-resuscitate orders (39%) and written advance directives (34%) were most often studied. Advance care planning was often found to decrease life-sustaining treatment, increase use of hospice and palliative care and prevent hospitalisation. Complex advance care planning interventions seem to increase compliance with patients' end-of-life wishes. The effects of different types of advance care planning have been studied in various settings and populations using different outcome measures. There is evidence that advance care planning positively impacts the quality of end-of-life care. Complex advance care planning interventions may be more effective in meeting patients' preferences than written documents alone. More studies are needed with an experimental design, in different settings, including the community. © The Author(s) 2014.

  11. End-of-life costs of medical care for advanced stage cancer patients

    Directory of Open Access Journals (Sweden)

    Kovačević Aleksandra

    2015-01-01

    Full Text Available Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care, hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25% had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR and the lowest (4.00 EUR ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs, followed by oncology medical care (21%, radiation therapy and interventional radiology (11%, surgery (9%, imaging diagnostics (9% and laboratory costs (8%. Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients’ quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency. [Projekat Ministarstva nauke

  12. Influence of physicians' life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries

    DEFF Research Database (Denmark)

    Cohen, J; van Delden, J; Mortier, F

    2008-01-01

    AIM: To examine how physicians' life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making. METHODS: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland......) and Protestants (up to 20.4% in The Netherlands) reported ever having made such a decision. DISCUSSION: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients...

  13. Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium

    Directory of Open Access Journals (Sweden)

    Bossuyt Nathalie

    2009-03-01

    Full Text Available Abstract Background This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002. Methods We performed a mortality follow-back study in 2005–2006. Data were collected via the nationwide Sentinel Network of General Practitioners, an epidemiological surveillance system representative of all Belgian GPs. Weekly, all GPs reported the medical end-of-life decisions among all non-sudden deaths of patients in their practice. We compared the northern Dutch-speaking (60% and southern French-speaking communities (40% controlling for population differences. Results We analysed 1690 non-sudden deaths. An end-of-life decision with possible life-shortening effect was made in 50% of patients in the Dutch-speaking community and 41% of patients in the French-speaking community (OR 1.4; 95%CI, 1.2 to 1.8. Continuous deep sedation until death occurred in 8% and 15% respectively (OR 0.5; 95%CI, 0.4 to 0.7. Community differences regarding the prevalence of euthanasia or physician-assisted suicide were not significant. Community differences were more present among home/care home than among hospital deaths: non-treatment decisions with explicit life-shortening intention were made more often in the Dutch-speaking than in the French-speaking community settings (OR 2.2; 95%CI, 1.2 to 3.9; while continuous deep sedation occurred less often in the Dutch-speaking community settings (OR 0.5; 95%CI, 0.3 to 0.9. Conclusion Even though legal and general healthcare systems are the same for the whole country, there are considerable variations between the communities in type and prevalence of certain end-of-life decisions, even after controlling for population differences.

  14. End-of-life communication in the intensive care unit.

    Science.gov (United States)

    Levin, Tomer T; Moreno, Beatriz; Silvester, William; Kissane, David W

    2010-01-01

    Because one in five Americans die in the intensive care unit (ICU), the potential role of palliative care is considerable. End-of-life (EOL) communication is essential for the implementation of ICU palliative care. The objective of this review was to summarize current research and recommendations for ICU EOL communication. For this qualitative, critical review, we searched PubMed, Embase, Cochrane, Ovid Medline, Cinahl and Psychinfo databases for ICU EOL communication clinical trials, systematic reviews, consensus statements and expert opinions. We also hand searched pertinent bibliographies and cross-referenced known EOL ICU communication researchers. Family-centered communication is a key component of implementing EOL ICU palliative care. The main forum for this is the family meeting, which is an essential platform for implementing shared decision making, e.g., transitioning from curative to EOL palliative goals of care. Better communication can improve patient outcomes such as reducing psychological trauma symptoms, depression and anxiety; shortening ICU length of stay; and improving the quality of death and dying. Communication strategies for EOL discussions focus on addressing family emotions empathically and discussing death and dying in an open and meaningful way. Central to this is viewing ICU EOL palliative care and withdrawal of life-extending treatment as predictable and not an unexpected emergency. Because the ICU is now a well-established site for death, ICU physicians should be trained with EOL communication skills so as to facilitate palliative care more hospitably in this challenging setting. Patient/family outcomes are important ways of measuring the quality of ICU palliative care and EOL communication. Copyright 2010 Elsevier Inc. All rights reserved.

  15. End of life in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Helena Moura

    2011-01-01

    Full Text Available PURPOSE: Death at the beginning of life is tragic but not uncommon in neonatal intensive care units. In Portugal, few studies have examined the circumstances surrounding the final moments of neonates. We evaluated the care given to neonates and their families in terminal situations and the changes that had occurred one decade later. DESIGN AND METHODS: We analyzed 256 charts in a retrospective chart review of neonatal deaths between two periods (1992-1995 and 2002-2005 in a level III neonatal intensive care unit. RESULTS: Our results show differences in the care of dying infants between the two periods. The analysis of the 2002-2005 cohort four years revealed more withholding and withdrawing of therapeutic activities and more effective pain and distress relief; however, on the final day of life, 95.7% of the infants received invasive ventilatory support, 76.3% received antibiotics, 58.1% received inotropics, and 25.8% received no opioid or sedative administration. The 2002-2005 cohort had more spiritual advisor solicitation, a higher number of relatives with permission to freely visit and more clinical meetings with neonatologists. Interventions by parents, healthcare providers and ethics committees during decision-making were not documented in any of the charts. Only eight written orders regarding therapeutic limitations and the adoption of palliative care were documented; seven (87.5% were from the 2002-2005 cohort. Parental presence during death was more frequent in the latter four years (2002-2005 cohort, but only 21.5% of the parents wanted to be present at that moment. CONCLUSION: Despite an increase in the withholding and withdrawing of therapeutic activities and improvements in pain management and family support, many neonates still receive curative and aggressive practices at the end of life.

  16. Homeless Individuals Approaching the End of Life: Symptoms and Attitudes.

    Science.gov (United States)

    Tobey, Matthew; Manasson, Julia; Decarlo, Kristen; Ciraldo-Maryniuk, Katrina; Gaeta, Jessie M; Wilson, Erica

    2017-04-01

    Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL). This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences. Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer "no" to the question "Would you be surprised if this patient were not alive in one year?" Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies. Participants (n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders (n = 18; 90%) and psychiatric diagnoses (n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal (n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little (n = 11; 55%) or too much (n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups (P < 0.01 for each comparison). Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  17. Engaging homeless persons in end of life preparations.

    Science.gov (United States)

    Song, John; Wall, Melanie M; Ratner, Edward R; Bartels, Dianne M; Ulvestad, Nancy; Gelberg, Lillian

    2008-12-01

    There are no prospective studies that have investigated the effects of an intervention to improve end of life (EOL) care in an underserved population. To determine whether homeless persons will complete an advance directive (AD). Randomized trial comparing two modes of providing an opportunity for homeless persons to complete an AD. Half of the subjects were randomized to a self-guided group (SG) who were given an AD and written instructions; the other half were given the same material but, in addition, were offered the opportunity to receive guidance to complete the AD (CG). Fifty-nine homeless persons recruited from a drop-in center. Rate of AD completion and baseline and 3-month follow-up EOL-related knowledge, attitudes, and behaviors. The overall AD completion rate was 44%, with a statistically significant higher completion rate of 59% in the CG group compared to 30% in the self-guided only group. Frequency of worry about death decreased among those who filled out an AD from 50% to 12.5%, and also among those who did not (25% to 12.5%) (p < .05). Among those who filled out an AD, there were increases in plans to write down EOL wishes (56% to 100%; p < .05) and plans to talk about these wishes with someone (63% to 94%; p < .05). This study demonstrates that people living in dire economic and social situations will complete an AD when offered the opportunity. While offering guidance resulted in higher rates of completion; even a simple self-guided AD process can achieve completion of ADs in this population.

  18. Identifying acute coronary syndrome patients approaching end-of-life.

    Science.gov (United States)

    Fenning, Stephen; Woolcock, Rebecca; Haga, Kristin; Iqbal, Javaid; Fox, Keith A; Murray, Scott A; Denvir, Martin A

    2012-01-01

    Acute coronary syndrome (ACS) is common in patients approaching the end-of-life (EoL), but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF)) and the Global Registry of Acute Coronary Events (GRACE) score, to help identify patients approaching EoL. 172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23%) patients suitable for EoL care while GRACE identified 32 (19%) patients with ≥ 10% risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006), had more comorbidities (1.6 ± 0.7 vs. 1.2 ± 0.9, p = 0.007), more frequent hospitalisations before (p = 0.001) and after (0.0001) their index admission, and were more likely to die during follow-up (GSF+ 20% vs GSF- 7%, p = 0.03). GRACE score was predictive of 12-month mortality (C-statistic 0.75) and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88). This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission.

  19. Identifying acute coronary syndrome patients approaching end-of-life.

    Directory of Open Access Journals (Sweden)

    Stephen Fenning

    Full Text Available BACKGROUND: Acute coronary syndrome (ACS is common in patients approaching the end-of-life (EoL, but these patients rarely receive palliative care. We compared the utility of a palliative care prognostic tool (Gold Standards Framework (GSF and the Global Registry of Acute Coronary Events (GRACE score, to help identify patients approaching EoL. METHODS AND FINDINGS: 172 unselected consecutive patients with confirmed ACS admitted over an eight-week period were assessed using prognostic tools and followed up for 12 months. GSF criteria identified 40 (23% patients suitable for EoL care while GRACE identified 32 (19% patients with ≥ 10% risk of death within 6 months. Patients meeting GSF criteria were older (p = 0.006, had more comorbidities (1.6 ± 0.7 vs. 1.2 ± 0.9, p = 0.007, more frequent hospitalisations before (p = 0.001 and after (0.0001 their index admission, and were more likely to die during follow-up (GSF+ 20% vs GSF- 7%, p = 0.03. GRACE score was predictive of 12-month mortality (C-statistic 0.75 and this was improved by the addition of previous hospital admissions and previous history of stroke (C-statistic 0.88. CONCLUSIONS: This study has highlighted a potentially large number of ACS patients eligible for EoL care. GSF or GRACE could be used in the hospital setting to help identify these patients. GSF identifies ACS patients with more comorbidity and at increased risk of hospital readmission.

  20. Reflecting on one's own death: The existential questions that nurses face during end-of-life care.

    Science.gov (United States)

    Karlsson, Margareta; Kasén, Anne; Wärnå-Furu, Carola

    2017-04-01

    When registered nurses care for patients at the end of life, they are often confronted with different issues related to suffering, dying, and death whether working in hospital or community care. Serious existential questions that challenge nurses' identities as human beings can arise as a result of these situations. The aim of our study was to describe and gain a deeper understanding of nurses' existential questions when caring for dying patients. Focus-group interviews with registered nurses who shared similar experiences and backgrounds about experiences in end-of-life care were employed to gain a deeper understanding about this sensitive subject. Focus-group interviews were performed in hospice care, in community care, and in a palliative care unit in western Sweden. A qualitative hermeneutic approach was employed to interpret the data. Nurses' existential questions balanced between responsibility and guilt in relation to their patients, between fear and courage in relation to being professional caregivers and fellow human beings, and between hope and despair in relation to the other's and their own death. Nurses in end-of-life care experience various emotions from patients related to things physical, spatial, and temporal. When nurses encounter these emotions as expressing a patient's suffering, they lead to challenges of balancing between different feelings in relation to patients, as both professional caregivers and fellow human beings. Nurses can experience growth both professionally and as human beings when caring for patients at the end of life.

  1. End-of-life care bonus promoting end-of-life care in nursing homes: An 11-year retrospective longitudinal prefecture-wide study in Japan

    National Research Council Canada - National Science Library

    Nishiguchi, Sho; Sugaya, Nagisa; Sakamaki, Kentaro; Mizushima, Shunsaku

    2017-01-01

    The end-of-life (EOL) care bonus introduced by the Japanese government works as a financial incentive and framework of quality preservation, including advance care planning, for EOL care among nursing home residents...

  2. Assessment of end-of-life design in solid-state lighting

    Science.gov (United States)

    Dzombak, Rachel; Padon, Jack; Salsbury, Josh; Dillon, Heather

    2017-08-01

    Consumers in the US market and across the globe are beginning to widely adopt light emitting diode (LED) lighting products while the technology continues to undergo significant changes. While LED products are evolving to consume less energy, they are also more complex than traditional lighting products with a higher number of parts and a larger number of electronic components. Enthusiasm around the efficiency and long expected life span of LED lighting products is valid, but research to optimize product characteristics and design is needed. This study seeks to address that gap by characterizing LED lighting products' suitability for end of life (EOL) recycling and disposal. The authors disassembled and assessed 17 different lighting products to understand how designs differ between brands and manufacture year. Products were evaluated based on six parameters to quantify the design. The analysis indicates that while the efficiency of LED products has improved dramatically in the recent past, product designers and manufacturers could incorporate design strategies to improve environmental performance of lighting products at end-of-life.

  3. Sustainable design for automotive products: dismantling and recycling of end-of-life vehicles.

    Science.gov (United States)

    Tian, Jin; Chen, Ming

    2014-02-01

    The growth in automotive production has increased the number of end-of-life vehicles (ELVs) annually. The traditional approach ELV processing involves dismantling, shredding, and landfill disposal. The "3R" (i.e., reduce, reuse, and recycle) principle has been increasingly employed in processing ELVs, particularly ELV parts, to promote sustainable development. The first step in processing ELVs is dismantling. However, certain parts of the vehicle are difficult to disassemble and use in practice. The extended producer responsibility policy requires carmakers to contribute in the processing of scrap cars either for their own developmental needs or for social responsibility. The design for dismantling approach can be an effective solution to the existing difficulties in dismantling ELVs. This approach can also provide guidelines in the design of automotive products. This paper illustrates the difficulty of handling polymers in dashboards. The physical properties of polymers prevent easy separation and recycling by using mechanical methods. Thus, dealers have to rely on chemical methods such as pyrolysis. Therefore, car designers should use a single material to benefit dealers. The use of materials for effective end-of-life processing without sacrificing the original performance requirements of the vehicle should be explored. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. End-of-life flows of multiple cycle consumer products.

    Science.gov (United States)

    Tsiliyannis, C A

    2011-11-01

    Explicit expressions for the end-of-life flows (EOL) of single and multiple cycle products (MCPs) are presented, including deterministic and stochastic EOL exit. The expressions are given in terms of the physical parameters (maximum lifetime, T, annual cycling frequency, f, number of cycles, N, and early discard or usage loss). EOL flows are also obtained for hi-tech products, which are rapidly renewed and thus may not attain steady state (e.g., electronic products, passenger cars). A ten-step recursive procedure for obtaining the dynamic EOL flow evolution is proposed. Applications of the EOL expressions and the ten-step procedure are given for electric household appliances, industrial machinery, tyres, vehicles and buildings, both for deterministic and stochastic EOL exit, (normal, Weibull and uniform exit distributions). The effect of the physical parameters and the stochastic characteristics on the EOL flow is investigated in the examples: it is shown that the EOL flow profile is determined primarily by the early discard dynamics; it also depends strongly on longevity and cycling frequency: higher lifetime or early discard/loss imply lower dynamic and steady state EOL flows. The stochastic exit shapes the overall EOL dynamic profile: Under symmetric EOL exit distribution, as the variance of the distribution increases (uniform to normal to deterministic) the initial EOL flow rise becomes steeper but the steady state or maximum EOL flow level is lower. The steepest EOL flow profile, featuring the highest steady state or maximum level, as well, corresponds to skew, earlier shifted EOL exit (e.g., Weibull). Since the EOL flow of returned products consists the sink of the reuse/remanufacturing cycle (sink to recycle) the results may be used in closed loop product lifecycle management operations for scheduling and sizing reverse manufacturing and for planning recycle logistics. Decoupling and quantification of both the full age EOL and of the early discard flows is

  5. End-of-Life Care Interventions: An Economic Analysis.

    Science.gov (United States)

    Pham, B; Krahn, M

    2014-01-01

    The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. To evaluate the cost-effectiveness of end-of-life (EoL) care interventions included in the EoL care mega-analysis. Multiple sources were used, including systematic reviews, linked health administration databases, survey data, planning documents, expert input, and additional literature searches. We conducted a literature review of cost-effectiveness studies to inform the primary economic analysis. We conducted the primary economic analysis and budget impact analysis for an Ontario cohort of decedents and their families and included interventions pertaining to team-based models of care, patient care planning discussions, educational interventions for patients and caregivers, and supportive interventions for informal caregivers. The time horizon was the last year of life. Costs were in 2013 Canadian dollars. Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days. We developed a Markov model; model inputs were obtained from a cohort of Ontario decedents assembled from Institute for Clinical Evaluative Sciences databases and published literature. In-home palliative team care was cost-effective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4,400 per patient. Expanding in-home palliative team care to those currently not receiving such services (approximately 45,000 per year, at an annual cost of $76-108 million) is likely to improve quality of life, reduce the use of acute care resources, and save $191-$385 million in health care costs. Results for the other interventions were uncertain. The cost-effectiveness analysis was

  6. End-of-Life Care Interventions: An Economic Analysis

    Science.gov (United States)

    Pham, B; Krahn, M

    2014-01-01

    Background The annual cost of providing care for patients in their last year of life is estimated to account for approximately 9% of the Ontario health care budget. Access to integrated, comprehensive support and pain/symptom management appears to be inadequate and inequitable. Objective To evaluate the cost-effectiveness of end-of-life (EoL) care interventions included in the EoL care mega-analysis. Data Sources Multiple sources were used, including systematic reviews, linked health administration databases, survey data, planning documents, expert input, and additional literature searches. Review Methods We conducted a literature review of cost-effectiveness studies to inform the primary economic analysis. We conducted the primary economic analysis and budget impact analysis for an Ontario cohort of decedents and their families and included interventions pertaining to team-based models of care, patient care planning discussions, educational interventions for patients and caregivers, and supportive interventions for informal caregivers. The time horizon was the last year of life. Costs were in 2013 Canadian dollars. Effectiveness measures included days at home, percentage dying at home, and quality-adjusted life-days. We developed a Markov model; model inputs were obtained from a cohort of Ontario decedents assembled from Institute for Clinical Evaluative Sciences databases and published literature. Results In-home palliative team care was cost-effective; it increased the chance of dying at home by 10%, increased the average number of days at home (6 days) and quality-adjusted life-days (0.5 days), and it reduced costs by approximately $4,400 per patient. Expanding in-home palliative team care to those currently not receiving such services (approximately 45,000 per year, at an annual cost of $76–108 million) is likely to improve quality of life, reduce the use of acute care resources, and save $191–$385 million in health care costs. Results for the other

  7. Fatigue in children with cancer at the end of life.

    Science.gov (United States)

    Ullrich, Christina K; Dussel, Veronica; Hilden, Joanne M; Sheaffer, Jan W; Moore, Caron L; Berde, Charles B; Wolfe, Joanne

    2010-10-01

    Fatigue is a prevalent source of suffering in children with advanced cancer; yet, little is known about it. This study aimed to describe fatigue experienced by children with advanced cancer and to identify the factors associated with suffering from fatigue and its treatment. A retrospective cross-sectional study of 141 parents of children who died of cancer (response rate: 64%) was conducted in two tertiary-level U.S. pediatric hospitals. By parent report, 96% of children experienced fatigue in the last month of life. Nearly 50% experienced significant suffering from fatigue; this was associated with suffering from pain, dyspnea, anorexia, nausea/vomiting, diarrhea, anxiety, sadness, or fear (P<0.05), and with side effects from pain or dyspnea treatment (P<0.05). In multivariate analysis of symptom-related factors, suffering from nausea/vomiting (odds ratio [OR]=3.93, 95% confidence interval [CI]=1.23-12.61, P=0.02); anorexia (OR=7.52, 95% CI=1.87-30.25, P=0.005); and fear (OR=5.13, 95% CI=2.03-12.96, P ≤ 0.001) remained independently associated with fatigue. Children suffering from fatigue had primary oncologists with fewer years' experience than children who did not suffer from fatigue (mean=7.7 years, standard deviation [SD]=4.9 vs. mean of 9.9 years, SD=6.0, P=0.02). Among children with fatigue, 17 of 129 (13%) received fatigue-directed treatment, which was successful in 3 of 12 (25%). Children experiencing side effects from dyspnea or pain treatment were more likely to be treated for fatigue (relative risk=1.25, 95% CI=1.06-1.47, P=0.009). Fatigue is a common source of suffering in children with cancer at the end of life. Palliation of this symptom is rarely successful. Increased attention to factors associated with fatigue and effective interventions to ameliorate fatigue are needed. Copyright © 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  8. End-of-life issues in the acute and critically ill patient

    Directory of Open Access Journals (Sweden)

    Marco Catherine A

    2009-04-01

    Full Text Available Abstract The challenges of end-of-life care require emergency physicians to utilize a multifaceted and dynamic skill set. Such skills include medical therapies to relieve pain and other symptoms near the end-of-life. Physicians must also demonstrate aptitude in comfort care, communication, cultural competency, and ethical principles. It is imperative that emergency physicians demonstrate a fundamental understanding of end-of-life issues in order to employ the versatile, multidisciplinary approach required to provide the highest quality end-of-life care for patients and their families.

  9. Australian nursing students' stories of end-of-life care simulation.

    Science.gov (United States)

    Gillan, Pauline Catherine; van der Riet, Pamela; Jeong, Sarah

    2016-03-01

    Because nurses are at the forefront of end-of-life care, it is imperative that nursing students are prepared for this role upon graduation. Research suggests that many nursing students are unprepared to deliver compassionate and quality end-of-life care. There have been many attempts to address this need; one emerging method is end-of-life care simulation. This paper explores the experiences of 18 undergraduate nursing students of end-of-life care simulation. Participants' stories were obtained via observation during end-of-life care simulation, audio-recorded post simulation debriefing, and semi-structured interviews. Using Clandinin and Connolly's three dimensions of Narrative Inquiry (temporality, spatiality, and sociality) participants' stories reflected convergence of time, place, and person. Findings revealed three distinct plotlines along a time continuum, specifically surrounding time of death: (i) "The privilege of end-of-life care;" (ii) "Witnessing death as surreal;" and (iii) "The honor of providing after-death care." Participants' narratives suggest that end-of-life care simulation is an important means of preparing students for clinical end-of-life care experiences. This has implications for nursing educators wishing to consider simulation in end-of-life care education. © 2015 Wiley Publishing Asia Pty Ltd.

  10. Simulation-based end-of-life care training during surgical clerkship: assessment of skills and perceptions.

    Science.gov (United States)

    Parikh, Priti P; Brown, Ronald; White, Mary; Markert, Ronald J; Eustace, Rosemary; Tchorz, Kathryn

    2015-06-15

    Assessment of interpersonal and psychosocial competencies during end-of-life care training is essential. This study reports the relationship between simulation-based end-of-life care Objective Structured Clinical Examination ratings and communication skills, trust, and self-assessed empathy along with the perceptions of students regarding their training experiences. Medical students underwent simulation-based end-of-life care OSCE training that involved standardized patients who evaluated students' communication skills and physician trust with the Kalamazoo Essential Elements Communication Checklist and the Wake Forest Physician Trust Scale. Students also completed the Jefferson Scale of Physician Empathy. Pearson correlation was used to examine the relationship between OSCE performance grades and communication, trust, and empathy scores. Student comments were analyzed using the constant comparative method of analysis to identify dominant themes. The 389 students (mean age 26.6 ± 2.8 y; 54.5% female) had OSCE grades that were positively correlated with physician trust scores (r = 0.325, P skills (r = 0.383, P skills or empathy. Overall, students perceived simulation-based end-of-life care training to be a valuable learning experience and appreciated its placement early in clinical training. We found that simulation-based OSCE training in palliative and end-of-life care can be effectively conducted during a surgery clerkship. Moreover, the standardized patient encounters combined with the formal assessment of communication skills, physician trust, and empathy provide feedback to students at an early phase of their professional life. The positive and appreciative comments of students regarding the opportunity to practice difficult patient conversations suggest that attention to these professional characteristics and skills is a valued element of clinical training and conceivably a step toward better patient outcomes and satisfaction. Copyright © 2015 Elsevier Inc

  11. Selection bias in family reports on end of life with dementia in nursing homes

    NARCIS (Netherlands)

    van der Steen, J.T.; Deliens, L.; Ribbe, M.W.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Selective participation in retrospective studies of families recruited after the patient's death may threaten generalizability of reports on end-of-life experiences. Objectives: To assess possible selection bias in retrospective study of dementia at the end of life using family reports.

  12. Medical end-of-life decisions in neonates and infants in Flanders

    NARCIS (Netherlands)

    Provoost, V.; Cools, F.; Mortier, F.; Bilsen, J.J.; Ramet, J.; Vandenplas, Y.; Deliens, L.H.J.

    2005-01-01

    BACKGROUND: Paediatricians are increasingly confronted with end-of-life decisions in critically ill neonates and infants. Little is known about the frequency and characteristics of end-of-life decisions in this population, nor about the relation with clinical and patients' characteristics. METHODS:

  13. End-of-Life Competencies and the NCLEX-RN Examination.

    Science.gov (United States)

    Wendt, Anne

    2001-01-01

    Outlines places in the National Council Licensure Examination for Registered Nurses that address 15 nursing competencies for care of clients at the end of life. Categories are safe, effective care environment; health promotion and maintenance; psychosocial integrity; and physiological integrity. Sources of information on end-of-life content are…

  14. Prioritizing lectures on end of life care in a Nigerian Medical School ...

    African Journals Online (AJOL)

    Prioritizing lectures on end of life care in a Nigerian Medical School: final year medical students' perspectives. A Akoria Obehi. Abstract. No Abstract. Keywords: End-of-life Care, Palliative Care, Dying & Death, Medical Students, Nigeria. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT ...

  15. Challenges in Providing End-of-Life Care for People with Intellectual Disability: Health Services Access

    Science.gov (United States)

    Wark, Stuart; Hussain, Rafat; Müller, Arne; Ryan, Peta; Parmenter, Trevor

    2017-01-01

    Background: Increasing life expectancy for people with intellectual disability is resulting in greater need for end-of-life care services. However, limited knowledge is available regarding what barriers to accessing end-of-life care support are evident, particularly comparatively across rural and metropolitan locations. Methods: Focus group…

  16. Nurse involvement in end-of-life decision making: the ETHICUS Study

    DEFF Research Database (Denmark)

    Benbenishty, Julie; Ganz, Freda DeKeyser; Lippert, Anne

    2006-01-01

    The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making.......The purpose was to investigate physicians' perceptions of the role of European intensive care nurses in end-of-life decision making....

  17. The broad spectrum of unbearable suffering in end of life cancer studied in dutch primary care

    NARCIS (Netherlands)

    Ruijs, C.D.M.; Kerkhof, A.J.F.M.; van der Wal, G.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Unbearable suffering most frequently is reported in end-of-life cancer patients in primary care. However, research seldom addresses unbearable suffering. The aim of this study was to comprehensively investigate the various aspects of unbearable suffering in end-of-life cancer patients

  18. Retrospective and Prospective Data Collection Compared in the Dutch End of Life in Dementia (DEOLD) Study

    NARCIS (Netherlands)

    van der Steen, J.T.; Ribbe, M.W.; Deliens, L.; Gutschow, G.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Studying end of life in dementia patients is challenging because of ill-defined prognoses and frequent inability to self-report. We aim to quantify and compare (1) feasibility and (2) sampling issues between prospective and retrospective data collection specific to end-of-life research in long-term

  19. Do Older Korean Immigrants Engage in End-of-Life Communication?

    Science.gov (United States)

    Ko, Eunjeong; Roh, Soonhee; Higgins, Doreen

    2013-01-01

    End-of-life communication is an important process as it allows individuals' treatment preferences to be known, yet not every culture is receptive to such discussions. Planning for end-of-life care is not readily supported in Asian culture, and little is known about individuals' communication with family and health care professionals among older…

  20. End-of-life communication: a retrospective survey of representative General Practitioner networks in four countries.

    NARCIS (Netherlands)

    Evans, N.; Costantini, M.; Pasman, H.R.; Block, L. van den; Donker, G.A.; Miccinesi, G.; Bertolissi, S.; Gil, M.; Boffin, N.; Zurriaga, O.; Deliens, L.; Onwuteaka-Philipsen, B.

    2014-01-01

    Context: Effective communication is central to high-quality end-of-life care. Objectives: This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care

  1. Transition between care settings at end of life in the Netherlands: results from a nationwide study.

    NARCIS (Netherlands)

    Abarshi, E.; Echteld, M.; Block, L. van den; Donker, G.; Deliens, L.; Onwuteaka-Philipsen, B.

    2009-01-01

    Background: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Objective: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to

  2. Transition between care settings at end of life in the Netherlands: results from a nationwide study.

    NARCIS (Netherlands)

    Abarshi, E.; Echteld, M.; Block, L. van den; Donker, G.; Deliens, L.; Onwuteaka-Philipsen, B.

    2009-01-01

    Issue/problem: Transitions between care settings at the end of life could hinder continuity of care for the terminally ill, suggesting a low quality of end-of-life care. Aim: To examine the nature and prevalence of care setting transitions in the last 3 months of life in the Netherlands, and to

  3. Good end-of-life care according to patients and their GPs.

    NARCIS (Netherlands)

    Borgsteede, S.D.; Graafland-Riedstra, C.; Deliens, L.; Francke, A.L.; Eijk, J.T.M. van; Willems, D.L.

    2006-01-01

    Background: Most patients prefer to die at home, where a GP provides end-of-life care. A few previous studies have been directed at the GPs' values on good end-of-life care, yet no study combined values of patients and their own GP. Aim: To explore the aspects valued by both patients and GPs in

  4. Looking at the end-of-life directive and challenges in recycling

    DEFF Research Database (Denmark)

    Smink, Carla

    2004-01-01

    The article deals with end-of-life vechile regulations. Focus is on the European end-of-life vechile directive (2000/53/EC) and how Denmark and the Netherlands have dealt with the regulations in the past 30 years....

  5. Leading end-of-life care: an action learning set approach in nursing homes.

    Science.gov (United States)

    Hewison, Alistair; Badger, Frances; Swani, Tina

    2011-03-01

    If the end-of-life care needs of people living in nursing homes are to be met, effective leadership is necessary. This in turn requires that appropriate training and support are provided for nursing home managers. To meet this need, an action learning set (ALS) involving nursing home managers was developed, and as a result of the continuous process of learning and reflection that characterizes ALS work the managers brought about a number of improvements in end-of-life care. These included more consistent use of care plans, increased involvement of clients and their families in planning end-of-life care, more training for staff, and the use of events and techniques to create opportunities for discussing the end of life. The managers set specific individual objectives focused on improving end-of-life care and were supported in meeting them through their membership of the set.

  6. Factors influencing Intensive Care Units nurses in end-of-life decisions

    Directory of Open Access Journals (Sweden)

    Michelle Freire Baliza

    2015-08-01

    Full Text Available OBJECTIVETo identify the factors that influence the Intensive Care Unit nurse in the decision-making process in end-of-life situations.METHODEthnographic case study, which used the theoretical framework of medical anthropology. Data were collected through semi-structured interviews with 10 nurses.RESULTSThe inductive thematic analysis enabled us to identify four themes:The cultural context of the Intensive Care Unit: decision-making in situations of end-of-life; Beliefs and subjectivity of care in end-of-life situations; Professional experience and context characteristics of end-of-life care situations; and Humanization practices in end-of-life situations: the patient and family centered care.CONCLUSIONProfessional maturity, the ability to transmit information and the ability to negotiate are directly related to the inclusion of nurses in the decision-making process.

  7. End-of-life communication in veterinary medicine: delivering bad news and euthanasia decision making.

    Science.gov (United States)

    Shaw, Jane R; Lagoni, Laurel

    2007-01-01

    Given the expectations of clients and the resultant impact of end-of-life conversations on pet owners and the veterinary team, compassionate end-of-life communication is considered to be an ethical obligation, a core clinical skill, and integral to the success of a veterinary team. End-of-life communication is related to significant clinical outcomes, including enduring veterinarian-client-patient relationships and veterinarian and client satisfaction. Effective techniques for end-of-life communication can be taught and are a series of learned skills. The purpose of this article is to present best practices for delivering bad news and euthanasia decision-making discussions. In this article, the SPIKES six-step model (setting, perception, invitation, knowledge, empathize, and summarize) currently employed in medical curricula is utilized to structure end-of-life conversations in veterinary medicine.

  8. Respiratory Therapists' Experiences and Attitudes Regarding Terminal Extubations and End-of-Life Care.

    Science.gov (United States)

    Grandhige, Anjali P; Timmer, Marjorie; O'Neill, Michael J; Binney, Zachary O; Quest, Tammie E

    2016-07-01

    Respiratory therapists (RTs) routinely care for patients with life-limiting illnesses and in some hospitals are responsible for terminal extubations. Data on how such experiences affect RTs are scarce. The objective of this work was to survey RTs at 2 academic medical centers about their experiences caring for patients with terminal extubations. An online survey was distributed to the hospitals' RTs. Survey data included demographics and experiences with end-of-life care and terminal extubations. The survey was derived from previously published questionnaires plus input from hospital RT leaders. Sixty-five of 173 RTs (37.6%) responded. Of these, 42.4% were ≥50 y old, and 62.7% were female. 20.3% had ≤5 y experience; 52.5% had ≥16 y. 93.8% self-reported being involved in at least one terminal extubation; of those, 36.1% reported performing ≥20. Nearly half (47.5%) wanted to be involved in family meetings discussing terminal extubations, but just 6.6% were frequently involved. Only 32.3% felt that they received adequate education regarding terminal illness in RT school; 32.3% reported gathering this knowledge while working. 60.0% wanted more formal education around terminal patient care. 27.9% reported sometimes being uncomfortable with performing a terminal extubation; most of these rarely felt that they had the option not to perform the extubation. RTs are rarely involved in end-of-life discussions despite a desire to be, and they experience situations that generate discomfort. There is demand for more formal RT training around care for terminal patients. Clinical protocols that involve RTs in meetings before ventilator withdrawal should be considered. Copyright © 2016 by Daedalus Enterprises.

  9. Discussing end-of-life issues in nursing homes: a nationwide study in France.

    Science.gov (United States)

    Morin, Lucas; Johnell, Kristina; Van den Block, Lieve; Aubry, Régis

    2016-05-01

    discussing end-of-life issues with nursing home residents and their relatives is needed to ensure patient-centred care near the end of life. this study aimed to estimate the frequency of nursing home physicians discussing end-of-life issues with residents and their relatives and to investigate how discussing end-of-life issues was associated with care outcomes in the last month of life. post-mortem cohort study in a nationwide, representative sample of 78 nursing home facilities in France. Residents who died from non-sudden causes between 1 October 2013 and 31 May 2014 in these facilities were included (n = 674). end-of-life issues were discussed with at most 21.7% of the residents who died during the study period. In one-third of the situations (32.8%), no discussion about end-of-life-related topics ever occurred, either with the resident or with the relatives. Older people with severe dementia were less likely to have discussed more than three of the six end-of-life topics we investigated, compared with residents without dementia (OR = 0.17, 95% CI = 0.08-0.22). In the last month of life, discussing more than three end-of-life issues with the residents or their relatives was significantly associated with reduced odds of dying in a hospital facility (adjusted OR = 0.51, 95% CI = 0.33-0.79) and with a higher likelihood of withdrawing potentially futile life-prolonging treatments (adjusted OR = 2.37, 95% CI = 1.72-3.29). during the last months of life, discussions about end-of-life issues occurred with only a minority of nursing home decedents, although these discussions may improve end-of-life care outcomes. © The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  10. Inequalities in End-of-Life Care for Colorectal Cancer Patients in Nova Scotia, Canada

    Science.gov (United States)

    Asada, Yukiko; Burge, Fred; Johnston, Grace W.; Urquhart, Robin

    2013-01-01

    Access to high-quality end-of-life (EOL) care is critical for all those with incurable cancer. The objective of this study was to examine inequalities in access to, and quality of, EOL care by assessing registration in a palliative care program, emergency room visits in the last 30 days of life, and location of death among individuals who died of colorectal cancer in Nova Scotia, Canada, between 2001 and 2008. We used population-based linked administrative data and performed multivariate logistic regression models to assess the association between socio-economic, geographic, and demographic factors and outcomes related to access to, and quality of, EOL care (n=1,201). This study demonstrates that although access to, and quality of, EOL care appears to have improved, there remain significant inequalities throughout the population. Of primary concern is the variation in access to, and quality of, EOL care based on geographic location of residence and patient age. PMID:22860381

  11. Recycling end-of-life vehicles of the future. Final CRADA report.

    Energy Technology Data Exchange (ETDEWEB)

    Jody, B. J.; Pomykala, J. A.; Spangenberger, J. S.; Daniels, E.; Energy Systems

    2010-01-14

    Argonne National Laboratory (the Contractor) entered into a Cooperative Research and Development Agreement (CRADA) with the following Participants: Vehicle Recycling Partnership, LLC (VRP, which consists of General Motors [GM], Ford, and Chrysler), and the American Chemistry Council - Plastics Division (ACC-PD). The purpose of this CRADA is to provide for the effective recycling of automotive materials. The long-term goals are to (1) enable the optimum recycling of automotive materials, thereby obviating the need for legislative mandates or directives; (2) enable the recovery of automotive materials in a cost-competitive manner while meeting the performance requirements of the applications and markets for the materials; and (3) remove recycling barriers/reasons, real or perceived, to the use of advanced lightweighting materials or systems in future vehicles. The issues, technical requirements, and cost and institutional considerations in achieving that goal are complex and will require a concerted, focused, and systematic analysis, together with a technology development program. The scope and tasks of this program are derived from 'A Roadmap for Recycling End-of-Life Vehicles of the Future,' prepared in May 2001 for the DOE Office of Energy, Efficiency, and Renewable Energy (EERE)-Vehicle Technologies Program. The objective of this research program is to enable the maximum recycling of automotive materials and obsolete vehicles through the development and commercialization of technologies for the separation and recovery of materials from end-of-life vehicles (ELVs). The long-term goals are to (1) enable the optimum recycling of automotive materials, thereby obviating the need for legislative mandates or directives; (2) enable the recovery of automotive materials in a cost-competitive manner while meeting the performance requirements of the applications and markets for the materials; and (3) remove recycling barriers/reasons, real or perceived, to the use

  12. The development and prospects of the end-of-life vehicle recycling system in Taiwan.

    Science.gov (United States)

    Chen, Kuan-chung; Huang, Shih-han; Lian, I-wei

    2010-01-01

    Automobiles usually contain toxic substances, such as lubricants, acid solutions and coolants. Therefore, inappropriate handling of end-of-life vehicles (ELVs) will result in environmental pollution. ELV parts, which include metallic and non-metallic substances, are increasingly gaining recycling value due to the recent global shortage of raw materials. Hence, the establishment of a proper recycling system for ELVs will not only reduce the impact on the environment during the recycling process, but it will also facilitate the effective reuse of recycled resources. Prior to 1994, the recycling of ELVs in Taiwan was performed by related operators in the industry. Since the publishing of the "End-of-life vehicle recycling guidelines" under the authority of the Waste Disposal Act by the Environmental Protection Administration (EPA) in 1994, the recycling of ELVs in Taiwan has gradually become systematic. Subsequently, the Recycling Fund Management Board (RFMB) of the EPA was established in 1998 to collect a Collection-Disposal-Treatment Fee (recycling fee) from responsible enterprises for recycling and related tasks. Since then, the recycling channels, processing equipment, and techniques for ELVs in Taiwan have gradually become established. This paper reviews the establishment of the ELV recycling system, analyzes the current system and its performance, and provides some recommendations for future development. The reduction of auto shredder residue (ASR) is a key factor in maximizing the resource recovery rate and recycling efficiency. The RFMB needs to provide strong economic incentives to further increase the recycling rate and to encourage the automobile industry to design and market greener cars. 2010 Elsevier Ltd. All rights reserved.

  13. Mechanical performance of irradiated beryllium pebbles

    Energy Technology Data Exchange (ETDEWEB)

    Scaffidi-Argentina, F.; Dalle-Donne, M.; Werle, H. [Forschungszentrum Karlsruhe GmbH Technik und Umwelt (Germany). Inst. fuer Neutronenphysik und Reaktortechnik

    1998-01-01

    For the Helium Cooled Pebble Bed (HCPB) Blanket, which is one of the two reference concepts studied within the European Fusion Technology Programme, the neutron multiplier consists of a mixed bed of about 2 and 0.1-0.2 mm diameter beryllium pebbles. Beryllium has no structural function in the blanket, however microstructural and mechanical properties are important, as they might influence the material behavior under neutron irradiation. The EXOTIC-7 as well as the `Beryllium` experiments carried out in the HFR reactor in Petten are considered as the most detailed and significant tests for investigating it. This paper reviews the present status of beryllium post-irradiation examinations performed at the Forschungszentrum Karlsruhe with samples from these irradiation experiments, emphasizing the effects of irradiation of essential material properties and trying to elucidate the processes controlling the property changes. The microstructure, the porosity distribution, the impurity content, the behavior under compression loads and the compatibility of the beryllium pebbles with lithium orthosilicate (Li{sub 4}SiO{sub 4}) during the in-pile irradiation are presented and critically discussed. Qualitative information on ductility and creep obtained by hardness-type measurements are also supplied. (author)

  14. Resource recovery from end-of-life tyres in Greece: a field survey, state-of-art and trends.

    Science.gov (United States)

    Karagiannidis, A; Kasampalis, T

    2010-06-01

    Lack of consistent and available information for the entire tyre industry has often hindered adequate understanding of current and future issues that need to be addressed for improving the sustainable end-of-life tyre management. The aim of this paper is to review related best available technologies and techniques for Greece, ranging from simple mechanical processing, up to complex multistep, mechanochemical and/or thermal treatment. End-of-life tyre management guidelines in the form of a manual for supporting future entrepreneurs in this field are also discussed. Extensive data mining, classification and inventorying was performed, both in the field via questionnaires and in the literature, for the purpose of accurately determining Hellenic conditions, in order to pinpoint encountered problems, propose interventions and determine new entrepreneurship opportunities.

  15. Improving End-of-Life Care Knowledge Among Senior Baccalaureate Nursing Students.

    Science.gov (United States)

    Glover, Toni L; Garvan, Cynthia; Nealis, Rose M; Citty, Sandra W; Derrico, David J

    2017-12-01

    It is imperative that nurses are proficient and comfortable providing care to patients at the end of life. Recent studies show that nurses' knowledge of end-of-life care is less than optimal. Effective, evidence-based methods to infuse palliative and end-of-life care education into the undergraduate nursing curriculum are needed. A descriptive pre- and postassessment evaluating senior nursing students' acquisition of knowledge on end-of-life care after attending the End-of-Life Nursing Education Consortium (ELNEC) core course was conducted. The course evaluation included qualitative statements. Before the ELNEC course, one-third of the students had cared for a dying patient during clinical rotations, yet 85% reported they had not received adequate training in end-of-life care. Posttest questions related to palliative care, symptom management, communication, and grief indicated that students acquired significant knowledge after participating in the ELNEC course ( P nursing students' knowledge of palliative and end-of-life care.

  16. End-of-Life Palliative Care Practices and Referrals in Uganda.

    Science.gov (United States)

    Low, Daniel; Merkel, Emily C; Menon, Manoj; Loggers, Elizabeth; Ddungu, Henry; Leng, Mhoira; Namukwaya, Elizabeth; Casper, Corey

    2017-10-23

    While early involvement and integration of palliative care with oncology can positively impact quality of life and survival of patients with advanced cancer, there is a dearth of information regarding this integration in sub-Saharan Africa. We sought to describe the rate and factors predicting specialist palliative referrals among cancer patients in Uganda. We examined the rate of referrals of cancer patients to palliative specialists via a chart review, while also surveying and interviewing doctors at the Uganda Cancer Institute (UCI) about their approaches to palliative care. All adult patients at the UCI who died in a 20-month interval from 2014 to 2015. All UCI doctors were approached for the survey and 25 (96%) participated. Seven of these doctors were also individually interviewed. Number of referrals to palliative specialists and qualitative responses to questions about end-of-life care management. Sixty-six (11.1%) of 595 patients were referred to palliative care specialists. Patients with worse ECOG performance statuses were more likely to be referred to palliative specialists (odds ratio 2.23, p = 0.03); no other factors were predictive of a referral. Median number of days lived after referral was 5 days (interquartile range 2-13). Doctors explained the low referral rate and short life expectancy after referral by limited palliative resources and a reticence to have end-of-life management conversations with patients due to cultural taboos. Despite recognized benefits of palliative collaboration, doctors at the UCI seldom refer patients to palliative care specialists due to limited staffing, cultural barriers, and difficult interservice communication.

  17. Life cycle assessment of the end-of-life phase of a residential building.

    Science.gov (United States)

    Vitale, Pierluca; Arena, Noemi; Di Gregorio, Fabrizio; Arena, Umberto

    2017-02-01

    The study investigates the potential environmental impacts related to the end-of-life phase of a residential building, identified in a multifamily dwelling of three levels, constructed in the South of Italy by utilizing conventional materials and up-to-date procedures. An attributional life cycle assessment has been utilised to quantify the contributions of each stage of the end-of-life phase, with a particular attention to the management of the demolition waste. The investigation takes into account the selective demolition, preliminary sorting and collection of main components of the building, together with the processes of sorting, recycling and/or disposal of main fractions of the demolition waste. It quantifies the connections between these on-site and off-site processes as well as the main streams of materials sent to recycling, energy recovery, and final disposal. A sensitivity analysis has been eventually carried out by comparing the overall environmental performances of some alternative scenarios, characterised by different criteria for the demolition of the reference building, management of demolition waste and assessment of avoided burdens of the main recycled materials. The results quantify the advantage of an appropriate technique of selective demolition, which could increase the quality and quantity of residues sent to the treatment of resource recovery and safe disposal. They also highlight the contributions to the positive or negative environmental impact of each stage of the investigated waste management system. The recycling of reinforcing steel appears to play a paramount role, accounting for 65% of the total avoided impacts related to respiratory inorganics, 89% of those for global warming and 73% of those for mineral extraction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Relatives in end-of-life care--part 2: a theory for enabling safety.

    Science.gov (United States)

    Ohlén, Joakim; Andershed, Birgitta; Berg, Christina; Frid, Ingvar; Palm, Carl-Axel; Ternestedt, Britt-Marie; Segesten, Kerstin

    2007-02-01

    To develop a goal-oriented praxis theory for enabling safety for relatives when an adult or older patient is close to end-of-life. This is the second part of a project focusing on the situation and needs of relatives in end-of-life care. Our interpretation of the existing corpus of knowledge pertaining to the needs of close relatives in this situation showed the significance of relatives' need for safety. The theory was developed step-by-step, through triangulation of critical review of empirical research in the field, our own clinical experiences from end-of-life care, renewed literature searches and theoretical reasoning. The foundation for the theory is taken from the ethical intention of the philosopher Paul Ricoeur. From this, the theory focuses on relatives in the context of end-of-life care with the goal of enabling safety. This is proposed by four aphorisms functioning as safety enablers and these are directed towards the professional's approach and attitude, the relative's concern for the patient, the specific situation for the relative and the patient's end-of-life period as a period in the life of the relative. Implications for end-of-life practice are considered and include aspects for promotion of just institutions in end-of-life care, the significance of negotiated partnership in end-of-life care, enabling safety for relatives living in existential and practical uncertainty in connection with end-of-life care and diversity of relatives' preferences as they live through this particular period.

  19. Parental decision making for children with cancer at the end of life: a meta-ethnography.

    Science.gov (United States)

    Heinze, Katherine E; Nolan, Marie T

    2012-01-01

    Parents of pediatric oncology patients are faced with difficult decisions when their child reaches the end of life. For health care providers to provide optimal care, they must understand parents' perspectives and preferences in end-of-life decision making. Therefore, this article provides a systematic review of the literature on the end-of-life decision making of parents of children with cancer as well as recommendations for practice and future research. Parents participated in surveys, focus groups, participant observation, and interviews to help researchers understand the expectations, hopes, fears, and values that guide their decision making. Common themes were patient-provider communication, extending time, and understanding prognosis.

  20. Comparing end-of-life practices in different policy contexts: a scoping review.

    Science.gov (United States)

    Boivin, Antoine; Marcoux, Isabelle; Garnon, Geneviève; Lehoux, Pascale; Mays, Nicholas; Prémont, Marie-Claude; Chao, Yi-Sheng; van Leeuwen, Evert; Pineault, Raynald

    2015-04-01

    End-of-life policy reforms are being debated in many countries. Research evidence is used to support different assumptions about the effects of public policies on end-of-life practices. It is however unclear whether reliable international practice comparisons can be conducted between different policy contexts. Our aim was to assess the feasibility of comparing similar end-of-life practices in different policy contexts. This is a scoping review of empirical studies on medical end-of-life practices. We developed a descriptive classification of end-of-life practices that distinguishes practices according to their legal status. We focused on the intentional use of lethal drugs by physicians because of international variations in the legal status of this practice. Bibliographic database searches were supplemented by expert consultation and hand searching of reference lists. The sensitivity of the search strategy was tested using a set of 77 articles meeting our inclusion criteria. Two researchers extracted end-of-life practice definitions, study methods and available comparisons across policy contexts. Canadian decision-makers were involved to increase the policy relevance of the review. In sum, 329 empirical studies on the intentional use of lethal drugs by doctors were identified, including studies from 19 countries. The bibliographic search captured 98.7% of studies initially identified as meeting the inclusion criteria. Studies on the intentional use of lethal drugs were conducted in jurisdictions with permissive (62%) and restrictive policies (43%). The most common study objectives related to the frequency of end-of-life practices, determinants of practices, and doctors' adherence to regulatory standards. Large variations in definitions and research methods were noted across studies. The use of a descriptive classification was useful to translate end-of-life practice definitions across countries. A few studies compared end-of-life practice in countries with

  1. Media coverage of medical decision making at the end of life: a Belgian case study.

    Science.gov (United States)

    Van Brussel, Leen; Van Landeghem, Paul; Cohen, Joachim

    2014-01-01

    This article presents a content analysis of Belgian media coverage of end-of-life decision making. The authors examine a selection of press articles and the differences among media genres in covering the issue. In general terms, they found an overreporting of euthanasia; a focus on dying processes resulting from cancer and Alzheimer's disease; and an attention to political discussions and political voices, which outnumber patient voices. In genre-specific terms, unlike mainstream media, niche media reported less mediagenic aspects of the end of life. Finally, although popular mainstream media focus on personal aspects of the end-of-life, elite mainstream media privilege political aspects.

  2. End-of-life practices at a Lebanese hospital: courage or knowledge?

    Science.gov (United States)

    Gebara, Jouhayna; Tashjian, Hera

    2006-10-01

    End-of-life care requires knowledgeable and culturally sensitive clinicians to assist patients and families dealing with the difficult journey of death. The authors present important end-of-life considerations for health care providers dealing with culturally diversified patients. A case study approach is used illustrating two case vignettes derived from the practice of an intensive care setting of a tertiary teaching facility in a large urban area in Lebanon. In a multidisciplinary fashion, practices of end of life were explored and a protocol developed to guide health care providers. Special cultural values were identified such as importance of family involvement and religious beliefs. Implications for practice are described.

  3. Recruiting end-of-life cancer patients in the Netherlands for a study on suffering and euthanasia requests.

    Science.gov (United States)

    Ruijs, C D M; Goedhart, J; Kerkhof, A J F M; van der Wal, G; Onwuteaka-Philipsen, B D

    2011-12-01

    In the Netherlands, GPs performed euthanasia or physician-assisted suicide (EAS) in ∼1 of 10 end-of-life cancer patients in their care. Of all explicit requests for EAS directed at GPs, ∼44% resulted in EAS. However, the suffering of patients who do and do not request EAS has never been studied. An important barrier for such research is the low prevalence of end-of-life cancer patients per practice (on average two/year). We studied whether it is possible to recruit end-of-life cancer patients, following-up for requests for EAS (if any), in an interview study in general practice, whether selection occurred and which were the threats and opportunities to recruitment. Our target was to recruit at least 50 patients. Characteristics of all eligible patients were monitored. One in every three eligible patients were recruited by 44 GPs in a 3-year inclusion period, resulting in 64 patients in the interview study with follow-up until death. The prevalence of explicit requests for EAS was higher (27%; P = 0.026) in the interview sample, and the presence of a depressed mood according to the GP was lower (5%; P = 0.013) than in the sample with eligible but not participating patients. Recruitment of slightly more than the minimal target number of end-of-life cancer patients in this study in general practice was realized. Monitoring of all eligible patients permitted to evaluate the selection which occurred. Recruitment through GPs who were direct professional colleagues of one of the researchers was a positive recruitment factor.

  4. Parent′s perspectives on the end-of-life care of their child with cancer: Indian perspective

    Directory of Open Access Journals (Sweden)

    Sneha Magatha Latha

    2016-01-01

    Full Text Available Context: Parents report that end-of-life decisions are the most difficult treatment-related decisions that they face during their child cancer experience. Research from the parent′s perspective of the quality of end-of-life care of their cancer children is scarce, particularly in developing countries like India. Aims: This study aimed to identify the symptoms (medical/social/emotional that most concerned parents at the end-of-life care of their cancer child and to identify the strategies parents found to be helpful during this period. Settings and Design: We wanted to conduct this to focus on the parents perspectives on their cancer child′s end-of-life care and to address the issues that could contribute to the comfort of the families witnessing their child′s suffering. Materials and Methods: The study was conducted at Sri Ramachandra University, Chennai, a Tertiary Care Pediatric Hemato Oncology Unit. Parents who lost their child to cancer, treated in our institution were interviewed with a validated prepared questionnaire. Statistical analysis was performed using SAS statistical software package. Results: Toward death, dullness (30%, irritability (30%, and withdrawn from surroundings (10% were the most common symptoms encountered. About 30% of the children had fear to be alone. About 50% of the children had the fear of death. Pain, fatigue, loss of appetite were the main distressful symptoms that these children suffered from parents′ perspective. Though the parents accepted that the child was treated for these symptoms, the symptom relief was seldom successful. Conclusion: The conclusion of the study was that at the end of their child′s life, parents value obtaining adequate information and communication, being physically present with the child, preferred adequate pain management, social support, and empathic relationships by the health staff members.

  5. Factors associated with family satisfaction with end-of-life care in the ICU: a systematic review.

    Science.gov (United States)

    Hinkle, Laura J; Bosslet, Gabriel T; Torke, Alexia M

    2015-01-01

    Family satisfaction with end-of-life care in the ICU has not previously been systematically reviewed. Our objective was to perform a review, synthesizing published data identifying factors associated with family satisfaction with end-of-life care in critically ill adult populations. The following electronic databases were searched: MEDLINE (Medical Literature Analysis and Retrieval System Online), MEDLINE Updated, EMBASE (Excerpta Medical Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycInfo, and PubMed. Two authors reviewed retrieved titles and abstracts. Studies describing nonadult and non-ICU populations or not addressing end-of-life care, family satisfaction, or factors affecting satisfaction were excluded. The remaining articles underwent full review and data extraction by two authors. Quality was assessed using a checklist based on the recommendations of the Consolidated Standards for Reporting Trials group. The search yielded 1,072 articles, with 23 articles describing 14 studies meeting inclusion criteria. All studies obtained satisfaction data from family members via surveys and structured interviews. Specific communication strategies increasing satisfaction included: expressions of empathy, nonabandonment, and assurances of comfort and provision of written information. Additionally, support for shared decision-making, family presence at time of death, and specific patient-care measures such as extubation before death were associated with increased satisfaction. Good-quality communication, support for shared decision-making, and specific patient-care measures were associated with increased satisfaction with end-of-life care. Assessing the family's desire to participate in shared decision-making may also be an important factor. Few interventions increased satisfaction. Future research is needed to further define optimal communication strategies, understand effective integration of palliative care into the ICU, and define

  6. Promoting health, wellness, and quality of life at the end of life: hospice interdisciplinary perspectives on creating a good death.

    Science.gov (United States)

    Pizzi, Michael A

    2014-01-01

    The purpose of this phenomenological study was to answer the broad questions: what do professional caregivers for the dying think about what they do, and how does that thinking influence their practice in end-of-life care? The participants were 12 hospice professionals working in four specific disciplines: occupational therapy, physical therapy, social work, and nursing. In-depth interviews were conducted and audiotaped, and transcripts were printed. Constant comparison and thematic analysis was performed. One overarching theme and five subthemes were generated. The central theme, "promoting a good death," emerged from the data, as the participants continually discussed health, wellness, and quality-of-life work in which they engaged that were discipline-specific yet overlapping. The subthemes that emerged were: holism; framing and re-framing practice; client- and family-centered care; being with dying; and interdisciplinary team. All participants concluded that their work emanated from a health and wellness lens, and that quality of life at the end of life was their ultimate goal. Quality of life, for each discipline, included doing, being, and becoming one's authentic self until the end of life.

  7. Best interests at end of life: a review of decisions made by the Consent and Capacity Board of Ontario.

    Science.gov (United States)

    Sibbald, Robert W; Chidwick, Paula

    2010-03-01

    When patients are unable to communicate their own wishes, surrogates are commonly used to aid in decision making. Although each jurisdiction has its own rules or legislation governing how surrogates are to make health care decisions, many rely on the notion of "best interests" when no prior expressed wishes are known. We purposively sampled written decisions of the Ontario Consent and Capacity Board that focused on the best interests of patients at the end of life. Interpretive content analysis was performed independently by 2 reviewers, and themes that were identified by consensus as describing best interests were construed, as well as the characteristics of an end-of-life dispute that may be most appropriately handled by an application to the Consent and Capacity Board. We found that many substitute decision makers rely on an appeal to religion or God in their interpretation of best interests, whereas physicians focused narrowly on the clinical condition of the patient in their interpretations. Several lessons are drawn for the benefit of health care teams engaged in end-of-life conflicts with substitute decision makers over the best interests of patients. Copyright 2010 Elsevier Inc. All rights reserved.

  8. Best interests at end of life: an updated review of decisions made by the Consent and Capacity Board of Ontario.

    Science.gov (United States)

    Chidwick, Paula; Sibbald, Robert; Hawryluck, Laura

    2013-02-01

    To increase our understanding of the notion of "best interests" in end of life disagreements through an updated review of decisions made by the Consent and Capacity Board of Ontario. There was a significant increase (235%) in decisions from this tribunal between 2009 and 2011. "Best interests" test is used when no prior expressed wishes are known to the surrogate decision-makers. Purposively sampled written decisions of the Consent and Capacity Board of Ontario between 2003 and 2011 that focused on the "best interests" of patients at the end of life. Interpretive content analysis was performed independently by 3 reviewers, and themes were identified by consensus. We found substitute decision makers (SDMs) rely on an appeal to their own values or religion in their interpretation of best interests; physicians rely on clinical conditions; board emphasizes alignment with Health Care Consent Act. In the more recent cases, we found that SDMs report that patients value suffering; that SDMs have unrealistic hope for recovery and can communicate and get direction from the incapable patient; that SDMs need education on their role and responsibility as SDM; and that SDMs need time to provide consent, and that most proposed treatment plans that were sources of conflict included "palliative care." Several lessons are drawn for the benefit of health care teams engaged in disagreements at end of life with SDMs over the best interests of patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. End-of-life care in U.S. nursing homes: nursing homes with special programs and trained staff for hospice or palliative/end-of-life care.

    Science.gov (United States)

    Miller, Susan C; Han, Beth

    2008-07-01

    The degree to which nursing homes have internal programs for hospice and palliative care is unknown. We used self-reported data from the 2004 National Nursing Home Survey (NNHS) to estimate the prevalence of special programs and (specially) trained staff (SPTS) for hospice or palliative/end-of-life care in U.S. nursing homes. Factors associated with the presence of SPTS for hospice or palliative/end-of-life care were identified. We merged 2004 NNHS data for 1174 nursing homes to county-level data from the 2004 Area Resource File and to Nursing Home 2004 Online Survey, Certification, and Reporting data. chi(2) tests and logistic regression models were applied. Twenty-seven percent of U.S. nursing homes reported (internal) SPTS for hospice or palliative/end-of-life care. After controlling for covariates, we found nonprofit status, being in the southern region of the United States, having an administrator certified by the American College of Health Care Administrators, contracting with an outside hospice provider, and having other specialty programs to be associated with a greater likelihood of nursing homes having SPTS for hospice or palliative/end-of-life care. The largest effects were observed for nursing homes with programs for behavioral problems (adjusted odds ratio [AOR] 3.59; 95% confidence interval [CI] 2.40, 5.37) and for pain management (AOR 5.92; 95% CI 4.09, 8.57). The presence of internal SPTS for hospice or palliative/end-of-life care is prevalent in U.S. nursing homes, and may be preceded by hospice contracting and/or the implementation of specialty programs that assist nursing homes in developing the expertise needed to establish their own palliative care programs.

  10. Communication Matters: Exploring the Intersection of Family and Practitioner End of Life Communication

    Directory of Open Access Journals (Sweden)

    Leah M. Omilion-Hodges

    2017-03-01

    Full Text Available After establishing a baseline understanding of some of the factors that influence and shape family end of life communication, empirical research centered on the communication tendencies of nationally-recognized palliative care clinicians is presented. Because death is no longer confined to the bedroom and individuals are increasingly turning to hospitals and health care institutes to assist with end of life, the role of palliative care practitioners is vital. To that end, common communication-rooted issues that may transpire among various medical personnel are explored. Focus on a shared underlying tension—care vs. cure—links the findings between family and palliative care clinician communication regarding end of life. Practical communication solutions and suggestions are offered to facilitate productive and mindful end of life communication between and among family members and health care practitioners.

  11. Factors Affecting Family Satisfaction with Inpatient End-of-Life Care: e110860

    National Research Council Canada - National Science Library

    Erin Sadler; Brigette Hales; Blair Henry; Wei Xiong; Jeff Myers; Lesia Wynnychuk; Ru Taggar; Daren Heyland; Robert Fowler

    2014-01-01

      Background Little data exists addressing satisfaction with end-of-life care among hospitalized patients, as they and their family members are systematically excluded from routine satisfaction surveys...

  12. Barriers to excellent end-of-life care for patients with dementia

    National Research Council Canada - National Science Library

    Sachs, Greg A; Shega, Joseph W; Cox-Hayley, Deon

    2004-01-01

    ... the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excellent end-of-life care for patients with dementia, including dementia not being viewed as a terminal illness...

  13. Artificial Nutrition (Food) and Hydration (Fluids) at the End of Life

    Science.gov (United States)

    Artificial Nutrition (Food) and Hydration (Fluids) at the End of Life It is very common for doctors to provide ... or recovering from surgery. This is called “artificial nutrition and hydration” and like all medical treatments, it ...

  14. Irradiation and performance evaluation of DUPIC fuel

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Ki Kwang; Yang, M. S.; Song, K. C. [and others

    2000-05-01

    The objectives of the project is to establish the performance evaluation system for the experimental verification of DUPIC fuel. The scope and content for successful accomplishment of the phase 1 objectives is established as follows : irradiation test of DUPIC fuel at HANARO using a noninstrument capsule, study on the characteristics of DUPIC pellets, development of the analysis technology on the thermal behaviour of DUPIC fuel, basic design of a instrument capsule. The R and D results of the phase 1 are summarized as follows : - Performance analysis technology development of DUPIC fuel by model development for DUPIC fuel, review on the extendability of code(FEMAXI-IV, FRAPCON-3, ELESTRESS). - Study on physical properties of DUPIC fuel by design and fabrication of the equipment for measuring the thermal property. - HANARO irradiation test of simulated DUPIC fuel by the noninstrument capsule development. - PIE and result analysis.

  15. Doctors? learning experiences in end-of-life care ? a focus group study from nursing homes

    OpenAIRE

    Fosse, Anette; Ruths, Sabine; Malterud, Kirsti; Schaufel, Margrethe Aase

    2017-01-01

    Background Doctors often find dialogues about death difficult. In Norway, 45% of deaths take place in nursing homes. Newly qualified medical doctors serve as house officers in nursing homes during internship. Little is known about how nursing homes can become useful sites for learning about end-of-life care. The aim of this study was to explore newly qualified doctors? learning experiences with end-of-life care in nursing homes, especially focusing on dialogues about death. Methods House offi...

  16. Empowering family members in end-of-life care decision making in the intensive care unit.

    Science.gov (United States)

    Browning, Annette M

    2009-01-01

    Critical care nurses are often faced with working with families during the end-of-life care of a loved one. Often there is indecisiveness in family members of critically ill patients when faced with making these difficult decisions. The purpose of this manuscript is to describe origins of indecisiveness in family members of critically ill patients who are faced with end-of-life care decisions. Strategies to empower family members during this crucial time are also discussed.

  17. Family Involvement at the End-of-Life and Receipt of Quality Care

    OpenAIRE

    Sudore, RL; Casarett, D; Smith, D.; Richardson, DM; Ersek, M

    2014-01-01

    © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved. Context Most patients will lose decision-making capacity at the end of life. Little is known about the quality of care received by patients who have family involved in their care. Objectives To evaluate differences in the receipt of quality end-of-life care for patients who died with and without family involvement. Methods We retrospectively reviewed the charts of 34,290 decedents from ...

  18. Oncologists' strategies and barriers to effective communication about the end of life.

    Science.gov (United States)

    Granek, Leeat; Krzyzanowska, Monika K; Tozer, Richard; Mazzotta, Paolo

    2013-07-01

    Communicating about the end of life with patients has been reported as one of the most difficult and stressful part of the work of oncologists. Despite this fact, oncologists receive little training in this area, and many do not communicate effectively with patients. The purpose of this analysis, part of a larger study examining oncologists' experiences of patient loss, was to explore oncologists' communication strategies and communication barriers when discussing end-of-life issues with patients. Twenty oncologists were interviewed at three hospitals about their communication strategies on end-of-life issues with patients. The data were analyzed using the grounded theory method. The findings revealed the strategies to effective communication about the end of life included: being open and honest; having ongoing, early conversations; communicating about modifying treatment goals; and balancing hope and reality. Barriers to implementing these strategies fell broadly into three domains, including physician factors, patient factors, and institutional factors. Physician factors included difficulty with treatment and palliation, personal discomfort with death and dying, diffusion of responsibility among colleagues, using the "death-defying mode," lack of experience, and lack of mentorship. Patient factors included, patients and/or families being reluctant to talk about the end of life, language barriers, and younger age. Institutional factors included stigma around palliative care, lack of protocol about end-of-life issues; and lack of training for oncologists on how to talk with patients about end-of-life issues. We conclude by drawing implications from our study and suggest that further research and intervention are necessary to aid oncologists in achieving effective communication about end-of-life issues.

  19. Regional Variation in Primary Care Involvement at the End of Life.

    Science.gov (United States)

    Ankuda, Claire K; Petterson, Stephen M; Wingrove, Peter; Bazemore, Andrew W

    2017-01-01

    Variation in end-of-life care in the United States is frequently driven by the health care system. We assessed the association of primary care physician involvement at the end of life with end-of-life care patterns. We analyzed 2010 Medicare Part B claims data for US hospital referral regions (HRRs). The independent variable was the ratio of primary care physicians to specialist visits in the last 6 months of life. Dependent variables included the rate of hospital deaths, hospital and intensive care use in the last 6 months of life, percentage of patients seen by more than 10 physicians, and Medicare spending in the last 2 years of life. Robust linear regression analysis was used to measure the association of primary care physician involvement at the end of life with the outcome variables, adjusting for regional characteristics. We assessed 306 HRRs, capturing 1,107,702 Medicare Part B beneficiaries with chronic disease who died. The interquartile range of the HRR ratio of primary care to specialist end-of-life visits was 0.77 to 1.21. HRRs with high vs low primary care physician involvement at the end of life had significantly different patient, population, and health system characteristics. Adjusting for these differences, HRRs with the greatest primary care physician involvement had lower Medicare spending in the last 2 years of life ($65,160 vs $69,030; P = .003) and fewer intensive care unit days in the last 6 months of life (2.90 vs 4.29; P care physician involvement in end-of-life care have overall less intensive end-of-life care. © 2017 Annals of Family Medicine, Inc.

  20. A Failing Grade for the German End-of-Life Vehicles Take-Back System

    Science.gov (United States)

    Nakajima, Nina; Vanderburg, Willem H.

    2005-01-01

    The German end-of-life vehicle take-back system is described and analyzed in terms of its impact on the environment and the car companies involved. It is concluded that although this system is often cited as an example of a successful take-back scheme, it is not one that maximizes the value recovered from end-of-life vehicles. As a result,…

  1. Barriers to Excellent End-of-life Care for Patients with Dementia

    OpenAIRE

    Sachs, Greg A.; Shega, Joseph W.; Cox-Hayley, Deon

    2004-01-01

    While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excellent end-of-life care for patients with dementia, including dementia not being viewed as a terminal illness; the nature of the course and treatment decisions in advanced dementia; ...

  2. Companion-Animal Caregiver Knowledge, Attitudes, and Beliefs Regarding End-of-Life Care.

    Science.gov (United States)

    Heuberger, Roschelle A; Pierce, Jessica

    2017-01-01

    Although awareness of end-of-life care is growing within the veterinary field and there appears to be consumer demand for these services, it is unclear exactly what caregivers know about end-of-life options for their companion animals. Are companion-animal caregivers aware of the range of options for their nonhuman animals? What do they value most highly for their nonhuman animals at the end of life? Answers to these and other related questions about caregiver perceptions are important because what they know about end-of-life care and how they approach decision-making for their companion animals will shape the kind of care an animal receives. This article presents the results of a large survey exploring companion-animal caregivers' knowledge, attitudes, and beliefs about end-of-life care, including in-home euthanasia, hospice and palliative care, financial commitment to end-of-life care, insurance usage, and level of comfort in providing care (e.g., subcutaneous fluids) in the home.

  3. Allowing Family to be Family: End-of-Life Care in Veterans Affairs Medical Foster Homes.

    Science.gov (United States)

    Manheim, Chelsea E; Haverhals, Leah M; Jones, Jacqueline; Levy, Cari R

    2016-01-01

    The Medical Foster Home program is a unique long-term care program coordinated by the Veterans Health Administration. The program pairs Veterans with private, 24-hour a day community-based caregivers who often care for Veterans until the end of life. This qualitative study explored the experiences of care coordination for Medical Foster Home Veterans at the end of life with eight Veterans' family members, five Medical Foster Home caregivers, and seven Veterans Health Administration Home-Based Primary Care team members. A case study, qualitative content analysis identified these themes addressing care coordination and impact of the Medical Foster Home model on those involved: (a) Medical Foster Home program supports Veterans' families; (b) Medical Foster Home program supports the caregiver as family; (c) Veterans' needs are met socially and culturally at the end of life; and (d) the changing needs of Veterans, families, and caregivers at Veterans' end of life are addressed. Insights into how to best support Medical Foster Home caregivers caring for Veterans at the end of life were gained including the need for more and better respite options and how caregivers are compensated in the month of the Veteran's death, as well as suggestions to navigate end-of-life care coordination with multiple stakeholders involved.

  4. [The practical wisdom gained in the provision of end-of-life care].

    Science.gov (United States)

    Liu, Ying-Chun; Chiang, Hsien-Hsien

    2014-10-01

    The suffering experienced by nurses while providing end-of-life care to patients influences the lived experience of these nurses. The perspectives of "for the other" and "practical wisdom" may be used to elicit the experience of nurses in caring for dying patients and to help illustrate the ethical contents and meanings of end-of-life care. This study describes the experiences of nurses who have provided end-of life care in hospital settings. In-depth interviews were used to explore the respective experiences of 7 nurses. Data were analyzed using interpretative phenomenological analysis (IPA). The findings show that practicing and engaging in end-of-life care provide nurses the opportunity to acquire practical care wisdom in three categories, including (1) the emotional difficulties of patient care; (2) the limitations of the self; and (3) learning to adjust to the needs and pace of the patient. End-of-life care is an opportunity for both dying patients and nurses to transform and grow spiritually. Dealing with the emotional difficulties of end-of-life care, recognizing their self-limitations in care, and adjusting their care provision to meet the needs and pace of their patients help increase the awareness of nurses to the ethical responsibility they have toward patients. These findings give nurses new perspectives on caring for others.

  5. Teaching end-of-life issues: survey of U.S. dental schools and dentists.

    Science.gov (United States)

    Sirmons, Karen L; Dickinson, George E; Burkett, Tracy L

    2010-01-01

    The aim of this research endeavor was to survey the teaching of end-of-life issues in the curriculum of U.S. dental schools (N=58) and to ascertain changes in education compared to a 1989 study of dental schools. In addition, the aim was to survey practicing dentists in South Carolina (N=400) regarding end-of-life issues. Response rates were 90 percent and 81 percent, respectively. Findings indicated that dental schools today are placing more emphasis on end-of-life issues than twenty years ago. Yet the majority of dentists agreed that more emphasis should be placed on communication skills with patients on end-of-life issues. Moreover, the overwhelming majority of dentists felt that dental school did not prepare them to relate to patients on end-of-life issues. Dentists in general give support to families of deceased patients by sending a card or flowers, attending the funeral, or in some way making personal contact with the family. Perhaps as little as one or two lectures in dental school on dying, death, and bereavement could enhance a dentist's effectiveness in coping with end-of-life issues.

  6. End-of-life resource recovery from emerging electronic products

    DEFF Research Database (Denmark)

    Parajuly, Keshav; Habib, Komal; Cimpan, Ciprian

    2016-01-01

    -case scenario, only 47% of the total materials in RVCs are ultimately recycled. While this low material recovery is mainly due to the lower plastic recycling rate, other market realities and the complex material flows in the recycling chain also contribute to it. The study provides a robust methodological...... at a conventional ‘shred-and-separate’ type preprocessing plant in Denmark. A detailed material flow analysis was performed throughout the recycling chain. The results show a mismatch between product design and EoL processing, and the lack of practical implementation of ‘Design for EoL’ thinking. In the best...... approach for assessing the EoL performance based on the knowledge of a product and its complex recycling chain. The lessons learned can be used to support both the design and EoL processing of products with similar features, which carry a high potential for resource recovery, especially at the initial...

  7. The drama of end of life care at home.

    Science.gov (United States)

    Newbury, Jenny

    Many terminally ill patients want to die at home. Family carers are fundamental to achieving this, but often feel anxious and unprepared for the role. Supporting them is vital in palliative care. To explore the experiences of carers of patients dying at home, in particular their expectations and preparedness for the dying process. The study followed a qualitative approach. In-depth, semi-structured interviews with 15 carers were carried out. Carers experienced uncertainty and felt unrehearsed for their role. They were reluctant to seek information to give them a script for their performance because it was too painful to contemplate the patient's death. The carers needed the direction of health and social care professionals, and the help of paid carers, but experiences of these services varied. The study highlighted the drama of the situation for carers, and the anxiety of being the leading player on stage with minimal preparation. Nurses play a crucial role in supporting carers and can use a "dramaturgical" perspective to guide them in giving carers the direction they need.

  8. End of life care and decision making: Opinions and experiences of the general public, bereaved relatives, and professionals

    NARCIS (Netherlands)

    N.J.H. Raijmakers (Natasja)

    2013-01-01

    textabstractEnd-of-life care aims to improve quality of life of patients and their relatives facing problems associated with life-threatening illness in the last days of life. End-of-life decision-making is an important aspect of end-of-life care that can have a significant impact on the process of

  9. Feedback on end-of-life care in dementia: the study protocol of the FOLlow-up project

    NARCIS (Netherlands)

    Boogaard, J.A.; van Soest-Poortvliet, M.C.; Anema, J.R.; Achterberg, W.P.; Hertogh, C.M.P.M.; de Vet, H.C.W.; van der Steen, J.T.

    2013-01-01

    Background: End-of-life care in dementia in nursing homes is often found to be suboptimal. The Feedback on End-of-Life care in dementia (FOLlow-up) project tests the effectiveness of audit- and feedback to improve the quality of end-of-life care in dementia. Methods/Design. Nursing homes

  10. Concerns about end-of-life care and support for euthanasia.

    Science.gov (United States)

    Givens, Jane L; Mitchell, Susan L

    2009-08-01

    Popular support for euthanasia is known to vary according to sociodemographic characteristics. However, little is known about whether support is associated with concerns regarding the emotional, physical, and economic burdens of end-of-life care. This study used data from the 1998 General Social Survey, a national survey of community-dwelling adults. The outcome variable assessed the respondents' support for a doctor's right to end life in the setting of terminal illness. Independent variables assessed the following concerns: 1) concern about the emotional burden of end-of-life decision making for family members; 2) worry about the economic burden of terminal illness; 3) concern about pain at the end of life; 4) worry that lack of money or insurance will result in second-class end-of-life care; and 5) belief that their religious community will be helpful at the end of life. Multivariable logistic regression estimated the independent effect of these concerns on support for euthanasia, adjusting for sociodemographic characteristics. Of 786 respondents, 70.6% approved of euthanasia in the setting of terminal illness. In adjusted analyses, respondents with concerns about the emotional toll of decision making on family members, economic burden, and poor health care because of lack of insurance were significantly more likely to support euthanasia. Respondents with faith in the helpfulness of their religious community were less likely to support euthanasia. In conclusion, emotional and economic concerns about end-of-life care were associated with support for the right to euthanasia. Future work can evaluate whether alleviating these concerns may reduce the perceived desire for euthanasia by patients near the end of life.

  11. Similarity, agreement, and assumed similarity in proxy end-of-life decision making.

    Science.gov (United States)

    McDade-Montez, Elizabeth; Watson, David; Beer, Andrew

    2013-12-01

    Medical decisions near the end of life are often made by proxies who can be inaccurate in their judgments of patient preferences. Given that accuracy in surrogate decision making is an important goal in end-of-life decision making, and in light of that previously seen levels of accuracy reflect substantial disagreement, error, or both, this study examined both relationship and individual factors that potentially affect surrogate accuracy. Specifically, this study examined similarity, agreement, and assumed similarity-a process whereby raters use their own traits and preferences to rate another person-in spousal ratings of end-of-life treatment. This study expands on previous research by examining the potential influence of relationship factors and assumed similarity on end-of-life decision making among a sample of newlyweds. Newly married couples (n = 197) completed self and spouse measures of hypothetical end-of-life preferences and scales assessing marital satisfaction, personality, and attitudes. Results indicate a moderate level of similarity on husband and wife self-rated end-of-life treatment preferences (rs = .18-.29) and a moderate level of agreement between self and proxy ratings (rs = .17-.41). The largest correlations were seen between self ratings and proxy ratings (e.g., husband self ratings and husband proxy ratings of wife preferences, rs = .46-.69), reflecting strong assumed similarity in proxy ratings. For wives, similarity with husbands on a few attitudinal variables (i.e., spirituality, moral strictness, and conservatism) influenced proxy accuracy. Recognizing the potential impact of personal preferences on proxy ratings, as well as the potential influence of relationship factors, may help improve proxy accuracy and end-of-life care for patients and families.

  12. Current debates on end-of-life sedation: an international expert elicitation study.

    Science.gov (United States)

    Papavasiliou, Evangelia Evie; Payne, Sheila; Brearley, Sarah

    2014-08-01

    End-of-life sedation, though increasingly prevalent and widespread internationally, remains one of the most highly debated medical practices in the context of palliative medicine. This qualitative study aims to elicit and record the perspectives of leading international palliative care experts on current debates. Twenty-one professionals from diverse backgrounds, sharing field-specific knowledge/expertise defined by significant scholarly contribution on end-of-life sedation, were recruited. Open-ended, semi-structured interviews, following a topic-oriented structure reflecting on current debates, were conducted. Results were analysed using thematic content analysis. Three main aspects of sedation were identified and discussed as potentially problematic: (a) continuous deep sedation as an extreme facet of end-of-life sedation, (b) psycho-existential suffering as an ambivalent indication for sedation and (c) withdrawal or withholding of artificial nutrition and hydration as potentially life-shortening. On these grounds, concerns were reported over end-of-life sedation being morally equivalent to euthanasia. Considerable emphasis was placed on intentions as the distinguishing factor between end-of-life acts, and protective safeguards were introduced to distance sedation from euthanasia. This study shows that, despite the safeguards introduced, certain aspects of sedation, including the intentions associated with the practice, are still under question, parallels being drawn between end-of-life sedation and euthanasia. This reaffirms the existence of a grey area surrounding the two practices, already evidenced in countries where euthanasia is legalized. More clarity over the issues that generate this grey area, with their causes being uncovered and eliminated, is imperative to resolve current debates and effectively inform research, policy and practice of end-of-life sedation.

  13. Proxy perspectives regarding end-of-life care for persons with cancer.

    Science.gov (United States)

    Bakitas, Marie; Ahles, Tim A; Skalla, Karen; Brokaw, Frances C; Byock, Ira; Hanscom, Brett; Lyons, Kathleen Doyle; Hegel, Mark T

    2008-04-15

    Each year, greater than a half million people die of cancer in the U.S. Despite progress in increasing access to palliative oncology services, end-of-life care still needs improvement. Measuring the quality of the end-of-life experience is difficult because of patient debility and reduced consciousness as death approaches. Family proxies have been proposed as valuable informants regarding the quality of end-of-life care. This article describes family proxy perspectives concerning care at the end of life in patients who died of advanced cancer. In the context of a novel outpatient palliative care demonstration project, 125 family proxy respondents completed a structured survey by telephone 3 months to 6 months after the patient's death from breast, lung, or gastrointestinal cancer. Four key quality of care indicators were measured: decision-making and physician communication, location of death, hospice involvement, and end-of-life symptoms. Proxies reported that 78% to 81% of patients completed at least 1 form of advance directive and approximately half of them were helpful in guiding care. Communication with physicians regarding end-of-life treatment wishes occurred in 67% of cases, but only 57% of the patients actually made a plan with their physician to ensure that their wishes were followed. The majority of patients died in their location of choice, most often at home, and greater than half had hospice involvement for an average of 41.8 days before death. During the last week of life, the majority of patients experienced troublesome physical and emotional symptoms. Measurement of proxy perspectives is feasible as an indicator of the quality of end-of-life care, and the results of the current study provide actionable data for areas of improvement in palliative oncology care.

  14. Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

    Science.gov (United States)

    Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia

    2017-07-01

    Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

  15. [End-of-life in specialized medical pediatrics department: A French national survey].

    Science.gov (United States)

    Ravanello, Alice; Desguerre, Isabelle; Frache, Sandra; Hubert, Philippe; Orbach, Daniel; Aubry, Régis

    2017-03-01

    In France, most of children die in the hospital. This national survey aimed to achieve better understanding of end-of life care in specialized medical pediatrics departments for children facing the end-of-life, identify the available resources, put forward the difficulties encountered by professionals and describe end-of-life paths of children who died in these departments. This study is based on a nationwide survey conducted among all existing specialized medical pediatrics departments (onco-haematology, neurology, reanimation) in France in 2015. Among 94 specialized medical pediatrics departments in France, 53 participated in our survey (response rate=56%). At the time of the survey, 13% of inpatients were facing the end-of-life. Regarding training, 13% of departments did not have personnel trained in palliative care and 21% did not set up any professional support. However, when taking care of a child's end of life in 2014, 77% of these departments solicited a regional resource team of pediatric palliative care. This survey helps describe 225 end-of-life paths of children decease of a terminal illness in the specialized pediatrics departments. Seventy-two percent suffered from refractory symptoms before their death, 64% were concerned by a terminal sedation and 75% by a limitation of life-sustaining treatment decision. End-of-life care is a reality for specialized pediatrics departments. The frequency of major and refractory symptoms often requires the completion of sedation. The resources of service are acceptable but some deficiencies have been noted especially concerning training and support for caregivers, adaptation of premises or family support. Copyright © 2017. Published by Elsevier SAS.

  16. End-of-Life Care Intensity and Hospice Use: A Regional-Level Analysis

    Science.gov (United States)

    Wang, Shi-Yi; Aldridge, Melissa D.; Gross, Cary P.; Canavan, Maureen; Cherlin, Emily; Johnson-Hurzeler, Rosemary; Bradley, Elizabeth

    2016-01-01

    Objectives Despite increased hospice use over the last decade, end-of-life care intensity continues to increase. To understand this puzzle, we sought to examine regional variation in intensive end-of-life care and determine its associations with hospice use patterns. Methods Using Medicare claims for decedents age ≥ 66 years in 2011, we assessed end-of-life care intensity in the last 6 months of life across hospital referral regions (HRRs) as measured by proportion of decedents per HRR experiencing hospitalization, emergency department (ED) use, intensive care unit (ICU) admission, and number of days spent in hospital (hospital-days) and ICU (ICU-days). Using hierarchical generalized linear models and adjusting for patient characteristics, we examined whether these measures were associated with overall hospice use, very short (≤ 7 days), medium (8–179 days), or very long (≥180 days) hospice enrollment, focusing on very short stay. Results End-of-life care intensity and hospice use patterns varied substantially across HRRs. Regional-level end-of-life care intensity was positively correlated with very short hospice enrollment. Comparing HRRs in the highest versus the lowest quintiles of intensity in end-of-life care, regions with more intensive care had higher rates of very short hospice enrollment, with adjusted odds ratios [AOR] 1.14 (99% confidence interval [CI]: 1.04–1.25) for hospitalization; 1.23 (CI: 1.12–1.36) for ED use; AOR 1.25 (CI: 1.14–1.38) for ICU admission; AOR 1.10 (CI: 1.00–1.21) for hospital-days and AOR 1.20 (CI: 1.08–1.32) for ICU-days. Conclusions At the regional level, increased end-of-life care intensity was consistently associated with very short hospice use. PMID:27111747

  17. The role and timing of palliative medicine consultation for women with gynecologic malignancies: association with end of life interventions and direct hospital costs.

    Science.gov (United States)

    Nevadunsky, Nicole S; Gordon, Sharon; Spoozak, Lori; Van Arsdale, Anne; Hou, Yijuan; Klobocista, Merieme; Eti, Serife; Rapkin, Bruce; Goldberg, Gary L

    2014-01-01

    Aggressive care interventions at the end of life (ACE) are reported metrics of sub-optimal quality of end of life care that are modifiable by palliative medicine consultation. Our objective was to evaluate the association of inpatient palliative medicine consultation with ACE scores and direct inpatient hospital costs of patients with gynecologic malignancies. A retrospective review of medical records of the past 100 consecutive patients who died from their primary gynecologic malignancies at a single institution was performed. Timely palliative medicine consultation was defined as exposure to inpatient consultation ≥ 30 days before death. Metrics utilized to tabulate ACE scores were ICU admission, hospital admission, emergency room visit, death in an acute care setting, chemotherapy at the end of life, and hospice admission evaluation is needed to validate the impact of palliative medicine consultation on quality of life and healthcare costs. © 2013. Published by Elsevier Inc. All rights reserved.

  18. Impact of End-of-Life manoeuvres on the collision risk in protected regions

    Science.gov (United States)

    Frey, Stefan; Lemmens, Stijn; Bastida Virgili, Benjamin; Flohrer, Tim; Gass, Volker

    2017-09-01

    The Inter-Agency Space Debris Coordination Committee (IADC) Space Debris Mitigation Guidelines, issued in 2002 and revised in 2007, address the post mission disposal of objects in orbit. After their mission, objects crossing the Low Earth Orbit (LEO) should have a remaining lifetime in orbit not exceeding 25 years. Objects near the Geostationary Orbit (GEO) region should be placed in an orbit that remains outside of the GEO protected region. In this paper, the impact of satellites and rocket bodies performing End-of-Life (EOL) orbital manoeuvres on the collision risk in the LEO and GEO protected regions is investigated. The cases of full or partial compliance with the IADC post mission disposal guideline are studied. ESA's Meteoroid and Space Debris Terrestrial Environment Reference (MASTER) model is used to compare the space debris flux rate of the object during the remaining lifetime estimated for the pre-EOL-manoeuvre and for the post-EOL-manoeuvre orbit. The study shows that, on average, the probability of collision can be significantly decreased by performing an EOL-manoeuver.

  19. CE: Original Research: End-of-Life Care Behind Bars: A Systematic Review.

    Science.gov (United States)

    Wion, Rachel K; Loeb, Susan J

    2016-03-01

    : To conduct a systematic review of the published research literature on end-of-life (EOL) care in prisons in order to determine the current state of the science and suggest implications for nursing practice and areas for future research.Applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a comprehensive search of the literature using the following databases: CINAHL, Criminal Justice Abstracts, the National Criminal Justice Reference Service, PsycINFO, PubMed, and Sociological Abstracts. All databases were searched from the time of their inception through June 2014. All English-language articles that reported on original quantitative and qualitative research involving EOL or palliative care delivered to prisoners were included. We abstracted data, using the matrix method, and independently reviewed and graded the evidence on its level of strength and quality in accordance with the Johns Hopkins Nursing Evidence-Based Practice rating scales.Nineteen articles, all published between 2002 and 2014, met the inclusion criteria. Of these, 53% were published between 2009 and 2014, and 58% reported findings from qualitative research. One article reported on research conducted in the United Kingdom; the remaining 18 reported on research conducted in the United States. Capacity (that is, the number of prisoners requiring EOL care and the ability of the prison to accommodate them) and the site of EOL care delivery varied across studies, as did the criteria for admission to EOL or hospice services. Care was provided by prison health care staff, which variously included numerous professional disciplines, corrections officers, and inmate caregivers. The inmate caregivers, in particular, provided a wide array of services and were viewed positively by both EOL patients and health care staff. There are insufficient data to characterize the patients' and inmate caregivers' perceptions of the EOL care staff and the quality

  20. Sustainable Logistics of End-of-life Vehicles – Trends in Europe

    Directory of Open Access Journals (Sweden)

    Agata Mesjasz-Lech

    2017-06-01

    Full Text Available Purpose of the article: In the article we have focused on the trends determining the development of reverse logistics of end-of-life vehicles in selected European countries. The analysis concentrates on quantity of end-of-life vehicles which are especially interesting for reverse logistics because of their fitness for recovery or reuse. End-of-life products contain fully valuable elements which, according to the idea of sustainable use of resources, should be recovered. Accordingly, reverse logistics aims at protecting natural resources and the environment through reintroduction of processed waste materials into the economic cycle as valuable products and materials. Methodology/methods: The aim of the article was achieved on the basis of a critical analysis of subject literature and the analysis of statistical data. In the article the method of descriptive and mathematical statistics and dynamic analysis were used. The 2006–2014 years were analyzed. The data come from the data base of the Eurostat, the statistical office of the European Union. The following variables were taken into account: the amount of end-of-life vehicles (in tonnes and in number of cars, reuse level (in tonnes, recovery level (in tonnes, and recycling level (in tonnes. The analysis was based on a t-Student test for two average values of dependent samples, sign test and the Wilcoxon signed rank test. In order to see if the reverse logistics actions implemented in European countries were effective, the analysis compares the average values of individual variables from the year 2014 and 2006. Measurements were done for the same countries on the same element of population. The chain indexes and the average change tempo for specified variables were calculated. The similarity of the formation of specified variables in each year was compared on the basis of the index of similarity structures. Scientific aim: The scientific aim of the article is to identify the basic trends

  1. Discussions by elders and adult children about end-of-life preparation and preferences.

    Science.gov (United States)

    Glass, Anne P; Nahapetyan, Lusine

    2008-01-01

    In the United States, 73% of deaths occur among people aged 65 years or older. Although most would prefer to die at home after a short illness, most actually die in institutions after prolonged declines. Despite this discrepancy, elders and their adult children often do not discuss end-of-life preferences. Use of advance directives has not been widespread, and people often avoid the subject until a crisis. This project focused on informal family communication about end-of-life preparation and preferences, about which little is known. In May 2006, we conducted in-depth exploratory interviews with 15 older adults about their end-of-life preparation and preferences and with 15 younger adults about their parents' end-of-life preparation and preferences. The interview included an item rating the depth of discussion. Participants in both groups were primarily female and white. Mean age of older adults was 78.6 years (range, 70-88 years). Mean age of younger adults was 53.1 years (range, 42-63 years); mean age of their parents was 82.6 years (range, 68-99 years). Nine older adults reported discussing end-of-life preparation and preferences with their adult children; six had barely discussed the topic at all. Ten younger adults reported having talked with their parents about end-of-life preparation and preferences; five had not discussed it. Barriers to discussions about end-of-life preparation and preferences were fear of death, trust in others to make decisions, family dynamics, and uncertainty about preferences. Facilitators for discussion were acceptance of the reality of death, prior experience with death, religion or spirituality, and a desire to help the family. Successful strategies included casually approaching the topic and writing down end-of-life preparation and preferences. Knowing the obstacles to and facilitators for discussion can help health care and public health professionals target approaches to encouraging elders and their families to discuss end-of-life

  2. Physician Communication in Pediatric End-of-Life Care: A Simulation Study.

    Science.gov (United States)

    Bateman, Lori Brand; Tofil, Nancy M; White, Marjorie Lee; Dure, Leon S; Clair, Jeffrey Michael; Needham, Belinda L

    2016-12-01

    The objective of this exploratory study is to describe communication between physicians and the actor parent of a standardized 8-year-old patient in respiratory distress who was nearing the end of life. Thirteen pediatric emergency medicine and pediatric critical care fellows and attendings participated in a high-fidelity simulation to assess physician communication with an actor-parent. Fifteen percent of the participants decided not to initiate life-sustaining technology (intubation), and 23% of participants offered alternatives to life-sustaining care, such as comfort measures. Although 92% of the participants initiated an end-of-life conversation, the quality of that discussion varied widely. Findings indicate that effective physician-parent communication may not consistently occur in cases involving the treatment of pediatric patients at the end of life in emergency and critical care units. The findings in this study, particularly that physician-parent end-of-life communication is often unclear and that alternatives to life-sustaining technology are often not offered, suggest that physicians need more training in both communication and end-of-life care. © The Author(s) 2015.

  3. Complementary and alternative medicine use in children with cancer at the end of life.

    Science.gov (United States)

    Heath, John A; Oh, Luke J; Clarke, Naomi E; Wolfe, Joanne

    2012-11-01

    The use of complementary and alternative medicines (CAM) in patients with cancer is well recognized. Little is known, however, about the use of CAM in children with cancer during the end-of-life period. We interviewed 96 parents of children who had died of cancer in Melbourne, Australia between 1996 and 2004 to establish the prevalence of CAM use during the end-of-life period. Factors affecting the use of CAM were explored. We also determined the perceived efficacy of CAM use and its effect on the overall experience of end-of-life care. Thirty percent of parents caring for a child with cancer reported using some form of CAM during the end-of-life period, with 44% of these families using more than one type. The most common therapies used were organic foods, faith healing, and homeopathy. There was a strong correlation between open discussion about treatment alternatives with the treating physician and parental use of CAM. The majority (78%) of respondents felt CAM use had benefited their child significantly and most felt it had not caused additional suffering. A significant number of children with cancer are administered CAM during the end-of-life period and most families in our study had found it beneficial. The main focus should continue to be on open and honest communication between caregivers and families in order to provide the best possible holistic care.

  4. Using routine data to improve palliative and end of life care.

    Science.gov (United States)

    Davies, Joanna M; Gao, Wei; Sleeman, Katherine E; Lindsey, Katie; Murtagh, Fliss E; Teno, Joan M; Deliens, Luc; Wee, Bee; Higginson, Irene J; Verne, Julia

    2016-09-01

    Palliative and end of life care is essential to healthcare systems worldwide, yet a minute proportion of research funding is spent on palliative and end of life care research. Routinely collected health and social care data provide an efficient and useful opportunity for evaluating and improving care for patients and families. There are excellent examples of routine data research in palliative and end of life care, but routine data resources are widely underutilised. We held four workshops on using routinely collected health and social care data in palliative and end of life care. Researchers presented studies from the UK, USA and Europe. The aim was to highlight valuable examples of work with routine data including work with death registries, hospital activity records, primary care data and specialist palliative care registers. This article disseminates that work, describes the benefits of routine data research and identifies major challenges for the future use of routine data, including; access to data, improving data linkage, and the need for more palliative and end of life care specific data. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  5. Intellectual Disabilities and Decision Making at End of Life: A Literature Review.

    Science.gov (United States)

    Kirkendall, Abbie; Linton, Kristen; Farris, Saritha

    2017-11-01

    Individuals with an intellectual disability are vulnerable to having end-of-life decisions made for them merely due to the presence of a disability. As a result, decisions made by others may not reflect the exact wishes of the individual. This review examines literature on individuals with an intellectual disability in making end-of-life decisions from the years 2000 to 2014. A total of 38 articles were found with 12 articles having a direct focus on end-of-life decision making. The emerging themes include the following: (i) assumption of lack of capacity, (ii) inconsistency in evaluating capacity and communication challenges and (iii) third party decisions. Earlier discussions about end-of-life planning before the diagnosis of a life-limiting illness would be beneficial. Lacking is a consistent approach to determining capacity for individuals with an intellectual disability. The findings from this review provide a foundation for a decision tree in end-of-life decision making for individuals with an intellectual disability. © 2016 John Wiley & Sons Ltd.

  6. Nursing and theatre collaborate: an end-of-life simulation using forum theatre.

    Science.gov (United States)

    Tuxbury, Janis S; Wall McCauley, Patricia M; Lement, Wendy

    2012-08-01

    End-of-life care is an essential part of undergraduate nursing education. However, students may not have the opportunity to be exposed to an actual end-of-life situation during clinical rotations. A pilot project was implemented to evaluate the use of forum theatre to teach end-of-life care to undergraduate nursing students. A simulation used live actors, with theatre faculty and students playing the roles of a hospice patient, family members, and nursing students providing end-of-life care. Additional nursing students were participant observers. Using forum theatre methods, students identified important moments that occurred during the simulation and suggested alternative actions for those moments. The simulation was repeated using those alternatives and was evaluated by the students. Group debriefing was provided by nursing faculty with all students. A reflective journal entry was completed by all students. Project outcomes indicated that forum theatre was an effective teaching method for the topic of end-of-life care. Copyright 2012, SLACK Incorporated.

  7. Palliative and end of life care for people living with dementia in care homes: part 1.

    Science.gov (United States)

    Mitchell, Gary; Agnelli, Joanne; McGreevy, Jessie; Diamond, Monica; Roble, Herlindina; McShane, Elaine; Strain, Joanne

    2016-06-22

    The terms palliative and end of life care are often used interchangeably and healthcare practitioners may perceive that palliative care is only appropriate during the terminal stages of an illness. This article, the first of two parts, provides healthcare practitioners with an overview of the concept of palliative care. It explains how this can be differentiated from end of life care and how it should be commenced in a timely manner, so that people who are living with dementia can contribute to the planning of their future care and death. The policies and tools used in the provision of palliative and end of life care are discussed, including advance care planning and The Gold Standards Framework. The article is framed in a care home context; there is little research about how to optimise palliative care for people living with dementia in care homes. The second part of this article will discuss end of life care and the best practices for providing end of life care, including nutrition and hydration, oral hygiene, pain management and spiritual care.

  8. Preferences on end-of-life decisions among older Chinese in Macau.

    Science.gov (United States)

    Ho, Sio-Wa; Sanders, Gregory F

    2015-03-01

    The purpose of the present study was to learn about the perspectives on end-of-life decision making among older Chinese people in Macau. A qualitative approach was used, and interviews were conducted with 18 Chinese aged 65 years or older. Four major themes were identified: (a) institutionalized care at the end of life was preferred as not to be a burden on family, (b) life-prolonging measures were not preferred, (c) funeral arrangement preferences were based on personal and religious beliefs, and (d) end-of-life decision making would be deferred to others. These themes provide an understanding of personal preferences of older Chinese on end-of-life issues, and personal preferences are always secondary to their respect toward family and medical doctors. This compliance with family and medical authority can be understood through Chinese cultural beliefs. Knowledge of cultural influences is needed for nursing professionals to deal effectively with older adults and families regarding end-of-life issues. © The Author(s) 2014.

  9. Futility: clinical decisions at the end-of-life in women with ovarian cancer.

    Science.gov (United States)

    von Gruenigen, Vivian E; Daly, Barbara J

    2005-05-01

    The purpose of this article is to provide a review of the clinical meaning of futility, discuss current normative uses of futility assessments and propose guidelines for clinicians to use in dialogue regarding treatment decisions for patients with advanced ovarian cancers. We performed a MEDLINE literature search of relevant clinical articles for this review that discussed futility and the application to women with ovarian cancer. Medical futility refers to treatments that serve no physiologic, quantitative or qualitative meaningful purpose. Despite the growth in options focused on symptom management rather than disease eradication, including hospice programs and the more recent development of palliative care programs, there is evidence that many patients continue to receive aggressive interventions, including chemotherapy, until days before their death. While the legal and moral acceptability of treatment limitation is well established, clarity in establishing goals of care, timing of the transition from cure to palliation and communication of specific decisions to withhold further aggressive interventions remain problematic for both patients and clinicians. There continues to be a distinct need for both better understanding of the dynamics of patient choice and increased education of physicians in addressing end-of-life care planning. It is essential that we continue to test specific communication and supportive interventions that will improve our ability to help patients avoid the burden of futile therapy while maintaining hope.

  10. Experiences and Opinions Related to End-of-Life Discussion: From Oncologists' and Resident physicians' Perspectives.

    Science.gov (United States)

    Koh, Su-Jin; Kim, Shinmi; Kim, JinShil; Keam, Bhumsuk; Heo, Dae Seog; Lee, Kyung Hee; Kim, Bong-Seog; Kim, Jee Hy; Chang, Hye Jung; Baek, Sun Kyung

    2017-07-03

    The aims of this study were to explore how oncologists and resident physicians practice end-of-life (EOL) discussions and to solicit their opinions on EOL discussions as a means to improve the quality of EOL care. A survey questionnaire was developed to explore the experiences and opinions about EOL discussions among oncologists and residents. Descriptive statistics, the t-test, and the Chi-square test were performed for the analyses. A total of 147 oncologists and 229 residents participated in this study. The study respondents reported diverse definitions of "terminal state", and most respondents tried to disclose the patient's condition to the patient and/or family members. Both groups were involved in EOL care discussions, with a rather low satisfaction level (57.82/100). The best timing to initiate discussion was considered when metastasis or disease recurrence occurred or when withdrawal of chemotherapy was anticipated. Furthermore, the study respondents suggested that patients and their family members should be included in the EOL discussion. Medical, legal, and ethical knowledge and communication difficulties along with practical issues were revealed as barriers and facilitators for EOL discussion. This study explored various perspectives of oncologists and resident physicians for EOL discussion. Since the Life-Sustaining-Treatment Decision-making Act will be implemented shortly in Korea, now is the time for oncologists and residents to prepare themselves by acquiring legal knowledge and communication skills. To achieve this, education, training, and clinical tools for healthcare professionals are required.

  11. Barriers to Hospice Care in Trauma Patients: The Disparities in End-of-Life Care.

    Science.gov (United States)

    Haines, Krista L; Jung, Hee Soo; Zens, Tiffany; Turner, Scott; Warner-Hillard, Charles; Agarwal, Suresh

    2018-01-01

    End-of-life and palliative care are important aspects of trauma care and are not well defined. This analysis evaluates the racial and socioeconomic disparities in terms of utilization of hospice services for critically ill trauma patients. Trauma patients ≥15 years old from 2012 to 2015 were queried from the National Trauma Databank. Chi-square and multivariate logistic regression analyses for disposition to hospice were performed after controlling for age, gender, comorbidities, injury severity, insurance, race, and ethnicity. Negative binomial regression analysis with margins for length of stay (LOS) was calculated for all patients discharged to hospice. Chi-square analysis of 2 966 444 patient's transition to hospice found patients with cardiac disease, bleeding and psychiatric disorders, chemotherapy, cancer, diabetes, cirrhosis, respiratory disease, renal failure, cirrhosis, and cerebrovascular accident (CVA) affected transfer ( P care than Caucasian patients (OR: 0.65, 0.60, 0.73; P care and significantly affect LOS. Our data demonstrate prominent racial and socioeconomic disparities exist, with uninsured and minority patients being less likely to receive hospice services and having a delay in transition to hospice care when compared to their insured Caucasian counterparts.

  12. Life cycle assessment of EPS and CPB inserts: design considerations and end of life scenarios.

    Science.gov (United States)

    Tan, Reginald B H; Khoo, Hsien H

    2005-02-01

    Expanded polystyrene (EPS) and corrugated paperboard (CPB) are used in many industrial applications, such as containers, shock absorbers or simply as inserts. Both materials pose two different types of environmental problems. The first is the pollution and resource consumption that occur during the production of these materials; the second is the growing landfills that arise out of the excessive disposal of these packaging materials. Life cycle assessment or LCA will be introduced in this paper as a useful tool to compare the environmental performance of both EPS and CPB throughout their life cycle stages. This paper is divided into two main parts. The first part investigates the environmental impacts of the production of EPS and CPB from 'cradle-to-gate', comparing two inserts--both the original and proposed new designs. In the second part, LCA is applied to investigate various end-of-life cases for the same materials. The study will evaluate the environmental impacts of the present waste management practices in Singapore. Several 'what-if' cases are also discussed, including various percentages of landfilling and incineration. The SimaPro LCA Version 5.0 software's Eco-indicator 99 method is used to investigate the following five environmental impact categories: climate change, acidification/eutrophication, ecotoxicity, fossil fuels and respiratory inorganics.

  13. End-of-Life Vehicles management: Italian material and energy recovery efficiency.

    Science.gov (United States)

    Santini, Alessandro; Morselli, Luciano; Passarini, Fabrizio; Vassura, Ivano; Di Carlo, Salvatore; Bonino, Francesco

    2011-03-01

    Each European Member State must comply with Directive 2000/53/EC recycling and recovery targets by 2015, set to 85% and 95%, respectively. This paper reports a shredder campaign trial developed and performed in Italy at the beginning of 2008. It turns out to be the first assessment about the critical aspects belonging to the Italian End-of-Life Vehicles (ELVs) reverse supply chain involving 18 dismantling plants, a shredder plant and 630 ELV representatives of different categories of vehicles treated in Italy during 2006. This trial aims at improving the experimental knowledge related to ELVs added waste, pre-treatment, part reuse, recycling and final metal separation and car fluff disposal. Finally, the study also focuses on the calculation of the effective Italian ELV recycling rate, which results equal to 80.8%, and auto shredder residue (ASR) characterization. According to the results obtained in this work, ASR still contains up to 8% of metals and 40% of polymers that could be recovered. Moreover, physical-chemical analysis showed a Lower Heat Value of almost 20,000 kJ/kg and revealed the presence of pollutants such as heavy metals, mineral oils, PCBs and hydrocarbons. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. [Facilitators and barriers regarding end of life care at nursing homes: A focus group study].

    Science.gov (United States)

    Sánchez-García, María Remedios; Moreno-Rodríguez, Marina; Hueso-Montoro, César; Campos-Calderón, Concepción; Varella-Safont, Ana; Montoya-Juárez, Rafael

    2017-05-01

    To identify the facilitators and barriers experienced by professional related to end of life care in nursing homes. Descriptive qualitative research with phenomenological orientation, through content analysis. Nursing Homes at Primary Care District in Granada (Spain). Fifteen clinical professionals with, at least 6 months of experience in nursing homes, without specific background in palliative care. Three focus groups were undertaken with professionals of different disciplines and nursing homes. Interviews were recorded and transcribed literally. An open and axial coding was performed to identify relevant categories. Professionals identified difficulties in the communication with families related to relatives' feelings of guilt, difficulty in understanding the deterioration of their relative, and addressing too late the issue of death. Regarding decision making, professionals recognized that they do not encourage participation of patients. Advance directives are valued as a necessary tool, but they do not contemplate implementing them systematically. Other difficulties that professionals highlighted are lack of coordination with other professionals, related to misunderstanding of patients' needs, as well as lack of training, and lack of material and human resources. Facilitators include relationships with primary care teams. It is necessary to improve communication among nursing homes professionals, families, patients and other health workers. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  15. Failure Mode Identification and End of Life Scenarios of Offshore Wind Turbines: A Review

    Directory of Open Access Journals (Sweden)

    Maria Martinez Luengo

    2015-08-01

    Full Text Available In 2007, the EU established challenging goals for all Member States with the aim of obtaining 20% of their energy consumption from renewables, and offshore wind is expected to be among the renewable energy sources contributing highly towards achieving this target. Currently wind turbines are designed for a 25-year service life with the possibility of operational extension. Extending their efficient operation and increasing the overall electricity production will significantly increase the return on investment (ROI and decrease the levelized cost of electricity (LCOE, considering that Capital Expenditure (CAPEX will be distributed over a larger production output. The aim of this paper is to perform a detailed failure mode identification throughout the service life of offshore wind turbines and review the three most relevant end of life (EOL scenarios: life extension, repowering and decommissioning. Life extension is considered the most desirable EOL scenario due to its profitability. It is believed that combining good inspection, operations and maintenance (O&M strategies with the most up to date structural health monitoring and condition monitoring systems for detecting previously identified failure modes, will make life extension feasible. Nevertheless, for the cases where it is not feasible, other options such as repowering or decommissioning must be explored.

  16. Quantifying EV battery end-of-life through analysis of travel needs with vehicle powertrain models

    Science.gov (United States)

    Saxena, Samveg; Le Floch, Caroline; MacDonald, Jason; Moura, Scott

    2015-05-01

    Electric vehicles enable clean and efficient transportation, however concerns about range anxiety and battery degradation hinder EV adoption. The common definition for battery end-of-life is when 70-80% of original energy capacity remains, however little analysis is available to support this retirement threshold. By applying detailed physics-based models of EVs with data on how drivers use their cars, we show that EV batteries continue to meet daily travel needs of drivers well beyond capacity fade of 80% remaining energy storage capacity. Further, we show that EV batteries with substantial energy capacity fade continue to provide sufficient buffer charge for unexpected trips with long distances. We show that enabling charging in more locations, even if only with 120 V wall outlets, prolongs useful life of EV batteries. Battery power fade is also examined and we show EVs meet performance requirements even down to 30% remaining power capacity. Our findings show that defining battery retirement at 70-80% remaining capacity is inaccurate. Battery retirement should instead be governed by when batteries no longer satisfy daily travel needs of a driver. Using this alternative retirement metric, we present results on the fraction of EV batteries that may be retired with different levels of energy capacity fade.

  17. Clinician Perspectives on Challenges to Patient Centered Care at the End of Life.

    Science.gov (United States)

    Bardach, Shoshana H; Dunn, Edward J; Stein, J Christopher

    2017-04-01

    Discussions regarding patient preferences for resuscitation are often delayed and preferences may be neglected, leading to the receipt of unwanted medical care. To better understand barriers to the expression and realization of patients' end of life wishes, a preventive ethics team in one Veterans Affairs Medical Center conducted a survey of physicians, nurses, social workers, and respiratory therapists. Surveys were analyzed through qualitative analysis, using sorting methodologies to identify themes. Analysis revealed barriers to patient wishes being identified and followed, including discomfort conducting end-of-life discussions, difficulty locating patients' preferences in medical records, challenges with expiring do not resuscitate (DNR) orders, and confusion over terminology. Based on these findings, the preventive ethics team proposed new terminology for code status preferences, elimination of the local policy for expiration of DNR orders, and enhanced systems for storing and retrieving patients' end-of-life preferences. Educational efforts were initiated to facilitate implementation of the proposed changes.

  18. End-of-life care considerations for gay, lesbian, bisexual, and transgender individuals.

    Science.gov (United States)

    Rawlings, Deb

    2012-01-01

    Negative social attitudes, discrimination, and homophobia affect gay, lesbian, bisexual, and transgender (GLBT) individuals during their lifetimes. These experiences can affect how these individuals access health services and interact with health professionals, resulting in adverse outcomes compared with their heterosexual counterparts. End-of-life experiences can also be shaped by these factors. There are implications for health professionals in terms of equity of access to targeted health care, preventive screening, and visibility in policy, as well as in principles of inclusiveness, dignity and respect, and competence in care. This article takes a brief look at some of the issues specific to the end-of-life care of GLBT individuals, using a case study as an illustrative example. Holistic care at the end of life is a familiar concept to palliative care nurses, but it is important to place greater emphasis on considering competence in aspects of care relating to sexuality.

  19. Integrating Quality Palliative and End-of-Life Care into the Geriatric Assessment: Opportunities and Challenges.

    Science.gov (United States)

    Swagerty, Daniel

    2017-08-01

    This article provides an overview of how integrating quality palliative and end-of-life care into geriatric assessment can be a tremendous benefit to older adult patients and their families. Although the quality of palliative and end-of-life care for older adults has improved greatly, there are still many opportunities to improve the quality of life and function for older adult patients in the last few years of their life. More clinical expertise in comprehensive palliative and end-of-life care must be developed and maintained. There also must be greater focus and more direct reimbursement developed for physicians and health system providers. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Condition Assessment and End-of-Life Prediction System for Electric Machines and Their Loads

    Science.gov (United States)

    Parlos, Alexander G.; Toliyat, Hamid A.

    2005-01-01

    An end-of-life prediction system developed for electric machines and their loads could be used in integrated vehicle health monitoring at NASA and in other government agencies. This system will provide on-line, real-time condition assessment and end-of-life prediction of electric machines (e.g., motors, generators) and/or their loads of mechanically coupled machinery (e.g., pumps, fans, compressors, turbines, conveyor belts, magnetic levitation trains, and others). In long-duration space flight, the ability to predict the lifetime of machinery could spell the difference between mission success or failure. Therefore, the system described here may be of inestimable value to the U.S. space program. The system will provide continuous monitoring for on-line condition assessment and end-of-life prediction as opposed to the current off-line diagnoses.

  1. [Refractory sufferings at the end of life: Which considerations, which propositions?].

    Science.gov (United States)

    Joly, Clémence; Ghazi Elie, Elisabeth; Maillet, Eric; Hannequin, Didier; Guédon, Elisabeth

    2011-04-01

    Refractory suffering of terminally ill people may be physical (pain, dyspnea, vomiting...) or existential (spiritual sufferings, anxiousness...). End-of-life decisions are often around ethics. Decision making near the end of life consists in witholding and withdrawing life-support treatment and prescribing both of treatments with risk of double effect and sedation for distress. In France, such decisions are defined by the deontology code and by the law of April 22nd, 2005 concerning the end of life and patients' rights. Recommendations from medical societies specify the means of implementation: obtaining other medical opinions, the patient's informed consent and full transparency of the decision (noted in the patient's medical chart). Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  2. Community nursing quality indicators for end-of-life care in England: identification, preparation, and coordination.

    Science.gov (United States)

    Cook, Jane; Horrocks, Susan

    2016-03-01

    High-quality community nursing is essential to ensure that end-of-life care can be provided in community settings in line with patient preferences. This article examines the quality priorities commissioners sought to incentivise in end-of-life care, by reviewing a survey of Commissioning for Quality and Innovation (CQUIN) indicators for community nursing conducted in England in 2014-2015. Findings from the survey suggest that end-of-life care was not given a high priority with the CQUIN indicators for community nursing. Vigorous quality standards, including training and development, need to be in place to make sure that the potential of community nursing is being used to sensitively engage with people nearing the end of their lives and support them to plan their future care, if they so wish.

  3. End-of-life decisions in Malaysia: Adequacies of ethical codes and developing legal standards.

    Science.gov (United States)

    Kassim, Puteri Nemie Jahn; Alias, Fadhlina

    2015-06-01

    End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.

  4. [Cultural aspects of ethical decisions at the end of life and cultural competence].

    Science.gov (United States)

    Ilkilic, Ilhan

    2008-08-01

    Advances in medical science and technology offer new medical interventions at the end of life. These new medical measures create new ethical issues, which increase in complexity in a multicultural society. This paper discusses three cases, in which cultural value systems play a decisive role. Change in the goals of therapy, truth telling of diagnosis and prognosis and presumed will of the patient are the key ethical points in these cases. Because of growth in minority populations in Germany, it is foreseeable that the number of these issues will increase in the near future. The author of this paper argues that concepts and measurements must be urgently developed in health care systems to help the medical staff in their daily practises. According to him, cultural competence and cultural sensitive advanced directives can be helpful for solving complex ethical problems at the end of life. Other interventions and measurements were also described for improved end-of-life care in multicultural setting.

  5. Spirituality in end-of-life care: attending the person on their journey.

    LENUS (Irish Health Repository)

    Hayden, Deborah

    2011-11-01

    Spirituality is a fundamental element to the human experience of health and healing, illness and dying. Spiritual care is an essential component of palliative and end-of-life care provision and is the responsibility of all staff and carers involved in the care of patients and families. As end-of-life care is a significant element of community nursing, this article explores the relevancy of spirituality to end-of-life practice, the challenge of defining spirituality and the attributes and skills required for the practice of spiritual care. The aim of is to encourage self reflection and open dialogue about the subject, thus enhancing community nurses\\' understanding of spiritual care practice. By reflecting and generating talk about the practice of spiritual care, it may become more normalized, recognized, and practically meaningful, thereby retaining its significance in holistic nursing.

  6. Broadening End-of-Life Comfort to Improve Palliative Care Practices in Long Term Care.

    Science.gov (United States)

    Sussman, Tamara; Kaasalainen, Sharon; Mintzberg, Susan; Sinclair, Shane; Young, Laurel; Ploeg, Jenny; Bourgeois-Guérin, Valérie; Thompson, Genevieve; Venturato, Lorraine; Earl, Marie; Strachan, Patricia; You, John J; Bonifas, Robin; McKee, Margaret

    2017-09-01

    This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents' perceptions of end-of-life comfort, sharing information about a fellow resident's death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles within LTC.

  7. Struggling in change at the end of life: a nursing inquiry.

    Science.gov (United States)

    Hutchings, Deanna

    2007-03-01

    The purpose of this human science nursing inquiry is to explore the meaning of struggling in change for persons at the end of life. Guided by Parse's theory of human becoming, a descriptive exploratory method was used to answer the research question: What is the meaning of the experience of struggling in change for persons at the end of life? Eight persons who were living with dying described experiences of struggling in change during face-to-face audiotaped interviews. A process of analysis-synthesis revealed three themes that are discussed in relation to extant related literature and interpreted in light of the human becoming perspective. Findings from the study contribute new knowledge about human experience at the end of life from a human science perspective and offer new insights on struggling in change as a rhythmical pattern of living and dying. Implications for palliative practice, research, and education are discussed.

  8. Barriers to excellent end-of-life care for patients with dementia.

    Science.gov (United States)

    Sachs, Greg A; Shega, Joseph W; Cox-Hayley, Deon

    2004-10-01

    While great strides have been made recently in improving end-of-life care in the United States, people with dementia often die with inadequate pain control, with feeding tubes in place, and without the benefits of hospice care. In this paper, we discuss the most important and persistent challenges to providing excellent end-of-life care for patients with dementia, including dementia not being viewed as a terminal illness; the nature of the course and treatment decisions in advanced dementia; assessment and management of symptoms; the caregiver experience and bereavement; and health systems issues. We suggest approaches for overcoming these barriers in the domains of education, clinical practice, and public policy. As the population ages, general internists increasingly will be called upon to provide primary care for a growing number of patients dying with dementia. There are great opportunities to improve end-of-life care for this vulnerable and underserved population.

  9. End of life content in geriatric textbooks: what is the current situation?

    Directory of Open Access Journals (Sweden)

    Higginson Irene J

    2006-05-01

    Full Text Available Abstract Background Physicians caring for elderly people encounter death and dying more frequently than their colleagues in most other disciplines. Therefore we sought to examine the end-of-life content in popular geriatric textbooks and determine their usefulness in helping geriatricians manage patients at the end of their lives. Methods Five popular geriatric textbooks were chosen. Chapters on Alzheimer's disease, stroke, chronic heart failure, chronic obstructive pulmonary disease and lung cancer were examined because of their high mortality rates among the elderly patients. Text relevant to end-of-life care was highlighted. Two reviewers independently coded text into 10 pre specified domains and rated them for the presence of end-of-life information. Content was rated as absent, minimally helpful, or helpful. The proportion of helpful information was calculated. Results The textbook with the best end-of-life coverage contained 38% helpful information, the worst had only 15% helpful information. Minimally helpful information ranged from 24% to 50%. As much as 61% of the content in one textbook contained no helpful information at all. Of the ten domains, epidemiology, disease progression and prognostic factors were fairly well covered. Information on advance care planning, ethical issues, decision making and effects of death and dying on patient's family were generally lacking under the individual diseases though they were covered as general topics in other parts of the textbooks. All except one textbook dedicated a chapter to the care of the dying. Conclusion This study showed that end-of-life content in geriatric textbooks differed significantly. Most of the textbooks lack good coverage on end-of-life care and more can be done to improve on this.

  10. OA34 Forum on end of life: working to influence policy.

    Science.gov (United States)

    McGuinness, Catherine; Murphy, Sarah; Clarke, Patricia Rickard

    2015-04-01

    The Forum on End of Life in Ireland was launched in 2009 and has conducted a year-long public consultation about end of life issues. A National Council was set up to carry out the work of the Forum. Think Ahead is a public awareness initiative of the Forum on End of Life in Ireland which guides people in recording important information in the event that they are unable to speak for themselves, due to serious illness, emergency or death. The Forum has advocated for legislation of advance health care directives and has worked to raise awareness among members of the public in relation to their rights. Currently in Ireland while common law recognises people's right to express preferences and make directives, there has been no legislative framework for this, despite European and international law regarding personal autonomy and the right to self-determination. Organised briefings and information seminars for public representatives Organised public meetings and national conferences which deal with the importance of advance healthcare directives Spoke of the importance of advance healthcare directives and advance care planning as part of the Oireachtas (Irish Parliament) Health Committee hearings on end of life Called for wider national end of life strategy to take a comprehensive approach to end of life issues, including health, legal, administrative, financial and social. Advance healthcare directives are provided for in the Assisted Decision Making (Capacity) Bill 2013. The aforementioned Bill has yet to be enacted and there remains work to be done in developing policy in this area. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Economic impact analysis of an end-of-life programme for nursing home residents.

    Science.gov (United States)

    Teo, W-S Kelvin; Raj, Anusha Govinda; Tan, Woan Shin; Ng, Charis Wei Ling; Heng, Bee Hoon; Leong, Ian Yi-Onn

    2014-05-01

    Due to limited end-of-life discussions and the absence of palliative care, hospitalisations are frequent at the end of life among nursing home residents in Singapore, resulting in high health-care costs. Our objective was to evaluate the economic impact of Project Care at the End-of-Life for Residents in homes for the Elderly (CARE) programme on nursing home residents compared to usual end-of-life care. DESIGN AND SETTINGS/PARTICIPANTS: Project CARE was introduced in seven nursing homes to provide advance care planning and palliative care for residents identified to be at risk of dying within 1 year. The cases consisted of nursing home residents enrolled in the Project CARE programme for at least 3 months. A historical group of nursing home residents not in any end-of-life care programme was chosen as the matched controls. Cost differences between the two groups were analysed over the last 3 months and final month of life. The final sample comprised 48 Project CARE cases and 197 controls. Compared to the controls, the cases were older with more comorbidities and higher nursing needs. After risk adjustment, Project CARE cases demonstrated per-resident cost savings of SGD$7129 (confidence interval: SGD$4544-SGD$9714) over the last 3 months of life and SGD$3703 (confidence interval: SGD$1848-SGD$5557) over the last month of life (US$1 = SGD$1.3). This study demonstrated substantial savings associated with an end-of-life programme. With a significant proportion of the population in Singapore requiring nursing home care in the near future, these results could assist policymakers and health-care providers in decision-making on allocation of health-care resources.

  12. Proxy Perspectives about End-of-Life Care for Person’s with Cancer

    Science.gov (United States)

    Bakitas, Marie; Ahles, Tim A.; Skalla, Karen; Brokaw, Frances C.; Byock, Ira; Hanscom, Brett; Lyons, Kathleen Doyle; Hegel, Mark T.

    2013-01-01

    Background Each year more than one-half million people die from cancer in the United States. Despite progress in increasing access to palliative oncology services, end-of-life care still needs improvement. Measuring the quality of the end-of-life experience is difficult due to patient debility and reduced consciousness as death approaches. Family proxies have been proposed as valuable informants regarding the quality of end-of-life care. This paper describes family proxy perspectives on care at the end of life in patients who died from advanced cancer Methods In the context of a novel outpatient palliative care demonstration project, 125 family proxy respondents completed a structured survey by phone 3–6 months following patients’ death from breast, lung, or gastrointestinal cancer. Four key quality of care indicators were measured: decision-making and physician communication, location of death, hospice involvement, and end-of-life symptoms. Results Proxies reported that 80% of patients completed advance directives and about half of them were helpful in guiding care; communication with physicians about end-of-life treatment wishes occurred in 67%, but less than half actually made a plan with the physician to ensure that their wishes were followed; the majority died in their location of choice, most often at home; over half had hospice involvement for an average of 41.8 days prior to death; and during the last week of life the majority of patients experienced troublesome physical and emotional symptoms. Conclusions Measurement of proxy perspectives is feasible and these results provide actionable data for areas of improvement in palliative oncology care. PMID:18306393

  13. End-of-Life Cancer Care: Temporal Association between Homecare Nursing and Hospitalizations.

    Science.gov (United States)

    Seow, Hsien; Sutradhar, Rinku; McGrail, Kim; Fassbender, Konrad; Pataky, Reka; Lawson, Beverley; Sussman, Jonathan; Burge, Fred; Barbera, Lisa

    2016-03-01

    Most cancer patients want to die at home, but scaleable models to achieve this are not well researched. Our objective was to investigate the temporal association of homecare nursing, especially by generalist nurses, with reduced end-of-life hospitalizations. We conducted a retrospective Canadian cohort study of end-of-life cancer decedents during 2004-2009 in Ontario (ON), Nova Scotia (NS), and British Columbia (BC), which have homecare systems that use generalist nurses to provide end-of-life care. Each province linked administrative databases to examine the association during the last six months of life between the homecare nursing rate and the hospitalization rate in the subsequent week, using standardized definitions and controlling for other covariates. We dichotomized nursing into standard and end-of-life care intent. Our cohort included 83,827 cancer decedents. Approximately 55% of decedents were older than 70 and the most common cancer was lung. Nearly 85% of the cohort had at least one hospital admission. Receiving end-of-life compared to standard homecare nursing significantly reduced a patient's hospitalization rate by 34%, 33%, and 17% in ON, BC, and NS. In the last month of life patients having a standard nursing rate of greater than five hours compared to one hour per week had a significantly lower hospitalization rate (relative reduction of 15%-23%) across the three provinces. Our study showed a protective effect of nursing with an end-of-life intent on hospitalization across the last six months of life and of standard nursing in the last month. This finding's generalizability is strengthened, since the trends were similar across three different homecare systems.

  14. LGBT people's knowledge of and preparedness to discuss end-of-life care planning options.

    Science.gov (United States)

    Hughes, Mark; Cartwright, Colleen

    2014-09-01

    Despite the devastating impact of HIV/AIDS, end-of-life care planning among lesbian, gay, bisexual and transgender (LGBT) communities is relatively under-researched, especially in Australia. This paper reports findings of a survey of 305 LGBT people living in New South Wales, which examined their knowledge of and attitudes towards end-of-life care. The focus of this paper is their preparedness to discuss with healthcare providers any end-of-life care plans. The results highlight that while the majority of respondents were aware of three of the four key end-of-life care planning options available in New South Wales--enduring powers of attorney, enduring guardians and person responsible (only a minority had heard of advance healthcare directives)--a much smaller number of people had actually taken up these options. Only a minority of respondents were able to identify correctly who had the legal right to make treatment decisions for a person who is unconscious following a car accident. A small proportion of people had discussed end-of-life care options with general practitioners or another main healthcare provider, and only in very few cases were these issues raised by the practitioners themselves. Those most likely to not feel comfortable discussing these issues with practitioners included younger people, those not fully open about their sexuality to family members, and transgender people and others who do not define their gender as male or female. The paper highlights the importance of education strategies to raise awareness of the end-of-life care planning options among LGBT people, as well as strategies for increasing health providers' preparedness to discuss these issues with LGBT patients. © 2014 John Wiley & Sons Ltd.

  15. Time Perception of Cancer Patients Without Evidence of Disease and Advanced Cancer Patients in a Palliative, End-of-Life-Care Setting

    NARCIS (Netherlands)

    Laarhoven, H.W.M. van; Schilderman, J.; Verhagen, C.A.H.H.V.M.; Prins, J.B.

    2011-01-01

    BACKGROUND: : Time perception may be an important factor influencing distress of cancer patients. However, no comparative studies have been performed for cancer patients without evidence of disease and advanced cancer patients in the palliative, end-of-life-care setting. OBJECTIVE: : The objectives

  16. Time perception of cancer patients without evidence of disease and advanced cancer patients in a palliative, end-of-life-care setting

    NARCIS (Netherlands)

    van Laarhoven, Hanneke W. M.; Schilderman, Johannes; Verhagen, Constans A. H. H. V. M.; Prins, Judith B.

    2011-01-01

    Time perception may be an important factor influencing distress of cancer patients. However, no comparative studies have been performed for cancer patients without evidence of disease and advanced cancer patients in the palliative, end-of-life-care setting. The objectives of the study were to assess

  17. Broadening cultural sensitivity at the end of life: an interprofessional education program incorporating critical reflection.

    Science.gov (United States)

    Halm, Margo A; Evans, Rhonda; Wittenberg, Amie; Wilgus, Edward

    2012-01-01

    BACKGROUND/PROBLEM: End-of-life beliefs and practices are as varied as one's culture. Little is known about what interventions are effective in developing clinician's skills to deliver culturally sensitive end-of-life care. Using a pre-post design, this pilot study aimed to evaluate the impact of a 2-stage educational program on enhancing clinician's knowledge and comfort in addressing and honoring diverse end-of-life care beliefs, as well as developing higher levels of cultural competence. Twenty-four interprofessional team members practicing on a combined medical-surgical oncology unit attended an in-service session on the end-of-life care beliefs, practices, and preferences of the Latino, Russian, and Micronesian cultures and then participated in critical reflection sessions where culturally specific end-of-life care cases were discussed using a structured dialogue guide. Outcomes measured were cultural competence using the Intercultural Development Inventory, Frommelt Attitudes Toward Caring of the Dying, knowledge of cultural beliefs/traditions, and self-perceived comfort in providing culturally sensitive end-of-life care. Collectively, the Intercultural Development Inventory showed that the team's perceived cultural competence was at the level of "acceptance" whereas team's developmental orientation was "minimization," meaning that the team overestimated its cultural competence. The t tests showed no significant differences between pre-post attitude and knowledge scores (P > .05). Despite these findings, staffs' perceived level of understanding of end-of-life care beliefs, preferences, and practices of the Latino, Russian, and Micronesian cultures, as well as comfort and effectiveness in providing culturally sensitive end-of-life care, were higher after the in-service and critical reflection sessions (P intercultural development continuum, nor did it significantly change knowledge and attitudes, likely due to the small sample and that maturity in cultural

  18. The influence of culture on end-of-life decision making.

    Science.gov (United States)

    Bullock, Karen

    2011-01-01

    In their research, scholars have documented racial and ethnic differences in end-of-life care preferences, which have translated into cultural barriers. However, few studies have explained the racial differences. In the present study, focus groups with semi-structured follow-up interviews were utilized to elicit explanations for variance in decision making in a sample of Black and White community-dwelling residents. Participants identified specific cultural beliefs, values, and communication patterns that can be used to promote cultural competency among practitioners who provide care at end of life.

  19. An appraisal of ethical issues in end-of-life care.

    Science.gov (United States)

    Ilemona, Ekore Rabi

    2014-01-01

    Caring for patients at the end-of-life period could involve a number of situations and incidents that pose moral dilemma for both the health workers and the patients' family members or loved ones. Some of these issues include shared decision-making, the right to refuse medical treatment, medical futility, and euthanasia versus assisted suicide, information disclosure (truth-telling), substitute decision-making, and confidentiality. They may seem improbable or remote, until one is confronted with them real-time. Providing good care for dying patients requires that physicians and other members of the health care team be knowledgeable of ethical issues pertinent to end-of-life care.

  20. End-of-Life Care for Undocumented Immigrants with Advanced Cancer: Documenting the Undocumented

    OpenAIRE

    Jaramillo, Sylvia; Hui, David

    2015-01-01

    There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through...

  1. Advance care planning: between tools and relational end-of-life care?

    OpenAIRE

    Borgstrom, Erica

    2015-01-01

    The way in which end-of-life care is delivered in the UK has changed dramatically over the last few years. Owing to the changes in systems and care practice promoted in the End of Life Care Strategy more people have access to higher quality care, including advance care planning and symptom management. Drawing on the ‘best practice’ at the time, the Strategy recommended the use of several tools to facilitate identifying dying patients, communicating and planning future care, and coordinating o...

  2. International comparison on the management system of end-of-life vehicles

    Science.gov (United States)

    Wang, Jiaxi; Zhu, Anqi; Zhou, Yaodong

    2017-04-01

    With the rapid development of economy, Chinese vehicle ownership has risen significantly. At the same time, the end-of-life vehicles put a huge pressure to energy and environment, which will finally have an extremely bad effect on sustainable development of economy. The paper takes the United States, the European Union and Japan as samples, compares and analyses these countries’ experiences in law, administration, operation. The key of developed country governance to solve ‘trust’ problem in recycling is its diversity within a complete legal system. At last, the paper gives some suggestions on the issue of Chinese end-of-life vehicles recycling.

  3. Caring for Older Patients on Peritoneal Dialysis at End of Life

    OpenAIRE

    Meeus, Frédérique; Brown, Edwina A.

    2015-01-01

    End of life is the last phase of life, not merely the last few days. For many older patients on peritoneal dialysis (PD), the end-of-life phase commences with the start of dialysis. The principal aim of management of this phase should be optimizing the quality of life of the patient. Evidence suggests that patients on dialysis mostly want involvement in decisions at this stage, but most do not have the opportunity to do so. Management should therefore include discussions with the patient and ...

  4. Family care conferences in long-term care: Exploring content and processes in end-of-life communication.

    Science.gov (United States)

    Durepos, Pamela; Kaasalainen, Sharon; Sussman, Tamara; Parker, Deborah; Brazil, Kevin; Mintzberg, Susan; Te, Alyssa

    2017-12-29

    End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA-LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada. The purpose of this substudy was to examine FCC content and such guiding processes as documentation and multidisciplinary staff participation. A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association's Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement. The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians. Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs. Recommendations for tailoring conferences to optimize communication include use of specific conference

  5. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey

    Science.gov (United States)

    2012-01-01

    Background A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of end-of-life decisions with a possible or certain life shortening effect (ELDs) and in the preceding decision making process in Flanders, Belgium in 2007, where euthanasia was legalised in 2002. Comparing with data from an identical survey in 1998 we also study the plausibility of the ‘slippery slope’ hypothesis which predicts a rise in the rate of administration of life ending drugs without patient request, especially among elderly patients, in countries where euthanasia is legal. Method We performed a post-mortem survey among physicians certifying a large representative sample (n = 6927) of death certificates in 2007, identical to a 1998 survey. Response rate was 58.4%. Results While the rates of non-treatment decisions (NTD) and administration of life ending drugs without explicit request (LAWER) did not differ between age groups, the use of intensified alleviation of pain and symptoms (APS) and euthanasia/assisted suicide (EAS), as well as the proportion of euthanasia requests granted, was bivariately and negatively associated with patient age. Multivariate analysis showed no significant effects of age on ELD rates. Older patients were less often included in decision making for APS and more often deemed lacking in capacity than were younger patients. Comparison with 1998 showed a decrease in the rate of LAWER in all age groups except in the 80+ age group where the rate was stagnant. Conclusion Age is not a determining factor in the rate of end-of-life decisions, but is in decision making as patient inclusion rates decrease with old age. Our results suggest there is a need to focus advance care planning initiatives on elderly patients. The slippery slope hypothesis

  6. The Understanding of Terminal Cancer and Its Relationship with Attitudes toward End-of-Life Care Issues.

    Science.gov (United States)

    Lee, June Koo; Yun, Young Ho; An, Ah Reum; Heo, Dae Seog; Park, Byeong-Woo; Cho, Chi-Heum; Kim, Sung; Lee, Dae Ho; Lee, Soon Nam; Lee, Eun Sook; Kang, Jung Hun; Kim, Si-Young; Lee, Jung Lim; Lee, Chang Geol; Lim, Yeun Keun; Kim, Samyong; Choi, Jong Soo; Jeong, Hyun Sik; Chun, Mison

    2014-08-01

    Although terminal cancer is a widely used term, its meaning varies, which may lead to different attitudes toward end-of-life issues. The study was conducted to investigate differences in the understanding of terminal cancer and determine the relationship between this understanding and attitudes toward end-of-life issues. A questionnaire survey was performed between 2008 and 2009. A total of 1242 cancer patients, 1289 family caregivers, 303 oncologists from 17 hospitals, and 1006 participants from the general population responded. A "6-month life expectancy" was the most common understanding of terminal cancer (45.6%), followed by "treatment refractoriness" (21.1%), "metastatic/recurrent disease" (19.4%), "survival of a few days/weeks" (11.4%), and "locally advanced disease" (2.5%). The combined proportion of "treatment refractoriness" and "6-month life expectancy" differed significantly between oncologists and the other groups combined (76.0% v. 65.9%, P = 0.0003). Multivariate analyses showed that patients and caregivers who understood terminal cancer as "survival of a few days/weeks" showed more negative attitudes toward disclosure of terminal status compared with participants who chose "treatment refractoriness" (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI] 0.22-0.79 for patients; aOR 0.34, 95% CI 0.18-0.63 for caregivers). Caregivers who understood terminal cancer as "locally advanced" or "metastatic/recurrent disease" showed a significantly lower percentage of agreement with withdrawal of futile life-sustaining treatment compared with those who chose "treatment refractoriness" (aOR 0.19, 95% CI 0.07-0.54 for locally advanced; aOR 0.39, 95% CI 0.21-0.72 for metastatic/recurrent). The understanding of terminal cancer varied among the 4 participant groups. It was associated with different preferences regarding end-of-life issues. Standardization of these terms is needed to better understand end-of-life care. © The Author(s) 2013.

  7. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey

    Directory of Open Access Journals (Sweden)

    Chambaere Kenneth

    2012-06-01

    Full Text Available Abstract Background A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of end-of-life decisions with a possible or certain life shortening effect (ELDs and in the preceding decision making process in Flanders, Belgium in 2007, where euthanasia was legalised in 2002. Comparing with data from an identical survey in 1998 we also study the plausibility of the ‘slippery slope’ hypothesis which predicts a rise in the rate of administration of life ending drugs without patient request, especially among elderly patients, in countries where euthanasia is legal. Method We performed a post-mortem survey among physicians certifying a large representative sample (n = 6927 of death certificates in 2007, identical to a 1998 survey. Response rate was 58.4%. Results While the rates of non-treatment decisions (NTD and administration of life ending drugs without explicit request (LAWER did not differ between age groups, the use of intensified alleviation of pain and symptoms (APS and euthanasia/assisted suicide (EAS, as well as the proportion of euthanasia requests granted, was bivariately and negatively associated with patient age. Multivariate analysis showed no significant effects of age on ELD rates. Older patients were less often included in decision making for APS and more often deemed lacking in capacity than were younger patients. Comparison with 1998 showed a decrease in the rate of LAWER in all age groups except in the 80+ age group where the rate was stagnant. Conclusion Age is not a determining factor in the rate of end-of-life decisions, but is in decision making as patient inclusion rates decrease with old age. Our results suggest there is a need to focus advance care planning initiatives on elderly patients. The

  8. Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study.

    Science.gov (United States)

    Shaw, Chloe; Chrysikou, Vasiliki; Davis, Sarah; Gessler, Sue; Rodin, Gary; Lanceley, Anne

    2017-02-01

    To examine how end-of-life talk is initiated in CALM therapy sessions with advanced cancer patients. Conversation analysis was used to systematically examine the sequences where talk about death was raised in the first sessions of ten patients. Open questions about the patients' experiences, feelings or understanding in the context of talk about their troubles, were found to regularly elicit talk concerning end-of-life. These questions were designed in ways that invite patients to discuss troubling aspects of their cancer journey, without making discussion of this topic an interactional requirement. That is, the interactional work required to not engage in such talk is minimised. This choice is provided through the open question design, the degree to which negative feeling descriptors are specified, and the sequential context of the question. The analysis shows that therapists provide patients with the opportunity to talk about end-of-life in a way that is supportive of the therapeutic relationship. The readiness of patients to engage in end-of-life talk displays the salience of this topic, as well as the reflective space provided by CALM therapy. The results provide important insight into the process of CALM therapy, which can be used to guide training. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. The Social Stratification of Older Adults' Preparations for End-of-Life Health Care

    Science.gov (United States)

    Carr, Deborah

    2012-01-01

    I use data from the Wisconsin Longitudinal Study (n = 4,971) to evaluate the extent to which socioeconomic status affects three health-related (living will, durable power of attorney for health care, and discussions) and one financial (will) component of end-of-life planning. Net worth is positively associated with all four types of planning,…

  10. Persistent problems in end-of-life planning among young- and middle-aged American couples.

    Science.gov (United States)

    Moorman, Sara M; Inoue, Megumi

    2013-01-01

    Guided by the transtheoretical model of health behavior change, this study sought to explain why (a) rates of advance care planning remain low in the general population and (b) surrogate decision makers are often inaccurate about patients' end-of-life preferences. The study used quantitative data from a cross-sectional internet survey conducted between July and October 2010. The 2,150 participants aged 18-64 belonged to 1,075 married or cohabiting heterosexual couples. Participants included members of a nationally representative internet panel and a convenience sample from online advertisements. Older age was associated with a greater likelihood of having executed a living will and/or appointed a durable power of attorney for health care. Both older age and poorer health were independently associated with a greater likelihood of having discussed end-of-life health care treatment preferences. Completion of one's own end-of-life planning was unrelated to one's ability to accurately report one's partner's treatment preferences. Readiness to plan for end of life appears to differ across planning behaviors. Age and health are related to aspects of one's own advance care planning, but none of these factors are related to accuracy as a partner's surrogate.

  11. IAGG/IAGG GARN International Survey of End-of-Life Care in Nursing Homes

    NARCIS (Netherlands)

    Wallace, C.L.; Swagerty, D.; Barbagallo, M.; Vellas, B.; Cha, H.B.; Holmerova, I.; Dong, B.; Koopmans, R.T.; Cruz-Jentoft, A.J.; Gutierrez Robledo, L.M.; Moreno, J.C.; Hajjar, R.; Woo, J.; Arai, H.; Okochi, J.; Visvanathan, R.; Abdul-Rahman, S.A.; Goel, A.; Moser, A.; Rolland, Y.; Abbatecola, A.M.; Russo, M.; Morley, J.E.

    2017-01-01

    This article reports the findings of a survey on end-of-life (EOL) care in nursing homes of 18 long-term care experts across 15 countries. The experts were chosen as a convenience-based sample of known experts in each country. The survey was administered in 2016 and included both open-ended

  12. Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

    Science.gov (United States)

    Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.

    2012-01-01

    Purpose of the study: This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used…

  13. [Support at the end of life in care homes by nursing assistants].

    Science.gov (United States)

    Croyère, Nicole

    2015-11-01

    In nursing homes, the nursing assistant supports patients at the end of life, notably as they move into palliative care. This involves team work to relieve pain, limit treatments considered disproportionate and improve comfort. Relations with the residents and their families are particularly important in this context. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. A Framework for Categorizing Social Interactions Related to End-of-Life Care in Nursing Homes

    Science.gov (United States)

    Bern-Klug, Mercedes

    2009-01-01

    Purpose: Almost half of people age 85 and older who die annually in the United States die as nursing home residents, yet because it is not always clear who is close to death, not all residents who might benefit from end-of-life care receive it. The purpose of this study is to develop a framework for organizing social interactions related to…

  15. Family Perspectives on End-of-Life Care Experiences in Nursing Homes

    Science.gov (United States)

    Wetle, Terrie; Shield, Renee; Teno, Joan; Miller, Susan C.; Welch, Lisa

    2005-01-01

    Purpose: The purpose of this study is to expand knowledge regarding end-of-life care received in nursing homes through the use of narrative interviews with family members close to the decedents. Design and Methods: We conducted follow-up qualitative interviews with 54 respondents who had participated in an earlier national survey of 1,578…

  16. A European model for the number of end-of-life vehicles

    DEFF Research Database (Denmark)

    Møller Andersen, Frits; Larsen, Helge V.; Skovgaard, M.

    2007-01-01

    This paper describes a model for the projection of the number of End-of-Life Vehicles (ELVs) and presents a baseline projection. Historical data on population, the number of cars per capita (car density), GDP per capita, and the vintage distribution of cars are combined to model ELVs. The lifetime...

  17. Communication Skills for End-of-Life Nursing Care: Teaching Strategies from the ELNEC Curriculum.

    Science.gov (United States)

    Matzo, Marianne LaPorte; Sherman, Deborah Witt; Sheehan, Denice C.; Ferrell, Betty Rolling; Penn, Barbara

    2003-01-01

    Presents a key module in a 3-day train-the-trainer course in end-of-life nursing--competence in communicating with patients and families. Factors affecting communication, coping strategies for families, strategies for classroom and clinical teaching, and resources are described. (SK)

  18. Learning About End-of-Life Care in Nursing-A Global Classroom Educational Innovation.

    Science.gov (United States)

    Bailey, Cara; Hewison, Alistair; Orr, Shelly; Baernholdt, Marianne

    2017-11-01

    Teaching nursing students how to provide patient-centered end-of-life care is important and challenging. As traditional face-to-face classroom teaching is increasingly supplanted by digital technology, this provides opportunities for developing new forms of end-of-life care education. The aim of this article is to examine how a global classroom was developed using online technology to enhance nursing students' learning of end-of-life care in England and the United States. The PDSA (Plan-Do-Study-Act) quality improvement approach was used to guide the design and delivery of this curriculum innovation. The global classroom enhanced the educational experience for students. Teaching needs to be inclusive, focused, and engaging; the virtual platform must be stable and support individual learning, and learning needs to be collaborative and authentic. These findings can be used to inform the integration of similar approaches to end-of-life care education in other health care professional preparation programs. [J Nurs Educ. 2017;56(11):688-691.]. Copyright 2017, SLACK Incorporated.

  19. Learning end-of-life care within a constructivist model: Undergraduate nursing students' experiences.

    Science.gov (United States)

    van der Wath, Anna E; du Toit, Pieter H

    2015-11-05

    Although nursing education aims to equip nursing students to provide care to dying patients and their families, nurses often feel ill-prepared to cope with the emotional labour involved in end-of-life care. The aim of the study was to explore and describe nursing students' experiences of end-of-life care through experiential learning within a constructivist educational model. A qualitative, descriptive design was used. As part of introducing experiential learning, innovative educational practices were initiated during a second year level undergraduate nursing module on end-of-life care. Qualitative data on second-year nursing students' experiences were collected through written reflections and analysed using open coding. The themes that emerged revealed participants' sensory and emotional experiences during the learning opportunities. Participants reflected on what they learnt and clarified their values related to death and dying. They indicated how they would apply the new meanings constructed in clinical practice. A constructivist educational model of experiential learning holds potential to enhance value clarification and nursing students' sensory and emotional awareness of death and dying. Experiential learning is recommended to develop nursing students' competency inproviding end-of-life care.

  20. Positive emotion communication: Fostering well-being at end of life.

    Science.gov (United States)

    Terrill, Alexandra L; Ellington, Lee; John, Kevin K; Latimer, Seth; Xu, Jiayun; Reblin, Maija; Clayton, Margaret F

    2017-11-28

    Little is known about positive emotion communication (PEC) in end-of-life care. This study aims to identify types and patterns of PEC among hospice nurses, caregivers, and patients. A coding system based on positive psychology theory was applied as a secondary analysis to audio recordings of hospice nurse home visits with cancer patients and family caregivers, collected as part of a prospective longitudinal study. Eighty recordings (4 visits from 20 triads) were coded for humor, connection, praise, positive focus, gratitude, taking joy/savoring, and perfunctory statements. Descriptive statistics revealed the greatest proportion of PEC was made by nurses. Humor was most frequently used across all speakers. Cluster analysis revealed four PEC visit types: Savor/Take Joy; Humor; Perfunctory; and Other-focused Expressions of Positive Emotions. Linear mixed effect regression was used to estimate the trajectory of PEC over time, but no significant change was found. We found that positive emotions are common in nurse, caregiver and patient communication at end-of-life and do not decline closer to death. This study is among the first to explore PEC at end-of-life, and offers a way to bring strengths-based approaches into end of life communication research. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Spiritual care of the child with cancer at the end of life: a concept analysis.

    Science.gov (United States)

    Petersen, Cheryl L

    2014-06-01

    The aim of this paper is to report an analysis of the concept of spiritual care of a child with cancer at the end of life. Spirituality is a vital dimension of a child's experience at the end of life; providing comfort; support; and a sense of connection. Spiritual care is paramount to address the substantial spiritual distress that may develop. Rodgers' method of evolutionary concept analysis guided the review process. The literature search was not limited by start date and literature through the end of 2012 was included. English, peer-reviewed texts in the databases CINAHL, ATLA and PubMed were included. Critical analysis of the literature identified surrogate terms, related concepts, attributes, antecedents and consequences. The analysis identified six attributes: assessing spiritual needs; assisting the child to express feelings; guiding the child in strengthening relationships; helping the child to be remembered; assisting the child to find meaning; and aiding the child to find hope. Antecedents include existential questions and spiritual distress. Consequences include a peaceful death, spiritual growth, a relationship of trust and enhanced end-of-life care. Spiritual care is a vital aspect of holistic nursing care; however, gaps in knowledge and practice prevent children from receiving adequate spiritual care at the end of life. Nurses would benefit from increased awareness, skills and knowledge about spiritual care. Research is needed to identify interventions that exert the greatest effect on patient care outcomes. © 2013 John Wiley & Sons Ltd.

  2. Nationwide veterans affairs quality measure for cancer: the family assessment of treatment at end of life.

    Science.gov (United States)

    Finlay, Esme; Shreve, Scott; Casarett, David

    2008-08-10

    The Veterans Affairs (VA) health care system has created a national initiative to measure quality of care at the end of life. This article describes the first phase of this national initiative, the Family Assessment of Treatment at End of Life (FATE), in evaluating the quality of end-of-life care for veterans dying with cancer. In the initial phase, next of kin of patients from five VA Medical Centers were contacted 6 weeks after patients' deaths and invited to participate in a telephone interview, and surrogates for 262 cancer patients completed FATE interviews. Decedents were 98% male with an average age of 72 years. There was substantial variation among sites. Higher FATE scores, consistent with family reports of higher satisfaction with care, were associated with palliative care consultation and hospice referral and having a Do Not Resuscitate order at the time of death, whereas an intensive care unit death was associated with lower scores. Early experience with FATE suggests that it will be a helpful tool to characterize end-of-life cancer care and to identify targets for quality improvement.

  3. Euthanasia and other end-of-life decisions: a mortality follow-back study in Belgium

    NARCIS (Netherlands)

    Block, L.; Deschepper, R.; Bilsen, J.J.; Bossuyt, N.; Casteren, van V.; Deliens, L.H.J.

    2009-01-01

    BACKGROUND: This study compares prevalence and types of medical end-of-life decisions between the Dutch-speaking and French-speaking communities of Belgium. This is the first nationwide study that can make these comparisons and the first measurement after implementation of the euthanasia law (2002).

  4. Bereaved relatives' perspectives of the patient's oral intake towards the end of life: a qualitative study.

    NARCIS (Netherlands)

    Raijmakers, N.J.H.; Clark, J.B.; Zuylen, L. van; Allan, S.G.; Heide, A. van der

    2013-01-01

    Background: Patients approaching death often have a decreasing oral intake, which can be distressing for relatives. Little is known about the relatives' experiences with and perceptions of oral intake at the end of life. Aim:This study aims to contribute to a more thorough understanding of

  5. Learning end-of-life care within a constructivist model: Undergraduate nursing students’ experiences

    Directory of Open Access Journals (Sweden)

    Anna E. van der Wath

    2015-07-01

    Full Text Available Background: Although nursing education aims to equip nursing students to provide care to dying patients and their families, nurses often feel ill-prepared to cope with the emotional labour involved in end-of-life care.Objectives: The aim of the study was to explore and describe nursing students’ experiences of end-of-life care through experiential learning within a constructivist educational model.Method: A qualitative, descriptive design was used. As part of introducing experiential learning, innovative educational practices were initiated during a second year level undergraduate nursing module on end-of-life care. Qualitative data on second-year nursing students’ experiences were collected through written reflections and analysed using open coding.Results: The themes that emerged revealed participants’ sensory and emotional experiences during the learning opportunities. Participants reflected on what they learnt and clarified their values related to death and dying. They indicated how they would apply the new meanings constructed in clinical practice.Conclusion: A constructivist educational model of experiential learning holds potential to enhance value clarification and nursing students’ sensory and emotional awareness of death and dying. Experiential learning is recommended to develop nursing students’ competency inproviding end-of-life care.

  6. Culture and end of life care: a scoping exercise in seven European countries

    NARCIS (Netherlands)

    Gysels, M.; Evans, N.; Meñaca, A.; Andrew, E.; Toscani, F.; Finetti, S.; Pasman, H.R.; Higginson, I.; Harding, R.; Pool, R.

    2012-01-01

    Aim: Culture is becoming increasingly important in relation to end of life (EoL) care in a context of globalization, migration and European integration. We explore and compare socio-cultural issues that shape EoL care in seven European countries and critically appraise the existing research evidence

  7. [The nursing role and ethical dimension of end of life care].

    Science.gov (United States)

    Daydé, Marie-Claude

    2016-02-01

    Supporting people in situations of precarity at the end of life is often fraught with complex problems, where one form of vulnerability amplifies another. This complexity requires interdisciplinary support, around the nursing care, to reflect together on the meaning of the action taken in an ethical approach. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Do Personality Traits Moderate the Impact of Care Receipt on End-of-Life Care Planning?

    Science.gov (United States)

    Ha, Jung-Hwa; Pai, Manacy

    2012-01-01

    Purpose of the Study: This study examines (a) the association between being a care recipient and end-of-life care planning (EOLCP) and (b) the extent to which personality traits moderate the relationship between care receipt and EOLCP. Design and Methods: Data are drawn from the Wisconsin Longitudinal Study, a survey of Wisconsin high school…

  9. End-of-Life Care for Undocumented Immigrants With Advanced Cancer: Documenting the Undocumented.

    Science.gov (United States)

    Jaramillo, Sylvia; Hui, David

    2016-04-01

    There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through the healthcare system in the last months of life. These included delayed diagnosis, limited social support, financial issues, fear of deportation, and language and cultural barriers, which resulted in significant physical and psychological distress. Within the undocumented patient population, there is often a lack of advance care planning, prognostic understanding, mistrust, religious practices, and cultural beliefs that may affect decision making. Given the growing number of undocumented immigrants in the United States, it is important for clinicians and policy makers to have a better understanding of the issues surrounding end-of-life care for undocumented immigrants, and work together to improve the quality of life and quality of end-of-life care for these disadvantaged individuals. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  10. Experiences and attitudes towards end-of-life decisions amongst Danish physicians

    DEFF Research Database (Denmark)

    Folker, Anna Paldam; Holtug, Nils; Jensen, Annette B

    1996-01-01

    In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered...

  11. Export, metal recovery and the mobile phone end-of-life ecosystem

    NARCIS (Netherlands)

    Bollinger, L.A.; Blass, V.

    2012-01-01

    Against a background of rapidly growing mobile phone consumption in developing and emerging economies, falling use times and looming metal scarcity, finding better ways to deal with end-of-life (EoL) phones is imperative. The current dynamic in which large numbers of EoL phones are exported from

  12. Caring for people at the end of life: Iranian oncology nurses′ experiences

    Directory of Open Access Journals (Sweden)

    Sedigheh Iranmanesh

    2009-01-01

    Conclusion: The study suggests that the nurses′ success in caring for people at the end of life is reliant on their interpersonal caring relationship. Facilitating such relationship requires the establishment of palliative care unit, incorporation of palliative care into undergraduate nursing studies, and cultural preparation through public education.

  13. End-of-life management in patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Connolly, Sheelah; Galvin, Miriam; Hardiman, Orla

    2015-04-01

    Most health-care professionals are trained to promote and maintain life and often have difficulty when faced with the often rapid decline and death of people with terminal illnesses such as amyotrophic lateral sclerosis (ALS). By contrast, data suggest that early and open discussion of end-of-life issues with patients and families allows time for reflection and planning, can obviate the introduction of unwanted interventions or procedures, can provide reassurance, and can alleviate fear. Patients' perspectives regarding end-of-life interventions and use of technologies might differ from those of the health professionals involved in their care, and health-care professionals should recognise this and respect the patient's autonomy. Advance care directives can preserve autonomy, but their legal validity and use varies between countries. Clinical management of the end of life should aim to maximise quality of life of both the patient and caregiver and, when possible, incorporate appropriate palliation of distressing physical, psychosocial, and existential distress. Training of health-care professionals should include the development of communication skills that help to sensitively manage the inevitability of death. The emotional burden for health-care professionals caring for people with terminal neurological disease should be recognised, with structures and procedures developed to address compassion, fatigue, and the moral and ethical challenges related to providing end-of-life care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Problems and training needs in end of life care for people with intellectual disabilities.

    NARCIS (Netherlands)

    Veer, A.J.E. de; Bekkema, N.; Hertogh, C.M.P.M.; Francke, A.L.

    2012-01-01

    Aims: In a previous Dutch study it was found that professionals caring for people with intellectual disabilities were experiencing deficits in their knowledge and skills regarding end- of-life care. The aim of this study was to identify changes between 2005 and 2011 in professionals’ views on the

  15. End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

    NARCIS (Netherlands)

    Gysels, M.H.; Pell, C.; Straus, L.; Pool, R.

    2011-01-01

    Background End of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL

  16. Attitudes of Social Work Students toward End-of-Life Planning.

    Science.gov (United States)

    Heyman, Janna C.; Gutheil, Irene A.

    2003-01-01

    Correlations and t-tests of data from 267 master of social work students found significant relationships between attitudes toward end-of-life planning and knowledge, comfort level, and personal desire for treatment; 57% were knowledgeable about living wills. Age, gender, and race accounted for only a small portion of variance in attitudes.…

  17. Older Latinos' Attitudes toward and Comfort with End-of-Life Planning

    Science.gov (United States)

    Heyman, Janna C.; Gutheil, Irene A.

    2010-01-01

    The purpose of this study was to determine which of two educational interventions delivered in Spanish would influence Latino elders' attitudes toward and comfort with end-of-life planning in comparison with a control group receiving only standard information routinely provided. Using a posttest-only control group design, elders receiving home…

  18. Measuring Experience With End-of-Life Care: A Systematic Literature Review

    National Research Council Canada - National Science Library

    Lendon, Jessica Penn; Ahluwalia, Sangeeta C; Walling, Anne M; Lorenz, Karl A; Oluwatola, Oluwatobi A; Anhang Price, Rebecca; Quigley, Denise; Teno, Joan M

    2015-01-01

    .... We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS(®) for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care...

  19. End-of-life care among head and neck cancer patients.

    Science.gov (United States)

    Shuman, Andrew G; Yang, Ye; Taylor, Jeremy M G; Prince, Mark E

    2011-05-01

    This study is designed to (1) determine the perceived quality of care received by patients with head and neck cancer at the end of their lives, in order to (2) better anticipate and improve upon the experiences of future patients. Cross-sectional survey. Single-institution, academic tertiary care medical center. A validated survey instrument, the Family Assessment of Treatment at the End of life (FATE), was administered to families of patients who died of head and neck cancer (n = 58). The primary outcome was the overall FATE score. Independent variables included clinical characteristics, treatments received, and the care provided at the time of death. Overall FATE scores and the domains assessing management of symptoms and care at the time of death did not vary by disease status (logoregional vs distant metastasis) at the end of life (P = .989). The location of death in the home or in hospice (vs hospital) significantly improves scores in all 3 categories (P = .023). Involvement of a palliative care team improved the care at the time of death (P care at the time of death (P = .011, P = .017). The FATE survey is a useful measure of the end-of-life experience of head and neck cancer patients. Palliative treatments of head and neck cancer, death outside of the hospital, and palliative care team involvement all improve the end-of-life experience in this population.

  20. End of life care in chronic obstructive pulmonary disease: in search of a good death

    Directory of Open Access Journals (Sweden)

    Anna Spathis

    2008-03-01

    Full Text Available Anna Spathis, Sara BoothPalliative Care Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UKAbstract: Chronic obstructive pulmonary disease (COPD is an incurable, progressive illness that is the fourth commonest cause of death worldwide. Death tends to occur after a prolonged functional decline associated with uncontrolled symptoms, emotional distress and social isolation. There is increasing evidence that the end of life needs of those with advanced COPD are not being met by existing services. Many barriers hinder the provision of good end of life care in COPD, including the inherent difficulties in determining prognosis. This review provides an evidence-based approach to overcoming these barriers, summarising current evidence and highlighting areas for future research. Topics include end of life needs, symptom control, advance care planning, and service development to improve the quality of end of life care.Keywords: chronic obstructive pulmonary disease (MeSH, palliative care (MeSH, dyspnoea (MeSH, advance care planning (MeSH

  1. Trends in End-of-Life Decision Making in Patients With and Without Cancer

    NARCIS (Netherlands)

    Pardon, K.; Chambaere, K.; Pasman, H.R.W.; Deschepper, R.; Rietjens, J.; Deliens, L.

    2013-01-01

    Purpose: Because of cancer's high symptom burden and specific disease course, patients with cancer are more likely than other patients to face end-of-life decisions that have possible or certain life-shortening effects (ELDs). This study examines the incidence of ELDs in patients with cancer

  2. Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Nursing Care.

    Science.gov (United States)

    American Association of Colleges of Nursing, Washington, DC.

    A group of health care ethicists and palliative care experts convened by the American Association of Colleges of Nursing developed a set of competencies that should be achieved through nursing curricula. The purpose of the 15 competency statements is to assist nurse educators in incorporating end-of-life content into nursing curricula. Every…

  3. End-of-life decisions in medicine : emperical studies on practice and attitudes in the Netherlands

    NARCIS (Netherlands)

    J.H. Groenewoud (Hanny)

    2002-01-01

    textabstractThe role of psychiatrists in end-of-life decision-making will be described in Chapters 2 to 4 (part II). Chapter 2 deals with the experience of Dutch psychiatrists with requests for euthanasia or physician-assisted suicide made by patients under their treatment. Chapter 3 examines

  4. Involvement of nurses in end-of-life discussions for severely disabled children

    NARCIS (Netherlands)

    Zaal-Schuller, I. H.; Willems, D. I.; Ewals, F.; van Goudoever, J. B.; de Vos, M. A.

    2018-01-01

    In children with profound intellectual and multiple disabilities (PIMD), discussions about end-of-life decisions (EoLDs) are comparatively common. Nurses play a crucial role in the care for these children, yet their involvement in EoLD discussions is largely unknown. The objective of this research

  5. Medication use during end-of-life care in a palliative care centre

    NARCIS (Netherlands)

    A.D. Masman (Anniek); M. van Dijk (Monique); D. Tibboel (Dick); F.P.M. Baar (Frans); R.A. Mathot (Ron)

    2015-01-01

    textabstractBackground In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination

  6. When Safe Oral Feeding Is Threatened: End-of-Life Options and Decisions

    Science.gov (United States)

    Groher, Michael E.; Groher, Tammy Peutz

    2012-01-01

    Managing one's dysphagia at the end-of-life is challenging for the patient and the medical care team. Decisions surrounding oral feeding safety and the use of artificially administered hydration and nutrition require the medical care team to provide its best advice, taking into consideration the patient's health-related goals and the impact the…

  7. Patients' perspective on deactivation of the implantable cardioverter-defibrillator near the end of life

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Chaitsing, Rismy; Szili-Torok, Tamas

    2013-01-01

    Recent guidelines have emphasized the importance of discussing the issue of deactivation near the end of life with patients with an implantable cardioverter-defibrillator (ICD). Few studies have examined the patient perspective and patients' wishes. We examined patients' knowledge and wishes...

  8. End-of-life care for Hispanic children: A study of California Medicaid beneficiaries

    Science.gov (United States)

    Lindley, Lisa C.; Trujillo, Laura V.

    2016-01-01

    Introduction Over 8,000 Hispanic children die annually in the United States; yet, little is known about the end-of-life care utilized. The purpose of this study was to examine the children and family characteristics associated with end-of-life care for Hispanic children. Methods A sample of 370 Hispanic children was created, using the 2009-2010 California Medicaid data. The relationship between child and family characteristics and end-of-life care utilization (i.e., hospice enrollment, emergency room utilization, hospital admissions) was analyzed using multivariate regression. Results Pediatric hospice accessibility ( p< 0.05), palliative care policy (p <0.01), congenital anomalies (p <0.01), and cardiovascular conditions (p <0.01) were related to hospice enrollment. Usual source of care (p <0.001), functional status (p <0.001), palliative care policy (p <0.01), and private insurance (p <0.01) were associated with emergency room utilization; while usual source of care (p <0.001), cancer (p <0.001), and disability status (p <0.01) corresponded with hospital admissions. Conclusion Nursing practices aimed at engaging Hispanic families in their community are critical to end-of-life care utilization for Hispanic children. PMID:27650201

  9. Hospice in Assisted Living: Promoting Good Quality Care at End of Life

    Science.gov (United States)

    Cartwright, Juliana C.; Miller, Lois; Volpin, Miriam

    2009-01-01

    Purpose: The purpose of this study was to describe good quality care at the end of life (EOL) for hospice-enrolled residents in assisted living facilities (ALFs). Design and Methods: A qualitative descriptive design was used to obtain detailed descriptions of EOL care provided by ALF medication aides, caregivers, nurses, and hospice nurses in…

  10. Complexity in non-pharmacological caregiving activities at the end of life: an international qualitative study.

    Directory of Open Access Journals (Sweden)

    Olav Lindqvist

    2012-02-01

    , respect, and further develop end-of-life care.

  11. Residents' end-of-life decision making with adult hospitalized patients: a review of the literature.

    Science.gov (United States)

    Gorman, Todd E; Ahern, Stéphane P; Wiseman, Jeffrey; Skrobik, Yoanna

    2005-07-01

    The authors performed a structured literature review to understand residents' experiences with end-of-life (EOL) decision making with adult hospitalized patients, specifically regarding decisions to withhold or withdraw advanced life-support measures. An Ovid-based strategy was used to search Medline, ERIC, PsychINFO, and CINHAL databases for articles published between 1966 and February 2005, combining the domains of "resuscitation orders," "decision making," and "internship and residency." All quantitative and qualitative studies examining residents' EOL decision making with adult hospitalized patients were included. The authors developed and applied a scoring system for relevance and quality, performed data abstraction and quality assessment independently and in duplicate, then met to collate findings and identify factors in residents' EOL decision making. The searches yielded 884 articles, of which 26 were included. Variable methodologies precluded meta-analysis. In these studies, residents felt unprepared to handle patient EOL decision making, although exposure to EOL discussions helped them gain confidence. Residents' attitudes, skills, and knowledge were key determinants of whether EOL decisions were addressed. Many misinterpreted the terms "DNR" and "futility." Residents' understanding of the patient EOL decision-making process could be extremely variable, and their do-not-resuscitate discussions suboptimal. Residents' lived practice experience of the patient EOL decision-making process was often at odds with what they were taught in formal curricula. Educational strategies aimed at changing residents' knowledge, skills and attitude should address the hidden curriculum for the patient EOL decision-making process that is part of the experienced culture of every day practice. Future studies of this experienced culture would inform specific educational interventions.

  12. Parents and end-of-life decision-making for their child: roles and responsibilities.

    Science.gov (United States)

    Sullivan, Jane; Gillam, Lynn; Monagle, Paul

    2015-09-01

    Whether parents want to be and should be the decision-maker for their child in end-of-life matters are contested clinical and ethical questions. Previous research outcomes are equivocal. A qualitative interview method was used to examine the views and experiences of 25 bereaved parents in end-of-life decision-making for their child. Data were analysed thematically. Three types of decision-making roles were identified: self-determined, guided (both involving active decision-making) and acquiescent (passive).The majority of parents had been active in the decision-making process for their child. They perceived themselves as the ultimate end-of-life decision-maker. This was perceived as part of their parental responsibility. A minority of parents did not consider that they had been an active, ultimate decision-maker. Generally, parents in the self-determined and guided groups reported no negative consequences from their decision-making involvement. Importantly, parents in the acquiescent group described their experience as difficult at the time and subsequently, although not all difficulties related directly to decision-making. Parents considered that in principle parents should be the end-of-life decision-maker for their child, but understood personal characteristics and preference could prevent some parents from taking this role. This study unequivocally supports parents' desire to fulfil the end-of-life decision-making role. It provides a nuanced understanding of parents' roles and contributes evidence for the ethical position that parents should be the end-of-life decision-makers for their child, unless not in the child's best interests. On the whole, parents want this role and can manage its consequences. Indeed, not being the end-of-life decision-maker could be detrimental to parents' well-being. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  13. Factors affecting family satisfaction with inpatient end-of-life care.

    Directory of Open Access Journals (Sweden)

    Erin Sadler

    Full Text Available BACKGROUND: Little data exists addressing satisfaction with end-of-life care among hospitalized patients, as they and their family members are systematically excluded from routine satisfaction surveys. It is imperative that we closely examine patient and institution factors associated with quality end-of-life care and determine high-priority target areas for quality improvement. METHODS: Between September 1, 2010 and January 1, 2012 the Canadian Health care Evaluation Project (CANHELP Bereavement Questionnaire was mailed to the next-of-kin of recently deceased inpatients to seek factors associated with satisfaction with end-of-life care. The primary outcome was the global rating of satisfaction. Secondary outcomes included rates of actual versus preferred location of death, associations between demographic factors and global satisfaction, and identification of targets for quality improvement. RESULTS: Response rate was 33% among 275 valid addresses. Overall, 67.4% of respondents were very or completely satisfied with the overall quality of care their relative received. However, 71.4% of respondents who thought their relative did not die in their preferred location favoured an out-of-hospital location of death. A common location of death was the intensive care unit (45.7%; however, this was not the preferred location of death for 47.6% of such patients. Multivariate Poisson regression analysis showed respondents who believed their relative died in their preferred location were 1.7 times more likely to be satisfied with the end-of-life care that was provided (p = 0.001. Items identified as high-priority targets for improvement included: relationships with, and characteristics of health care professionals; illness management; communication; and end-of-life decision-making. INTERPRETATION: Nearly three-quarters of recently deceased inpatients would have preferred an out-of-hospital death. Intensive care units were a common, but not preferred

  14. Factors affecting family satisfaction with inpatient end-of-life care.

    Science.gov (United States)

    Sadler, Erin; Hales, Brigette; Henry, Blair; Xiong, Wei; Myers, Jeff; Wynnychuk, Lesia; Taggar, Ru; Heyland, Daren; Fowler, Robert

    2014-01-01

    Little data exists addressing satisfaction with end-of-life care among hospitalized patients, as they and their family members are systematically excluded from routine satisfaction surveys. It is imperative that we closely examine patient and institution factors associated with quality end-of-life care and determine high-priority target areas for quality improvement. Between September 1, 2010 and January 1, 2012 the Canadian Health care Evaluation Project (CANHELP) Bereavement Questionnaire was mailed to the next-of-kin of recently deceased inpatients to seek factors associated with satisfaction with end-of-life care. The primary outcome was the global rating of satisfaction. Secondary outcomes included rates of actual versus preferred location of death, associations between demographic factors and global satisfaction, and identification of targets for quality improvement. Response rate was 33% among 275 valid addresses. Overall, 67.4% of respondents were very or completely satisfied with the overall quality of care their relative received. However, 71.4% of respondents who thought their relative did not die in their preferred location favoured an out-of-hospital location of death. A common location of death was the intensive care unit (45.7%); however, this was not the preferred location of death for 47.6% of such patients. Multivariate Poisson regression analysis showed respondents who believed their relative died in their preferred location were 1.7 times more likely to be satisfied with the end-of-life care that was provided (p = 0.001). Items identified as high-priority targets for improvement included: relationships with, and characteristics of health care professionals; illness management; communication; and end-of-life decision-making. Nearly three-quarters of recently deceased inpatients would have preferred an out-of-hospital death. Intensive care units were a common, but not preferred, location of in-hospital deaths. Family satisfaction with end-of-life

  15. Context, mechanisms and outcomes in end of life care for people with advanced dementia.

    Science.gov (United States)

    Kupeli, Nuriye; Leavey, Gerard; Moore, Kirsten; Harrington, Jane; Lord, Kathryn; King, Michael; Nazareth, Irwin; Sampson, Elizabeth L; Jones, Louise

    2016-03-10

    The majority of people with dementia in the UK die in care homes. The quality of end of life care in these environments is often suboptimal. The aim of the present study was to explore the context, mechanisms and outcomes for providing good palliative care to people with advanced dementia residing in UK care homes from the perspective of health and social care providers. The design of the study was qualitative which involved purposive sampling of health care professionals to undertake interactive interviews within a realist framework. Interviews were completed between September 2012 and October 2013 and were thematically analysed and then conceptualised according to context, mechanisms and outcomes. The settings were private care homes and services provided by the National Health Service including memory clinics, mental health and commissioning services in London, United Kingdom. The participants included 14 health and social care professionals including health care assistants, care home managers, commissioners for older adults' services and nursing staff. Good palliative care for people with advanced dementia is underpinned by the prioritisation of psychosocial and spiritual care, developing relationships with family carers, addressing physical needs including symptom management and continuous, integrated care provided by a multidisciplinary team. Contextual factors that detract from good end of life care included: an emphasis on financial efficiency over person-centred care; a complex health and social care system, societal and family attitudes towards staff; staff training and experience, governance and bureaucratisation; complexity of dementia; advance care planning and staff characteristics. Mechanisms that influence the quality of end of life care include: level of health care professionals' confidence, family uncertainty about end of life care, resources for improving end of life care and supporting families, and uncertainty about whether dementia specific

  16. Family Perspectives on Aggressive Cancer Care Near the End of Life.

    Science.gov (United States)

    Wright, Alexi A; Keating, Nancy L; Ayanian, John Z; Chrischilles, Elizabeth A; Kahn, Katherine L; Ritchie, Christine S; Weeks, Jane C; Earle, Craig C; Landrum, Mary B

    2016-01-19

    Patients with advanced-stage cancer are receiving increasingly aggressive medical care near death, despite growing concerns that this reflects poor-quality care. To assess the association of aggressive end-of-life care with bereaved family members' perceptions of the quality of end-of-life care and patients' goal attainment. Interviews with 1146 family members of Medicare patients with advanced-stage lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance study (a multiregional, prospective, observational study) who died by the end of 2011 (median, 144.5 days after death; interquartile range, 85.0-551.0 days). Claims-based quality measures of aggressive end-of-life care (ie, intensive care unit [ICU] admission or repeated hospitalizations or emergency department visits during the last month of life; chemotherapy ≤2 weeks of death; no hospice or ≤3 days of hospice services; and deaths occurring in the hospital). Family member-reported quality rating of "excellent" for end-of-life care. Secondary outcomes included patients' goal attainment (ie, end-of-life care congruent with patients' wishes and location of death occurred in preferred place). Of 1146 patients with cancer (median age, 76.0 years [interquartile range, 65.0-87.0 years]; 55.8% male), bereaved family members reported excellent end-of-life care for 51.3%. Family members reported excellent end-of-life care more often for patients who received hospice care for longer than 3 days (58.8% [352/599]) than those who did not receive hospice care or received 3 or fewer days (43.1% [236/547]) (adjusted difference, 16.5 percentage points [95% CI, 10.7 to 22.4 percentage points]). In contrast, family members of patients admitted to an ICU within 30 days of death reported excellent end-of-life care less often (45.0% [68/151]) than those who were not admitted to an ICU within 30 days of death (52.3% [520/995]) (adjusted difference, -9.4 percentage points [95% CI, -18.2 to -0.6 percentage

  17. Community end-of-life care among Chinese older adults living in nursing homes.

    Science.gov (United States)

    Chu, Leung-Wing; So, Jason C; Wong, Lai-Chin; Luk, James K H; Chiu, Patrick K C; Chan, Cherry S Y; Kwan, Fiona S M; Chau, June; Hui, Elsie; Woo, Jean; McGhee, Sarah M

    2014-04-01

    The aim of the present study was to investigate the preference and willingness-to-pay (WTP) of older Chinese adults for community end-of-life care in a nursing home rather than a hospital. A total of 1540 older Chinese adults from 140 nursing homes were interviewed. Four hypothetical questions were asked to explore their preferences for end-of-life care. Using a discrete choice approach, specific questions explored acceptable trade-offs between three attributes: availability of doctors onsite, attitude of the care staff and additional cost of care per month. Approximately 35% of respondents preferred end-of-life care in the nursing home, whereas 23% of them would consider it in a better nursing home. A good attitude of staff was the most important attribute of the care site. Respondents were willing to pay an extra cost of US$5 (HK$39) per month for more coverage of doctor's time, and US$49 (HK$379) for a better attitude of staff in the nursing home. The marginal WTP for both more coverage of doctor's time and better attitude of staff amounted to US$54 (HK$418). Respondents on government subsidy valued the cost attribute more highly, as expected, validating the hypothesis that those respondents would be less willing to pay an additional cost for end-of-life care. Older Chinese adults living in nursing homes are willing to pay an additional fee for community end-of-life care services in nursing homes. Both the availability of the doctor and attitudes of nursing home staff are important, with the most important attribute being the staff attitudes. Geriatr Gerontol Int 2013; 14: 273-284. © 2013 Japan Geriatrics Society.

  18. End-of-life decisions for people with intellectual disabilities, an interview study with patient representatives.

    Science.gov (United States)

    Wagemans, Annemieke M A; Van Schrojenstein Lantman-de Valk, Henny M J; Proot, Ireen M; Metsemakers, Job; Tuffrey-Wijne, Irene; Curfs, Leopold M G

    2013-09-01

    Not much is known about the process of end-of-life decision-making for people with intellectual disabilities. To clarify the process of end-of-life decision-making for people with intellectual disabilities from the perspective of patient representatives. A qualitative study based on semi-structured interviews, recorded digitally and transcribed verbatim. Data were analysed using Grounded Theory procedures. We interviewed 16 patient representatives after the deaths of 10 people with intellectual disabilities in the Netherlands. The core category 'Deciding for someone else' describes the context in which patient representatives took end-of-life decisions. The patient representatives felt highly responsible for the outcomes. They had not involved the patients in the end-of-life decision-making process, nor any professionals other than the doctor. The categories of 'Motives' and 'Support' were connected to the core category of 'Deciding for someone else'. 'Motives' refers to the patient representatives' ideas about quality of life, prevention from suffering, patients who cannot understand the burden of interventions and emotional reasons reported by patient representatives. 'Support' refers to the support that patient representatives wanted the doctors to give to them in the decision-making process. From the perspective of the patient representatives, the process of end-of-life decision-making can be improved by ensuring clear roles and an explicit description of the tasks and responsibilities of all participants. Regular discussion between everyone involved including people with intellectual disabilities themselves can improve knowledge about each other's motives for end-of-decisions and can clarify expectations towards each other.

  19. End-of-life communication: a retrospective survey of representative general practitioner networks in four countries.

    Science.gov (United States)

    Evans, Natalie; Costantini, Massimo; Pasman, H R; Van den Block, Lieve; Donker, Gé A; Miccinesi, Guido; Bertolissi, Stefano; Gil, Milagros; Boffin, Nicole; Zurriaga, Oscar; Deliens, Luc; Onwuteaka-Philipsen, Bregje

    2014-03-01

    Effective communication is central to high-quality end-of-life care. This study examined the prevalence of general practitioner (GP)-patient discussion of end-of-life topics (according to the GP) in Italy, Spain, Belgium, and The Netherlands and associated patient and care characteristics. This cross-sectional, retrospective survey was conducted with representative GP networks. Using a standardized form, GPs recorded the health and care characteristics in the last three months of life, and the discussion of 10 end-of-life topics, of all patients who died under their care. The mean number of topics discussed, the prevalence of discussion of each topic, and patient and care characteristics associated with discussions were estimated per country. In total, 4396 nonsudden deaths were included. On average, more topics were discussed in The Netherlands (mean=6.37), followed by Belgium (4.45), Spain (3.32), and Italy (3.19). The topics most frequently discussed in all countries were "physical complaints" and the "primary diagnosis," whereas "spiritual and existential issues" were the least frequently discussed. Discussions were most prevalent in The Netherlands, followed by Belgium. The GPs from all countries tended to discuss fewer topics with older patients, noncancer patients, patients with dementia, patients for whom palliative care was not an important treatment aim, and patients for whom their GP had not provided palliative care. The prevalence of end-of-life discussions varied across the four countries. In all countries, training priorities should include the identification and discussion of spiritual and social problems and early end-of-life discussions with older patients, those with cognitive decline if possible, and those with non-malignant diseases. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

  20. Intensity of Care at the End of Life Among Older Adults in Korea.

    Science.gov (United States)

    Kim, Su Hyun; Kang, Sangwook; Song, Mi-Kyung

    2018-01-01

    To examine the intensity of care at the end of life among older adults in Korea and to identify the individual and institutional factors associated with care intensity. This secondary data analysis included a sample of 6278 decedents aged 65 years or older who were identified from the 2009 to 2010 Korean National Health Insurance Service-National Sample Cohort Claims data. We examined the medical care received by the cohort in the last 30 days of their lives. Overall, 36.5% of the sample received at least 1 intensive care procedure in the last 30 days of their lives; 26.3% of patients experienced intensive care unit admission, with an average stay of 7.45 days, 19.5% received mechanical ventilation, 12.3% received cardiopulmonary resuscitation, and 15.5% had a feeding tube placement. A statistical analysis using a multiple logistic regression model with random effects showed that younger age, higher household income, primary diagnoses of diseases (ischemic heart disease, infectious disease, chronic lung disease, or chronic heart disease), and characteristics of care setting (large hospitals and facilities located in metropolitan areas) were significantly associated with the likelihood of receiving high-intensity care at the end of life. A substantial number of older adults in Korea experienced high-intensity end-of-life care. Both individual and institutional factors were associated with the likelihood of receiving high-intensity care. Gaining an understanding of the intensity of care at the end of life and the impact of the determinants would advance efforts to improve quality of care at the end of life for older adults in Korea.

  1. A framework for resolving disagreement during end of life care in the critical care unit.

    Science.gov (United States)

    Choong, Karen; Cupido, Cynthia; Nelson, Erin; Arnold, Donald M; Burns, Karen; Cook, Deborah; Meade, Maureen

    2010-08-01

    End-of-life decisions regarding the administration, withdrawal or withholding of life-sustaining therapy in the critical care setting can be challenging. Disagreements between health care providers and family members occur, especially when families believe strongly in preserving life, and physicians are resistant to providing medically "futile" care. Such disagreements can cause tension and moral distress among families and clinicians. To outline the roles and responsibilities of physicians, substitute decision makers, and the judicial system when decisions must be made on behalf of incapable persons, and to provide a framework for conflict resolution during end-of-life decision-making for physicians practicing in Canada. We used a case-based example to illustrate our objectives. We employed a comprehensive approach to understanding end-of-life decision making that included: 1) a search for relevant literature; 2) a review of provincial college policies; 3) a review of provincial legislation on consent; 4) a consultation with two bioethicists and 5) a consultation with two legal experts in health law. In Canada, laws about substitute decision-making for health care are primarily provincial or territorial. Thus, laws and policies from professional regulatory bodies on end-of-life care vary across the country. We tabulated the provincial college policies on end-of-life care and the provincial legislation on consent and advance directives, and constructed a 10-step approach to conflict resolution. Knowledge of underlying ethical principles, understanding of professional duties, and adoption of a process for mediation and conflict resolution are essential to ensuring that physicians and institutions act responsibly in maintaining a patients' best interests in the context of family-centred care.

  2. Nurses' autonomy in end-of-life situations in intensive care units.

    Science.gov (United States)

    Paganini, Maria Cristina; Bousso, Regina Szylit

    2015-11-01

    The intensive care unit environment focuses on interventions and support therapies that prolong life. The exercise by nurses of their autonomy impacts on perception of the role they assume in the multidisciplinary team and on their function in the intensive care unit context. There is much international research relating to nurses' involvement in end-of-life situations; however, there is a paucity of research in this area in Brazil. In the Brazilian medical scenario, life support limitation generated a certain reluctance of a legal nature, which has now become unjustifiable with the publication of a resolution by the Federal Medical Council. In Brazil, the lack of medical commitments to end-of-life care is evident. To understand the process by which nurses exercise autonomy in making end-of-life decisions in intensive care units. Symbolic Interactionism and Corbin and Strauss theory methodology were used for this study. Data were collected through single audio-recorded qualitative interviews with 14 critical care nurses. The comparative analysis of the data has permitted the understanding of the meaning of nurse's experience in exercising autonomy relating to end-of-life decision-making. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were anonymized. The results revealed that nurses experience the need to exercise autonomy in intensive care units on a daily basis. Their experience expressed by the process of increase opportunities to exercise autonomy is conditioned by the pressure of the intensive care unit environment, in which nurses can grow, feel empowered, and exercise their autonomy or else can continuously depend on the decisions made by other professionals. Nurses exercise their autonomy through care. They work to create new spaces at the same time that they acquire new knowledge and make decisions. Because of the complexity of the end-of-life situation, nurses must adopt a proactive attitude

  3. End-of-life decision making and emotional burden: placing family meetings in context.

    Science.gov (United States)

    Radwany, Steven; Albanese, Terry; Clough, Lynn; Sims, Linda; Mason, Hallie; Jahangiri, Sudy

    2009-01-01

    Helping families make end-of-life care decisions can be challenging for health care providers in an intensive care unit (ICU). Family meetings facilitated by palliative care consult services (PCCS) have been recommended and found effective for improving support for families in these difficult situations. These services can be improved with a deeper understanding of factors associated with emotional burden in the aftermath of end-of-life decision making. This qualitative study seeks to provide a better understanding of family experiences and emotional burden surrounding end-of-life decision making. We conducted in-depth, semistructured interviews with 23 family members following the death of a loved one in the ICU. All participants had been involved in a PCCS-led family meeting concerning end-of-life decisions about their loved one. Methodology from grounded theory was used to analyze the content of transcripts and to build a theoretical model. From the perspective of the family, decision making at the end of life is described within a theoretical model of salient experiences that are relevant to families' emotional burdens. Three temporal stages were evident: (1) the illness experience, (2) decision making in the family meeting, and (3) the dying process. However, emotional burden in the form of lingering questions and resentment was more common when families reported having negative experiences during the final hospital stay. Supportive responsiveness from the PCCS for families who have experienced critical incidents or who have unanswered questions or resentment about treatment may be an important consideration to alleviate later emotional burden.

  4. End-of-life care in patients with advanced lung cancer.

    Science.gov (United States)

    Lim, Richard B L

    2016-10-01

    Despite advances in the detection, pathological diagnosis and therapeutics of lung cancer, many patients still develop advanced, incurable and progressively fatal disease. As physicians, the duties to cure sometimes, relieve often and comfort always should be a constant reminder to us of the needs that must be met when caring for a patient with lung cancer. Four key areas of end-of-life care in advanced lung cancer begin with first recognizing 'when a patient is approaching the end of life'. The clinician should be able to recognize when the focus of care needs to shift from an aggressive life-sustaining approach to an approach that helps prepare and support a patient and family members through a period of progressive, inevitable decline. Once the needs are recognized, the second key area is appropriate communication, where the clinician should assist patients and family members in understanding where they are in the disease trajectory and what to expect. This involves developing rapport, breaking bad news, managing expectations and navigating care plans. Subsequently, the third key area is symptom management that focuses on the goals to first and foremost provide comfort and dignity. Symptoms that are common towards the end of life in lung cancer include pain, dyspnoea, delirium and respiratory secretions. Such symptoms need to be anticipated and addressed promptly with appropriate medications and explanations to the patient and family. Lastly, in order for physicians to provide quality end-of-life care, it is necessary to understand the ethical principles applied to end-of-life-care interventions. Misconceptions about euthanasia versus withholding or withdrawing life-sustaining treatments may lead to physician distress and inappropriate decision making. © The Author(s), 2016.

  5. Palliative and end of life care for people with dementia: lessons for clinical commissioners.

    Science.gov (United States)

    Raymond, Mareeni; Warner, Alex; Davies, Nathan; Nicholas, Nirusha; Manthorpe, Jill; Iliffe, Steve

    2014-10-01

    To synthesize information about management of end of life care in people with dementia using review papers. There are increasing numbers of people being diagnosed with dementia worldwide, and the needs of people with dementia and their carers at the end of life may be different from those with other chronic diseases. By highlighting the challenges of palliative care in persons with dementia and the ways they are best managed, practitioners in primary care may be able to improve services for this group of people at the end of life. A search of electronic databases of English language papers published in peer-reviewed journals, 2000-2011 inclusive was undertaken using broad terms related to palliative care and dementia. 6167 papers were identified. Titles and abstracts were read. Papers were included if they were literature reviews of palliative or end of life care for people with dementia/Parkinson's disease/Lewy body dementia/cognitive impairment/Alzheimer's disease or any other cognitive impairment, in any setting (hospital, care home, community) and covering people of all ages. Papers were excluded if they covered palliative care focusing on other conditions, or were about an aspect of dementia care and treatment not related to palliative care. Our critical synthesis generated five main themes from this review of the reviews: (1) carers' (family caregivers') experiences; (2) person-centred care; (3) practice (including advance care planning, pain and comfort, nutrition, medical complications and minimizing the distress of behavioural symptoms); (4) system factors, including ethical dilemmas, decision making, information, and training; and (5) research priorities. There appears to be good evidence on the care and management of patients with dementia at the end of life which can be used to influence policy development and emerging specificity about research priorities in palliative care practice for people with dementia.

  6. Sense of responsibility in ICU end-of-life decision-making: Relatives' experiences.

    Science.gov (United States)

    Lind, Ranveig

    2017-01-01

    Relatives of intensive care unit patients who lack or have reduced capacity to consent are entitled to information and participation in decision-making together with the patient. Practice varies with legislation in different countries. In Norway, crucial decisions such as withdrawing treatment are made by clinicians, usually morally justified to relatives with reference to the principle of non-maleficence. The relatives should, however, be consulted about whether they know what the patient would have wished in the situation. To examine and describe relatives' experiences of responsibility in the intensive care unit decision-making process. A secondary analysis of interviews with bereaved relatives of intensive care unit patients was performed, using a narrative analytical approach. Participants and research context: In all, 27 relatives of 21 deceased intensive care unit patients were interviewed about their experiences from the end-of-life decision-making process. Most interviews took place in the participants' homes, 3-12 months after the patient's death. Ethical considerations: Based on informed consent, the study was approved by the Data Protection Official of the Norwegian Social Science Data Services and by the Regional Committee for Medical and Health Research Ethics. The results show that intensive care unit relatives experienced a sense of responsibility in the decision-making process, independently of clinicians' intention of sparing them. Some found this troublesome. Three different variants of participation were revealed, ranging from paternalism to a more active role for relatives. For the study participants, the sense of responsibility reflects the fact that ethics and responsibility are grounded in the individual's relationship to other people. Relatives need to be included in a continuous dialogue over time to understand decisions and responsibility. Nurses and physicians should acknowledge and address relatives' sense of responsibility, include

  7. Rural Emergency Nurses' Suggestions for Improving End-of-Life Care.

    Science.gov (United States)

    Beckstrand, Renea L; Smith, Kelly E; Luthy, Karlen E Beth; Macintosh, Janelle L B

    2017-05-01

    Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments. A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska. One item asked nurses to identify the one aspect of EOL care they would change for dying patients in rural emergency departments. Each qualitative response was individually reviewed by a research team and then coded into a theme. Four major themes and three minor themes were identified. The major themes were providing greater privacy during EOL care for patients and family members, increasing availability of support services, additional staffing, and improved staff and community education. Providing adequate privacy for patients and family members was a major obstacle to providing EOL care in the emergency department, largely because of poor department design, especially in rural emergency departments where space is limited. Lack of support services and adequate staffing were also obstacles to providing quality EOL care in rural emergency departments. Consequently, rural nurses are commonly pulled away from EOL care to perform ancillary duties because additional support personnel are lacking. Providing EOL care in rural emergency departments is a challenging task given the limited staffing and resources, and thus it is imperative that nurses' suggestions for improvement of EOL care be acknowledged. Because of the current lack of research in rural EOL care, additional research is needed. Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights

  8. Strategies for handling ethical problems in end of life care: obstacles and possibilities.

    Science.gov (United States)

    Rejnö, Åsa; Berg, Linda

    2015-11-01

    In end of life care, ethical problems often come to the fore. Little research is performed on ways or strategies for handling those problems and even less on obstacles to and possibilities of using such strategies. A previous study illuminated stroke team members' experiences of ethical problems and how the teams managed the situation when caring for patients faced with sudden and unexpected death from stroke. These findings have been further explored in this study. The aim of the study was to illuminate obstacles and possibilities perceived by stroke team members in using strategies for handling ethical problems when caring for patients afflicted by sudden and unexpected death caused by stroke. A qualitative method with combined deductive and inductive content analysis was utilized. Data were collected through individual interviews with 15 stroke team members working in stroke units of two associated county hospitals in western Sweden. The study was approved by the Regional Ethics Review Board, Gothenburg, Sweden. Permission was also obtained from the director of each stroke unit. All the studied strategies for handling of ethical problems were found to have both obstacles and possibilities. Uncertainty is shown as a major obstacle and unanimity as a possibility in the use of the strategies. The findings also illuminate the value of the concept "the patient's best interests" as a starting point for the carers' ethical reasoning. The concept "the patient's best interests" used as a starting point for ethical reasoning among the carers is not explicitly defined yet, which might make this value difficult to use both as a universal concept and as an argument for decisions. Carers therefore need to strengthen their argumentation and reflect on and use ethically grounded arguments and defined ethical values like dignity in their clinical work and decisions. © The Author(s) 2014.

  9. The impact of volunteer befriending services for older people at the end of life: Mechanisms supporting wellbeing

    OpenAIRE

    Gardiner, C.; S; Barnes

    2016-01-01

    Introduction: Older people at the end of life are particularly vulnerable to social isolation and loneliness, the associated health effects of which are significant. Increasingly, charitable organizations are offering befriending services for people at the end of life. However, there is little research evidence around the mechanisms by which befriending facilitates wellbeing at the end of life. The aim of the study was to explore the mechanisms by which befriending facilitates wellbeing in ol...

  10. Changes in Properties of Cement and Lime Mortars When Incorporating Fibers from End-of-Life Tires

    Directory of Open Access Journals (Sweden)

    Lluís Gil

    2016-02-01

    Full Text Available This paper studies the addition of fibers from end-of-life tires to commercial mortar mixtures. Two different types of mortar, one lime-plastic and other cement-fluid, are mixed with different percentage of fibers ranging from 0% to 1%. The changes in bulk density, consistency, compressive and flexural strength, dynamic Young modulus and water absorption are studied. According to the results, consistency is the property that shows more relevant changes for an addition of 0.25% fibers. Consistency is related to workability and affects the water absorption and the Young modulus values. On the contrary, bulk density and mechanical properties did not change with the addition of fibers. The results prove that this fiber, considered a waste from recycling of end-of-life tires, can be used in commercial mixtures without losing strength. On the other hand, mortar workability limits the amount of fibers that can be included in the mixture and this parameter determines the performance of the mortar.

  11. Hospital at home: home-based end-of-life care.

    Science.gov (United States)

    Shepperd, Sasha; Gonçalves-Bradley, Daniela C; Straus, Sharon E; Wee, Bee

    2016-02-18

    The policy in a number of countries is to provide people with a terminal illness the choice of dying at home. This policy is supported by surveys indicating that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fourth update of the original review. To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs, and caregivers, compared with inpatient hospital or hospice care. We searched the following databases until April 2015: Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), Ovid MEDLINE(R) (from 1950), EMBASE (from 1980), CINAHL (from 1982), and EconLit (from 1969). We checked the reference lists of potentially relevant articles identified and handsearched palliative care publications, clinical trials registries, and a database of systematic reviews for related trials (PDQ-Evidence 2015). Randomised controlled trials, interrupted time series, or controlled before and after studies evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older. Two review authors independently extracted data and assessed study quality. We combined the published data for dichotomous outcomes using fixed-effect Mantel-Haenszel meta-analysis. When combining outcome data was not possible, we reported the results from individual studies. We included four trials in this review and did not identify new studies from the search in April 2015. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (risk ratio (RR) 1.33, 95% confidence interval (CI) 1.14 to 1.55, P = 0.0002; Chi(2) = 1.72, df = 2, P = 0.42, I(2) = 0%; 3 trials; N = 652; high quality evidence). Admission to hospital while receiving home-based end-of-life care varied between trials, and this was

  12. Impact of a Palliative Care Elective Course on Nursing Students' Knowledge and Attitudes Toward End-of-Life Care.

    Science.gov (United States)

    Robinson, Evelyn; Epps, Fayron

    Being knowledgeable about end-of-life care can help nurses overcome barriers to managing chronicity in terminally ill patients. The purpose of this causal-comparative research study was to examine the influence of a palliative care elective course on 74 senior nursing students' knowledge and attitudes toward providing end-of-life care. This study compared the differences between 2 groups of students, with 1 group receiving end-of-life care instruction based on the principles of the End-of-Life Nursing Education Consortium as an elective course.

  13. The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision.

    Science.gov (United States)

    Lewis, Claire; Reid, Joanne; McLernon, Zara; Ingham, Rory; Traynor, Marian

    2016-08-02

    The concerns of undergraduate nursing and medical students' regarding end of life care are well documented. Many report feelings of emotional distress, anxiety and a lack of preparation to provide care to patients at end of life and their families. Evidence suggests that increased exposure to patients who are dying and their families can improve attitudes toward end of life care. In the absence of such clinical exposure, simulation provides experiential learning with outcomes comparable to that of clinical practice. The aim of this study was therefore to assess the impact of a simulated intervention on the attitudes of undergraduate nursing and medical students towards end of life care. A pilot quasi-experimental, pretest-posttest design. Attitudes towards end of life care were measured using the Frommelt Attitudes Towards Care of the Dying Part B Scale which was administered pre and post a simulated clinical scenario. 19 undergraduate nursing and medical students were recruited from one large Higher Education Institution in the United Kingdom. The results of this pilot study confirm that a simulated end of life care intervention has a positive impact on the attitudes of undergraduate nursing and medical students towards end of life care (p nursing and medical students towards end of life. In the absence of clinical exposure, simulation is a viable alternative to help prepare students for their professional role regarding end of life care.

  14. Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology.

    Science.gov (United States)

    Hammami, Muhammad M; Hammami, Safa; Amer, Hala A; Khodr, Nesrine A

    2016-01-01

    Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females' end-of-life choices. A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology. The mean age of the females in the sample was 30.3 years (range, 19-55 years). Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: "physical and emotional privacy concerned, family caring" (younger, lower religiosity), "whole person" (higher religiosity), "pain and informational privacy concerned" (lower life quality), "decisional privacy concerned" (older, higher life quality), and "life quantity concerned, family dependent" (high life quality, low life satisfaction). Out of the extreme 14 priorities/dis-priorities for each group, 21%-50% were not represented among the extreme 20 priorities/dis-priorities for the entire sample. Consistent with the previously reported findings in Saudi males, transcendence and dying in the hospital were the extreme end-of-life priority and dis

  15. End-of-life conversations and care: an asset-based model for community engagement.

    Science.gov (United States)

    Matthiesen, Mary; Froggatt, Katherine; Owen, Elaine; Ashton, John R

    2014-09-01

    Public awareness work regarding palliative and end-of-life care is increasingly promoted within national strategies for palliative care. Different approaches to undertaking this work are being used, often based upon broader educational principles, but little is known about how to undertake such initiatives in a way that equally engages both the health and social care sector and the local communities. An asset-based community engagement approach has been developed that facilitates community-led awareness initiatives concerning end-of-life conversations and care by identifying and connecting existing skills and expertise. (1) To describe the processes and features of an asset-based community engagement approach that facilitates community-led awareness initiatives with a focus on end-of-life conversations and care; and (2) to identify key community-identified priorities for sustainable community engagement processes. An asset-based model of community engagement specific to end-of-life issues using a four-step process is described (getting started, coming together, action planning and implementation). The use of this approach, in two regional community engagement programmes, based across rural and urban communities in the northwest of England, is described. The assets identified in the facilitated community engagement process encompassed people's talents and skills, community groups and networks, government and non-government agencies, physical and economic assets and community values and stories. Five priority areas were addressed to ensure active community engagement work: information, outreach, education, leadership and sustainability. A facilitated, asset-based approach of community engagement for end-of-life conversations and care can catalyse community-led awareness initiatives. This occurs through the involvement of community and local health and social care organisations as co-creators of this change across multiple sectors in a sustainable way. This approach

  16. Hospice family members’ perceptions and experiences with end-of-life care in the nursing home

    Science.gov (United States)

    Washington, Karla; Kruse, Robin L.; Albright, David L; Lewis, Alexandria; Demiris, George

    2014-01-01

    Objective Despite the fact that more than 25% of Americans die in nursing homes, end-of-life care has consistently been found to be less than adequate in this setting. Even for those residents on hospice, end-of-life care has been found to be problematic. This study had two research questions; 1) How do family members of hospice nursing home residents differ in their anxiety, depression, quality of life, social networks, perceptions of pain medication, and health compared to family members of community dwelling hospice patients? 2) What are family members’ perceptions of and experiences with end-of-life care in the nursing home setting? Methods This study is a secondary mixed methods analysis of interviews with family members of hospice nursing home residents and a comparative statistical analysis of standard outcome measures between family members of hospice patients in the nursing home and family member of hospice patients residing in the community. Results Outcome measures for family members of nursing home residents were compared (n=176) with family members of community dwelling hospice patients (n=267). The family members of nursing home residents reported higher quality of life however, levels of anxiety, depression, perceptions of pain medicine, and health were similar for hospice family members in the nursing home and in the community. Lending an understanding to the stress for hospice family members of nursing home residents concerns were found with collaboration between the nursing home and the hospice, nursing home care that did not meet family expectations, communication problems, and resident care concerns including pain management. Some family members reported positive end-of-life care experiences in the nursing home setting. Conclusion These interviews identify a multitude of barriers to quality end-of-life care in the nursing home setting, and demonstrate that support for family members is an essential part of quality end-of-life care for

  17. [Decision-making processes in nursing and activities at the end of life in intensive care–An international comparative study].

    Science.gov (United States)

    Kohlen, Helen; McCarthy, Joan; Szylit Buosso, Regina; Gallagher, Ann; Andrews, Tom

    2015-12-01

    Intensive care units (ICUs) are traditionally settings that offer high technologically advanced treatment for those who are in critical situations due to an illness or accident. Questions regarding the withdrawal and withholding as well as the ending of life sustaining treatment are related to ethical dilemmas. Nurses’ decision-making processes and nursing activities in different countries are scarcely studied. Which end-of-life decision-making processes and activities that are performed by nurses can be identified and described? The objective is the identification of a nursing terrain regarding decision-making and activities in patient end-of-life care on the intensive care unit. Semi-structured interviews were conducted with 51 experienced nurses in university or hospital premises: 10 in Brazil, 9 in England, 10 in Germany, 10 in Ireland and 12 nurses in Palestine. The study used grounded theory to inform data collection and analysis. The finding of the study is the identification of a dynamic process in which activities with a focus on cure shift to activities with a focus on end-of-life care. The core category that emerged was ’negotiated reorienting’: The shift of activities implies negotiations between nurses and physicians, relatives as well as with oneself. Moreover the process is characterized by a constant re-orientation that is induced by changing patient data and the realisation of the whole situation. Nurses’ core practices are ’consensus seeking’ and ’emotional holding’ (sub-categories). In all countries a nursing terrain of activities in end-of-life care could be identified and described. However, it is unclear whether nursing activities connected to relatives of the patient are dominant in such a way that relations to dying patients and respect for their autonomy are put into the background. A field study could give answers to this question possible.

  18. Structural health monitoring tools for late and end of life management of offshore wind turbines

    DEFF Research Database (Denmark)

    McGugan, Malcolm; McKirdy, Scott

    2016-01-01

    The late and end of life stages in an offshore wind turbines (OWT) life cycle have unique features that must be considered. The initial focus on risks associated with start-up issues due to design, manufacturing or process elements gives way to a stable period of operation and maintenance...... optimisation and service condition monitoring. However, as with other structures, in time the issues of "wear and tear" and remaining life assessment become increasingly prevalent. The dynamics of operating an offshore wind farm varies considerably from existing oil & gas structures. With lower operating...... margins and the predominance of low redundancy structures, accurate structural health monitoring can play a strong role in safe management and enable increased operating time at end of life and decommissioning. Late life operations of offshore wind farms can pose significant challenges, balancing...

  19. Talking about end-of-life care: Perspectives of nursing home residents.

    Science.gov (United States)

    Towsley, Gail L; Hirschman, Karen B

    2017-08-01

    The purpose of the paper is to describe how residents express preferences for end-of-life (EOL) care. For this qualitative study, we conducted semi-structured interviews and completed conventional content analysis to describe how residents' expressed their preferences for care at the end of life. Sixteen residents from four nursing homes (NH) in southeastern Pennsylvania participated in this study. Residents were on average 88 years old, primarily non White, and widowed. Three key domains emerged from the analyses: Preferences for Today, Anticipating the End of My Life, and Preferences for Final Days. Residents linked their everyday living and EOL preferences by using 'if and then' logic to convey anticipation and readiness related to EOL. These findings suggest new strategies to start discussions of EOL care preferences with NH residents. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. End of life care in nursing homes: Translating focus group findings into action.

    Science.gov (United States)

    Bükki, Johannes; Neuhaus, Petra M; Paal, Piret

    Therapeutic options for nursing home residents focus on functional improvement, while inadequate hospital admissions in the dying phase are frequent. The aim of this study was to explore views, attitudes, and concerns among staff and to embark on a process that facilitates end-of-life care on an institutional level. Three focus group interviews were conducted with nursing home staff (nurses, care managers, physicians). The discussants (22) expressed the following issues: workload; ethical conflicts; additional resources; "living palliative care"; deleterious effect of restorative aims; lack of training; fear; knowledge and skills; rituals; lack of attachment, frustration, and abuse; team; discouragement; resilience enhanced by good care; style of communication; avoidance; the "palliative status"; legal concerns and hospital admissions. Nursing home staff expressed willingness to care for the dying. Providing good end of life care may promote professional resilience and personal integrity. Therefore, team issues, fears, and avoidance should be addressed. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. A Discourse Analysis: One Caregiver's Voice in End-of-Life Care.

    Science.gov (United States)

    Kitt-Lewis, Erin; Strauss, Susan; Penrod, Janice

    2018-02-01

    Informal family caregivers make a significant contribution to the U.S. health care system, and the need for caregivers will likely increase. Gaining deeper insights into the caregiver experience will provide essential knowledge needed to support the future caregiver workforce delivering care. Discourse analysis is a viable approach in analyzing textual caregiver data that focuses on the end-of-life caregiving experience. The purpose of this study was to conduct an in-depth discourse analytic examination of 13 hours of caregiver interview data, which reveal the multiplicity of shifting stances and perceptions of one caregiver in the midst of end-of-life care, specifically with regard to his perceptions of self (caregiver) and other (care recipient). By isolating a specific but limited set of reference terms used throughout the discourse, we gained systematic glimpses into the mind and perceptions of this single caregiver in relation to his role as caregiver for his terminally ill wife.

  2. Typology of end-of-life priorities in Saudi females: averaging analysis and Q-methodology

    Directory of Open Access Journals (Sweden)

    Hammami MM

    2016-05-01

    Full Text Available Muhammad M Hammami,1,2 Safa Hammami,1 Hala A Amer,1 Nesrine A Khodr1 1Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, 2College of Medicine, Alfaisal University, Riyadh, Saudi Arabia Background: Understanding culture-and sex-related end-of-life preferences is essential to provide quality end-of-life care. We have previously explored end-of-life choices in Saudi males and found important culture-related differences and that Q-methodology is useful in identifying intraculture, opinion-based groups. Here, we explore Saudi females’ end-of-life choices.Methods: A volunteer sample of 68 females rank-ordered 47 opinion statements on end-of-life issues into a nine-category symmetrical distribution. The ranking scores of the statements were analyzed by averaging analysis and Q-methodology.Results: The mean age of the females in the sample was 30.3 years (range, 19–55 years. Among them, 51% reported average religiosity, 78% reported very good health, 79% reported very good life quality, and 100% reported high-school education or more. The extreme five overall priorities were to be able to say the statement of faith, be at peace with God, die without having the body exposed, maintain dignity, and resolve all conflicts. The extreme five overall dis-priorities were to die in the hospital, die well dressed, be informed about impending death by family/friends rather than doctor, die at peak of life, and not know if one has a fatal illness. Q-methodology identified five opinion-based groups with qualitatively different characteristics: “physical and emotional privacy concerned, family caring” (younger, lower religiosity, “whole person” (higher religiosity, “pain and informational privacy concerned” (lower life quality, “decisional privacy concerned” (older, higher life quality, and “life quantity concerned, family dependent” (high life quality, low life satisfaction. Out of the

  3. Trust and autonomy in end of life: considering the interrelation between patients and their relatives.

    Science.gov (United States)

    Marx, Gabriella; Owusu Boakye, Sonja; Jung, Antje; Nauck, Friedemann

    2014-12-01

    Patients' autonomy is seen as a major issue in modern medicine but requires the ability to understand and rate an issue without being influenced by others. However, near the end of life, patients often decide considering the consequences for their relatives. Our study results and recent literature suggest that existing relational patterns determine experiences, family dynamics, and decision-making processes at the end of life. Relatives as a resource can promote patients' autonomy. In doubt of the patients' judgment or prioritizing their own needs, relatives can undermine patient's autonomy in a paternalistic way. Trust in others should be seen as a reciprocal process. With respect to the patient's autonomy, healthcare providers need to consider the family structure and its relations.

  4. Integrative review: parent perspectives on care of their child at the end of life.

    Science.gov (United States)

    Aschenbrenner, Ann P; Winters, Jill M; Belknap, Ruth Ann

    2012-10-01

    This integrative review aims to describe parents' perspectives on end-of-life care for their children. Fifteen publications from a literature search of the Cochrane databases, CINAHL, MEDLINE, and PSYCHinfo were included in the review. Recurring themes included poor communication/lack of information, strained relationships/inadequate emotional support, parental need to maintain parent/child relationships in life and death, quality of care continues after the death of the child, influence of services/planning on parent/child impacts quality of life, and the difficult decision to terminate life support. No studies were identified that focused on parents' perspectives on the care their child received at the end of life. Further research that focuses on the special needs of parents at this difficult time is needed. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. [Palliative care: between humanization and medicalization at the end of life].

    Science.gov (United States)

    Alonso, Juan Pedro

    2013-09-01

    This paper analyzes the palliative care of terminal patients, examining the tensions between the humanization of care and the progressive medicalization at the end-of-life situation. The research upon which the article is based adopts a qualitative methodological approach derived from interviews with professionals and patients and ethnographic observations in a palliative care unit in the City of Buenos Aires, Argentina. The article describes the configuration of personalized and comprehensive health care based on the core values of more humanized end-of-life care promoted by palliative care supporters. Similarly, the paper analyzes how these practices are assisted by progress in the medicalization process in which the dimension of care is considered less an unprofessional area of medical practice than an area of care in which specific technical skills and know-how are employed. The articles explores how instead of being divergent, the logic of care and medicalization work in a complementary fashion.

  6. Multimorbidity and End of Life Care in Patients with Cardiovascular Disease.

    Science.gov (United States)

    Pak, Esther; Wald, Joyce; Kirkpatrick, James N

    2016-05-01

    The care of patients with severe cardiovascular disease and multimorbidity entails complex medical decision-making especially at the end of life. Proven therapies must be incorporated into the context of patient preferences, values, and goals to achieve effective titration of medications and appropriate initiation and withdrawal of cardiac device therapies. As patients decline in the terminal stages, it is important to modify medical and device therapies in accordance with goals and values, and with hemodynamic changes, increasing multimorbidity, and accumulating symptom burden. The provision of effective end of life care for those with cardiovascular disease and multimorbidity requires cooperation between palliative care, specialty care, and primary care. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Seven legal barriers to end-of-life care: myths, realities, and grains of truth.

    Science.gov (United States)

    Meisel, A; Snyder, L; Quill, T

    2000-11-15

    The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) End-of-Life Care Consensus Panel was convened in 1997 to identify clinical, ethical, and policy problems in end-of-life care, to analyze critically the available evidence and guidelines, and to offer consensus recommendations on how to improve care of the dying. Topic selection and content presentation were carefully debated to maximize the project's focus on providing practical clinical and other guidance to clinicians who are not specialists in palliative care. This statement examines current legal myths, realities, and grains of truth in end-of-life care. The Consensus Panel comprises 13 medical and bioethics experts, clinicians, and educators in care at the end of life selected by the Ethics and Human Rights Committee, College leadership, and the Center for Ethics and Professionalism at the ACP-ASIM. A literature review including a MEDLINE search of articles from 1970-1998 and review of end-of-life care literature and organizational bibliographies was conducted. Unpublished sources were also identified by participants, as was anecdotal clinical experience. The draft statement was debated by panel members over a series of 3 to 4 meetings. For this statement, the initial draft and subsequent revised drafts were discussed in 1998-1999. The statement then underwent external peer review and revision before panel approval and the journal peer review process. Legal myths about end-of-life care can undermine good care and ethical medical practice. In addition, at times ethics, clinical judgment, and the law conflict. Patients (or families) and physicians can find themselves considering clinical actions that are ethically appropriate, but raise legal concerns. The 7 major legal myths regarding end-of-life care are: (1) forgoing life-sustaining treatment for patients without decision-making capacity requires evidence that this was the patient's actual wish; (2) withholding or withdrawing

  8. Caregivers' perceptions of illness severity and end of life service utilization in advanced heart failure.

    Science.gov (United States)

    Alonso, Windy; Hupcey, Judith E; Kitko, Lisa

    To assess perceptions of illness severity and terminality in caregivers of advanced heart failure (HF) patients and how these perceptions influence utilization of palliative care and end-of life services. HF is a terminal disease; yet patients and caregivers do not understand the severity of HF or acknowledge disease terminality. This study was conducted using a qualitative design with in-depth interviews and content analysis. Most caregivers did not understand the severity of HF (68%) or disease terminality (67%). Patients were more likely to receive services when their caregivers expressed an understanding of illness severity and/or terminality. Inclusion of caregivers in discussions of goals of care, advance care planning, and palliative care and end-of-life services with patients and providers is imperative. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. A social work perspective: attitudes toward end-of-life planning.

    Science.gov (United States)

    Gutheil, Irene A; Heyman, Janna C

    2011-01-01

    This research examined social workers' attitudes toward end-of-life planning and related factors in a cross-sectional study (N = 844). Data were gathered on completion of a health care proxy, personal comfort, training experiences of social workers, and demographics. Attitudes toward end-of-life planning were related to personal completion of the health care proxy, personal comfort, and years of social work experience. These measures remained significant in all steps of the regression, regardless of practice grouping (health and aging or other than health and aging), suggesting the relative importance of personal rather than professional aspects. Respondents in the health and aging fields are older than those in other than health and aging, underscoring concerns about workforce issues in the field of aging.

  10. 'Having a different conversation around death': diverse hospital chaplains' views on end-of-life care.

    Science.gov (United States)

    Bradby, Hannah; Kenten, Charlotte; Deedat, Sarah; Morgan, Myfanwy

    2013-01-01

    Hospital chaplaincy in the UK's National Health Service (NHS) is an allied profession that is emerging from its origins as an aspect of Anglican clerical organisation. This paper describes the perceptions and practices of hospital chaplains around end of life care and organ donation. Qualitative study involving 19 semi-structured exploratory interviews with hospital chaplains in five NHS Hospital Trusts across two regions in the UK. Chaplains provided generic support for the family around death and in relation to end of life conversations. While chaplains were supportive of efforts to increase awareness of issues around deceased donation they held a range of views on organ donation and had limited knowledge of hospital processes and practices. There is scope for greater training and involvement of hospital chaplains in hospital work on organ donation, and in developing new forms of community engagement to promote awareness and debate.

  11. [Nursing and the humanization of the end- of-life care within healthcare systems].

    Science.gov (United States)

    Gómez Arca, Marina

    2014-01-01

    The reflection upon the humanisation of the end-of-life process within healthcare systems and the implication of healthcare professionals is the main objective of this article. The evolution of the model of care and nurses leadership role at the end-of-life process is evaluated. This analysis starts from the first European references regarding advance wills, made in 1997 at the Oviedo Convention, until the introduction of the idea of advance directives incorporated into Spanish law in 2002. It sets the concept of advance planning in health-related decisions, which establishes a process of voluntary dialogue where every person can clarify values, preferences and wishes regarding the final moments of life, with the support of the healthcare professionals. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  12. Elderly Japanese people living in small towns reflect on end-of-life issues.

    Science.gov (United States)

    Okuno, S; Tagaya, A; Tamura, M; Davis, A J

    1999-07-01

    This article, reporting on selected data from a larger study, discusses some responses to end-of-life questions that elderly Japanese people who were living in small towns gave in a questionnaire survey. Japan is now the country with the largest number of elderly people in the world and confronts numerous social and economic questions concerning how best to cope with its older population. Although it is a highly urbanized society, Japan also has large semirural areas. The focus here is on the questions in the survey that sought responses to ethical dimensions of end-of-life issues. The findings demonstrate the strength of traditional values that still exist throughout small towns in Japan.

  13. Factors considered in end-of-life care decision making by health care professionals.

    Science.gov (United States)

    Foo, Wei Ting; Zheng, Yiliang; Kwee, Ann K; Yang, Grace M; Krishna, Lalit

    2013-06-01

    To explore the importance of factors influencing the end-of-life care decision making of health care professionals (HCPs) in Singapore. This cross-sectional survey encompassed facets of patient, family, and HCP-related care considerations. In total, 187 questionnaires were distributed to physicians and nurses and had a response rate of 78.6%. The respondents rated patients' wishes (96.6%), their clinical symptoms (93.9%), and patients' beliefs (91.1%) very high. In all, 94.6% of the HCPs would respect a competent patient's wishes over the family's wishes when goals conflict. However, 59.9% of HCPs would abide by the family's wishes when the patient loses capacity even if the patient's previously expressed wishes are known. End-of-life care decision making by HCPs appears largely patient centered, although familial determination still wields significant influence with implications for advance care planning.

  14. The end of life decisions -- should physicians aid their patients in dying?

    Science.gov (United States)

    Sharma, B R

    2004-06-01

    Decisions pertaining to end of life whether legalized or otherwise, are made in many parts of the world but not reported on account of legal implications. The highly charged debate over voluntary euthanasia and physician assisted suicide was brought into the public arena again when two British doctors confessed to giving lethal doses of drugs to hasten the death of terminally ill patients. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Some equate withdrawal of life support measures to physician assisted suicide whereas physician assisted suicide is often misinterpreted as euthanasia. Debate among the medical practitioners, law makers and the public taking into consideration the cultural, social and religious ethos will lead to increased awareness, more safeguards and improvement of medical decisions concerning the end of life. International Human Rights Law can provide a consensual basis for such a debate on euthanasia.

  15. Palliative and end-of-life decision-making in dementia care.

    Science.gov (United States)

    Mitchell, Gary

    2015-11-01

    This paper will highlight some of the pertinent issues associated with palliative and end-of-life decision-making in relation to dementia. To achieve this, the author will consider why there is disparity in relation to shared decision-making practices across non-malignant disease through exploration of models of disease trajectories. The author will then go on to highlight how people living with dementia, a non-malignant disease, have a human right to receive palliative care and be an active agent in the shared decision-making process about their future and care preferences. The challenges of shared decision-making in dementia care will be discussed along with some implications for nursing practice. The aim of this paper is to provide nurses, practising across all settings, with an overview of the fundamental importance of timely palliative and end-of-life shared decision-making in dementia care.

  16. Physicians' attitudes at the end-of-life: a cross-cultural evaluation.

    Science.gov (United States)

    Buken, Nuket Ornek; Balseven-Odabasi, Aysun

    2013-12-01

    Physician's attitudes towards patients with incurable cancer or at the end-of-life process--treatment of patients, withholding ventilation support, physician-assisted suicide--have changed rapidly in recent years. In cases such as incurable cancer, illnesses in the terminal phase, some neurologic diseases and AIDS, physicians and other health care workers experience dilemmas, arguments and problems on the subjects of whether or not to tell the truth or how to do it, who should inform the patient or his/her guardian, and then, how to give treatment to patients with incurable cancer or withhold ventilation support. All of these issues are affected by the country's' sociocultural and economic structures, the physician's attitudes at the end of life,the medical practice and the form of health structures. In this study our objectives are to assess physicians' views in Turkey regarding the process of the end of life and decision-making, to compare them with views from the USA, Japan and Saudi Arabia and to cristalize a cross-cultural assessment. Our study contains three clinical situations covering the following areas: (1) a patient's right to be informed of incurable cancer, (2) doctor-assisted suicide (3) the conflicting rights of patients, doctors and the family in issues such as refusing ventilatory support or witholding treatment. The four-point Likert Scale was used to mark the responses to the statements. The significant cultural, social and economic differences that exist in health care services between regions in our country affect physician-patient communication and end of life decision-making, as reflected in the process of obtaining informed consent.

  17. [End-of-life with dementia in Dutch antroposofic and traditional nursing homes].

    Science.gov (United States)

    Gijsberts, M J H E; van der Steen, J T; Muller, M T; Deliens, L

    2008-12-01

    Every year more than 20,000 people with dementia die in Dutch nursing homes and this number steadily increases. Therefore, the importance of good end-of-life care for these patients including physical, psychosocial and spiritual care is evident. Although the training standards for Dutch nursing home physicians and nurses share a common standard, the philosophy of a nursing home may affect end-of-life care strategies for the residents. We compared end of life of nursing home residents with dementia in two anthroposophic and two traditional nursing homes in a retrospective study using the most specific instrument available: the End-of-Life in Dementia scales (EOLD). Family caregivers completed the EOLD questionnaire. There was no difference in mean Satisfaction With Care scale scores between both types of nursing homes: 32.9 (SD 4.3) and 31.6 (SD 4.9), respectively. The anthroposophic nursing homes had significant higher scores on the 'Symptom Management' ((32.9 (SD 7.5) versus 26.9 (SD 9.5)), and 'Comfort Assessment in Dying' scales (34.0 (SD 3.9) versus 30.8 (SD 5.8)) and on its subscale Well Being (7.7 (SD 1.2) versus 6.7 (SD 2.1)). Our results suggest that death with dementia was more favourable in anthroposophic nursing homes than in regular homes. The results inform further prospective studies on nursing homes how this and other philosophies are translated into daily nursing home practice, including decision making in multi-disciplinary teams, family consultation, and complementary non-pharmacological therapies.

  18. Comfort-Supporting Nursing Activities for End-of-Life Patients in an Institutionalized Environment.

    Science.gov (United States)

    Kisvetrová, Helena; Vévodová, Šárka; Školoudík, David

    2017-09-04

    Comfort promotion plays a significant role in end-of-life patient care. The objective of this study was to determine the utilization rate of comfort supporting nursing activities in end-of-life patients in an institutionalized environment in the Czech Republic in relation to the age of the registered nurses (RNs), length of work experience, education level, and type of workplace. A cross-sectional, descriptive study was designed. A questionnaire with Likert scales included 31 activities of dying care and spiritual support interventions. The sample comprised 907 RNs working in 49 institutions in nine regions of the Czech Republic. The Kruskal-Wallis test, Mann-Whitney U post-hoc test with Bonferroni correction of significance, Spearman's correlation analysis, and logical regression model were used for statistical evaluation. The least frequently implemented activity by RNs was "Show the patient's willingness to discuss death" and the most frequent activity was "Threat to the patient's dignity and respect." The highest utilization rate of nursing activities was reported in the physical dimension, while the lowest utilization rate of nursing activities was in the social dimension set. Significant predictors for the high utilization rate of physical dimension set activities were hospice care departments, long-term care facilities (LTCFs), and the age of RNs. Hospice departments were also a predictor of high utilization rate of activities in the psychological, spiritual, and social dimension set activities. With the exception of hospice departments, RNs used activities encouraging psychological, spiritual, and social comfort for end-of-life patients less frequently than the physical dimension. RNs in hospitals and LTCFs focus insufficiently on the spiritual and psychosocial comfort of end-of-life patients. This study is of particular significance to educators who prepare the next generation of nurses. © 2017 Sigma Theta Tau International.

  19. End of life care in nursing homes: Palliative drug prescribing and doctors' existential vulnerability

    OpenAIRE

    Jansen, Kristian

    2017-01-01

    Nursing homes are the main arena for end-of-life (EOL) care in Norway. Patients, their informal caregivers and academics alike have called for doctors more involved in EOL care, but the nursing home doctor’s role has been given relatively little attention in research. This thesis explores the doctor’s work with EOL care in nursing homes from the perspectives of EOL prescription changes (paper I); the effectiveness and safety of palliative prescriptions (paper II); and from...

  20. Assessment procedures regarding end-of-life decisions in neonatology in the Netherlands.

    Science.gov (United States)

    Dorscheidt, Jozef H H M

    2005-12-01

    This paper describes the position of Dutch law concerning end-of-life decisions in neonatology consequent on rulings of the Dutch appeals court in two cases. The concept of a multidisciplinary assessment committee is explored. The European Convention on Human Rights in its articles 2 and 13 is relevant to this concept. The author provides a detailed discussion of the current situation and draws conclusions based on his perception of future developments in regulating thanatic practices in neonatology.

  1. Family Matters: Dyadic Agreement in End-of-Life Medical Decision Making

    OpenAIRE

    Schmid, Bettina; Allen, Rebecca S.; Haley, Philip P.; DeCoster, Jamie

    2009-01-01

    Purpose: We examined race/ethnicity and cultural context within hypothetical end-of-life medical decision scenarios and its influence on patient–proxy agreement. Design and Methods: Family dyads consisting of an older adult and 1 family member, typically an adult child, responded to questions regarding the older adult’s preferences for cardiopulmonary resuscitation, artificial feeding and fluids, and palliative care in hypothetical illness scenarios. The responses of 34 Caucasian dyads and 30...

  2. Physician perspectives on legal processes for resolving end-of-life disputes.

    Science.gov (United States)

    Chidwick, Paula; Sibbald, Robert

    2011-01-01

    In order to understand how to effectively approach end-of-life disputes, this study surveyed physicians' attitudes towards one process for resolving end-of-life disputes, namely, the Consent and Capacity Board of Ontario. In this case, the process involved examining interpretation of best interests between substitute decision-makers and medical teams. Physicians who made "Form G" applications to the Consent and Capacity Board of Ontario that resulted in a decision posted on the open-access database, Canadian Legal Information Institute (CanLii), were identified and surveyed. This purposive sample led to 13 invitations to participate and 12 interviews (92% response rate). Interviews were conducted using a prescribed interview guide. No barriers to the Consent and Capacity Board process were reported. Applications were made when physicians reached an impasse with the family and further treatment was perceived to be "unethical." The most significant challenge reported was the delay when appeals were launched. Appeals extended the process for an indefinite period of time making it so lengthy it negated any perceived benefits of the process. Benefits included that a neutral third party, namely the Consent and Capacity Board, was able to assess best interests. Also, when decisions were timely, further harm to the patient was minimized. Physicians reported this particular approach, namely the Consent and Capacity Board has a mechanism that is worthwhile, patient centred, process oriented, orderly and efficient for resolving end-of-life disputes and, in particular, determining best interests. However, unless the appeal process can be adjusted to respond to the ICU context there is a risk of not serving the best interest of patients. Physicians would recommend framing end-of-life treatment plans in the positive instead of negative, for example, propose palliative care and no escalation of treatment as opposed to withdrawal.

  3. Measuring Experience With End-of-Life Care: A Systematic Literature Review.

    Science.gov (United States)

    Lendon, Jessica Penn; Ahluwalia, Sangeeta C; Walling, Anne M; Lorenz, Karl A; Oluwatola, Oluwatobi A; Anhang Price, Rebecca; Quigley, Denise; Teno, Joan M

    2015-05-01

    Increasing interest in end-of-life care has resulted in many tools to measure the quality of care. An important outcome measure of end-of-life care is the family members' or caregivers' experiences of care. To evaluate the instruments currently in use to inform next steps for research and policy in this area. We conducted a systematic review of PubMed, PsycINFO, and PsycTESTS(®) for all English-language articles published after 1990 using instruments to measure adult patient, family, or informal caregiver experiences with end-of-life care. Survey items were abstracted and categorized into content areas identified through an iterative method using three independent reviewers. We also abstracted information from the most frequently used surveys about the identification of proxy respondents for after-death surveys, the timing and method of survey administration, and the health care setting being assessed. We identified 88 articles containing 51 unique surveys with available content. We characterized 14 content areas variably present across the 51 surveys. Information and care planning, provider care, symptom management, and overall experience were the most frequent areas addressed. There was also considerable variation across the surveys in the identification of proxy respondents, the timing of survey administration, and in the health care settings and services being evaluated. This review identified several comprehensive surveys aimed at measuring the experiences of end-of-life care, covering a variety of content areas and practical issues for survey administration. Future work should focus on standardizing surveys and administration methods so that experiences of care can be reliably measured and compared across care settings. Published by Elsevier Inc.

  4. Medical futility in children's nursing: making end-of-life decisions.

    LENUS (Irish Health Repository)

    Brien, Irene O

    2012-02-01

    Caring for infants at end of life is challenging and distressing for parents and healthcare professionals, especially in relation to making decisions regarding withholding or withdrawal of treatment. The concept of medical futility must be considered under these circumstances. Parents and healthcare professionals should be involved together in making these difficult decisions. However, for some parents, emotions and guilt often are unbearable and, understandably, parents can be reluctant to make a decision. Despite the recognition of parental autonomy, if parents disagree with a decision made by medical staff, the case will be referred to and solved by the courts. The courts\\' decisions are often based on the best interest of the child. In this article, the authors discuss the concepts of \\'parental autonomy\\' and \\'the child\\'s best interests\\' when determining medical futility for infants or neonates. The role of the nurse when caring for the dying child and their family is multifaceted. While nurses do not have a legitimate role in decision making at the end of life, it is often nurses who, through their advocacy role, inform doctors about parents\\' wishes and it is often nurses who support parents during this difficult time. Furthermore, nurses caring for dying children should be familiar to the family, experienced in end-of-life care and comfortable talking to parents about death and dying and treatment choices. Children\\'s nurses therefore require advanced communication skills and an essential understanding of the ethical and legal knowledge relating to medical futility in end-of-life children\\'s nursing.

  5. Hospice or community network? Choices in end-of-life care in Jamaica.

    Science.gov (United States)

    Mendoza, Roger Lee

    2017-09-01

    Now considered a subspecialty of medicine and nursing, palliative care is a critical aspect of healthcare at the end of life. National and international healthcare agencies typically attribute its slow or haphazard growth in developing countries to various resource constraints. However, this study provides evidence of the substantial and widening gap between policy advocacy and patient choices in end-of-life care. It does so by establishing the incentives and risks that underlie decision-making by patients and providers against the relative scarcity of palliative care and hospices in these countries. Jamaica offers an illustrative case. It shares the socioeconomic conditions and isolated provision of hospice and palliative care that remain prevalent in many developing countries. Empirical information was collected from all Jamaican hospices, along with agency and media reports, for comparative institutional analysis. Financial and infrastructural challenges hamper hospice expansion and integration into formal healthcare systems in developing countries. Yet, other equally vital considerations are too often neglected. These include the high transaction costs of decision-making, which account for limited hospice accessibility, affordability, and efficiency, particularly to underserved populations. Risk and payoff calculations by patients and their families as well as hospices and their providers lead to two strategic options in maximizing hospice value and/or minimizing transaction costs in end-of-life care. Policy formulation and advocacy for hospice and palliative care should match aggregate demand. The socio-cultural milieu of care is critical and should be equally considered. Otherwise, providing and expanding free or subsidized palliative care at the end-of-life stage can become cost-inefficient relative to robust family and grassroots community networks.

  6. Communicating prognostic uncertainty in potential end-of-life contexts: experiences of family members.

    Science.gov (United States)

    Krawczyk, Marian; Gallagher, Romayne

    2016-07-12

    This article reports on the concept of "communicating prognostic uncertainty" which emerged from a mixed methods survey asking family members to rank their satisfaction in seven domains of hospital end-of-life care. Open-ended questions were embedded within a previously validated survey asking family members about satisfaction with end-of-life care. The purpose was to understand, in the participants' own words, the connection between their numerical rankings of satisfaction and the experience of care. Our study found that nearly half of all family members wanted more information about possible outcomes of care, including knowledge that the patient was "sick enough to die". Prognostic uncertainty was often poorly communicated, if at all. Inappropriate techniques included information being cloaked in confusing euphemisms, providing unwanted false hope, and incongruence between message and the aggressive level of care being provided. In extreme cases, these techniques left a legacy of uncertainty and suspicion. Family members expressed an awareness of both the challenges and benefits of communicating prognostic uncertainty. Most importantly, respondents who acknowledged that they would have resisted (or did) knowing that the patient was sick enough to die also expressed a retrospective understanding that they would have liked, and benefitted, from more prognostic information that death was a possible or probable outcome of the patient's admission. Family members who reported discussion of prognostic uncertainty also reported high levels of effective communication and satisfaction with care. They also reported long-term benefits of knowing the patient was sick enough to die. While a patient who is sick enough to die may survive to discharge, foretelling with family members in potential end of life contexts facilitates the development of a shared and desired prognostic awareness that the patient is nearing end of life.

  7. Family communication and decision making at the end of life: a literature review.

    Science.gov (United States)

    Wallace, Cara L

    2015-06-01

    Patients and families coping with a terminal illness are faced with a number of decisions over the course of their disease. The role that family communication plays in the process of decision making is an important one. The objectives for this review are to examine the current state of empirical literature on the relationship between family communication and decision making about end-of-life care, to identify gaps, and to discuss implications for policy, practice, and future research. Articles were identified using systematic keyword searches within the following relevant databases: Academic Search Complete, CINAHL Plus, Communications and Mass Media Complete, ERIC, PsychINFO, MEDLINE, SocINDEX, and ProQuest. The three bodies of relevant literature that emerged during this review include: (1) the importance of family communication at the end of life (EoL); (2) family decision making at the EoL; and (3) the interrelationship of communication (both within the family and with healthcare professionals) and decision making at the EoL. While the literature highlights the role of communication between medical professionals and the patient or family members, there is very little focus on the process of how family communication among the family members themselves contributes to decision making at the end of life. Barriers to end-of-life care are important considerations for helping patients to access timely and appropriate services. Understanding the pertinent role of family communication as it relates to the decision for EoL care is the first step in working to provide another avenue for overcoming these barriers.

  8. [End of life conflicts in palliative care: a systematic review of the literature].

    Science.gov (United States)

    Mpinga, Emmanuel Kabengele; Chastonay, Philippe; Rapin, Charles-Henri

    2006-09-01

    To evaluate the extent and the quality of the research related to End of life conflicts in palliative care from 1995 to 2004. Accessible Literature of several electronic data bases (BDSP, Cinhal, Cochrane, Francis, Medline, Psychinfo, Saphir, Scopus and Web of science) as well as the grey literature. Studies published in French and English between 1995 and 2004 reporting end of life conflicts, tensions, disagreements, disputes in the context of palliative care. One hundred and two studies were included (87.2% published in English, 12.8% in French). Study designs include revues 27.4%), cross-sections 18.6% and case studies 18.6%. Reported conflicts are related to ethical issues 26.2%, to care 19.1%, to tensions between professionals and patients or families 11.1%, to team experiences 9%. Six studies 5.8% give prevalence figures of conflicts. Half of the studies 51.3% identify possible causes of conflicts: communication issues, euthanasia and suicide assistance demands, autonomy of patients, non respect of advance directives, cultural differences. Ten studies 9.8% identify specifically some effects of the conflicts: moral distress of patients; stress, burn out and guilt of health professionals; lack of trust between doctors and patients or families. Conflicts are mainly resolved through mediation and ethical discussions. Research data on end of life conflicts is scarce at all levels (quantity, quality, methods, social impact, and epistemology). A better understanding of end of life conflict might foster a more adequate management of difficult situations and ultimately a more peaceful death of patients, mourning of families and every day work of health professionals

  9. Nurses' care practices at the end of life in intensive care units in Bahrain.

    Science.gov (United States)

    O'Neill, Catherine S; Yaqoob, Maryam; Faraj, Sumaya; O'Neill, Carla L

    2017-12-01

    The process of dying in intensive care units is complex as the technological environment shapes clinical decisions. Decisions at the end of life require the involvement of patient, families and healthcare professionals. The degree of involvement can vary depending on the professional and social culture of the unit. Nurses have an important role to play in caring for dying patients and their families; however, their knowledge is not always sought. This study explored nurses' care practices at the end of life, with the objective of describing and identifying end of life care practices that nurses contribute to, with an emphasis on culture, religious experiences and professional identity. Research Design and context: Grounded theory was used. In all, 10 nurses from intensive care unit in two large hospitals in Bahrain were participated. Ethical Considerations: Approval to carry out the research was given by the Research Ethics Committee of the host institution, and the two hospitals. A core category, Death Avoidance Talk, was emerged. This was supported by two major categories: (1) order-oriented care and (2) signalling death and care shifting. Death talk was avoided by the nurses, doctors and family members. When a decision was made by the medical team that a patient was not to be resuscitated, the nurses took this as a sign that death was imminent. This led to a process of signalling death to family and of shifting care to family members. Despite the avoidance of death talk and nurses' lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.

  10. Palliative care physicians' experiences of end-of-life communication : A focus group study

    OpenAIRE

    Udo, Camilla; Lövgren, M; Lundquist, G; Axelsson, B

    2017-01-01

    The aim of this study was to explore palliative home care physicians' experiences regarding end-of-life breakpoint communication (BPC). This is a qualitative study where focus group interviews were conducted and analysed using qualitative content analysis. The results show that the participants saw themselves as being responsible for accomplishing BPC, and they were convinced that it should be regarded as a process of communication initiated at an early stage, i.e. proactively. However, BPC w...

  11. Drug treatment at the end of life: an epidemiologic study in nursing homes.

    Science.gov (United States)

    Jansen, Kristian; Schaufel, Margrethe Aase; Ruths, Sabine

    2014-12-01

    To examine drug treatment in nursing home patients at the end of life, and identify predictors of palliative drug therapy. A historical cohort study. Three urban nursing homes in Norway. All patients admitted from January 2008 and deceased before February 2013. Drug prescriptions, diagnoses, and demographic data were collected from electronic patient records. Palliative end-of-life drug treatment was defined on the basis of indication, drug, and formulation. 524 patients were included, median (range) age at death 86 (19-104) years, 59% women. On the day of death, 99.4% of the study population had active prescriptions; 74.2% had palliative drugs either alone (26.9%) or concomitantly with curative/preventive drugs (47.3%). Palliative drugs were associated with nursing home, length of stay > 16 months (AOR 2.10, 95% CI 1.12-3.94), age (1.03, 1.005-1.05), and a diagnosis of cancer (2.12, 1.19-3.76). Most initiations of palliative drugs and withdrawals of curative/preventive drugs took place on the day of death. Palliative drug therapy and drug therapy changes are common for nursing home patients on the last day of life. Improvements in end-of-life care in nursing homes imply addressing prognostication and earlier response to palliative needs.

  12. Developing, implementing and sustaining an end-of-life care programme in residential care homes.

    Science.gov (United States)

    Kinley, Julie; Stone, Louisa; Butt, Anna; Kenyon, Barbara; Lopes, Nuno Santos

    2017-04-02

    In the UK 15.8% of people aged 85 years and over live in a care home or long-stay hospital setting. With the projection of an ageing population it is realistic to expect that the number of people both living and dying in all care homes will increase. This article describes the implementation of an end-of-life care programme to empower staff to meet their resident's end-of-life care needs. To implement an end-of-life care programme, namely the 'Steps to Success' programme, in residential care homes. Measurable outcomes were collected through audit. Over four years audit of all deceased residents' records in the participating homes was collected. This shows an increase of home deaths in 2011/12 to 2014/15 from 44% (n=8/18) within four residential care homes to 64% (n=74/115) in 23 residential care homes with corresponding increase in advance care plan discussions and completion of 'do not attempt cardiopulmonary resuscitation' forms. Achieving change is any organisation let alone sustaining such change is not easy. Six factors enabled this to occur and these should be considered when implementing other such initiatives in residential care homes.

  13. Understanding bereaved family members' dissatisfaction with end-of-life care in nursing homes.

    Science.gov (United States)

    Thompson, Genevieve N; McClement, Susan E; Menec, Verena H; Chochinov, Harvey M

    2012-10-01

    With increasing numbers of older adults identifying a nursing home (NH) as their final place of care, it is important to assess the quality of dying in this setting and understand factors that impact family members' dissatisfaction with end-of-life care. A retrospective bereaved family member survey (N = 208) was conducted in 21 NHs located in urban areas of central Canada. Bereaved family members who were dissatisfied with care identified significantly more concerns in all domains assessed and were more likely to have problems with: (a) receiving confusing information from nursing staff about the resident's care, including medical treatments; (b) receiving inadequate information from nursing staff; and (c) feeling that end-of-life care was different than they had expected. Since the quality of communication between nurses, residents, and family members is the main factor that determines families' dissatisfaction with care, strategies and interventions aimed at reducing unmet information needs will be vital to improving end-of-life care in NHs. Copyright 2012, SLACK Incorporated.

  14. Attitudes of adolescent cancer survivors toward end-of-life decisions for minors.

    Science.gov (United States)

    Pousset, Geert; Bilsen, Johan; De Wilde, Joke; Benoit, Yves; Verlooy, Joris; Bomans, An; Deliens, Luc; Mortier, Freddy

    2009-12-01

    The present study aimed to investigate the attitudes of adolescent cancer survivors toward end-of-life decisions with life-shortening effects, including nontreatment decisions (NTDs), intensified alleviation of pain and symptoms (APS), and euthanasia, and the influence of illness experience on these attitudes. Adolescent cancer survivors were interviewed with a structured questionnaire using hypothetical case descriptions. The results were compared with a study of 1769 adolescents without experience of chronic illness. Eighty-three adolescents, 11 to 18 years of age, were interviewed. In terminal situations, 70% to 90% found requests for NTDs acceptable, 84% requests for APS, and 57% to 64% requests for euthanasia. Requests for end-of-life decisions were less acceptable in nonterminal situations, where 28% found requests for NTDs acceptable, 39% to 47% requests for APS, and 11% to 21% requests for euthanasia. Frequently cited reasons for holding back physicians from administering a lethal drug to a child were the child not being well informed about his or her condition (92%) and the parents' opinion not being asked (92%). Compared with adolescents without experience with chronic illness, cancer survivors were more accepting toward requests for NTDs and APS in terminal situations. Adolescent cancer survivors, like other adolescents, want to be involved in medical decision-making at the end of life. They value autonomous decision-making, without excluding parents from the process. The experience of living through a life-threatening illness can alter adolescents' attitudes toward requests for NTDs and APS.

  15. Balancing hope and despair at the end of life: The contribution of organ and tissue donation.

    Science.gov (United States)

    Walker, Wendy; Sque, Magi

    2016-04-01

    Concern for the grieving family can moderate the intentions of critical care staff to advocate deceased organ and tissue donation. Conversely, benevolent actions may provoke distress through missed opportunities to save or transform lives. This article provides insight into the perceived benefits of organ and tissue donation for grieving families who experienced end-of-life care in the intensive care unit. Data were collected via semistructured, face-to-face or telephone interviews with 43 participants from 31 donor families. Audio recordings were transcribed verbatim and subjected to qualitative content analysis. The study findings affirmed the importance of person-centered end-of-life care. Donor families shared examples of good-quality care and communication that contained the hallmarks of compassion, respect, dignity, and choice. We uncovered a trajectory of hope and despair in which the option of organ and tissue donation appeared to give meaning to the life and death of the deceased person and was comforting to some families in their bereavement. Our study findings underlined the significance of donation decision making for grieving families. Organ and tissue donation has the potential to balance hope and despair at the end of life when the wishes of the dying, deceased, and bereaved are fulfilled. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Senior Nursing Students' Perceptions of Caring for Patients at the End of Life.

    Science.gov (United States)

    Colley, Sharon L

    2016-05-01

    Nursing students often feel unprepared to provide end-of-life care. Studies have examined students' learning outcomes and attitudes regarding end-of-life care, but it is unclear how students perceived their nursing program prepared them in both knowledge and confidence. Such research could help inform curricula revisions. This pilot study used a primarily qualitative approach with narrative questions and quantitative survey questions to a lesser degree. Seventy-one students from three baccalaureate nursing cohorts were participants. Five themes became apparent: Students Have Confidence in Provision of Physical Care, Students Lack Confidence in Provision of Emotional Care, Students Experience Stress and Lack of Knowledge When Caring for Families, Students Have Concern They Will Be Too Emotionally Involved, and Students Feel Personal Experiences Enhance Their Confidence. Student perceptions are important to consider when revising curricula to enhance learning and promote confidence in addressing emotional care at the end of life. [J Nurs Educ. 2016;55(5):279-283.]. Copyright 2016, SLACK Incorporated.

  17. Facing death, gazing inward: end-of-life and the transformation of clinical subjectivity in Thailand.

    Science.gov (United States)

    Stonington, Scott

    2011-06-01

    In this article, I describe a new form of clinical subjectivity in Thailand, emerging out of public debate over medical care at the end of life. Following the controversial high-tech death of the famous Buddhist monk Buddhadasa, many began to denounce modern death as falling prey to social ills in Thai society, such as consumerism, technology-worship, and the desire to escape the realities of existence. As a result, governmental and non-governmental organizations have begun to focus on the end-of-life as a locus for transforming Thai society. Moving beyond the classic outward focus of the medical gaze, they have begun teaching clinicians and patients to gaze inward instead, to use the suffering inherent in medicine and illness to face the nature of existence and attain inner wisdom. In this article, I describe the emergence of this new gaze and its major conceptual components, including a novel idea of what it means to be 'human,' as well as a series of technologies used to craft this humanity: confession, "facing suffering," and untying "knots" in the heart. I also describe how this new subjectivity has begun to change the long-stable Buddhist concept of death as taking place at a moment in time, giving way for a new concept of "end-of-life," an elongated interval to be experienced, studied, and used for inner wisdom.

  18. Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.

    Science.gov (United States)

    Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T

    2017-08-01

    The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

  19. Administrators’ Perspectives on Changing Practice in End-of-Life Care in a State Prison System

    Science.gov (United States)

    Penrod, Janice; Loeb, Susan J.; Smith, Carol A.

    2013-01-01

    Objective Sentencing trends have created a demographic shift in prison populations. Greater numbers of inmates are aging and dying in prison, creating a demand for enhanced end-of-life care. Changing practice to meet escalating care demands in corrections settings is complicated by economic constraints, attitudinal barriers, and organizational features. This study explored perspectives of end-of-life care held by administrators in a state prison system to reveal challenges to changing practice to meet the needs of inmates suffering advanced illness and dying in prison. Design and Sample Qualitative interviews were conducted with 12 administrators from the central office of a state department of corrections. Results Key influences impacting end-of-life care services included: local prison culture; treatment versus security focus; case-by-case consideration; public sentiment; budget neutral approaches; and conflicting views of service targets. Conclusions These findings revealed the organizational structures, attitudes, and beliefs held by the administrative echelon of a state prison system and were used to guide the derivation of discrete approaches to changing practice in this complex system. Contextual evaluation permitted a much deeper understanding of the influences on changing practice in this hierarchical bureaucracy. This type of preliminary evaluation is crucial to infusing new practice initiatives in complex organizations caring for stigmatized, at-risk populations. PMID:24588128

  20. End of life of patients treated with haemodialysis as narrated by their close relatives.

    Science.gov (United States)

    Axelsson, Lena; Klang, Birgitta; Lundh Hagelin, Carina; Jacobson, Stefan H; Gleissman, Sissel Andreassen

    2015-12-01

    The study aimed to describe end of life for patients treated with maintenance haemodialysis as narrated by their close relatives. Many patients undergoing haemodialysis are older, have several comorbidities and underestimated symptoms and are in their last year of life. To improve care, we need to know more about their end-of-life situation. Qualitative and descriptive. Qualitative retrospective interviews were conducted with 14 close relatives of deceased haemodialysis patients (3-13 months after death). Data were analysed using qualitative content analysis. The study is ethically approved. In the last months, a gradual deterioration in health with acute episodes necessitating hospital admissions was described. This involved diminishing living space and expressions of dejection, but also of joy. Three patterns emerged in the last weeks: uncertain anticipation of death as life fades away; awaiting death after haemodialysis withdrawal; and sudden but not unexpected death following intensive care. Findings show complexities of decisions on haemodialysis withdrawal. Different end-of-life patterns all involved increasingly complex care needs and existential issues. Findings show a need for earlier care planning. The identification of organisational factors to facilitate continuity and whole person care to meet these patients' specific care needs with their complex symptom burdens and comorbidities is needed. Findings indicate the need for integration of a palliative care approach in the treatment of patients in haemodialysis care. © 2015 Nordic College of Caring Science.

  1. Palliative and end-of-life care in nephrology: moving from observations to interventions.

    Science.gov (United States)

    Eneanya, Nwamaka D; Paasche-Orlow, Michael K; Volandes, Angelo

    2017-07-01

    In comparison with patients who have other serious illnesses, patients with advanced kidney disease have a higher rate of intensive care utilization at the end of life and receive palliative care less frequently. Consensus and clinical practice guidelines have therefore recommended the incorporation of palliative care earlier in the disease trajectory. This review summarizes recent literature on this aspect of care and will highlight future directions for patient-centered care within palliative nephrology. Patients with advanced kidney disease and their families frequently do not engage effectively with their clinicians to make informed treatment decisions or plan for care at the end of life. Furthermore, racial and ethnic minority patients continue to receive a lower rate of palliative care services compared to other racial groups. Interventions that promote better palliative care communication and education among nephrology clinicians, patients and their families are becoming increasingly more common in nephrology. Overall, improved understanding of the unique care needs of patients with advanced and end-stage kidney disease provides a solid foundation to improve palliative and end-of-life care delivery among diverse populations in nephrology.

  2. Advance directives at end-of-life: nursing home resident preferences for artificial nutrition.

    Science.gov (United States)

    Monturo, Cheryl A; Strumpf, Neville E

    2007-05-01

    Nursing homes are increasingly the place where many Americans die. Thus, advance directives are critical to the preservation of the autonomous wishes at end-of-life. The purpose of this paper is to determine if preferences for artificial nutrition, as stated in the advance directives of nursing home residents, are honored in the last 2 months of life. Secondary analysis. Six Maryland community nursing homes. Fifty-seven consented residents (age 62 to 98) from the parent study who died during the study period. Retrospective document review including advance directives and clinical care provided in the last 2 months of life. Most of the nursing home residents in this sample refused feeding tubes, and these preferences were honored during the last 2 months of life (93%), despite some (17% to 26%) with documented weight loss. A small percentage (8.8%) of residents received feeding tubes at end-of-life and, of those, only 1 was consistent with advance directive preferences. Most advance directives in this study included feeding tube preferences. In this nursing home sample, advance directives were significant documents guiding decisions on artificial nutrition, and feeding tubes were in fact uncommon at the end of life. The study suggests that advance care planning, quality palliative care training, and administrative support are necessary for the honoring of preferences. Future research is needed to examine more broadly tube-feeding practices and prevalence in nursing homes.

  3. End of life decisions in amyotrophic lateral sclerosis: a cross-cultural perspective.

    Science.gov (United States)

    Smyth, A; Riedl, M; Kimura, R; Olick, R; Siegler, M

    1997-10-01

    In an era where life-sustaining technology offers physicians unprecedented powers to prolong survival in terminal illness, the question of how end of life decisions are made has become a major subject of study and debate. Amyotrophic lateral sclerosis (ALS) is a disease in which physical ability declines while mental capacity most often remains intact. Since most patients with ALS die of respiratory failure, a distinguishing feature of this disease is whether a patient is offered and accepts a chance to go on long-term mechanical ventilation. This unusual feature makes ALS a compelling model for studying end of life decisions in different countries. This paper reviews the literature and presents preliminary data on how end of life decisions in ALS are made in the US, Great Britain, and Japan. We address this issue by examining how cultural differences in truth-telling and informed consent, societal differences in attitudes toward the use of artificial life support, and legal differences in the role and status of advance directives in each country influenced decisions in the following three groups of patients: (1) the mentally competent; (2) mentally incompetent patients who previously completed advance directives when competent; and (3) mentally incompetent patients who have not provided advance guidance about their wishes.

  4. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-05-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. Copyright: © Singapore Medical Association.

  5. Exhaust All Measures: Ethical Issues in Pediatric End-of-Life Care.

    Science.gov (United States)

    Thieleman, Kara J; Wallace, Cara; Cimino, Andrea N; Rueda, Heidi A

    2016-01-01

    The death of a child may have a profound impact on parents, family members, and health care providers who provided care for the child. Unique challenges are faced by parents of seriously ill children as they must serve as the legal authority for health care decisions of children under age 18, although the child's wishes must also be considered. Social workers must balance core social work values, bioethical values, and psychosocial issues presented by such situations. While studies have been conducted with physicians and nurses regarding ethical issues in pediatric end-of-life care settings, little is known about how social workers experience these conflicts. This article utilizes two vignettes to illustrate potential ethical issues in this setting and applies the National Association of Social Workers Standards for Palliative and End of Life Care (NASW, 2004 ) to explore options for their resolution. These vignettes provide descriptions of possible reactions in this setting and can be used as a basis for further exploration of ethics in pediatric end-of-life care from a social work perspective.

  6. Simple changes can improve conduct of end-of-life care in the intensive care unit.

    Science.gov (United States)

    Hall, Richard I; Rocker, Graeme M; Murray, Dawnelda

    2004-01-01

    To describe changes to the conduct of withdrawal of life support (WOLS) in two teaching hospital tertiary care medical surgical intensive care units (ICUs) in a single centre over two distinct time periods. We used a retrospective chart review with a before and after comparison. We assessed aspects of end-of-life care for ICU patients dying after a WOLS before and after we introduced instruments to clarify do not resuscitate (DNR) orders and to standardize the WOLS process, sought family input into the conduct of end-of-life care, and modified physicians' orders regarding use of analgesia and sedation. One hundred thirty-eight patients died following life support withdrawal in the ICUs between July 1996 and June 1997 (PRE) and 168 patients died after a WOLS between May 1998 and April 1999 (POST). Time from ICU admission to WOLS (mean +/- SD) was shorter in the POST period (191 +/- 260 hr PRE vs 135 +/- 205 hr POST, P = 0.05). Fewer patients in the POST group received cardiopulmonary resuscitation in the 12-hr interval prior to death (PRE = 7; POST = 0: P involvement of physicians in WOLS discussions was unchanged but increased for pastoral care (PRE: 10/138 vs POST: 120/168 cases; P end-of-life care in the ICU.

  7. From Theory to Practice: Measuring end-of-life communication quality using multiple goals theory.

    Science.gov (United States)

    Van Scoy, L J; Scott, A M; Reading, J M; Chuang, C H; Chinchilli, V M; Levi, B H; Green, M J

    2017-05-01

    To describe how multiple goals theory can be used as a reliable and valid measure (i.e., coding scheme) of the quality of conversations about end-of-life issues. We analyzed conversations from 17 conversations in which 68 participants (mean age=51years) played a game that prompted discussion in response to open-ended questions about end-of-life issues. Conversations (mean duration=91min) were audio-recorded and transcribed. Communication quality was assessed by three coders who assigned numeric scores rating how well individuals accomplished task, relational, and identity goals in the conversation. The coding measure, which results in a quantifiable outcome, yielded strong reliability (intra-class correlation range=0.73-0.89 and Cronbach's alpha range=0.69-0.89 for each of the coded domains) and validity (using multilevel nonlinear modeling, we detected significant variability in scores between games for each of the coded domains, all p-values theory-based measure of end-of-life conversation quality that is superior to other methods of measuring communication quality. Our description of the coding method enables researches to adapt and apply this measure to communication interventions in other clinical contexts. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. A death with dignity: a nurse's story of the end of life of her mother.

    Science.gov (United States)

    Nelson, Noreen

    2013-01-01

    Recognizing and accepting when someone is within the palliative care trajectory is often a challenge, particularly for nursing students. In sharing this story of a nurse's experience of caring for her mother, it is hoped that the reader will gain insight into ways to enhance comfort and improve the quality of life of family members, friends, and patients. Through the lens of this lived experience, the challenges associated with honoring the wishes of a loved one during the palliative care trajectory through the end of life are shared. Exploring a person's perceptions about their quality of life is an important component of a nursing assessment. Nurses need to be prepared to maximize opportunities with patients and provide resources and information about options on their quality of life issues. Understanding and respecting another's choice develops with awareness and utilization of evidence-based knowledge in planning interventions. This article provides information on evidence-based resources and standards of practice in the context of a lived experience. Experiencing the death of loved ones is always difficult. Accepting their wish to not seek medical treatment and the provision of end-of-life care is a challenge. Nurses who become comfortable and knowledgeable about the palliative care trajectory and the end of life experience will be able to provide a higher level of support and thus improve the quality of life for those they encounter. © 2013 Wiley Periodicals, Inc.

  9. New challenges and old problems: end of life care and the dilemma of prognostic accuracy.

    Science.gov (United States)

    Tanneberger, K S; Pannuti, F; Malavasi, I; Mariano, P; Strocchi, E

    2002-01-01

    Dignity of the natural end of life for everybody is one of the new great challenges of medicine and social care for the beginning 21st century. However, many end of life care providing doctors are confused about how to categorize the help they give. One of the central problems is predicting the life expectancy of an individual patient. Difficulties in this field can become ethical dilemmas when physicians are obliged to predict accurately a patient's prognosis as the basis for a certain care strategy. Clinical estimation of the duration of life for patients with end of life cancer needs experience and training. Education programmes in the field should include this topic much more until now. Prognosis should be based more on proven indices and less on intuition. However, there is no doubt that daily clinical practice limits the use of highly sophisticated computer-based score models. Even maximal accuracy of prognosis will not exclude the risk of errors in a great part of patients. This limits their classification in care categories too strictly defined. Health care systems should avoid models for care with standards and budgets based on prognostic estimates and the medical community should avoid claim by disciplines of certain categories of patients defined by their prognoses. What we need is a network of assistance for incurable patients with single parts defined by patients needs and not by predicted life expectancy. Separating palliative and terminal care is artificial and often in contrast to the needs of the patients.

  10. Death talk: Basic linguistic rules and communication in perinatal and paediatric end-of-life discussions.

    Science.gov (United States)

    Xafis, Vicki; Watkins, Andrew; Wilkinson, Dominic

    2016-04-01

    This paper considers clinician/parent communication difficulties noted by parents involved in end-of-life decision-making in the light of linguistic theory. Grice's Cooperative Principle and associated maxims, which enable effective communication, are examined in relation to communication deficiencies that parents have identified when making end-of-life decisions for the child. Examples from the literature are provided to clarify the impact of failing to observe the maxims on parents and on clinician/parent communication. Linguistic theory applied to the literature on parental concerns about clinician/parent communication shows that the violation of the maxims of quantity, quality, relation, and manner as well as the stance that some clinicians adopt during discussions with parents impact on clinician/parent communication and lead to distrust, anger, sadness, and long-term difficulties coping with the experience of losing one's child. Parents have identified communication deficiencies in end-of-life discussions. Relating these communication deficiencies to linguistic theory provides insight into communication difficulties but also solutions. Gaining an understanding of basic linguistic theory that underlies human interactions, gaining insight into the communication deficiencies that parents have identified, and modifying some communication behaviours in light of these with the suggestions made in this article may lead to improved clinician/parent communication. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Five-Year Experience: Reflective Writing in a Preclinical End-of-Life Care Curriculum.

    Science.gov (United States)

    Rosenbaum, Marcy E; Ferguson, Kristi J; Broderick, Ann

    2008-01-01

    This paper examines the use of reflective writing in a preclinical end-of-life curriculum including comparison of the role and outcomes of out-of-class (OC) versus in-class (IC) writing. Learners were required to complete one-page essays on their experiences and concerns about death and dying after attending a series of end-of-life care lectures. From 2002-2005, essays were completed OC and in 2006 and 2007 essays were completed during the first ten minutes of small group discussion sessions. Essays were collected and analyzed for salient themes. Between 2002-2007, reflection essays were gathered from 829 learners, including 522 OC essays and 307 IC essays. Essay analysis identified four major themes of student concerns related to caring for dying patients, as well as student reactions to specific curricular components and to the use of reflection. IC essays were shorter and less polished than OC essays but utilized a wider variety of formats including poems and bulleted lists. IC essays tended to react to lecture content immediately preceding the writing exercise whereas OC varied in curricular components upon which they focused. OC essays have the advantage of giving learners more time to choose subject matter, whereas IC essays provide a structured time in which to actively reflect. Both formats served as catalysts for small group discussions. Writing exercises can effectively provide an important opportunity and motivation for learners to reflect on past experiences and future expectations related to providing end-of-life care.

  12. Iranian nurses' preparation for loss: finding a balance in end-of-life care.

    Science.gov (United States)

    Boroujeni, Ali Zargham; Mohammadi, Rakhshandeh; Oskouie, Sayede Fatemeh Haghdoost; Sandberg, Jonas

    2009-08-01

    To explore the nurse-patient interaction in terminally ill situations in acute care, focusing on the nurses' preparation for loss. Caring for dying patients can be a distressing and sometimes even threatening experience for nurses. Despite the vast body of literature on nurse/patient interaction and the quality of end-of-life care, few studies focus specifically on nurses' experience. A grounded theory approach was used to explore nurses' interaction with dying patients and their families and examine how nurses deal with situations in which the patient's death is inevitable. Eighteen nurses were interviewed up to three times each at three teaching hospitals in Isfahan, Iran, during autumn 2006. A shortlist of possible participants was obtained by means of theoretical sampling and those who had experienced the death of patients and were able to express their feelings verbally were selected. The results clarified a core consideration: striking a balance between restorative and palliative care, information and hope, expectations and abilities and intimacy and distance. Attaining a balance in caring for dying patients is a major challenge to nurses: it concerns not only their interactions with patients and their families, but also their perceptions of themselves and their actions in end-of-life care. In end-of-life care, it is important for nurses to be able to change the focus of their care when the patient's condition is diagnosed as irreversible. They also need to be well equipped to maintain a balance, thereby preparing themselves for the patient's forthcoming death.

  13. European perspectives on ethics and law in end-of-life care.

    Science.gov (United States)

    Jox, Ralf J; Horn, Ruth J; Huxtable, Richard

    2013-01-01

    End-of-life care practices and attitudes in Europe are highly diverse, which is unsurprising given the variety of cultural and religious patterns across this region. The most marked differences are in the legal and ethical stances towards assisted dying, although there are also variations in limitation of life-sustaining treatment and the authority of advance directives to decline such treatment. Palliative care has made a rapid and impressive development in many European countries over the last decade, and alleviating symptoms at the end of life is permitted, even if the drugs used might (in the rare case) not only relieve suffering but also shorten life. Fueled by the politically led process of European harmonization, future policies and laws on end-of-life care might converge. However, at the base of many ethical conflicts there remain deeply rooted differences about promoting the sanctity of life, eradicating suffering, and respecting patients' autonomous wishes. © 2013 Elsevier B.V. All rights reserved.

  14. The experience of providing end of life care at a children's hospice: a qualitative study.

    Science.gov (United States)

    McConnell, Tracey; Porter, Sam

    2017-02-13

    More attention is being paid to the wellbeing of staff working in stressful situations. However, little is known about staff experience of providing end-of-life care to children within a hospice setting. This study aims to explore the experiences of care team staff who provide end-of-life care within a children's hospice. Qualitative research incorporating interviews and a focus group. Data were analysed using thematic analysis. Purposeful sampling led to a total of 15 care team staff recruited from a children's hospice offering palliative and specialist care to life-limited children and young people. The hospice setting provides a model of excellence in supporting staff and mitigating challenging aspects of their role, which includes peer/organisational support, and regular ongoing training in key aspects of children's palliative care. Key recommendations for improving their experience included advanced communication training and knowledge sharing with other children's palliative care specialists within the acute setting. Service and policy initiatives should encourage open, informal peer/organisational support among the wider children's palliative care sector. Further research should focus on paediatric palliative care education, particularly in relation to symptom management and communication at end-of-life, harnessing the expertise and breadth of knowledge that could be shared between children's hospices and hospital settings.

  15. Concordance of Family and Staff Member Reports about End of Life in Assisted Living and Nursing Homes

    Science.gov (United States)

    Rich, Shayna E.; Williams, Christianna S.; Zimmerman, Sheryl

    2010-01-01

    Purpose: To identify differences in perspectives that may complicate the process of joint decision making at the end of life, this study determined the agreement of family and staff perspectives about end-of-life experiences in nursing homes and residential care/assisted living communities and whether family and staff roles, involvement in care,…

  16. Attitudes of Dutch nurses towards their involvement in end-of-life decisions with a possible life-shortening effect.

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; Veer, A.J. de; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Background: Nurses are often involved in end-of-life decision making as they play an important role in caring for terminally ill patients. Aim: To investigate nurses’ attitudes towards their involvement in end-of-life decisions with a possible lifeshortening effect, and a possible relationship with

  17. Attaining Good End-of-Life Care in Intensive Care Units in Taiwan—The Dilemma And the Strategy

    Directory of Open Access Journals (Sweden)

    Shih-Yi Lee

    2009-03-01

    Full Text Available One of the major challenges for intensivists is resolving the conflicting interests in end-of-life care. We reviewed patients' characteristics in an intensive care unit to determine the major barriers of practicing good end-of-life care and the medical ethics involved for the care team to resolve these conflicts.

  18. 76 FR 59145 - Submission for OMB Review; Comment Request; NINR End-of-Life and Palliative Care Science Needs...

    Science.gov (United States)

    2011-09-23

    ...-Life and Palliative Care Science Needs Assessment: Funding Source (Survey of Authors) Summary: Under... Request: NEW. Need and Use of Information Collection: The NINR End-of-Life Science Palliative Care (EOL PC... in the 30-day Federal Register Notice. Proposed Collection: Title: NINR End-of-Life and Palliative...

  19. Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey

    NARCIS (Netherlands)

    Chambaere, K.; Rietjens, J.A.C.; Smets, T.; Bilsen, J.; Deschepper, R.; Pasman, H.R.W.; Deliens, L.

    2012-01-01

    Background: A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of

  20. 'Older peoples' attitudes towards euthanasia and an end-of-life pill in The Netherlands: 2001-2009

    NARCIS (Netherlands)

    Buiting, H.M.; Deeg, D.J.H.; Knol, D.L.; Ziegelmann, J.P.; Pasman, H.R.W.; Widdershoven, G.A.; Onwuteaka-Philipsen, B.D.

    2012-01-01

    Introduction With an ageing population, end-of-life care is increasing in importance. The present work investigated characteristics and time trends of older peoples' attitudes towards euthanasia and an end-of-life pill. Methods Three samples aged 64 years or older from the Longitudinal Ageing Study

  1. End-of-life decisions: a cross-national study of treatment preference discussions and surrogate decision-maker appointments.

    NARCIS (Netherlands)

    Evans, N.; Pasman, H.R.W.; Vega Alonso, T.; Block, L. van den; Miccinesi, G.; Viviane, V.C.; Donker, G.; Bertolissi, S.; Zurriaga, O.; Deliens, L.

    2013-01-01

    Aim: Making decisions in anticipation of possible future incapacity is part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment preference discussions and appointments of surrogate decision-makers in Italy,

  2. Efficacy of the end-of-life nursing care continuing education program for nurses in general wards in Japan.

    Science.gov (United States)

    Yoshioka, Saori; Moriyama, Michiko; Ohno, Yumiko

    2014-08-01

    This study aimed to examine effectiveness of the End-of-life nursing care continuing education program for general ward nurses. A nonrandomized, before-after trial was conducted. The program was implemented for 25 nurses. The contents of the program consisted of the family assessment, general symptom management and practical use of theories and models regarding end-of-life nursing care. The primary outcome, implementation ability of end-of-life nursing care, was significantly improved after the program; improvements continued even at 2 months after. Similar results were obtained for nurses' confidence and knowledge concerning end-of-life nursing care. As for attitude toward end-of-life care, participants' scores were further elevated after the program. The participants rated the usefulness of the program as high. The effectiveness of the program was suggested from these results. In the future, this program should be widely used for in-service training. © The Author(s) 2013.

  3. Turkish critical care nurses' views on end-of-life decision making and practices.

    Science.gov (United States)

    Badır, Aysel; Topçu, İbrahim; Türkmen, Emine; Göktepe, Nilgün; Miral, Mukaddes; Ersoy, Nermin; Akın, Esra

    2015-05-06

    Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues. The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care. This was a cross-sectional study. The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection. The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary. ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision-making process about EOL care. Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision-making process in Turkey. © 2015 British Association of Critical Care Nurses.

  4. Influence of institutional culture and policies on do-not-resuscitate decision making at the end of life.

    Science.gov (United States)

    Dzeng, Elizabeth; Colaianni, Alessandra; Roland, Martin; Chander, Geetanjali; Smith, Thomas J; Kelly, Michael P; Barclay, Stephen; Levine, David

    2015-05-01

    Controversy exists regarding whether the decision to pursue a do-not-resuscitate (DNR) order should be grounded in an ethic of patient autonomy or in the obligation to act in the patient's best interest (beneficence). To explore how physicians' approaches to DNR decision making at the end of life are shaped by institutional cultures and policies surrounding patient autonomy. We performed semistructured in-depth qualitative interviews of 58 internal medicine physicians from 4 academic medical centers (3 in the United States and 1 in the United Kingdom) by years of experience and medical subspecialty from March 7, 2013, through January 8, 2014. Hospitals were selected based on expected differences in hospital culture and variations in hospital policies regarding prioritization of autonomy vs best interest. This study identified the key influences of institutional culture and policies on physicians' attitudes toward patient autonomy in DNR decision making at the end of life. A hospital's prioritization of autonomy vs best interest as reflected in institutional culture and policy appeared to influence the way that physician trainees conceptualized patient autonomy. This finding may have influenced the degree of choice and recommendations physician trainees were willing to offer regarding DNR decision making. Trainees at hospitals where policies and culture prioritized autonomy-focused approaches appeared to have an unreflective deference to autonomy and felt compelled to offer the choice of resuscitation neutrally in all situations regardless of whether they believed resuscitation to be clinically appropriate. In contrast, trainees at hospitals where policies and culture prioritized best-interest-focused approaches appeared to be more comfortable recommending against resuscitation in situations where survival was unlikely. Experienced physicians at all sites similarly did not exclusively allow their actions to be defined by policies and institutional culture and were

  5. A Critical Review of Research on Reuse of Mechanically Recycled FRP Production and End-of-Life Waste for Construction

    Directory of Open Access Journals (Sweden)

    Ardavan Yazdanbakhsh

    2014-06-01

    Full Text Available For the last three decades, fiber reinforced polymer (FRP composite materials have been widely used in major engineering industries. Managing FRP waste is becoming an important issue due to the growth in the production of FRP composite materials. In this article, the issue of FRP waste management is discussed and the commonly used methods for the handling of FRP waste are reviewed. One potentially viable use of FRP waste is in the partial replacement of fillers or aggregates in cementitious materials (particularly portland cement mortar and concrete. A number of important prior investigations performed on the use of FRP waste in concrete and mortar are reviewed. The results from most of those investigations suggest that FRP aggregates significantly reduce the strength of cementitious materials with little significant effect on durability. Recommendations for future research in this area are provided for producing stronger mortars and concretes incorporating FRP production and end-of-life waste.

  6. Palliative and end-of-life care in prisons: a content analysis of the literature.

    Science.gov (United States)

    Maschi, Tina; Marmo, Suzanne; Han, Junghee

    2014-01-01

    The growing numbers of terminally ill and dying in prison has high economic and moral costs as global correctional systems and the society at large. However, to date little is known about the extent to which palliative and end-of-life care is infused within global prison health care systems. The purpose of this paper is to fill a gap in the literature by reviewing and critically appraising the methods and major findings of the international peer-reviewed literature on palliative and end-of-life care in prison, identify the common elements of promising palliative and end-of-life services in prison, and what factors facilitate or create barrier to implementation. A content analysis was conducted of the existing peer-reviewed literature on palliative and end-of-life care in prison. English-language articles were located through a comprehensive search of peer-reviewed journals, such as Academic Search Premier Literature databases using differing combinations of key word search terms, "prison," "palliative care," and "end-of-life care." A total of 49 studies published between 1991 and 2013 met criteria for sample inclusion. Deductive and inductive analysis techniques were used to generate frequency counts and common themes related to the methods and major findings. The majority (n=39) of studies were published between 2001-2013 in the USA (n=40) and the UK (n=7). Most were about US prison hospice programs (n=16) or barriers to providing palliative and end of life care in prisons (n=10). The results of the inductive analysis identified common elements of promising practices, which included the use of peer volunteers, multi-disciplinary teams, staff training, and partnerships with community hospices. Obstacles identified for infusing palliative and end-of-life care in prison included ethical dilemmas based on custody vs care, mistrust between staff and prisoners, safety concerns, concern over prisoners' potential misuse of pain medication, and institutional, staff, and

  7. Impact of Treatment Subsidies and Cash Payouts on Treatment Choices at the End of Life.

    Science.gov (United States)

    Finkelstein, Eric; Malhotra, Chetna; Chay, Junxing; Ozdemir, Semra; Chopra, Akhil; Kanesvaran, Ravindran

    To examine the extent to which financial assistance, in the form of subsidies for life-extending treatments (LETs) or cash payouts, distorts the demand for end-of-life treatments. A discrete choice experiment was administered to 290 patients with cancer in Singapore to elicit preferences for LETs and only palliative care (PC). Responses were fitted to a latent class conditional logistic regression model. We also quantified patients' willingness to pay to avoid and willingness to accept a less effective LET or PC-only. We then simulated the effects of various LET subsidy and cash payout policies on treatment choices. We identified three classes of patients according to their preferences. The first class (26.1% of the sample) had a strong preference for PC and were willing to give up life expectancy gains and even pay for receiving only PC. The second class (29.8% of the sample) had a strong preference for LETs and preferred to extend life regardless of cost or quality of life. The final class (44.1% of the sample) preferred LETs to PC, but actively traded off costs and length and quality of life when making end-of-life treatment choices. Policy simulations showed that LET subsidies increase demand for LETs at the expense of demand for PC, but an equivalent cash payout was not shown to distort demand. Patients with cancer have heterogeneous end-of-life preferences. LET subsidies and cash payouts have differing effects on the use of LETs. Policymakers should be mindful of these differences when designing health care financing schemes for patients with life-limiting illnesses. Copyright © 2016. Published by Elsevier Inc.

  8. Advance Care Planning and the Quality of End-of-Life Care among Older Adults

    Science.gov (United States)

    Bischoff, Kara E.; Sudore, Rebecca; Miao, Yinghui; Boscardin, W. John; Smith, Alexander K.

    2013-01-01

    Background Advance care planning is increasingly common, but whether it influences end-of-life quality of care remains controversial. Design Medicare data and survey data from the Health and Retirement Study were combined to determine whether advance care planning was associated with quality metrics. Setting The nationally representative Health and Retirement Study. Participants 4394 decedent subjects (mean age 82.6 years at death, 55% women). Measurements Advance care planning was defined as having an advance directive, durable power of attorney or having discussed preferences for end-of-life care with a next-of-kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤3 days). Results Seventy-six percent of subjects engaged in advance care planning. Ninety-two percent of advance directives stated a preference to prioritize comfort. After adjustment, subjects who engaged in advance care planning were less likely to die in a hospital (adjusted RR 0.87, 95% CI 0.80-0.94), more likely to be enrolled in hospice (aRR 1.68, 1.43-1.97), and less likely to receive hospice for ≤3 days before death (aRR 0.88, 0.85-0.91). Having an advance directive, a durable-power-of-attorney or an advance care planning discussion were each independently associated with a significant increase in hospice use (pplanning was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an advance directive, assigning a durable power of attorney and conducting advance care planning discussions are all important elements of advance care planning. PMID:23350921

  9. Ethical challenges in the provision of end-of-life care in Norwegian nursing homes.

    Science.gov (United States)

    Gjerberg, Elisabeth; Førde, Reidun; Pedersen, Reidar; Bollig, Georg

    2010-08-01

    As in other Western countries, most Norwegian nursing home patients are suffering from multi-pathological conditions and a large majority of them will die in the nursing home. End-of-life care represents many challenges, and it is a widespread concern that several nursing homes lack both resources and competence to ensure good quality care. This article examines the types and prevalence of ethical challenges in end-of-life care as nursing home staff consider them, as well as what they believe can help them to better cope with the ethical challenges. It is based on a national survey probing Norwegian nursing homes' end-of-life care at the ward level conducted in 2007. 664 respondents from 364 nursing homes answered the questionnaire, representing 68% of the patients and 76% of the nursing home sample. Inadequate care due to lack of resources and breaches of the patient's autonomy and integrity were the ethical challenges reported most often. Conflicts with the next of kin regarding nursing care and termination of life-prolonging treatment were reported more seldom. However, when asking the respondents to outline one of the most recent ethical dilemmas they had encountered, the majority of the respondents described ethical dilemmas concerning limitation of life-prolonging treatment, often mixed with disagreements between the wish of the family and that of the patient, or between the wish of the next of kin and what the staff consider to be right. Ethical dilemmas associated with breaches of the patient's autonomy and integrity were also thoroughly described. According to the staff, better ethical knowledge along with more time to reflect on ethical dilemmas were the initiatives most desired to improve the staff's way of handling ethical challenges. Furthermore, to have an opportunity to consult with a person holding ethical competence was emphasised by more than half of the respondents. (c) 2010 Elsevier Ltd. All rights reserved.

  10. Selection bias in family reports on end of life with dementia in nursing homes.

    Science.gov (United States)

    van der Steen, Jenny T; Deliens, Luc; Ribbe, Miel W; Onwuteaka-Philipsen, Bregje D

    2012-12-01

    Selective participation in retrospective studies of families recruited after the patient's death may threaten generalizability of reports on end-of-life experiences. To assess possible selection bias in retrospective study of dementia at the end of life using family reports. Two physician teams covering six nursing home facilities in the Netherlands reported on 117 of 119 consecutive decedents within two weeks after death unaware of after-death family participation in the study. They reported on characteristics; treatment and care; overall patient outcomes such as comfort, nursing care, and outcomes; and their own perspectives on the experience. We compared results between decedents with and without family participation. The family response rate was 55%. There were no significant differences based on participation versus nonparticipation in demographics and other nursing home resident characteristics, treatment and care, or overall resident outcome. However, among participating families, physicians perceived higher-quality aspects of nursing care and outcome, better consensus between staff and family on treatment, and a more peaceful death. Participation was less likely with involvement of a new family member in the last month. Families may be more likely to participate in research with more harmonious teamwork in end-of-life caregiving. Where family participation is an enrollment criterion, comparing demographics alone may not capture possible selection bias, especially in more subjective measures. Selection bias toward more positive experiences, which may include the physician's and probably also the family's experiences, should be considered if representativeness is aimed for. Future work should address selection bias in other palliative settings and countries, and with prospective recruitment.

  11. Cross-current leaching of indium from end-of-life LCD panels.

    Science.gov (United States)

    Rocchetti, Laura; Amato, Alessia; Fonti, Viviana; Ubaldini, Stefano; De Michelis, Ida; Kopacek, Bernd; Vegliò, Francesco; Beolchini, Francesca

    2015-08-01

    Indium is a critical element mainly produced as a by-product of zinc mining, and it is largely used in the production process of liquid crystal display (LCD) panels. End-of-life LCDs represent a possible source of indium in the field of urban mining. In the present paper, we apply, for the first time, cross-current leaching to mobilize indium from end-of-life LCD panels. We carried out a series of treatments to leach indium. The best leaching conditions for indium were 2M sulfuric acid at 80°C for 10min, which allowed us to completely mobilize indium. Taking into account the low content of indium in end-of-life LCDs, of about 100ppm, a single step of leaching is not cost-effective. We tested 6 steps of cross-current leaching: in the first step indium leaching was complete, whereas in the second step it was in the range of 85-90%, and with 6 steps it was about 50-55%. Indium concentration in the leachate was about 35mg/L after the first step of leaching, almost 2-fold at the second step and about 3-fold at the fifth step. Then, we hypothesized to scale up the process of cross-current leaching up to 10 steps, followed by cementation with zinc to recover indium. In this simulation, the process of indium recovery was advantageous from an economic and environmental point of view. Indeed, cross-current leaching allowed to concentrate indium, save reagents, and reduce the emission of CO2 (with 10 steps we assessed that the emission of about 90kg CO2-Eq. could be avoided) thanks to the recovery of indium. This new strategy represents a useful approach for secondary production of indium from waste LCD panels. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Family Member Satisfaction with End-of-Life Decision-making in the Intensive Care Unit

    Science.gov (United States)

    Gries, Cynthia J.; Curtis, J. Randall; Wall, Richard J.; Engelberg, Ruth A.

    2009-01-01

    Rationale Families of ICU patients may be at risk for increased psychological morbidity due to end-of-life decision-making. Identification of chart-based quality indicators of palliative care that predict family satisfaction with decision-making may help guide interventions to improve decision-making and family outcomes. Objective To determine patient and family characteristics and chart documentation of processes of care that are associated with increased family satisfaction with end-of-life decision-making for ICU patients. Methods We conducted a cohort study of ICU patients dying in 10 Seattle-Tacoma area medical centers. Measurement Outcomes from family surveys included summary scores for family satisfaction with decision-making and a single item score that indicated feeling supported during decision-making. Predictor variables were obtained from surveys and chart abstraction. Main Results Survey response rate was 41% (442/1074). Analyses were conducted on 356 families with questionnaire and chart abstraction data. Family satisfaction with decision-making was associated with withdrawal of life-support and chart documentation of: physician recommendations to withdraw life-support; discussions of patients’ wishes; and discussions of families’ spiritual needs. Feeling supported during decision-making was associated with withdrawal of life-support, spiritual care involvement and chart documentation of: physician recommendations to withdraw life-support; expressions of families’ wishes to withdraw life-support; and discussions of families’ spiritual needs. Conclusions Increased family satisfaction with decision-making is associated with withdrawing life-support and documentation of palliative care indicators including: physician recommendations to withdraw life-support, expressions of patients’ wishes and discussions of families’ spiritual needs. These findings provide direction for future intervention studies to improve family satisfaction in end-of-life

  13. Health care professionals’ comprehension of the legal status of end-of-life practices in Quebec

    Science.gov (United States)

    Marcoux, Isabelle; Boivin, Antoine; Arsenault, Claude; Toupin, Mélanie; Youssef, Joseph

    2015-01-01

    Abstract Objective To determine health care professionals’ understanding of the current legal status of different end-of-life practices and their future legal status if medical aid in dying were legalized, and to identify factors associated with misunderstanding surrounding the current legal status. Design Cross-sectional survey using 6 clinical scenarios developed from a validated European questionnaire and from a validated classification of end-of-life practices. Setting Quebec. Participants Health care professionals (physicians and nurses). Main outcome measures Perceptions of the current legal status of the given scenarios and whether or not the practices would be authorized in the event that medical aid in dying were legalized. Results Among the respondents (n = 271, response rate 88.0%), more than 98% knew that the administration or prescription of lethal medication was currently illegal. However, 45.8% wrongly thought that it was not permitted to withdraw a potentially life-prolonging treatment at the patient’s request, and this misconception was more common among nurses and professionals who had received their diplomas longer ago. Only 39.5% believed that, in the event that medical aid in dying were legalized, the use of lethal medication would be permitted at the patient’s request, and 34.6% believed they would be able to give such medication to an incompetent patient upon a relative’s request. Conclusion Health care professionals knew which medical practices were illegal, but some wrongly believed that current permitted practices were not legal. There were various interpretations of what would or would not be allowed if medical aid in dying were legalized. Education on the clinical implications of end-of-life practice legislation should be promoted. PMID:26052600

  14. Family involvement at the end-of-life and receipt of quality care.

    Science.gov (United States)

    Sudore, Rebecca L; Casarett, David; Smith, Dawn; Richardson, Diane M; Ersek, Mary

    2014-12-01

    Most patients will lose decision-making capacity at the end of life. Little is known about the quality of care received by patients who have family involved in their care. To evaluate differences in the receipt of quality end-of-life care for patients who died with and without family involvement. We retrospectively reviewed the charts of 34,290 decedents from 146 acute and long-term care Veterans Affairs facilities between 2010 and 2011. Outcomes included: (1) palliative care consult, (2) chaplain visit, and 3) death in an inpatient hospice or palliative care unit. We also assessed "do not resuscitate" (DNR) orders. Family involvement was defined as documented discussions with the health care team in the last month of life. We used logistic regression adjusted for demographics, comorbidity, and clustered by facility. For chaplain visit, hospice or palliative care unit death, and DNR, we additionally adjusted for palliative care consults. Mean (SD) age was 74 (±12) years, 98% were men, and 19% were nonwhite. Most decedents (94.2%) had involved family. Veterans with involved family were more likely to have had a palliative care consult, adjusted odds ratio (AOR) 4.31 (95% CI 3.90-4.76); a chaplain visit, AOR 1.18 (95% CI 1.07-1.31); and a DNR order, AOR 4.59 (95% CI 4.08-5.16) but not more likely to die in a hospice or palliative care unit. Family involvement at the end of life is associated with receipt of palliative care consultation and a chaplain visit and a higher likelihood of a DNR order. Clinicians should support early advance care planning for vulnerable patients who may lack family or friends. Published by Elsevier Inc.

  15. Life cycle and nano-products: end-of-life assessment

    Science.gov (United States)

    Asmatulu, Eylem; Twomey, Janet; Overcash, Michael

    2012-03-01

    Understanding environmental impacts of nanomaterials necessitates analyzing the life cycle profile. The initial emphasis of nanomaterial life cycle studies has been on the environmental and health effects of nanoproducts during the production and usage stages. Analyzing the end-of-life (eol) stage of nanomaterials is also critical because significant impacts or benefits for the environment may arise at that particular stage. In this article, the Woodrow Wilson Center's Project on Emerging Nanotechnologies (PEN) Consumer Products Inventory (CPI) model was used, which contains a relatively large and complete nanoproduct list (1,014) as of 2010. The consumer products have wide range of applications, such as clothing, sports goods, personal care products, medicine, as well as contributing to faster cars and planes, more powerful computers and satellites, better micro and nanochips, and long-lasting batteries. In order to understand the eol cycle concept, we allocated 1,014 nanoproducts into the nine end-of-life categories (e.g., recyclability, ingestion, absorption by skin/public sewer, public sewer, burning/landfill, landfill, air release, air release/public sewer, and other) based on probable final destinations of the nanoproducts. This article highlights the results of this preliminary assessment of end-of-life stage of nanoproducts. The largest potential eol fate was found to be recyclability, however little literature appears to have evolved around nanoproduct recycling. At lower frequency is dermal and ingestion human uptake and then landfill. Release to water and air are much lower potential eol fates for current nanoproducts. In addition, an analysis of nano-product categories with the largest number of products listed indicated that clothes, followed by dermal-related products and then sports equipment were the most represented in the PEN CPI (http://www.nanotechproject.org/inventories/consumer/browse/categories/, 2010).

  16. End-of-life treatment decisions in nursing home residents dying with dementia in the Netherlands.

    Science.gov (United States)

    Hendriks, Simone A; Smalbrugge, Martin; Deliens, Luc; Koopmans, Raymond T C M; Onwuteaka-Philipsen, Bregje D; Hertogh, Cees M P M; van der Steen, Jenny T

    2017-12-01

    The objective was to describe end-of-life treatment decisions for patients dying with dementia in various stages of dementia in long-term care facilities in the Netherlands with elderly care physicians responsible for treatment and care. We present data collected in the nationally representative Dutch End of Life in Dementia study (2007-2011). Within 2 weeks after death, 103 physicians completed questionnaires about the last phase of life in 330 residents with dementia who resided in 1 of 34 participating long-term care facilities. We used descriptive statistics. Advance directives were rare (4.9%). A minority was hospitalized (8.0%) in the last month (mainly for fractures) or received antibiotics (24.2%) in the last week (mainly for pneumonia). Four residents received tube feeding or rehydration therapy in the last week. In almost half of the residents (42.3%), decisions were made not to start potentially life-prolonging treatment such as hospital transfer and artificial nutrition and hydration. In more than half of the residents (53.7%), decisions were made to withdraw potentially life-prolonging treatment such as artificial nutrition and hydration and medication. Antibiotics were more frequently prescribed for residents with less advanced dementia, but otherwise there were no differences in treatment decisions between residents with advanced and less advanced dementia. Physicians often withhold potentially burdensome life-prolonging treatment in nursing home residents in all stages of dementia in the Netherlands. This suggests that the physicians feel that a palliative care approach is appropriate at the end of life in dementia in long-term care. Copyright © 2016 John Wiley & Sons, Ltd. StartCopTextCopyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  17. The role of parents in end-of-life decisions in neonatology: physicians' views and practices.

    Science.gov (United States)

    van der Heide, A; van der Maas, P J; van der Wal, G; Kollée, L A; de Leeuw, R; Holl, R A

    1998-03-01

    End-of-life decisions for newborn infants are usually made with the consent of parents as well as physicians, but may occasionally involve disagreement about which decision is in the best interest of the child. Our study was aimed at providing an empirical background for the ethical discussion on the parent's versus the physician's role in decision-making. We conducted face-to-face interviews with a stratified sample of pediatricians. The response rate was 99%. The most recent decisions in newborn infants to hasten death or not prolong life and the most recent cases in which such decisions were not made because either the parents or the physician objected were comprehensively discussed. Decisions to hasten death or not prolong life were usually made after discussing it with parents and did not occur while parents were known to disagree. Situations in which an end-of-life decision was not made because parents did not consent predominantly involved infants with complications of prematurity (24%) or perinatal asphyxia (40%), whereas situations in which parents requested an end-of-life decision that was not acceded to by the pediatrician involved Down syndrome as the main diagnosis in 43% and as a concurrent diagnosis in 21%. Pediatricians afterwards often expressed feelings of discontent about situations in which there had been disagreement with parents. The opinion of parents about which medical decision is in the best interest of their child is for pediatricians only decisive in case it invokes the continuation of treatment. The principle of preserving life is abandoned only when the physician feels sufficiently sure that the parents agree that such a course of action is in the best interest of the child.

  18. [Inadequate involvement of general practitioners in end-of-life's decisions in an intensive care unit].

    Science.gov (United States)

    Le Meur, Matthieu; Lainé, Laurent; Roucaud, Nicolas; Muller, Nelly; Paulet, Rémi; Thyrault, Martial; Coudray, Jean-Michel; Montesino, Laurent

    2014-11-01

    Patients' general practitioners (GPs) could be relevant consultants for collegial decisions of withholding or withdrawing treatment (WWT) defined by the Leonetti law. We therefore studied their implication by intensivists in end-of-life decisions and collected their feelings. Their wishes for the coming law revision were also investigated. Retrospective descriptive study conducted in the polyvalent intensive care unit (ICU) of Longjumeau's hospital (France) using a distributed questionnaire to GPs of patients who benefited from collegial decisions of WWT in 2012. The response rate was 60.4% (32/53) and only 18.8% of the respondents participated as a consultant in WWT's decision for their patient. Two GPs out of three reported that they never participate in such decisions for their others patients. All uninvolved GPs did not contribute because intensivists did not consult them. Only 43.7% of GPs were contacted by intensivists during the stay and 21.9% at the discharge or death of their patient. GPs took news about their patient during ICU hospitalization in 37.5% of cases. Regarding uninvolved GPs, their participation could have changed WWT's decisions made for two patients (7.7%). Most respondents felt available (78.1%) and skilled (81.2 %) to participate in this kind of decision. A third was also questioned by the patient's family about it. Only 21.7% of GPs report to be familiar with the French end-of-life legislation. In case of a next revision, two thirds considered important to make the use of GPs obligatory in such decisions. Despite an undeniable interest, GPs are rarely involved in collegial processes of WWT in ICUs, partially related to an insufficient knowledge of the law by the healthcare providers. At the dawn of end-of-life law's revision, their share could however improve our practices in this field. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Education, ethics, and end-of-life decisions in the intensive care unit.

    Science.gov (United States)

    Stevens, Lesley; Cook, Deborah; Guyatt, Gordon; Griffith, Lauren; Walter, Steven; McMullin, Joseph

    2002-02-01

    To examine the influence of education and clinical experience on residents' attitudes toward withdrawal of life support. Self-administered survey. Four Canadian teaching hospitals. Residents rotating through four intensive care units. The survey examined ethics education and experience regarding end-of-life care, importance of factors influencing withdrawal of life support, confidence in decisions, and recommendations for enhancing end-of-life education. The response rate was 83.9% (52 of 62). A minority of residents reported an appropriate amount of formal teaching on ethical principles (17.3%), patient-centered education (28.8%), and informal discussion (28.8%) before their intensive care unit rotation. During their rotation, most residents cared for patients in whom withdrawal of life support was considered. Although they usually attended family meetings, residents were never (34.6%) or rarely (42.3%) the primary discussant. Before the intensive care unit rotation, confidence in withdrawal decisions was related to male sex (p =.001) and previous patient-centered ethics education (p =.02). At the end of the intensive care unit rotation, only resident involvement in family meetings (p =.02) and being the primary discussant at such meetings (p =.01) were associated with confidence. After we adjusted for pre-rotation confidence in withdrawal of life support decision-making, the only predictor of post-rotation confidence was family meeting involvement (p end-of-life issues, and opportunity to lead family meetings. Experiential, case-based, patient-centered curricula are associated with resident confidence in withdrawal of life support decisions in the intensive care unit.

  20. Prevalence of end-of-life visual impairment in patients followed for glaucoma.

    Science.gov (United States)

    Ernest, Paul J G; Busch, Michiel J W M; Webers, Carroll A B; Beckers, Henny J M; Hendrikse, Fred; Prins, Martin H; Schouten, Jan S A G

    2013-12-01

    To assess the prevalence of end-of-life visual impairment in patients followed for glaucoma. Data of 122 patients followed for glaucoma who had died between July 2008 and July 2010 and who had visited the ophthalmology outpatient department of a large non-academic Dutch hospital were collected from the medical files. Sixty-one patients had open-angle glaucoma (OAG), and 61 patients were suspect for glaucoma or had ocular hypertension (OHT). Visual impairment was defined as a mean deviation value visual acuity visual impairment on the last patient visit before death and investigated its main explanations. Overall, the mean age at death was 81.8 years after a mean follow-up period of 9.2 years. Seventy-three per cent of all patients had their last visit in the year preceding death. In OAG, 16 patients (26%) had an end-of-life visual impairment. In nine patients (15%), this was caused by glaucoma. Eight of them had substantial visual loss at the initial visit. Six (10%) impaired OAG cases were mainly explained by ocular comorbidity, and there was an equal contribution of comorbidity and glaucoma in one case. Five glaucoma suspects or patients with OHT (8%) were visually impaired at death and these were all caused by ocular comorbidity. The prevalence of end-of-life visual impairment is considerable in patients with OAG. Substantial visual loss at baseline is an important contributing factor. In glaucoma suspects or patients with OHT, the prevalence is lower and can be attributed to ocular comorbidity. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

  1. Validation of quality indicators for end-of-life communication: results of a multicentre survey.

    Science.gov (United States)

    Heyland, Daren K; Dodek, Peter; You, John J; Sinuff, Tasnim; Hiebert, Tim; Tayler, Carolyn; Jiang, Xuran; Simon, Jessica; Downar, James

    2017-07-31

    The lack of validated quality indicators is a major barrier to improving end-of-life communication and decision-making. We sought to show the feasibility of and provide initial validation for a set of quality indicators related to end-of-life communication and decision-making. We administered a questionnaire to patients and their family members in 12 hospitals and asked them about advance care planning and goals-of-care discussions. Responses were used to calculate a quality indicator score. To validate this score, we determined its correlation with the concordance between the patients' expressed wishes and the medical order for life-sustaining treatments recorded in the hospital chart. We compared the correlation with concordance for the advance care planning component score with that for the goal-of-care discussion scores. We enrolled 297 patients and 209 family members. At all sites, both overall quality indicators and individual domain scores were low and there was wide variability around the point estimates. The highest-ranking institution had an overall quality indicator score (95% confidence interval) of 40% (36%-44%) and the lowest had a score of 18% (11%-25%). There was a strong correlation between the overall quality indicator score and the concordance measure (r = 0.72, p = 0.008); the estimated correlation between the advance care planning score and the concordance measure (r = 0.35) was weaker than that between the goal-of-care discussion scores and the concordance measure (r = 0.53). Quality of end-of-life communication and decision-making appears low overall, with considerable variability across hospitals. The proposed quality indicator measure shows feasibility and partial validity. Study registration: ClinicalTrials.gov, no. NCT01362855. © 2017 Canadian Medical Association or its licensors.

  2. Discrepancies in end-of-life decisions between elderly patients and their named surrogates.

    Science.gov (United States)

    Foo, Aaron S C; Lee, Tze Wee; Soh, Chai Rick

    2012-04-01

    This study aims to determine the attitudes of Asian elderly patients towards invasive life support measures, the degree of patient-surrogate concordance in end-of-life decision making, the extent to which patients desire autonomy over end-of-life medical decisions, the reasons behind patients' and surrogates' decisions, and the main factors influencing patients' and surrogates' decision-making processes. We hypothesize that there is significant patient-surrogate discordance in end-of-life decision making in our community. The patient and surrogate were presented with a hypothetical scenario in which the patient experienced gradual functional decline in the community before being admitted for life-threatening pneumonia. It was explained that the outcome was likely to be poor even with intensive care and each patient-surrogate pair was subsequently interviewed separately on their opinions of extraordinary life support using a standardised questionnaire. Both parties were blinded to each other's replies. In total, 30 patients and their surrogate decision-makers were interviewed. Twenty-eight (93.3%) patients and 20 (66.7%) surrogates rejected intensive care. Patient-surrogate concurrence was found in 20 pairs (66.7%). Twenty-four (80.0%) patients desired autonomy over their decision. The patients' and surrogates' top reasons for rejecting intensive treatment were treatment-related discomfort, poor prognosis and financial cost. Surrogates' top reasons for selecting intensive treatment were the hope of recovery, the need to complete final tasks and the sanctity of life. The majority of patients desire autonomy over critical care issues. Relying on the surrogates' decisions to initiate treatment may result in treatment against patients' wishes in up to one-third of critically ill elderly patients.

  3. The meaning of home at the end of life: A video-reflexive ethnography study.

    Science.gov (United States)

    Collier, Aileen; Phillips, Jane L; Iedema, Rick

    2015-09-01

    While 'home' is cited most frequently as being the preferred place of death, most people will die in institutions. Yet, the meaning and significance of home for people nearing the end of life has not been fully explored. The aim of this article is to critically examine the meaning of home for dying patients and their families. The qualitative study used video-reflexive ethnography methods. Data were collected and analysed over an 18-month period. Participants were recruited from two Australian sites: a palliative care day hospital and an acute hospital. Participants included patients with a prognosis of 6 months or less (n = 29), their nominated family member(s) (n = 5) and clinicians (n = 36) caring for them. Patients and families were 'followed' through care settings including the palliative care unit and into their own homes. Whether or not participants deemed space(s) safe or unsafe was closely related to the notion of home. Six themes emerged concerning this relationship: 'No place like home'; 'Safety, home and the hospital'; 'Hospital "becomes" home'; 'Home "becomes" hospital'; 'Hospital and "connections with home"'; and 'The built environment'. Home is a dynamic concept for people nearing the end of life and is concerned with expression of social and cultural identity including symbolic and affective connections, as opposed to being merely a physical dwelling place or street address. Clinicians caring for people nearing the end of life can foster linkages with home by facilitating connections with loved ones and meaningful artefacts. © The Author(s) 2015.

  4. Hospice nurses and genetics: implications for end-of-life care.

    Science.gov (United States)

    Metcalfe, Alison; Pumphrey, Rachel; Clifford, Collette

    2010-01-01

    The overall aim of this study is to determine hospice nurses' perception of the importance of genetics to hospice care provision and their personal level of confidence in carrying out genetics-related activities within an end-of-life care context. Hospices nurses regularly care for patients and their families affected by inherited genetic conditions (e.g. some cancers). Therefore, nurses need knowledge and awareness of the implications of genetic conditions and confidence in their abilities to provide appropriate care and support for patients and families. Survey. Questionnaires were sent to a stratified sample of hospice nurses (n = 1149) in England and Wales. Using Likert scales, nurses were asked to rate the importance of and their confidence in undertaking a range of scenario-based activities that accompany caring for a patient and family affected by a genetic condition in the hospice setting. Open questions invited comments on their experiences of nursing patient/family in similar situations. Follow-up telephone interviews were carried out with hospice nurse educators to explore emerging issues. Response rate was 29% (n = 328). Hospice nurses felt that all aspects of genetics-related care were 'very important' to hospice care, but lacked confidence in their ability to carry out the activities. Many respondents had not considered the relevance of genetics to hospice-care prior to completing the questionnaire but now considered it essential to end-of-life care even if they were not confident to provide it. Hospice nurses' need genetics education focusing on the psychosocial implications of caring for patients and families affected by genetic conditions to enable them to provide the complex care and support in face of the difficult issues that arise in practice. This study highlights the genetics education needs of hospice nurses in providing end-of life care for patients and their families affected by inherited genetic conditions.

  5. Discussing Death, Dying, and End-of-Life Goals of Care: A Communication Skills Training Module for Oncology Nurses.

    Science.gov (United States)

    Coyle, Nessa; Manna, Ruth; Shen, Megan; Banerjee, Smita C; Penn, Stacey; Pehrson, Cassandra; Krueger, Carol A; Maloney, Erin K; Zaider, Talia; Bylund, Carma L

    2015-12-01

    Effective communication, particularly at the end of life, is an essential skill for oncology nurses, but few receive formal training in this area. The aim of this article is to adapt an end-of-life care communication skills training (CST) module, originally developed for oncologists, for oncology nurses and to evaluate participants' confidence in using the communication skills learned and their satisfaction with the module. The adapted end-of-life care module consisted of a 45-minute didactic, exemplary video and 90 minutes of small group interaction and experiential role play with a simulated patient. Using a five-point Likert-type scale, 247 inpatient oncology nurses completed pre-/post-workshop surveys rating their confidence in discussing death, dying, and end-of-life goals of care with patients, as well as overall satisfaction with the module. Nurses' confidence in discussing death, dying, and end-of-life goals of care increased significantly after attending the workshop. Nurse participants indicated satisfaction with the module by agreeing or strongly agreeing to all six items assessing satisfaction 90%-98% of the time. Nurses' CST in discussing death, dying, and end-of-life care showed feasibility, acceptability, and potential benefit at improving confidence in having end-of-life care discussions.

  6. The family physician's perceived role in preventing and guiding hospital admissions at the end of life: a focus group study.

    Science.gov (United States)

    Reyniers, Thijs; Houttekier, Dirk; Pasman, H Roeline; Stichele, Robert Vander; Cohen, Joachim; Deliens, Luc

    2014-01-01

    Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life. © 2014 Annals of Family Medicine, Inc.

  7. Economic-Environmental Indicators to Support Investment Decisions: A Focus on the Buildings’ End-of-Life Stage

    Directory of Open Access Journals (Sweden)

    Elena Fregonara

    2017-07-01

    Full Text Available The aim of this paper is to propose a methodology for supporting decision making in design activities; in case of new projects or retrofitting of existing buildings. A multidisciplinary approach is adopted; involving Real Estate Appraisal and Economic Evaluation of Project and Building Environmental Design. It is proposed a methodology for selecting the preferable solutions among technological options; considering both economic and environmental aspects; in terms of global performance. Assuming the principles of Life Cycle Thinking and Circular Economy focus is posed at the end-of-life stage. Attention is paid on disposal costs and residual value as relevant items enable to orient investment decisions. This is done through an approach for quantifying environmental indicators related to Life Cycle Assessment (Standard ISO 14040:2006; and economic indicators adopting the Life Cycle Costing (Standard ISO 15686:2008. The paper proposes a conjoint “economic-environmental indicator”. An application of Global Cost calculation is illustrated; including monetized environmental impacts (Embodied energy and Embodied carbon; disposal/dismantling costs and residual value. The result of the Global Cost calculation is expressed through a “synthetic economic-environmental indicator” in order to select; between two different technologies; the most viable solution for a multifunctional building glass façade project; in Northern Italy. The study demonstrates that the initial investment decisions depend on the design solutions; since the early stages; related to the whole building life cycle considering conjointly the construction-management phases and the end-of-life stage.

  8. A United Methodist approach to end-of-life decisions: intentional ambiguity or ambiguous intentions.

    Science.gov (United States)

    Thobaben, James R

    1997-12-01

    The position of the United Methodist Church on end-of-life decisions is best described as intentional ambiguity or ambiguous intentions or both. The paper analyzes the official position of the denomination and then considers the actions of a U.M.C. bishop who served as a foreman for a trial of Dr. Jack Kevorkian. In an effort to find some common ground within an increasingly divided denomination, the work concludes with a consideration of the work of John Wesley and his approach to human death.

  9. Disseminating end-of-life education to cancer centers: overview of program and of evaluation.

    Science.gov (United States)

    Grant, Marcia; Hanson, Jo; Mullan, Patricia; Spolum, Maren; Ferrell, Betty

    2007-01-01

    Systematic provision of compassionate end-of-life (EOL) care requires strategic training of health professionals. Disseminating EOL Education to Cancer Centers (DELEtCC) targeted education of interdisciplinary institutional teams. Competitively-selected two-person teams participated in a national three-day EOL conference. Nationally recognized faculty created and presented the curriculum. Project faculty supported teams over 18 months as they implemented EOL goals. Conference evaluations were very positive. Independent participant and administrative evaluations reported successful implementation of goals aimed an improving EOL care. DELEtCC disseminated education representing best EOL practices, and participants used this knowledge to create and implement goals aimed at improving EOL care.

  10. Growing old and getting sick: maintaining a positive spirit at the end of life.

    Science.gov (United States)

    Clarke, David M

    2007-06-01

    End of life throws up significant mental health challenges. A high proportion of people in the terminal stages of illness experience depressive symptoms. This paper integrates a theory of hierarchy of human needs and empirical research describing experiences of grief and depression in terminal illness, to develop a model of care aimed at reducing depression and suffering. This care attends to physical, psychological, social and spiritual aspects, taking into account the concerns of patients and their families. Professional help can be offered to patients to restore dignity and hope, strengthen their ways of coping, and encourage social connections. To offer this, a well-resourced and coordinated, multidisciplinary and skilled workforce is needed.

  11. The rapid response team nurse's role in end-of-life discussions during critical situations.

    Science.gov (United States)

    Bouley, Gary

    2011-01-01

    Rapid response teams have been in existence in hospitals over the past decade. This team call may offer life-saving interventions that save lives but, in some cases, may prolong the dying process. There are times in which the rapid response team nurse and the intensive care nurses need to have an understanding of the families' perception of what is occurring and manage this situation through communication, empathy, and information sharing. The nurse must be involved during discussions surrounding end-of-life decisions. The nurse also has a role in supporting the family through this difficult time of making a decision to withhold life-supporting measures.

  12. Prognosis terminal: truth-telling in the context of end-of-life care.

    Science.gov (United States)

    Rich, Ben A

    2014-04-01

    Recent contributions to the medical literature have raised yet again the issue of whether the term "terminal" is an intelligible one and whether there is a consensus view of its meaning that is sufficient to justify or even require its use in discussing end-of-life care and treatment options with patients. Following a review of the history and development of informed consent, persistent problems with the communication of prognosis and the breaking of bad news are analyzed. The author argues that candid but compassionate communication between physicians and patients about prognosis is essential to informed decisions about both disease-directed (curative) and palliative therapies.

  13. Experiences and needs of family members in the end of life care at a nursinghome

    OpenAIRE

    Lena, Sallstrom-Olsson

    2005-01-01

    Background: There might be a risk that family members experience limited possibilities to act, participate and influence the end of life care for the elderly in the nursing home. For family members it could be the first time they face death which can imply a lot of questions and existential needs. Aim: The aim of this study was to examine the needs of family members in the patient terminal care in a nursing home. Research methods: The study implemented a qualitative approach and data was coll...

  14. Framing Effects on End-of-Life Preferences Among Latino Elders.

    Science.gov (United States)

    Vélez Ortiz, Daniel; Martinez, Rubén O; Espino, David V

    2015-01-01

    This study compared how the presentation of end-of-life (EOL) choices influences responses by Latino and White older adults relative to resuscitation preferences. The authors apply prospect theory, which deals with decision making based on how choices are framed. Participants were presented with differently ordered questions framing a resuscitation scenario and asked to rate their preferences. Results show that Latino participants were significantly influenced by the framing order of treatment options with regard to resuscitation while Whites were not. Health professionals need to be aware that the ways they present EOL options are likely to affect the choices of Latino older adults. Further research is needed with Latino subgroups.

  15. An artist's defense against the fear of loss of creativity toward the end of life.

    Science.gov (United States)

    Viederman, M

    1995-10-01

    A creative artist in his mid-sixties had a strong desire to own and carry with him a drawing by Picasso--a self-portrait done three days before his death. The drawing created a sense of calm in the patient, such as had never occurred before with the possession of an object. An apparent preoccupation with death might have obscured the primary concern of the artist, which was about the loss of creative power, and it was for this reason that he wanted to possess the drawing. The idea that this might be viewed as a transitional object at the end of life is discussed.

  16. Talking about end-of-life preferences in marriage: applying the theory of motivated information management.

    Science.gov (United States)

    Rafferty, Katherine A; Cramer, Emily; Priddis, DeAnne; Allen, Mike

    2015-01-01

    The theory of motivated information management (TMIM) provides one framework to examine information-seeking behaviors, especially in conversations involving sensitive or difficult information such as preferences for end-of-life (EOL) care. The spouse plays a significant role in decision making surrounding EOL care. Consequently, individuals need information about spouses' EOL preferences in order to ensure carrying out those desires. Our findings support the value of TMIM as a framework to understand factors that influence couples' EOL care information-seeking behaviors. In support of the theory, we provide factors that influence the initiation or avoidance of EOL conversations between spouses.

  17. Development of Efficient Recycling System for Steel Alloying Elements in End of Life Vehicles

    Science.gov (United States)

    Ohno, Hajime; Matsubae, Kazuyo; Nakajima, Kenichi; Nakamura, Shinichiro; Nagasaka, Testsuya

    Special steels, which have been imparted various properties by the addition of alloying elements, have become increasingly important as materials for human life in recent years. As the largest industrial consumer of special steel materials, the motor vehicle industry requires large volumes of various types of special steel for vehicle production. Scrap containing base metals and alloying elements is generated from end-of-life vehicles (ELVs). In current scrap treatment processes, alloying elements in steel materials are rarely considered, instead becoming impurities in steel recycling processes at electric arc furnaces (EAF) and losing their worth.

  18. Cross-current leaching of indium from end-of-life LCD panels

    Energy Technology Data Exchange (ETDEWEB)

    Rocchetti, Laura; Amato, Alessia; Fonti, Viviana [Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy); Ubaldini, Stefano [Institute of Environmental Geology and Geoengineering IGAG, National Research Council, Via Salaria km 29300, 00015 Montelibretti, Rome (Italy); De Michelis, Ida [Department of Industrial Engineering, Information and Economy, University of L’Aquila, Via Giovanni Gronchi 18, 67100, Zona industriale di Pile, L’Aquila (Italy); Kopacek, Bernd [ISL Kopacek KG, Beckmanngasse 51, 1140 Wien (Austria); Vegliò, Francesco [Department of Industrial Engineering, Information and Economy, University of L’Aquila, Via Giovanni Gronchi 18, 67100, Zona industriale di Pile, L’Aquila (Italy); Beolchini, Francesca, E-mail: f.beolchini@univpm.it [Department of Life and Environmental Sciences, Università Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy)

    2015-08-15

    Graphical abstract: Display Omitted - Highlights: • End-of-life LCD panels represent a source of indium. • Several experimental conditions for indium leaching have been assessed. • Indium is completely extracted with 2 M sulfuric acid at 80 °C for 10 min. • Cross-current leaching improves indium extraction and operating costs are lowered. • Benefits to the environment come from reduction of CO{sub 2} emissions and reagents use. - Abstract: Indium is a critical element mainly produced as a by-product of zinc mining, and it is largely used in the production process of liquid crystal display (LCD) panels. End-of-life LCDs represent a possible source of indium in the field of urban mining. In the present paper, we apply, for the first time, cross-current leaching to mobilize indium from end-of-life LCD panels. We carried out a series of treatments to leach indium. The best leaching conditions for indium were 2 M sulfuric acid at 80 °C for 10 min, which allowed us to completely mobilize indium. Taking into account the low content of indium in end-of-life LCDs, of about 100 ppm, a single step of leaching is not cost-effective. We tested 6 steps of cross-current leaching: in the first step indium leaching was complete, whereas in the second step it was in the range of 85–90%, and with 6 steps it was about 50–55%. Indium concentration in the leachate was about 35 mg/L after the first step of leaching, almost 2-fold at the second step and about 3-fold at the fifth step. Then, we hypothesized to scale up the process of cross-current leaching up to 10 steps, followed by cementation with zinc to recover indium. In this simulation, the process of indium recovery was advantageous from an economic and environmental point of view. Indeed, cross-current leaching allowed to concentrate indium, save reagents, and reduce the emission of CO{sub 2} (with 10 steps we assessed that the emission of about 90 kg CO{sub 2}-Eq. could be avoided) thanks to the recovery of indium

  19. Palliative and End-of-Life Ethical Dilemmas in the Intensive Care Unit.

    Science.gov (United States)

    Wiegand, Debra L; MacMillan, Julia; dos Santos, Maiara Rogrigues; Bousso, Regina Szylit

    2015-01-01

    Critical care nurses and advanced practice registered nurses frequently face bioethical dilemmas in clinical practice that are related to palliative and end-of-life care. Many of these dilemmas are associated with decisions made concerning continuing, limiting, or withdrawing life-sustaining treatments. The purpose of this article is to describe common ethical challenges through case study presentations and discuss approaches that critical care nurses and advanced practice registered nurses in collaboration with the interdisciplinary team can use to address these challenges. Resources that may be helpful in managing ethical dilemmas are identified.

  20. Narrative autonomy: three literary models of healthcare in the end of life.

    Science.gov (United States)

    Casado da Rocha, Antonio

    2014-04-01

    This article proposes a concept of narrative autonomy to supplement existing accounts in healthcare ethics. This is done by means of a comparison between three end-of-life scenarios: Tolstoy's The Death of Ivan Ilyich and two related contemporary stories by Lorrie Moore and Bernhard Schlink, which explore some problems arising when extremely individualistic notions of patient autonomy are put into practice. It is argued that the best model for palliative care is a cooperative one in which patient autonomy is understood as essentially social, and that involves decisional, executive, informational, and narrative dimensions.

  1. A Welsh pilot study on a distance learning module for end of life care.

    Science.gov (United States)

    Lewis, Melanie; Jeynes, Kay; Anstey, Sally; Way, Helen

    2009-01-01

    In order to build on and improve the palliative care knowledge and skills of the district nurses in Cardiff, and the Vale of Glamorgan, the South East Wales Cancer Network in partnership with the local NHS Trust, commissioned Cardiff University to develop, implement and audit a bespoke distance learning style module in the foundations of end of life and palliative care. This will be utilised as an internal requirement for all band 5 and 6 nurses. The outcomes will determine whether the module is suitable as an All-Wales programme and whether it has potential for use with other disciplines.

  2. End of life and life after death - issues to be addressed

    Directory of Open Access Journals (Sweden)

    Poojar Sridhar

    2012-01-01

    Full Text Available Being an Oncologist, I have seen many patients suffering from cancer. It pains a lot looking at them fighting the battle of life, though knowing that they would lose miserably and surrender meekly as majority of the patients report to the hospital at an advanced stage of disease and only palliative care may be the option. There is an urgent need to create - Cancer Awareness in the villages and also about the end of life care in all terminally ill patients. 20 patients in the terminal phase were questioned regarding end of life care. The common questions they asked are, why has God punished me like this? Why me on earth? Should I die so early? Why should I leave my near and dear ones and go far away, from the point of no return? Do I ever see them again? With deep sorrow and sigh, they suffer till the last breath, having the feeling of insecurity as what would happen to their dear ones. In the terminal phase, the patients wishes must be respected and their needs must be fulfilled. The health care professionals should plan an appropriate care for each patient. Most of them feel that the best place to be in end of life is the home. Research has shown that Hospice care may improve the quality of life of a patient who is dying and of the patient′s family. Communication about end of life care and decision making during the final moments of a person′s life are very important. The patients suffering are mainly due to the physical, psychological, social and spiritual issues. Death of a terminally ill patient should never be a sudden loss. All healthcare professionals, Social workers and Non-Governmental Organisations must install the life after death of the person, who has struggled for every breath and assure that he/she shall rest in peace and shall smile seeing their near and dear ones living with dignity and pride in the society. Ultimately, the patient must have dignity in dying.

  3. A qualitative study exploring the difficulties influencing decision making at the end of life for people with dementia.

    Science.gov (United States)

    Lamahewa, Kethakie; Mathew, Rammya; Iliffe, Steve; Wilcock, Jane; Manthorpe, Jill; Sampson, Elizabeth L; Davies, Nathan

    2017-06-22

    Dementia is a progressive neurodegenerative condition characterized by declining functional and cognitive abilities. The quality of end of life care for people with dementia in the UK can be poor. Several difficult decisions may arise at the end of life, relating to the care of the person with dementia, for example management of comorbidities. To explore difficulties in decision making for practitioners and family carers at the end of life for people with dementia. Qualitative methodology using focus groups and semi-structured interviews and thematic analysis methods. Former (n=4) and current (n=6) family carers of people with experience of end of life care for a person with dementia were recruited from an English dementia voluntary group in 2015. A further 24 health and care professionals were purposively sampled to include a broad range of expertise and experience in dementia end of life care. Four key themes were identified as follows: challenges of delivering coherent care in dynamic systems; uncertainty amongst decision makers; internal and external conflict amongst decision makers; and a lack of preparedness for the end of life. Overarching difficulties such as poor communication, uncertainty and conflict about the needs of the person with dementia as well as the decision maker's own role can characterize decision making at the end of life. This study suggests that decision making at the end of life for people with dementia has the potential to be improved. More planning earlier in the course of dementia with an on-going approach to conversation may increase preparedness and family carers' expectations of end of life. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  4. The Concept of Autonomy in End-of-Life Decisions: Ethical and Legal Regulation regarding Advance Directives

    OpenAIRE

    Veshi, Denard

    2016-01-01

    In this thesis the concept of autonomy in end-of-life decisions is analyzed through ethical and legal comparative approaches. The definition of advance directives – living wills and the appointment of a legal proxy – is studied. In addition, Recommendation CM/Rec (2009) 11 and the “Guide on the decision-making process regarding medical treatment in end-of-life situations” is examined. Currently, end-of-life decisions are part of the exclusive competence of national parliaments. Thus, diff...

  5. "They don't want to hear us": Hispanic elders and adult children speak about end-of-life planning.

    Science.gov (United States)

    Gutheil, Irene A; Heyman, Janna C

    2006-01-01

    This study used focus groups to understand Hispanic elders' and adult children's concerns about end-of-life planning. Ten older persons participated in the elders group, and ten adult children in a separate group. Themes in both groups included communication, control, burden, spirituality, religious issues, and importance of family relationships. Communication regarding end-of-life planning was of particular importance to both elders and adult children. The most striking indication of the challenges in communication about end-of-life issues is the insistence by both the elders and the adult children that their children/ parents do not want to have these discussions.

  6. Good deaths, bad deaths, and preferences for the end of life: a qualitative study of geriatric outpatients.

    Science.gov (United States)

    Vig, Elizabeth K; Davenport, Nathaniel A; Pearlman, Robert A

    2002-09-01

    Patient involvement in decision-making has been advocated to improve the quality of life at the end of life. Although the size of the oldest segment of the population is growing, with greater numbers of older adults facing the end of life, little is known about their preferences for the end of life. This study aimed to explore the attitudes of older adults with medical illness about the end of life, and to investigate whether current values could be extended to end-of-life preferences. Descriptive study with interviews using open- and closed-ended questions. Patients attending two university-affiliated geriatric clinics were interviewed in a private conference room near the clinic they attended or in their homes. Sixteen older men and women identified by their physicians as having nonterminal heart disease or cancer. The interview contained open-ended questions such as: "What are the most important things in your life right now?" and "What would you consider a good/bad death?" The interview also contained closed-ended questions about symptoms, quality of life, and health status. Additional questions elicited preferences for the end of life, such as location of death and the presence of others. The open-ended questions were tape-recorded, transcribed, and analyzed using qualitative methods. The closed-ended questions were analyzed using descriptive statistics. Patients with heart disease and cancer provided similar responses. Participants' views about good deaths, bad deaths, and end-of-life scenarios were heterogeneous. Each participant voiced a unique combination of themes in describing good and bad deaths. Because each participant described a multifaceted view of a good death, for instance, no theme was mentioned by even half of the participants. Participants provided differing explanations for why given themes contributed to good deaths. Currently valued aspects of life were not easily translated into end-of-life preferences. For example, although the majority

  7. Performance of irradiated CVD diamond micro-strip sensors

    CERN Document Server

    Adam, W; Bergonzo, P; Bertuccio, G; Bogani, F; Borchi, E; Brambilla, A; Bruzzi, Mara; Colledani, C; Conway, J; D'Angelo, P; Dabrowski, W; Delpierre, P A; Deneuville, A; Dulinski, W; van Eijk, B; Fallou, A; Fizzotti, F; Foulon, F; Friedl, M; Gan, K K; Gheeraert, E; Hallewell, G D; Han, S; Hartjes, F G; Hrubec, Josef; Husson, D; Kagan, H; Kania, D R; Kaplon, J; Kass, R; Koeth, T W; Krammer, Manfred; Lo Giudice, A; Lü, R; MacLynne, L; Manfredotti, C; Meier, D; Mishina, M; Moroni, L; Noomen, J; Oh, A; Pan, L S; Pernicka, Manfred; Peitz, A; Perera, L P; Pirollo, S; Procario, M; Riester, J L; Roe, S; Rousseau, L; Rudge, A; Russ, J; Sala, S; Sampietro, M; Schnetzer, S R; Sciortino, S; Stelzer, H; Stone, R; Suter, B; Tapper, R J; Tesarek, R J; Trischuk, W; Tromson, D; Vittone, E; Walsh, A M; Wedenig, R; Weilhammer, Peter; Wetstein, M; White, C; Zeuner, W; Zöller, M

    2002-01-01

    CVD diamond detectors are of interest for charged particle detection and tracking due to their high radiation tolerance. In this article we present, for the first time, beam test results from recently manufactured CVD diamond strip detectors and their behavior under low doses of electrons from a $\\beta$-source and the performance before and after intense ($>10^{15}/{\\rm cm^2}$) proton- and pion-irradiations. We find that low dose irradiations increase the signal-to-noise ratio (pumping of the signal) and slightly deteriorate the spatial resolution. Intense irradiations with protons ($2.2\\times 10^{15}~p/{\\rm cm^2}$) lowers the signal-to-noise ratio slightly. Intense irradiation with pions ($2.9\\times 10^{15}~\\pi/{\\rm cm^2}$) lowers the signal-to-noise ratio more. The spatial resolution of the diamond sensors improves after irradiations.

  8. End-of-life care bonus promoting end-of-life care in nursing homes: An 11-year retrospective longitudinal prefecture-wide study in Japan.

    Science.gov (United States)

    Nishiguchi, Sho; Sugaya, Nagisa; Sakamaki, Kentaro; Mizushima, Shunsaku

    2017-03-22

    The end-of-life (EOL) care bonus introduced by the Japanese government works as a financial incentive and framework of quality preservation, including advance care planning, for EOL care among nursing home residents. This study aims to clarify the effects of the EOL care bonus in promoting EOL care in nursing homes. A longitudinal observational study using a questionnaire was conducted. We invited 378 nursing homes in Kanagawa prefecture in Japan, a region with a rapidly aging population, to participate in the study. The outcome was the number of residents dying in nursing homes from 2004 to 2014. In a linear mixed model, fixed-effect factors included year established, unit care, regional elderly population rate and hospital beds, adjacent affiliated hospital, full-time physician on site, physician's support during off-time, basic EOL care policy, usage of the EOL care bonus, EOL care conference, and staff experience of EOL care. A total of 237 nursing home facilities responded (62.7%). The linear mixed model showed that the availability of the EOL care bonus (coefficient 3.1, 95 % CI 0.67-5.51, p = 0.012) and years of usage of the EOL care bonus (p nursing homes. Our analysis revealed that the EOL care bonus has the potential to increase the number of residents receiving EOL care in nursing homes over several years. EOL care conferences, physician support for emergency care during off-time, and the presence of an adjacent affiliated hospital may also increase the number of residents receiving EOL care in nursing homes. These results suggest that a government financial incentive may contribute to effective EOL care among nursing home residents in other developed countries with rapidly aging populations.

  9. Next of kin's feelings of guilt and shame in end-of-life care.

    Science.gov (United States)

    Andershed, Birgitta; Harstäde, Carina Werkander

    2007-12-01

    In this study the aim was to explore and describe next of kin's feelings of guilt and shame in end-of-life care via secondary analysis of 47 qualitative interviews. In the analysis categories and subcategories emerged which conveyed how the next of kin experienced guilt; not having done or talked enough, being absent at important events or making errors of judgement. Categories conveying feelings of shame were situations where the next of kin felt inferior, was ashamed on behalf of the dying person and when family conflicts became apparent. Receiving help and support in order to make the remaining period as pleasant as possible can facilitate the next of kin's sense of having fulfilled their duties and responsibilities and therein reduce feelings of guilt and shame. It is apparent that these feelings should be taken into account and the next of kin should receive support to increase their well-being during the remaining time in end-of-life care and the grieving period.

  10. Interprofessional, simulation-based training in end of life care communication: a pilot study.

    Science.gov (United States)

    Efstathiou, Nikolaos; Walker, Wendy Marina

    2014-01-01

    This paper reports on the process and outcomes of a study, designed to pilot the use of interprofessional, simulation-based training in end of life care communication. Participants comprised 50 final year medicine, nursing, physiotherapy and pharmacy students. Learning methods included observation of role play and facilitated, interactive group discussion. A Likert scale rating questionnaire was used to evaluate the impact of the learning experience. Evaluation data revealed that students were supportive of interprofessional learning and could recognise its benefits. The results indicated self-perceived improvements in knowledge, skills, confidence and competence when dealing with challenging end of life care communication situations. Comparison of pre- and post-intervention scores revealed a statistically significant positive change in the students' perceptions about their level of knowledge (Z = -5.887, p = 0.000). The reported benefits need to be balanced against design and delivery issues that proved labour and resource intensive. Economic evaluation is worthy of further consideration.

  11. Engaging Physician Learners Through a Web-Based Platform: Individualized End-of-Life Education.

    Science.gov (United States)

    Bergman, Jonathan; Ballon-Landa, Eric; Lerman, Steven E; Kwan, Lorna; Bennett, Carol J; Litwin, Mark S

    2016-09-01

    Web-based modules provide a convenient and low-cost education platform, yet should be carefully designed to ensure that learners are actively engaged. In order to improve attitudes and knowledge in end-of-life (EOL) care, we developed a web-based educational module that employed hyperlinks to allow users access to auxiliary resources: clinical guidelines and seminal research papers. Participants took pre-test evaluations of attitudes and knowledge regarding EOL care prior to accessing the educational module, and a post-test evaluation following the module intervention. We recorded the type of hyperlinks (guideline or paper) accessed by learners, and stratified participants into groups based on link type accessed (none, either, or both). We used demographic and educational data to develop a multivariate mixed-effects regression analysis to develop adjusted predictions of attitudes and knowledge. 114 individuals participated. The majority had some professional exposure to EOL care (prior instruction 62%; EOL referral 53%; EOL discussion 56%), though most had no family (68%) or personal experience (51%). On bivariate analysis, non-partnered (p = .04), medical student training level (p = .03), prior palliative care referral (p = .02), having a family member (p = .02) and personal experience of EOL care (p web-based learning in end-of-life care. © The Author(s) 2015.

  12. Experiences and Expressions of Spirituality at the End of Life in the Intensive Care Unit.

    Science.gov (United States)

    Swinton, Marilyn; Giacomini, Mita; Toledo, Feli; Rose, Trudy; Hand-Breckenridge, Tracy; Boyle, Anne; Woods, Anne; Clarke, France; Shears, Melissa; Sheppard, Robert; Cook, Deborah

    2017-01-15

    The austere setting of the intensive care unit (ICU) can suppress expressions of spirituality. To describe how family members and clinicians experience and express spirituality during the dying process in a 21-bed medical-surgical ICU. Reflecting the care of 70 dying patients, we conducted 208 semistructured qualitative interviews with 76 family members and 150 clinicians participating in the Three Wishes Project. Interviews were recorded and transcribed verbatim. Data were analyzed by three investigators using qualitative interpretive description. Participants characterize dying as a spiritual event. Spirituality is an integral part of the life narrative of the patient before, during, and after death. Experiences and expressions of spirituality for patients, families, and clinicians during end-of-life care in the ICU are supported by eliciting and implementing wishes in several ways. Eliciting wishes stimulates conversations for people of diverse spiritual orientations to respond to death in personally meaningful ways that facilitate continuity and closure, and ease emotional trauma. Soliciting wishes identifies positive aspirations, which provide comfort in the face of death. The act of soliciting wishes brings clinician humanity to the fore. Wishing makes individual spiritual preferences and practices more accessible. Wishes may be grounded in spiritual goals, such as peace, comfort, connections, and tributes; they may seek a spiritually enhanced environment or represent specific spiritual interventions. Family members and clinicians consider spirituality an important dimension of end-of-life care. The Three Wishes Project invites and supports the expression of myriad forms of spirituality during the dying process in the ICU.

  13. Identifying changes in the support networks of end-of-life carers using social network analysis.

    Science.gov (United States)

    Leonard, Rosemary; Horsfall, Debbie; Noonan, Kerrie

    2015-06-01

    End-of-life caring is often associated with reduced social networks for both the dying person and for the carer. However, those adopting a community participation and development approach, see the potential for the expansion and strengthening of networks. This paper uses Knox, Savage and Harvey's definitions of three generations social network analysis to analyse the caring networks of people with a terminal illness who are being cared for at home and identifies changes in these caring networks that occurred over the period of caring. Participatory network mapping of initial and current networks was used in nine focus groups. The analysis used key concepts from social network analysis (size, density, transitivity, betweenness and local clustering) together with qualitative analyses of the group's reflections on the maps. The results showed an increase in the size of the networks and that ties between the original members of the network strengthened. The qualitative data revealed the importance between core and peripheral network members and the diverse contributions of the network members. The research supports the value of third generation social network analysis and the potential for end-of-life caring to build social capital. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Pediatric Primary Care Involvement in End-of-Life Care for Children.

    Science.gov (United States)

    Lindley, Lisa C; Nageswaran, Savithri

    2017-03-01

    To examine the relationship between pediatric primary care involvement and hospice and home health care use at end of life. California Medicaid data were used to estimate the relationship between pediatric primary care involvement and use of hospice and home health care using generalized estimating equations. Of the 2037 children who died between 2007 and 2010, 11% used hospice and 23% used home health. Among all children, primary care was not related to hospice use and was associated with home health use, usual source of care (OR = 1.83, P care (OR = 1.60, P care (low: OR = 1.49, P Primary care for children aged 15 to 20 years was related to hospice use, usual source of care (OR = 4.06, P care (low: OR = 4.92, P Primary care for children under 5 years was associated with home health use, usual source of care (OR = 2.59, P care (OR = 2.49, P care (low: OR = 2.22, P care (moderate: OR = 2.38, P care (moderate: OR = 2.32, P Primary care involvement affected hospice use among older age-groups and home health use among younger age-groups. These findings underscore the need for clinical knowledge about end-of-life care for children of all ages among primary care providers.

  15. Communication with Residents and Families in Nursing Homes at the End of Life.

    Science.gov (United States)

    Johnson, Samantha; Bott, Marjorie J

    2016-04-01

    Communication with residents and their families is important to ensure that the end-of-life experience is in accordance with resident's wishes. A secondary analysis was conducted to determine: (a) who should communicate with the resident/family about death and dying; (b) when communication should occur around death and dying, obtaining a "DNR" order, and obtaining a hospice referral; and (c) what differences exist in communication about death and dying between Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and unlicensed staff. Greater than 90% of staff (N=2,191) reported that the physician or social worker should communicate about death and dying with residents/families, but only 53% thought that direct care staff should talk with them. Weighted scores for "When communication should occur about death and dying and obtaining a 'DNR' Order" revealed significantly (p care-planning meeting, or when the resident's family requested it. No differences were found between staff on communication about obtaining a hospice referral. The identified gaps in perception about who should be communicating can assist in developing appropriate interventions that need future testing. The potential for training regarding communication strategies and techniques could lead to higher satisfaction with end-of-life care for residents and their families.

  16. End-of-life care in nursing homes: the high cost of staff turnover.

    Science.gov (United States)

    Tilden, Virginia P; Thompson, Sarah A; Gajewski, Byron J; Bott, Marjorie J

    2012-01-01

    Nursing home staff turnover results in high cost--both economic and personal--and has a negative impact on the quality of care provided to residents at the end of life. Reducing staff turnover in nursing homes would benefit both the cost to the U.S. health care system, and, most importantly, the care residents receive in the vulnerable period leading to death. There is rising pressure on nursing homes to improve their palliative and end-of-life care practices and reduce transfers to hospital for situations and conditions that can be safely managed on site. Nursing care staff deserve an investment in the specific training necessary for them to give the highest quality care to dying residents. This training should be multifaceted and include the physiological, psychological, spiritual, interpersonal, and cultural (including ethnic) aspects of dying. Empowerment with these necessary knowledge, skills, and attitudes will not only result in better care for residents but likely also will reduce the burnout and frustration staff experience in caring for residents near death.

  17. IAGG/IAGG GARN International Survey of End-of-Life Care in Nursing Homes.

    Science.gov (United States)

    Wallace, Cara L; Swagerty, Daniel; Barbagallo, Mario; Vellas, Bruno; Cha, Heung Bong; Holmerova, Iva; Dong, Birong; Koopmans, Raymond; Cruz-Jentoft, Alfonso J; Gutierrez Robledo, Luis Miguel; Moreno, Juan Cuadros; Hajjar, Ramzi; Woo, Jean; Arai, Hidenori; Okochi, Jiro; Visvanathan, Renuka; Abdul-Rahman, Samia A; Goel, Ashish; Moser, Andrea; Rolland, Yves; Abbatecola, Angela M; Russo, Marcello; Morley, John E

    2017-06-01

    This article reports the findings of a survey on end-of-life (EOL) care in nursing homes of 18 long-term care experts across 15 countries. The experts were chosen as a convenience-based sample of known experts in each country. The survey was administered in 2016 and included both open-ended responses for defining hospice care, palliative care, and "end of life," and a series of questions related to the following areas-attitudes toward EOL care, current practice and EOL interventions, structure of care, and routine barriers. Overall experts strongly agreed that hospice and palliative care should be available in long-term care facilities and that both are defined by holistic, interdisciplinary approaches using measures of comfort across domains. However, it appears the experts felt that in most countries the reality fell short of what they believed would be ideal care. As a result, experts call for increased training, communication, and access to specialized EOL services within the nursing home. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  18. Product or waste? Importation and end-of-life processing of computers in Peru.

    Science.gov (United States)

    Kahhat, Ramzy; Williams, Eric

    2009-08-01

    This paper considers the importation of used personal computers (PCs) in Peru and domestic practices in their production, reuse, and end-of-life processing. The empirical pillars of this study are analysis of government data describing trade in used and new computers and surveys and interviews of computer sellers, refurbishers, and recyclers. The United States is the primary source of used PCs imported to Peru. Analysis of shipment value (as measured by trade statistics) shows that 87-88% of imported used computers had a price higher than the ideal recycle value of constituent materials. The official trade in end-of-life computers is thus driven by reuse as opposed to recycling. The domestic reverse supply chain of PCs is well developed with extensive collection, reuse, and recycling. Environmental problems identified include open burning of copper-bearing wires to remove insulation and landfilling of CRT glass. Distinct from informal recycling in China and India, printed circuit boards are usually not recycled domestically but exported to Europe for advanced recycling or to China for (presumably) informal recycling. It is notable that purely economic considerations lead to circuit boards being exported to Europe where environmental standards are stringent, presumably due to higher recovery of precious metals.

  19. [Palliative care in patients without cancer: Impact of the end-of-life care team].

    Science.gov (United States)

    Nishikawa, Mitsunori; Yokoe, Yuriko; Kubokawa, Naomi; Hukuda, Koji; Hattori, Hideyuki; Hong, Young-Jae; Miura, Hisayuki; Shibasaki, Masataka; Endo, Hidetoshi; Takeda, Jun; Odate, Mitsuru; Senda, Kazuyoshi; Nakashima, Kazumitsu

    2013-01-01

    Palliative care improves the quality of life of patients and their families facing problems associated with life-threatening illnesses by promoting the prevention and relief of suffering. Palliative care in Japan has been developed mainly for cancer patients. At the National Center for Geriatrics and Gerontology, an end-of-life care team (EOLCT) has been developed to promote palliative care for patients without cancer. In the first 6 months of its operation, 109 requests were received by the team, 40% of which were for patients without cancer or related disease, including dementia, frailty due to advanced age, chronic respiratory failure, chronic heart failure, and intractable neurologic diseases. The main purpose of the EOLCT is to alleviate suffering. The relevant activities of the team include the use of opioids, providing family care, and giving support in decision-making (advance care planning) regarding withholding; enforcement; and withdrawal of mechanical ventilators, gastric feeding tubes, and artificial alimentation. The EOLCT is also involved in ongoing discussions of ethical problems. The team is actively engaged in the activities of the Japanese Geriatric Society and contributes to the development of decision-making guidelines for end-of-life by the Ministry of Health, Labour and Welfare. The EOLCT can be helpful in promoting palliative care for patients with diseases other than cancer. The team offers support during times of difficulty and decision-making.

  20. End-of-life care in intensive care unit: Family experiences.

    Science.gov (United States)

    Kisorio, Leah C; Langley, Gayle C

    2016-08-01

    To elicit family members' experiences of end-of-life care in adult intensive care units. A descriptive, exploratory, qualitative design was utilised. A purposive sampling method was used to select a sample of seventeen family members who had relatives receiving end-of-life care in the intensive care units at three academic affiliated, tertiary/quaternary specialist hospitals in the Johannesburg and Pretoria regions, South Africa. An interview guide was used to facilitate individual, semi-structured interviews with the selected participants. Data collection and analysis took place simultaneously as interviews were transcribed verbatim immediately after the interview. Tesch's (1990) steps of analysis were used to establish the major themes that arose from the data. Lincoln and Guba's (1985) criteria for ensuring trustworthiness of qualitative research were applied. Five major themes emerged: "most of the time we are in darkness", "emotional support", "involvement", "family presence" and "spiritual support". The findings reflect inadequate care to the families who had dying relatives in the intensive care unit. Negative experiences expressed by the families outweighed their positive experiences, as most families were not happy with the care observed or personally received while their relatives were in the intensive care unit. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Ethics and end-of-life care for adults in the intensive care unit.

    Science.gov (United States)

    Curtis, J Randall; Vincent, Jean-Louis

    2010-10-16

    The intensive care unit (ICU) is where patients are given some of the most technologically advanced life-sustaining treatments, and where difficult decisions are made about the usefulness of such treatments. The substantial regional variability in these ethical decisions is a result of many factors, including religious and cultural beliefs. Because most critically ill patients lack the capacity to make decisions, family and other individuals often act as the surrogate decision makers, and in many regions communication between the clinician and family is central to decision making in the ICU. Elsewhere, involvement of the family is reduced and that of the physicians is increased. End-of-life care is associated with increased burnout and distress among clinicians working in the ICU. Since many deaths in the ICU are preceded by a decision to withhold or withdraw life support, high-quality decision making and end-of-life care are essential in all regions, and can improve patient and family outcomes, and also retention of clinicians working in the ICU. To make such a decision requires adequate training, good communication between the clinician and family, and the collaboration of a well functioning interdisciplinary team. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. Predictive Modeling for End-of-Life Pain Outcome using Electronic Health Records.

    Science.gov (United States)

    Lodhi, Muhammad K; Stifter, Janet; Yao, Yingwei; Ansari, Rashid; Kee-Nan, Gail M; Wilkie, Diana J; Khokhar, Ashfaq A

    2015-07-01

    Electronic health record (EHR) systems are being widely used in the healthcare industry nowadays, mostly for monitoring the progress of the patients. EHR data analysis has become a big data problem as data is growing rapidly. Using a nursing EHR system, we built predictive models for determining what factors influence pain in end-of-life (EOL) patients. Utilizing different modeling techniques, we developed coarse-grained and fine-grained models to predict patient pain outcomes. The coarse-grained models help predict the outcome at the end of each hospitalization, whereas fine-grained models help predict the outcome at the end of each shift, thus providing a trajectory of predicted outcomes over the entire hospitalization. These models can help in determining effective treatments for individuals and groups of patients and support standardization of care where appropriate. Using these models may also lower the cost and increase the quality of end-of-life care. Results from these techniques show significantly accurate predictions.

  3. Reducing environmental burdens of solid-state lighting through end-of-life design

    Science.gov (United States)

    Hendrickson, C. T.; Matthews, D. H.; Ashe, M.; Jaramillo, P.; McMichael, F. C.

    2010-01-01

    With 20% of US electricity used for lighting, energy efficient solid-state lighting technology could have significant benefits. While energy efficiency in use is important, the life cycle cost, energy and environmental impacts of light-emitting diode (LED) solid-state lighting could be reduced by reusing, remanufacturing or recycling components of the end products. Design decisions at this time for the nascent technology can reduce material and manufacturing burdens by considering the ease of disassembly, potential for remanufacturing, and recovery of parts and materials for reuse and recycling. We use teardowns of three commercial solid-state lighting products designed to fit in conventional Edison light bulb sockets to analyze potential end-of-life reuse strategies for solid-state lighting and recommend strategies for the industry. Current lamp designs would benefit from standardization of part connections to facilitate disassembly and remanufacturing of components, and fewer material types in structural pieces to maximize homogeneous materials recovery. The lighting industry should also start now to develop an effective product take-back system for collecting future end-of-life products.

  4. Use of intravenous acetaminophen (paracetamol) in a pediatric patient at the end of life: case report.

    Science.gov (United States)

    Marks, Adam D; Keefer, Patricia; Saul, D'Anna

    2013-12-01

    For the better part of 100 years, acetaminophen (or paracetamol as it is known outside of the United States) has been a common first-line analgesic in pediatrics and is typically well tolerated with minimal side effects. Its use as an anti-pyretic is also well-documented and thus it is used broadly for symptom control in the general pediatric population. In pediatric palliative care, acetaminophen is also used as an adjuvant to opioid therapy for pain as well as an anti-pyretic. For many pediatric patients near end-of-life, however, the ability to tolerate oral intake is diminished and rectal suppository administration can be distressing or contraindicated as in the setting of neutropenia, thus limiting use of acetaminophen by its usual routes. In Europe and Australia, an intravenous formulation of acetaminophen has been used for many years and has only recently become available in the United States. Here, we describe a case using intravenous acetaminophen in a pediatric patient at the end of life.

  5. Nurse care assesment at the end of life in intensive critical units

    Directory of Open Access Journals (Sweden)

    Mª Cristina Pascual Fernández

    2013-11-01

    Full Text Available To die nowadays is not the critical instant of our existence in occidental societies. Technological and scientific advances in health sciences have not been developed equally company and humanization in care. Nurses play an important and responsible role at end of life care, to provide patients and their families comfort cares in dying process. The main objective was to describe and analyze the professionals’ cares in Intensive Care Unit at the end of life process. An observational study was developed and 472 surveys to critical care nurses of six high complexity hospitals of Madrid Community were made. The questionnaire on the evaluation from the cares to the children that die in Pediatrics Intensive Care was applied. We have obtained that nurses said that most of the families remained with their patient in the moment of the death and needed support and empathy from the staff. As a conclusion we could say that the cares to the patients in Intensive Care Unit should be improved.

  6. Perceptions of nurses' roles in end-of-life care and organ donation - imposition or obligation?

    Science.gov (United States)

    Crymble, Kim; Fabian, June; Etheredge, Harriet; Gaylard, Petra

    2017-06-30

    South Africa has a rich organ-transplant history, and studies suggest that the SA public supports organ donation. In spite of this, persistently low donor numbers are a significant challenge. This may be due to a lack of contextually appropriate awareness and education, or to barriers to referring patients and families in clinical settings. It may also be due to ad hoc regulations that are not uniformly endorsed or implemented. In this article we present the findings of a study in Johannesburg that explored the attitudes and roles of nurses in end-of-life care and organ donation. A total of 273 nurses participated. Most were female and <50 years old. The majority expressed positive attitudes towards both end-of-life care and organ donation, but there was ambiguity as to whether referring patients and families for these services was within nursing scope of practice. The vast majority of participants noted that they would refer patients themselves if there was a mandatory, nationally endorsed referral policy. These findings have implications for clinical practice and policy, and suggest that the formulation and implementation of robust national guidelines should be a priority. Because nurses would follow such guidelines, this might lead to an increase in donor rates and circumvent some uncertainty regarding referral.

  7. [Implantable cardioverter-defibrillator deactivation at the end of life: ethical, clinical and communication issues].

    Science.gov (United States)

    Romanò, Massimo; Piga, Maria Antonella; Bertona, Roberta; Negro, Roberto; Ruggeri, Chiara; Zorzoli, Federica; Villani, Rosvaldo

    2017-02-01

    The number of cardioverter-defibrillator implants is increasing worldwide, with the main indication being primary prevention of sudden cardiac death. During the follow-up, patients may die from progression of their underlying heart disease or from nonarrhythmic causes, such as malignancies, dementia and lung disease, without receiving appropriate shocks until the last few days or weeks of their life. These events occur roughly in 30% of patients, mainly in the last 24 hours before death. In this case, inappropriate and even appropriate shock deliveries can no longer prolong life and may simply lead to pain and reduced quality of life. Therefore, it appears important to discuss early with the patients and their relatives about deactivation of the implantable cardioverter-defibrillator (ICD) at the end of life.The goal of this review is to provide an overview of the ethical, clinical and communication issues of ICD deactivation, with a special focus on patients' wishes. It is outlined that patients are not adequately informed about risks and benefits of ICD and the option of ICD deactivation; the doctors are not used to discuss with the patients the topics of end-of-life decisions. Complete information must be part of current informed consent before ICD implantation and should be updated during the follow-up, with special attention to patients with heart failure in relation to their prognosis and advance directives, as suggested by international guidelines.

  8. End-of-life patients, intensive care and consent: difficulties facing French intensivists.

    Science.gov (United States)

    Franchitto, N; Vinour, H; Gavarri, L; Telmon, N; Rouge, D

    2007-08-01

    The French legislature passed a law in 2005 that assigns a new role to the physician and redefines his liability in end-of-life decisions. This law is presented and discussed in context with current French legal practice. This law emphasizes patient autonomy, advocating that the patient be fully informed before treatment, and creates specific procedures to be followed according to whether the patient is conscious or unconscious. In the latter situation, the law reinforces the role of both the patient's surrogate and the patient's advance directives in establishing consent. In these extreme situations, doctors have the option to request a second medical opinion. This joint decision-making procedure is laid down by law and becomes obligatory in the interests of transparency. Respect for patients' consent implies the possibility that they may refuse medical care, creating an ethical and legal dilemma of providing medical care or respecting the patients' wishes. The key issue concerning end-of-life patients rests in the decisions taken concerning the continuation or withdrawal of life support and the administration of palliative care.

  9. Parental Perspectives of Communication at the End of Life at a Pediatric Oncology Institution.

    Science.gov (United States)

    Snaman, Jennifer M; Torres, Carlos; Duffy, Brian; Levine, Deena R; Gibson, Deborah V; Baker, Justin N

    2016-03-01

    The interaction of health care providers and hospital staff with patients and families at the end of life affects the parental grief experience. Both verbal and nonverbal communication are key components of this interaction. The study objective was to explore the communication between hospital staff members and patients and families at the time of patients' health decline near the end of life. Twelve bereaved parents participated in a focus group. Semantic content analysis was used to analyze the transcript. Parents' responses to the prompt about typical ways the medical team communicated yielded 109 codes, which were grouped into 12 themes. The most common themes were "patient inclusion" and "explanation of medical plan," both used in 17% of responses. Responses to the prompt about positive and negative aspects of communication generated 208 codes, yielding 15 different themes. The most common theme about positive communication was the "strong relationship between family and staff." The theme "variations in care with a negative impact" was used most frequently in describing negative communication. This study helps to identify techniques that should be used by clinicians as they work with children with cancer and their families, particularly including patients in treatment decisions, ongoing relationship building, communicating with caring and empathy, using an interdisciplinary team for additional support, and pairing bad news with a plan of action.

  10. Implantable cardioverter defibrillator knowledge and end-of-life device deactivation: A cross-sectional survey.

    Science.gov (United States)

    McEvedy, Samantha M; Cameron, Jan; Lugg, Eugene; Miller, Jennifer; Haedtke, Chris; Hammash, Muna; Biddle, Martha J; Lee, Kyoung Suk; Mariani, Justin A; Ski, Chantal F; Thompson, David R; Chung, Misook Lee; Moser, Debra K

    2018-01-01

    End-of-life implantable cardioverter defibrillator deactivation discussions should commence before device implantation and be ongoing, yet many implantable cardioverter defibrillators remain active in patients' last days. To examine associations among implantable cardioverter defibrillator knowledge, patient characteristics and attitudes to implantable cardioverter defibrillator deactivation. Cross-sectional survey using the Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients Questionnaire. Participants were classified as insufficient or sufficient implantable cardioverter defibrillator knowledge and the two groups were compared. Implantable cardioverter defibrillator recipients ( n = 270, mean age 61 ± 14 years; 73% male) were recruited from cardiology and implantable cardioverter defibrillator clinics attached to two tertiary hospitals in Melbourne, Australia, and two in Kentucky, the United States. Participants with insufficient implantable cardioverter defibrillator knowledge ( n = 77, 29%) were significantly older (mean age 66 vs 60 years, p = 0.001), less likely to be Caucasian (77% vs 87%, p  = 0.047), less likely to have received implantable cardioverter defibrillator shocks (26% vs 40%, p = 0.031), and more likely to have indications of mild cognitive impairment (Montreal Cognitive Assessment score trajectory. An interdisciplinary approach is required to ensure that discussions about implantable cardioverter defibrillator deactivation issues are initiated at appropriate time points, with family members ideally also included.

  11. Islamic perspectives on clinical intervention near the end-of-life: We can but must we?

    Science.gov (United States)

    Padela, Aasim I; Qureshi, Omar

    2017-12-01

    The ever-increasing technological advances of modern medicine have increased physicians' capacity to carry out a wide array of clinical interventions near the end-of-life. These new procedures have resulted in new "types" of living where a patient's cognitive functions are severely diminished although many physiological functions remain active. In this biomedical context, patients, surrogate decision-makers, and clinicians all struggle with decisions about what clinical interventions to pursue and when therapeutic intent should be replaced with palliative goals of care. For some patients and clinicians, religious teachings about the duty to seek medical care and the care of the dying offer ethical guidance when faced with such choices. Accordingly, this paper argues that traditional Sunni Islamic ethico-legal views on the obligation to seek medical care and Islamic theological concepts of human dignity (karāmah) and inviolability (ḥurmah) provide the ethical grounds for non-intervention at the end-of-life and can help calibrate goals of care discussions for Muslim patients. In closing the paper highlights the pressing need to develop a holistic ethics of healthcare of the dying from an Islamic perspective that brings together multiple genres of the Islamic intellectual tradition so that it can meet the needs of the patients, clinicians and Muslim religious leaders interacting with the healthcare system.

  12. Older Adults Making End of Life Decisions: An Application of Roy's Adaptation Model

    Directory of Open Access Journals (Sweden)

    Weihua Zhang

    2013-01-01

    Full Text Available Purpose. The purpose of this study was to identify variables that influenced completion of advanced directives in the context of adaptation from national data in older adults. Knowledge gained from this study would help us identify factors that might influence end of life discussions and shed light on strategies on effective communication on advance care planning. Design and Method. A model-testing design and path analysis were used to examine secondary data from 938 participants. Items were extracted from the data set to correspond to variables for this study. Scales were constructed and reliabilities were tested. Results. The final path model showed that physical impairment, self-rated health, continuing to work, and family structure had direct and indirect effects on completion of advanced directives. Five percent of the variance was accounted for by the path analysis. Conclusion. The variance accounted for by the model was small. This could have been due to the use of secondary data and limitations imposed for measurement. However, health care providers and families should explore patient’s perception of self-health as well as their family and work situation in order to strategize a motivational discussion on advance directive or end of life care planning.

  13. Iron-catalyzed depolymerizations of end-of-life silicones with fatty alcohols

    Directory of Open Access Journals (Sweden)

    Maik Weidauer

    2015-12-01

    Full Text Available During the last decades, polymers became one of the major materials in our society and a future without polymers is hardly imaginable. However, as negative issue of this success enormous amount of end-of-life materials are accumulated, which are mainly treated by landfill storage, thermal recycling or down-cycling. On the other hand, feedstock recycling can be an interesting option to convert end-of-life polymers to high quality polymers, via depolymerization reactions to low-molecular weight building blocks and subsequent transformation via polymerization reactions. In this regard, we present herein the depolymerization of polysiloxanes (silicones applying fatty alcohols as depolymerization reagents. In more detail, in the presence of catalytic amounts of simple iron salts, low-molecular weight products with the motif R(OSiMe2mOR (R = alkyl, m = 1–2 were attained. Remarkably, the reaction of R(OSiMe2mOR with water showed the formation of new cyclic siloxanes, which are useful starting materials for long-chain silicones, and the corresponding fatty alcohol as side product, which can be directly reused in subsequent depolymerization reactions. Importantly, a recycling of the silicones and a straightforward recycling of the depolymerization reagent are feasible.

  14. End-of-life decision-making in the United States.

    Science.gov (United States)

    Truog, R D

    2008-01-01

    Decision-making at the end-of-life in the United States has evolved over the last 50 yr, beginning with the development of the concept of brain death as a criterion for permitting patients who are in a state of 'irreversible coma' to be considered as 'dead' for purposes of ventilator withdrawal and organ transplantation. Since then, a firm consensus has emerged in American law and ethics that 'Patients have a virtually unlimited right to refuse any unwanted medical treatment, even if necessary for life itself.' With regard to patients who are unable to make decisions for themselves, both Europe and the United States are converging toward a view that respects a role for surrogates in decision-making while recognizing the need to limit their authority. Beyond decisions to withdraw and withhold treatments, both the United States and Europe are experimenting with active hastening of the dying process through euthanasia and physician-assisted suicide. In the author's opinion, the next big question to be addressed in end-of-life decision-making is 'Just how bad does the neurological condition and prognosis need to be before it is acceptable to allow a decision to withdraw life support'? Although the practices described here have wide acceptance throughout the United States and Europe, the worldwide emergence of religious fundamentalism and the associated vitalistic view about the sanctity of life may result in significant changes over the next few decades.

  15. Designing a Reverse Logistics Network for End-of-Life Vehicles Recovery

    Directory of Open Access Journals (Sweden)

    Masoud Zarei

    2010-01-01

    Full Text Available The environmental factors are receiving increasing attention in different life cycle stages of products. When a product reaches its End-Of-Life (EOL stage, the management of its recovery process is affected by the environmental and also economical factors. Selecting efficient methods for the collection and recovery of EOL products has become an important issue. The European Union Directive 2000/53/EC extends the responsibility of the vehicle manufacturers to the postconsumer stage of the vehicle. In order to fulfill the requirements of this Directive and also efficient management of the whole recovery process, the conceptual framework of a reverse logistics network is presented. The distribution of new vehicles in an area and also collecting the End-of-Life Vehicles (ELVs and their recovery are considered jointly. It is assumed that the new vehicles distributors are also responsible for collecting the ELVs. Then a mathematical model is developed which minimizes the costs of setting up the network and also the relevant transportation costs. Because of the complexity of the model, a solution methodology based on the genetic algorithm is designed which enables achieving good quality solutions in a reasonable algorithm run time.

  16. Choice and compassion at the end of life: A critical analysis of recent English policy discourse.

    Science.gov (United States)

    Borgstrom, Erica; Walter, Tony

    2015-07-01

    End of life care in England has recently been framed by two very different discourses. One (connected to advance care planning) promotes personal choice, the other promotes compassionate care; both are prominent in professional, policy and media settings. The article outlines the history of who promoted each discourse from 2008 to early 2015, when, why and how and this was done. Each discourse is then critically analysed from a standpoint that takes account of bodily decline, structural constraints, and human relationality. We focus on the biggest group of those nearing the end of their life, namely frail very old people suffering multiple conditions. In their care within contemporary healthcare organisations, choice becomes a tick box and compassion a commodity. Informed choice, whether at the end of life or in advance of it, does not guarantee the death the person wants, especially for those dying of conditions other than cancer and in the absence of universally available skilled and compassionate care. Enabling healthcare staff to provide compassionate, relational care, however, implies reversing the philosophical, political and financial direction of healthcare in the UK and most other Anglophone countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Thermo-Catalytic Pyrolysis of Waste Plastics from End of Life Vehicle

    Directory of Open Access Journals (Sweden)

    Miskolczi Norbert

    2016-01-01

    Full Text Available Pyrolysis of waste plastics is widely used recycling method. Owing to the end-of-life vehicles regulations, 95% of passenger cars and vehicles must reused/recovered after the dismantling. Pyrolysis of waste polyethylene and polypropylene obtained from end-of-life vehicles was investigated in a continuously stirred batch reactor using 500 and 600°C temperatures. To ensure the pyrolysis reactions the tested catalysts (5% of ZSM-5, HZSM-5, Ni-ZSM-5 and Fe-ZSM-5 were added directly to the mixtures of raw materials. Products of pyrolysis were separated into gases, pyrolysis oil and heavy oil, which was further analyzed by gas-chromatography, Fourier transformed infrared spectroscopy and other standardized methods. Based on the results it was concluded, that the catalysts significantly increase the yields of volatile products, and modify their composition. Especially the alkane/alkene ratio, the methane concentration and the concentration of branched hydrocarbon could be affected by the applied catalysts. Ni-ZSM-5 catalyst had the highest activity in methane production, while HZSM-5 catalyst proved effective in isomerization reactions. Using H-ZSM-5, Ni-ZSM-5, and Fe-ZSM-5 catalyst notably decreased average molecular weight of pyrolysis oils and significantly higher aromatic content was observed.

  18. Unusual perceptions at the end of life: limitations to the diagnosis of hallucinations in palliative medicine.

    Science.gov (United States)

    Kellehear, Allan

    2017-09-01

    The diagnosis of hallucination for unusual perceptions such as deathbed visions, near-death experiences, or visions of the bereaved, is unhelpful in palliative medicine both academically and clinically. This paper reviews the broad prevalence data about unusual perceptions in the general population as background to identifying the more narrow epidemiological source from which the much smaller focus on hallucinations seem to emerge. Major debates and limitations of current hallucination research are reviewed to show that current academic and clinical certainties are largely confined to unusual perceptions that can be readily linked to psychopathology, quite specific organic disease states and psychoactive drug use. Current state-of-the-art in hallucination studies does not warrant broad or uncritical use of this type of diagnosis in end-of-life care. Conclusions from interdisciplinary (as opposed to single discipline) hallucination studies suggest that the way forward for clinical and research work in palliative medicine may lie in a more biographical and cultural approach to unusual perceptions at the end of life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Medication use during end-of-life care in a palliative care centre.

    Science.gov (United States)

    Masman, Anniek D; van Dijk, Monique; Tibboel, Dick; Baar, Frans P M; Mathôt, Ron A A

    2015-10-01

    In end-of-life care, symptoms of discomfort are mainly managed by drug therapy, the guidelines for which are mainly based on expert opinions. A few papers have inventoried drug prescriptions in palliative care settings, but none has reported the frequency of use in combination with doses and route of administration. To describe doses and routes of administration of the most frequently used drugs at admission and at day of death. Setting Palliative care centre in the Netherlands. In this retrospective cohort study, prescription data of deceased patients were extracted from the electronic medical records. Doses, frequency and route of administration of prescribed drugs All regular medication prescriptions of 208 patients, 89% of whom had advanced cancer, were reviewed. The three most prescribed drugs were morphine, midazolam and haloperidol, to 21, 11 and 23% of patients at admission, respectively. At the day of death these percentages had increased to 87, 58 and 50%, respectively. Doses of these three drugs at the day of death were statistically significantly higher than at admission. The oral route of administration was used in 89% of patients at admission versus subcutaneous in 94% at the day of death. Nearing the end of life, patients in this palliative care centre receive discomfort-relieving drugs mainly via the subcutaneous route. However, most of these drugs are unlicensed for this specific application and guidelines are based on low level of evidence. Thus, there is every reason for more clinical research on drug use in palliative care.

  20. The social stratification of older adults' preparations for end-of-life health care.

    Science.gov (United States)

    Carr, Deborah

    2012-09-01

    I use data from the Wisconsin Longitudinal Study (n = 4,971) to evaluate the extent to which socioeconomic status affects three health-related (living will, durable power of attorney for health care, and discussions) and one financial (will) component of end-of-life planning. Net worth is positively associated with all four types of planning, after demographic, health, and psychological characteristics are controlled. Low rates of health-related planning among persons with low or negative assets are largely accounted for by the fact that they are less likely to execute a will, an action that triggers health-related preparations. Rates of health-related planning alone are higher among recently hospitalized persons, whereas financial planning only is more commonly done by homeowners and those with richer assets. The results suggest that economically advantaged persons engage in end-of-life planning as a two-pronged strategy entailing financial and health-related preparations. Implications for health policy, practice, and theory are discussed.

  1. Media coverage of the persistent vegetative state and end-of-life decision-making.

    Science.gov (United States)

    Racine, E; Amaram, R; Seidler, M; Karczewska, M; Illes, J

    2008-09-23

    Conflicting perspectives about the diagnosis and prognosis of the persistent vegetative state (PVS) as well as end-of-life (EOL) decision-making were disseminated in the Terri Schiavo case. This study examined print media coverage of these features of the case. We retrieved print media coverage of the Schiavo case from the LexisNexis Academic database and used content analysis to examine headlines and text of articles describing Schiavo's neurologic condition, behavioral repertoire, prognosis, and withdrawal of life support. The accuracy of claims about PVS was assessed. Our search yielded 1,141 relevant articles published (1990-2005) in the four most prolific American newspapers for this case. The most frequent headline themes featured legal (31%), EOL (25%), and political (22%) aspects of the case. Of the articles analyzed, 21% reported that Schiavo "might improve" and 7% that she "might recover." Statements explicitly denying the PVS diagnosis were found in 6% of articles. Explanations of PVS and other chronic disorders of consciousness were rare (end of life decision-making. Strategies are needed to achieve better internal agreement within the professional community and effective communication with patient communities, families, the media, and stakeholders.

  2. A comparison of the willingness of resident and attending physicians to comply with the requests of patients at the end of life.

    Science.gov (United States)

    Thomas, John M; O'Leary, John R; Fried, Terri R

    2014-07-01

    Little is known about the differences between physicians in training and post training in their willingness to comply with patient requests at the end of life. To compare the attitudes of attendings and residents regarding a range of patient requests at the end of life Written, cross-sectional survey The cohort included 191 attendings randomly selected across the state of Connecticut and 240 residents from 2 university-affiliated Internal Medicine programs. We surveyed attendings and residents about their willingness to honor the requests of the same decisionally capable elderly patient in five scenarios involving different requests regarding end-of-life treatment. While a large majority of both attendings and residents were willing to comply with each of the requests to withhold intubation (100 % and 94 %, respectively), to extubate (92 % and 77 %), and to give increasingly higher doses of narcotics (94 % and 71 %), a significantly larger proportion of attendings versus residents was willing to comply with each of these requests. Small proportions of attendings and residents were willing to prescribe a lethal amount of sleeping pills (3 % and 5 %, respectively) and to give a lethal injection in its current illegal state (1 % and 4 %). A significantly larger proportion of residents (32 %) compared to attendings (19 %) was willing to give a lethal injection if legal. Adjusting for sociodemographic factors, attending status was independently associated with willingness to extubate [adjusted odds ratio (AOR) = 3.0, 95 % CI = 1.6-5.7] and to give a lethal injection if legal (AOR = 0.5, 95 % CI = 0.3-0.8). The proportion of physicians willing to extubate increased across years since graduation, with the greatest differences occurring across the residency years (69 % to 86 %). Clinical experience was an important determinant of physicians' willingness to perform multiple patient requests at the end of life, with substantial changes in attitudes occurring during

  3. The effectiveness of the Liverpool care pathway in improving end of life care for dying cancer patients in hospital. A cluster randomised trial

    Directory of Open Access Journals (Sweden)

    Pellegrini Fabio

    2011-01-01

    Full Text Available Abstract Background Most cancer patients still die in hospital, mainly in medical wards. Many studies in different countries have shown the poor quality of end-of-life care delivery in hospitals. The Program "Liverpool Care Pathway for the dying patient" (LCP, developed in the UK to transfer the hospice model of care into hospitals and other care settings, is a complex intervention to improve the quality of end-of-life care. The results from qualitative and quantitative studies suggest that the LCP Program can improve significantly the quality of end-of-life care delivery in hospitals, but no randomised trial has been conducted till now. Methods and design This is a randomized cluster trial, stratified by regions and matched for assessment period. Pairs of eligible medical wards from different hospitals will be randomized to receive the LCP-I Program or no intervention until the end of the trial. The LCP-I Program will be implemented by a Palliative Care Unit. The assessment of the end-points will be performed for all cancer deaths occurred in the six months after the end of the LCP-I implementation in the experimental wards and, in the same period of time, in the matched control wards. The primary end-point is the overall quality of end-of-life care provided on the ward to dying cancer patients and their families, assessed using the Global Scale of the Italian version of the Toolkit "After-death Bereaved Family Member Interview". Discussion This study can be interpreted as a Phase III trial according to the Medical Research Council Framework. In this study, the effectiveness of a fully defined intervention is assessed by comparing the distribution of the endpoints in the experimental and in the control arm. Research ID RFPS-2006-6-341619 Trial registration ClinicalTrials.gov Identifier: NCT01081899

  4. Attitudes of nursing staff towards involvement in medical end-of-life decisions: A national survey study

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; de Veer, A.J.E.; Bilsen, J.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Objectives: To investigate nursing staff attitudes towards involvement and role in end-of-life decisions (ELDs) and the relationships with sociodemographic and work-related characteristics. Methods: Survey study among nationally representative Dutch research sample consisting of care professionals.

  5. Attitudes of nursing staff towards involvement in medical end-of-life decisions: a national survey study.

    NARCIS (Netherlands)

    Albers, G.; Francke, A.L.; Veer, A.J.E. de; Bilsen, J.; Onwuteaka-Philipsen, B.D.

    2014-01-01

    Objectives: To investigate nursing staff attitudes towards involvement and role in end-of-life decisions (ELD) and the relationships with sociodemographic and work-related characteristics. Methods: Survey study among nationally representative Dutch research sample consisting of care professionals.

  6. Controversies surrounding continuous deep sedation at the end of life: the parliamentary and societal debates in France

    National Research Council Canada - National Science Library

    Raus, Kasper; Chambaere, Kenneth; Sterckx, Sigrid

    2016-01-01

    Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying...

  7. Advance Directive in End of Life Decision-Making among the Yoruba of South-Western Nigeria.

    Science.gov (United States)

    Jegede, Ayodele Samuel; Adegoke, Olufunke Olufunsho

    2016-11-01

    End-of-life decision making is value-laden within the context of culture and bioethics. Also, ethics committee role is difficult to understand on this, thus need for ethnomethodological perspective in an expanding bioethical age. Anthropological approach was utilized to document Yoruba definition and perspective of death, cultural beliefs about end-of-life decision making, factors influencing it and ethics committee role. Interviews were conducted among selected Yoruba resident in Akinyele LGA, Oyo State, Nigeria. Content analytical approach was used for data analysis. Yoruba culture, death is socially constructed having spiritual, physical and social significance. Relationship between the dying and significant others influences decision making. Hierarchy of authority informs implementing traditional advance directive. Socialization, gender, patriarchy, religious belief and tradition are major considerations in end-of-life decision making. Awareness, resource allocation and advocacy are important ethics committees' roles. Further research into cultural diversity of end-of-life decision making will strengthen ethical practice in health care delivery.

  8. End-of-life care decisions: importance of reviewing systems and limitations after 2 recent North American cases

    National Research Council Canada - National Science Library

    Burkle, Christopher M; Benson, Jeffre J

    2012-01-01

    .... As countries have explored the greater influence that patients and their representatives may play on end-of-life treatment decisions, the benefits and struggles involved with such a movement must be appreciated...

  9. Interventions at the end of life – a taxonomy for ‘overlapping consensus’ [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    David Clark

    2017-02-01

    Full Text Available Context: Around the world there is increasing interest in end of life issues. An unprecedented number of people dying in future decades will put new strains on families, communities, services and governments.  It will also have implications for representations of death and dying within society and for the overall orientation of health and social care. What interventions are emerging in the face of these challenges? Methods: We conceptualize a comprehensive taxonomy of interventions, defined as ‘organized responses to end of life issues’. Findings: We classify the range of end of life interventions into 10 substantive categories: policy, advocacy, educational, ethico-legal, service, clinical, research, cultural, intangible, self-determined. We distinguish between two empirical aspects of any end of life intervention: the ‘locus’ refers to the space or spaces in which it is situated; the ‘focus’ captures its distinct character and purpose. We also contend that end of life interventions can be seen conceptually in two ways – as ‘frames’ (organized responses that primarily construct a shared understanding of an end of life issue or as ‘instruments’ (organized responses that assume a shared understanding and then move to act in that context. Conclusions: Our taxonomy opens up the debate about end of life interventions in new ways to provide protagonists, activists, policy makers, clinicians, researchers and educators with a comprehensive framework in which to place their endeavours and more effectively to assess their efficacy. Following the inspiration of political philosopher John Rawls, we seek to foster an ‘overlapping consensus’ on how interventions at the end of life can be construed, understood and assessed.

  10. A co-design process developing heuristics for practitioners providing end of life care for people with dementia

    OpenAIRE

    Davies, Nathan; Mathew, Rammya; Wilcock, Jane; Manthorpe, Jill; Sampson, Elizabeth L; Lamahewa, Kethakie; Iliffe, Steve

    2016-01-01

    Background The end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia. Methods An iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2) fo...

  11. Performance degradation of ferrofluidic feedthroughs in a mixed irradiation field

    Science.gov (United States)

    Simos, Nikolaos; Fernandes, S.; Mittig, Wolfgang; Pellemoine, Frederique; Avilov, M.; Kostin, M.; Mausner, L.; Ronningen, R.; Schein, M.; Bollen, G.

    2017-01-01

    Ferrofluidic feedthrough (FF) rotary seals containing either NdFeB or SmCo-type permanent magnets have been considered for use in the target and beam dump systems of the Facility for Rare Isotope Beams (FRIB). To evaluate their performance under irradiation three FF seals were irradiated in a mixed field consisting of fast neutrons, protons and γ-rays to an average absorbed dose of 0.2, 2.0, and 20.0 MGy at the Brookhaven Linac Isotope Producer facility (BLIP). The radiation types and energy profiles mimic those expected at the FRIB facility. Degradation of the operational performance of these devices due to irradiation is expected to be the result of the de-magnetization of the permanent magnets contained within the seal and the changes in the ferrofluid properties. Post-irradiation performance was evaluated by determining the ferrofluidic seal vacuum tightness and torque under static and dynamic conditions. The study revealed that the ferrofluidic feedthrough seal irradiated to a dose of 0.2 MGy maintained its vacuum tightness under both static and rotational condition while the one irradiated to a dose of 2.0 MGy exhibited signs of ferrofluid damage but no overall performance loss. At 20 MGy dose the effects of irradiation on the ferrofluid properties (viscosity and particle agglomeration) were shown to be severe. Furthermore, limited de-magnetization of the annular shaped Nd2Fe14B and Sm2Co17 magnets located within the irradiated FFs was observed for doses of 0.2 MGy and 20 MGy respectively.

  12. Staying Out of the Closet: LGBT Older Adults' Hopes and Fears in Considering End-of-Life.

    Science.gov (United States)

    Wilson, Kimberley; Kortes-Miller, Katherine; Stinchcombe, Arne

    2018-03-01

    Canada is experiencing population aging, and given the heterogeneity of older adults, there is increasing diversity in late life. The purpose of this study was to help fill the research gaps on LGBT aging and end-of-life. Through focus groups, we sought to better understand the lived experience of older LGBT individuals and to examine their concerns associated with end-of-life. Our analysis highlights the idea that identifying as LGBT matters when it comes to aging and end-of-life care. In particular, gender identity and sexual orientation matter when it comes to social connections, in the expectations individuals have for their own care, and in the unique fear related to staying out of the closet and maintaining identity throughout aging and end-of-life. This study underscores the need to consider gender identity and sexual orientation at end-of-life. In particular, recognition of intersectionality and social locations is crucial to facilitating positive aging experiences and end-of-life care.

  13. End of life care in nursing homes in Spain: Exploratory analysis and evidences of validity of a new scale.

    Science.gov (United States)

    Sánchez-García, María Remedios; Gutiérrez-Romero, Jose Antonio; Fernández-Alcántara, Manuel; Hueso-Montoro, César; Goodman, Claire; Montoya-Juárez, Rafael

    2017-10-01

    Quality end-of-life care is a central issue in nursing homes, requiring the assessment of individual and family needs by health professionals. Although previous instruments have been developed, they usually rely on family reports and have been adapted from other clinical contexts (hospital or primary care). It is important to consider how health care professionals working in nursing homes perceive what is necessary to achieve quality end-of-life care. In this study, the objective was to develop an instrument to assess quality of end-of-life care in the context of Spanish care homes. A 24 item scale Nursing Home End of Life Care Scale (NHEOLC) was developed through a systematic evaluation of existing tools combined with an iterative process of consultation with group experts in end of life care in long term care settings. A total of 307 health care professionals agreed to participate in the study and completed the scale. The scale was grouped in six dimensions: physical, psychological aspects and spiritual aspects of care, family care, bereavement, and patient/family preferences management. The results suggest an adequate factorial structure of the scale and good internal consistency for the total score and the subscales. In addition, the results showed significant differences depending on the size of the nursing home, the category of health professionals, and their own perceptions of his work regarding end-of-life care. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Translating psychosocial insight into ethical discussions supportive of families in end-of-life decision-making.

    Science.gov (United States)

    Foster, Larry W; McLellan, Linda J

    2002-01-01

    A large number of Americans would rather rely on family and friends more than their physicians about end-of-life care and decisions. Moving beyond traditional clinical ethics and its dyadic focus on the physician-patient relationship, this article presents an approach to ethical decision-making at the end of life that is more inclusive of the patient's family and has the potential to advance social work practice in end-of-life care. Initial attention is given to how psychosocial and bioethical perspectives and practices interact to shape understanding of moral issues in end-of-life decisions. Morally relevant principles are then adapted from contextual therapy as being useful for including more of a family focus and viewing ethical decision-making at the end of life as a family process. Specifically, focus is on exploring the ethical dynamics of family systems that impact the decision-making process and translating psychosocial insight into ethical discussions that are supportive of families. The case of a patient with sudden and unexpected brain death and without advance directives demonstrates one family's unresolved grief and illustrates how its members were helped to reason morally about end-of-life choices. Contributions of a social worker and bioethicist are illustrated.

  15. Community nurses' experiences of ethical problems in end-of-life care in the patient's own home.

    Science.gov (United States)

    Karlsson, Margareta; Karlsson, Christina; Barbosa da Silva, António; Berggren, Ingela; Söderlund, Maud

    2013-12-01

    To gain a deeper understanding of community nurses' experiences of ethical problems in end-of-life care in the patient's own home. Ten female nurses from five different communities with experience of end-of-life care were interviewed. A hermeneutic approach inspired by Gadamer was used to analyse the qualitative data from the interviews. In the first step of interpretation, two themes emerged: Uncomfortable feelings and Lack of cooperation and in the second step, one theme Lack of security emerged. Finally, the overall interpretation revealed the theme Feelings of loss of control in end-of-life care in the patient's own home. The nurses exhibited commitment and a desire to do good when caring for patients in the end-of-life phase, even if they sometimes experienced feelings of lack of control. This implies that, when confronted with care-related issues, they have the power to both act and react. This study aimed to increase understanding of ethical problems that arise in end-of-life care in the patient's own home and revealed the need to take the patients', relatives' and nurses' perspectives on health and suffering into consideration to ensure good end-of-life home care. © 2012 The Authors Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  16. Discussing End-of-Life Decisions in a Clinical Ethics Committee: An Interview Study of Norwegian Doctors' Experience.

    Science.gov (United States)

    Bahus, Marianne K; Førde, Reidun

    2016-09-01

    With disagreement, doubts, or ambiguous grounds in end-of-life decisions, doctors are advised to involve a clinical ethics committee (CEC). However, little has been published on doctors' experiences with discussing an end-of-life decision in a CEC. As part of the quality assurance of this work, we wanted to find out if clinicians have benefited from discussing end-of-life decisions in CECs and why. We will disseminate some Norwegian doctors' experiences when discussing end-of-life decisions in CECs, based on semi-structured interviews with fifteen Norwegian physicians who had brought an end-of-life decision case to a CEC. Almost half of the cases involved conflicts with the patients' relatives. In a majority of the cases, there was uncertainty about what would be the ethically preferable solution. Reasons for referring the case to the CEC were to get broader illumination of the case, to get perspective from people outside the team, to get advice, or to get moral backing on a decision already made. A great majority of the clinicians reported an overall positive experience with the CECs' discussions. In cases where there was conflict, the clinicians reported less satisfaction with the CECs' discussions. The study shows that most doctors who have used a CEC in an end-of-life decision find it useful to have ethical and/or legal aspects illuminated, and to have the dilemma scrutinized from a new perspective. A systematic discussion seems to be significant to the clinicians.

  17. Common or multiple futures for end of life care around the world? Ideas from the 'waiting room of history'.

    Science.gov (United States)

    Zaman, Shahaduz; Inbadas, Hamilton; Whitelaw, Alexander; Clark, David

    2017-01-01

    Around the world there is growing interest in the manner in which care is delivered to people at the end of life. However, there is little unanimity on what constitutes a 'good death' and the appropriate societal responses to the issue of delivering culturally relevant and sustainable forms of end of life care in different settings are not subjects of broad agreement. In this critical conceptual paper we focus on the emerging narratives of global palliative care and offer an assessment of their implications. We relate this to calls to improve end of life care across jurisdictions and settings, attempts to map and grade the development of palliative care provision, and to the emergence of a widely recognised global 'quality of death index'. We consider an alternative approach to framing this debate, drawn from a subaltern and post-colonial studies perspective and suggest that adopting a truly global perspective will require acceptance of the plurality of past and present local problems and issues relating to end of life care, as well as the plural possibilities of how they might be overcome. In that context, we would not aim to universalise or privilege one particular global future for end of life care. Instead of homogenising end of life interventions, we seek to be open to multiple futures for the care of the dying. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Manifold dynamics in the Earth-Moon system via isomorphic mapping with application to spacecraft end-of-life strategies

    Science.gov (United States)

    Pontani, Mauro; Giancotti, Marco; Teofilatto, Paolo

    2014-12-01

    application of manifold dynamics to defining suitable, convenient end-of-life strategies for spacecraft orbiting the Earth. Seven distinct options are identified, and lead to placing the spacecraft into the final disposal orbit, which is either (a) a lunar capture orbit, (b) a lunar impact trajectory, (c) a stable lunar periodic orbit, or (d) an outer orbit, never approaching the Earth or the Moon. Two remarkable properties that relate the velocity variations with the spacecraft energy are employed for the purpose of identifying the optimal locations, magnitudes, and directions of the velocity impulses needed to perform the seven transfer trajectories. The overall performance of each end-of-life strategy is evaluated in terms of time of flight and propellant budget.

  19. Blended e-learning and end of life care in nursing homes: a small-scale mixed-methods case study

    National Research Council Canada - National Science Library

    Farrington, Conor Jt

    2014-01-01

    .... staff with relatively infrequent contact with end of life care) has been delivered across several English counties with the aim of improving end of life care in nursing and residential care homes...

  20. End-of-Life Dreams and Visions: A Qualitative Perspective From Hospice Patients.

    Science.gov (United States)

    Nosek, Cheryl L; Kerr, Christopher W; Woodworth, Julie; Wright, Scott T; Grant, Pei C; Kuszczak, Sarah M; Banas, Anne; Luczkiewicz, Debra L; Depner, Rachel M

    2015-05-01

    End-of-life dreams and visions (ELDVs) are well documented throughout history and across cultures with impact on the dying person and their loved ones having profound meaning. Published studies on ELDVs are primarily based on surveys or interviews with clinicians or families of dead persons. This study uniquely examined patient dreams and visions from their personal perspective. This article reports the qualitative findings from dreams and visions of 63 hospice patients. Inductive content analysis was used to examine the content and subjective significance of ELDVs. Six categories emerged: comforting presence, preparing to go, watching or engaging with the deceased, loved ones waiting, distressing experiences, and unfinished business. © The Author(s) 2014.

  1. Dementia at the End of Life and Family Partners: A Symbolic Interactionist Perspective on Communication

    Directory of Open Access Journals (Sweden)

    Christopher Johnson

    2017-07-01

    Full Text Available People with dementia are not dying; they are experiencing changes in the brain. This paper utilizes a symbolic interaction theoretical perspective to outline communicative alternatives to polypharmacy. There is a growing interest in sociological interventions to untangle the “disordered discourses” associated with dementia. Such practices challenge common stigmas attached to dementia as an “ongoing funeral” or “death certificate.” Changing the expectations, attitudes and communication patterns of family care partners can positively impact them and the person living with dementia at the end of life. This paper delineates multiple non-verbal communication interventions (e.g., the trip back in time, dementia citizenship and sensory engagement modalities to explore techniques to engage persons with advanced dementia.

  2. Physical and chemical characterization of representative samples of recycled rubber from end-of-life tires.

    Science.gov (United States)

    Re Depaolini, Andrea; Bianchi, Giancarlo; Fornai, Daniele; Cardelli, Angela; Badalassi, Marco; Cardelli, Camillo; Davoli, Enrico

    2017-10-01

    A large number of end-of-life tires (ELTs) were sampled and classified by type, age and origin to obtain recycled rubber samples representative of the materials placed on the Italian market. The selected recycled tire rubber samples were physically and chemically characterized and a chemometric approach was used to determine correlations. The polycyclic aromatic hydrocarbons (PAHs) content was correlated to the aromaticity index and a model was built to establish the H-Bay aromaticity index (H-Bay) from the PAH concentrations. ELT of different origin and age produced in non-European countries generally had higher PAH content and a higher H-Bay index. H-Bay values of all the samples were lower than the REACH limits and old tires had higher aromatic content than recent ones, possibly due to the replacement of aromatic oils in tire production. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Unravelling the Tensions Between Chronic Disease Management and End-of-Life Planning.

    Science.gov (United States)

    Thorne, Sally; Roberts, Della; Sawatzky, Richard

    2016-01-01

    An increasing appreciation for the burden that chronic conditions represent for people and for societies has triggered an evolving body of popular and professional conceptualizations of the nature of the chronic disease challenge. In this discussion article, we trace the trajectory of thinking about chronic illness care, surfacing underlying assumptions and drivers that have shaped current dominant models of service delivery. We note significant gaps in these conceptualizations, especially with respect to the reality that many chronic conditions are life limiting. Contrasting chronic disease theorizing with the conversations that have arisen around end-of-life care for other kinds of health conditions, we argue for a shift in our thinking to accommodate the implications of life limitation in our service delivery planning. We see significant leadership potential in optimizing the role nurses can play across the chronic disease trajectory by integrating the healthy optimism of self-care management with the profound compassion of a person-centered palliative approach.

  4. Telecom 2 End of Life Operations-Moving Stakes, Solutions and Reality

    Science.gov (United States)

    Varinois, Arnaud

    2013-09-01

    Since 70's, CNES has operated four families of geostationary telecommunication satellites (Symphonie, Telecom 1, TDF and Telecom 2). Telecom 2D was the final satellite of the latest family and it has been reorbited in november 2012. The four TC2 satellites have finished their service on a 8 years period (2004, 2005, 2009 and 2012) during which regulation and stakes have changed. All the satellites had to be operated out of their qualification domain and despite the fact that they were reaching their retirement, all risks had to be analysed precisely. This article aims at describing the stakes, the solutions and end of life strategies decided before, and the actual operations as they occurred.

  5. End-of-Life in Disney and Pixar Films: An opportunity for Engaging in Difficult Conversation.

    Science.gov (United States)

    Tenzek, Kelly E; Nickels, Bonnie M

    2017-01-01

    This study expanded upon previous scholarship by examining end-of-life (EOL) depictions and messages of death within Disney and Pixar animated films. We argue Disney and Pixar depictions of EOL and death can provide critical opportunities for discussing death and dying processes with children and adults alike. A content analysis of 57 movies resulted in a total of 71 character deaths. These instances of death became the discourse used for analysis. The EOL discourse was coded based on five categories (character status, depiction of death, death status, emotional reaction, and causality). After quantitative analysis, the films were qualitatively analyzed. Four themes emerged from analysis, unrealistic moments, managing EOL, intentions to kill, and transformation and spiritual connection. Discussion of results, limitations, and directions for future research are included.

  6. Challenges of Providing End-of-Life Care for Homeless Veterans.

    Science.gov (United States)

    Hutt, Evelyn; Whitfield, Emily; Min, Sung-Joon; Jones, Jacqueline; Weber, Mary; Albright, Karen; Levy, Cari; O'Toole, Thomas

    2016-05-01

    To describe challenges of caring for homeless veterans at end of life (EOL) as perceived by Veterans Affairs Medical Center (VAMC) homeless and EOL care staff. E-mail survey. Homelessness and EOL programs at VAMCs. Programs and their ratings of personal, structural, and clinical care challenges were described statistically. Homelessness and EOL program responses were compared in unadjusted analyses and using multivariable models. Of 152 VAMCs, 50 (33%) completed the survey. The VAMCs treated an average of 6.5 homeless veterans at EOL annually. Lack of appropriate housing was the most critical challenge. The EOL programs expressed somewhat more concern about lack of appropriate care site and care coordination than did homelessness programs. Personal, clinical, and structural challenges face care providers for veterans who are homeless at EOL. Deeper understanding of these challenges will require qualitative study of homeless veterans and care providers. © The Author(s) 2015.

  7. Detained and Dying: Ethical Issues Surrounding End-of-Life Care in Prison.

    Science.gov (United States)

    Stensland, Meredith; Sanders, Sara

    2016-01-01

    Prisons are increasingly being called upon to provide end-of-life (EOL) care within the restrictive correctional environment. Several relatively recent phenomena have brought medical ethics to the forefront of prison EOL care-including aging behind bars, a paradigm shift in prison culture, the increasing rate of in-prison deaths, and the corresponding prison hospice movement. This article examines prominent ethical issues that emerge for prison personnel who are tasked with providing care to terminally ill offenders by presenting three offender composite characters that exemplify dying offenders and emergent ethical issues surrounding their care. Identification and critical analysis of these ethical issues demonstrate the need for strong commitment to ethical practice and highlights specific issues for prisons to examine in their own EOL care practice.

  8. Artificial nutrition and hydration at the end of life: ethics and evidence.

    Science.gov (United States)

    Ganzini, Linda

    2006-06-01

    The case of Terri Schiavo resulted in substantial media attention about the use of artificial nutrition and hydration (ANH) especially by percutaneous endoscopic gastrostomy (PEG). In this article, I review ethical and legal principles governing decisions to choose or forgo ANH at the end of life, including issues of autonomy and decision-making capacity, similarities and differences between ANH and other medical treatments, the role of proxies when patients lack decision-making capacity, and the equivalence of withholding and withdrawing treatment. Evidence for palliative or life-sustaining benefits for ANH are reviewed in three disease processes: amyotrophic lateral sclerosis (ALS), cancer, and dementias, including Alzheimer's disease. Although more recent studies suggest a possible palliative role for ANH in ALS and terminal cancer, feeding tubes do not appear to prolong survival or increase comfort in advanced dementia of the Alzheimer's type.

  9. Care versus treatment at the end of life for profoundly disabled persons.

    Science.gov (United States)

    Spike, Jeffrey P

    2012-01-01

    Individuals who are profoundly mentally handicapped do not have the capacity to make their own decisions and also do not have a past record of decisions, from when they had capacity, to guide us in making decisions for them. They represent a difficult group, ethically, for surrogate decision making. Here I propose some guidelines, distinguishing between these patients and patients in a persistent vegetative state (PVS). As the life span of patients becomes shorter, or their level of consciousness becomes permanently impaired, the presumption for comfort care should become an imperative, and the standard of evidence to justify any invasive intervention should become higher. For members of this population, who have no more ability to refuse treatment than to consent to it, protection of the vulnerable must mean allowing a peaceful death as well as a comfortable life. Reasonable legal safeguards are also proposed to allow improved end-of-life decisions to be made for this population.

  10. District nurse consultations with vulnerable patients over wishes for end-of-life care.

    Science.gov (United States)

    Griffith, Richard

    2014-09-01

    As part of an enhanced service under NHS England's Transforming Primary Care initiative, GP practices will begin to proactively case manage patients at risk of unplanned hospital admissions. At the centre of this service is a case management register and personalised care plan that indicates the patient's wishes for future care. The initiative, and particularly the asking of questions about 'do not attempt resuscitation' orders and end-of-life care, has drawn the criticism of district nurses who are frequently asked to complete the personalised care plans with patients-many of whom they have not previously met. This article considers whether the template for personal care plans is reflective of the law on consent and, in particular, the Mental Capacity Act 2005.

  11. End-of-Life Caregiver Social Support Activation: The Roles of Hospice Clinicians and Professionals.

    Science.gov (United States)

    LaValley, Susan A

    2018-01-01

    Caregivers of those with life-limiting illness face many complicated tasks, including providing direct patient care, communicating with professionals, and managing the logistical demands of daily activities. To assist with caregiving responsibilities, caregivers require social support from social network members at all points in the illness process. This study analyzes themes from interviews with 61 caregivers of patients enrolled in hospice services to identify the types of support caregivers mobilize from new social network members for social support during the end-of-life care process. Themes indicate that caregivers receive accessible, immediate, caregiver-centered emotional support from hospice health care professionals, and situationally tailored, understandable informational support from other types of professionals. In addition, caregivers received overlapping emotional and informational support from hospice health care professionals. Findings enhance the understanding of how caregivers receive tailored emotional and informational support.

  12. End-of-Life Vehicle Dismantling and Recycling Enterprises: Developing Directions in China

    Science.gov (United States)

    Wang, Lu; Chen, Ming

    2013-08-01

    End-of-life vehicle (ELV) dismantling and recycling enterprises are the final disposer of the life-cycle process of vehicles. ELV collecting, dismantling technology, and waste disposal directly affect the recovery rate and the friendliness of vehicles toward the environment. China law stipulates that, by 2017, the recovery rate of vehicles should not be less than 95%, and the recycling rate of materials should not be less than 85%. Therefore, knowing the practical running state of such enterprises is needed. This study investigated four ELV dismantling and recycling enterprises in the Yangzi delta district in China and surveyed the ELV collecting, dismantling technology, policy implementation, and running difficulties. After the comparison with the developed countries, the relevant experiences were drawn, and effective measures were put forward to meet the aims stipulated in the law based on the current practical ELV market in China.

  13. The Liminal and the Parallax: Living and Dying at the End of Life.

    Science.gov (United States)

    MacArtney, John I; Broom, Alex; Kirby, Emma; Good, Phillip; Wootton, Julia

    2017-04-01

    Transitions to palliative care can involve a shift in philosophy from life-prolonging to life-enhancing care. People living with a life-limiting illness will often receive palliative care through specialist outpatient clinics, while also being cared for by another medical specialty. Experiences of this point of care have been described as being liminal in character, that is, somewhere between living and dying. Drawing on experiences of illness and care taken from semistructured interviews with 30 palliative care outpatients in Australia, we found that this phase was frequently understood as concurrently living and dying. We suggest that this is a "parallax experience" involving narratives of a coherent linear self that is able to understand both realities, in a way that acknowledges the benefits of being multiple. These findings have significant implications for the ways in which palliative care is understood and how the self and subjectivity might be conceptualized at the end of life.

  14. Establishing an end-of-life program in an academic acute care hospital.

    Science.gov (United States)

    Counsell, Colleen; Adorno, Gail; Guin, Peggy

    2003-01-01

    The primary goal of end-of-life (EOL) care is to relieve suffering through measures that improve comfort and address the psychological, social, and spiritual needs of the dying. This article discusses the components of a pilot project that focused on palliative EOL care at an academic acute care hospital. An interdisciplinary team of nurses, social workers, chaplains, patient care coordinators, and advanced practice nurses established a common vision for the care of patients who were "in the dying process," or were expected to die during their hospitalizations. A nurse-social worker "Care-Pair Team" completed a consistent interdisciplinary EOL care needs assessment when treatment goals became strictly palliative. Interventions were driven by a clinical pathway and a pre-printed physician's order set that continually clarified the goals of treatment. Key elements of the program included leadership support, advance directives, education, communication, family involvement, symptom management, professional collaboration, and outcomes measurement.

  15. How respect and kindness are experienced at the end of life by nursing home residents.

    Science.gov (United States)

    Thompson, Genevieve N; McClement, Susan E; Chochinov, Harvey M

    2011-09-01

    Respect and kindness are core principles of nursing practice, yet little is known about how they are experienced by nursing home (NH) residents at the end of life. The aim of this study was to examine the factors associated with being treated with respect and kindness in the last month of life as an NH resident. A retrospective survey of 208 bereaved family members was conducted in 21 NHs located in a city in central Canada. The majority of participants indicated that the resident had always been treated with respect or kindness. However, significant differences emerged, with not all family members believing that their loved one had always been treated with respect or kindness. The apparent lapses in care practices are troubling and indicate that steps must be taken to address them.

  16. Existential distress among healthcare providers caring for patients at the end of life.

    Science.gov (United States)

    Pessin, Hayley; Fenn, Natalie; Hendriksen, Ellen; DeRosa, Antonio P; Applebaum, Allison

    2015-03-01

    Existential distress is well documented among patients at end of life (EOL) and increasingly recognized among informal caregivers. However, less information is known about existential concerns among healthcare providers working with patients at EOL, and the impact that such concerns may have on professionals. Recent literature documents five key existential themes for professionals working in EOL care: (1) opportunity for introspection; (2) death anxiety and potential to compromise patient care; (3) risk factors and negative impact of existential distress; (4) positive effects such as enhanced meaning and personal growth; and (5) the importance of interventions and self-care. EOL work can be taxing, yet also highly rewarding. It is critical for healthcare providers to make time for reflection and prioritize self-care in order to effectively cope with the emotional, physical, and existential demands that EOL care precipitates.

  17. End-of-life expectations and experiences among nursing home patients and their relatives

    DEFF Research Database (Denmark)

    Fosse, Anette; Schaufel, Margrethe Aase; Ruths, Sabine

    2014-01-01

    OBJECTIVE: Synthesize research about patients' and relatives' expectations and experiences on how doctors can improve end-of-life care in nursing homes. METHODS: We systematically searched qualitative studies in English in seven databases (Medline, Embase, PsycINFO, CINAHL, Ageline, Cochrane...... Systematic Reviews and Cochrane Trials). We included 14 publications in the analysis with meta-ethnography. RESULTS: Patients and families emphasized the importance of health personnel anticipating illness trajectories and recognizing the information and palliation needed. Family members who became proxy...... decision-makers reported uncertainty and distress when guidance from health personnel was lacking. They worried about staff shortage and emphasized doctor availability. Relatives and health personnel seldom recognized patients' ability to consent, and patients' preferences were not always recognized...

  18. Managing cardiac devices near the end of life: a survey of hospice and palliative care providers.

    Science.gov (United States)

    Morrison, Laura J; Calvin, Amy O; Nora, Hope; Porter Storey, C

    2010-12-01

    Implantable cardioverter defibrillators (ICDs) and pacemakers may change the character of an individual's eventual death. The objective of this study was to explore hospice and palliative care provider attitudes and experience in managing ICDs and pacemakers for patients near the end of life. A voluntary survey was distributed to session attendees at a national conference. Doctors and nurses surveyed overwhelmingly agreed it is appropriate to disable these devices in a terminally ill patient who does not wish to be resuscitated or prolong life. However, respondents emphasized a less defined burden for pacemakers. Respondents also reported limited involvement in such cases and few institutional protocols. As more terminal patients have these devices, research and education on device management protocols/guidelines and on provider communication skills are critical.

  19. [End-of-life and palliative care: the experience of the Tuscany region, Italy].

    Science.gov (United States)

    Rodella, Stefania; Serraino, Diego; Benocci, Sara; Cislaghi, Cesare

    2007-01-01

    This paper summarizes a research of the Regional Agency for Health in Tuscany (Florence, Italy) on end-of-life and palliative care. The evolving concepts and definitions at the international level as well as some relevant experiences of research and intervention are reported. The national context is described through recent legislation and the state-of-the art of health services. The experience of Tuscany is discussed with respect to regulation, health services and significant experiences in epidemiological research, education, and cultural promotion. The population needs for palliative care are estimated on the basis of mortality rates and hospital admissions in the last year of life. Seventy-five percent of people dying in 2003 had at least one hospital admission in the 12 previous months, while 42.1 percent of deaths occurred in hospital (more than half of them in Internal Medicine or Intensive Care Units).

  20. Equality for followers of South Asian religions in end-of-life care.

    Science.gov (United States)

    Samanta, Jo

    2013-06-01

    Significant minority populations confer richness and diversity to British society. Responsive end-of-life care is a universal need that has ascended the public agenda following myriad reports of inadequate provision. Nevertheless, the potential exists for unwitting discrimination when caring for terminally ill patients on the basis of their religion or faith. Recent implementation of the Equality Act 2010, together with the government and professional initiatives, promises to positively impact upon this area of contemporary relevance and concern, although the extent to which facilitative policies can truly enhance patient care will depend upon how these are translated into care at the bedside. The contributions of health professionals will be central in meeting the challenges and seizing the opportunities for meeting the religion and faith interests of patients of South Asian descent.