This article discusses how to best support relatives and carers at the end of a patient's life. While the focus is on the hospital setting, the principles are applicable to community and care home settings. In this article, "relative" encompasses family members, care givers, and those close to the patient. The article presumes throughout that the patient has given consent for information to be shared with relatives (Box 1). Communicate and anticipate individual needsGrief is a normal human reaction to loss, however the manner in which professionals respond to those facing bereavement can have a long term impact on how they grieve, and on their health. For example, support from specialist palliative care teams can lead to improved short and long term outcomes for the bereaved. In contrast, a poor relationship between healthcare providers and families, and poor communication, are risk factors for adverse bereavement outcomes such as complex grief, experienced by about 20% of bereaved relatives (Box 2). Sensitively discuss with relatives the deteriorating clinical condition of the patient, and whether there are any potential reversible causes. Consider with relatives whether clinical interventions such as antibiotics, nutrition and hydration, patient monitoring, blood tests, and intravenous lines are appropriate. It is good practice to discuss cardiopulmonary resuscitation, even if previously discussed with the patient so that relatives have a chance to express their views. Explain to relatives that a Do Not Attempt Cardiopulmonary Resuscitation order does not imply that no care will be given; rather all care deemed clinically appropriate will be given except cardiopulmonary resuscitation. Create an individualised multidisciplinary care plan for all patients whose deaths are expected.11 Talk this through with relatives.Relatives need to balance visiting the patient with other responsibilities, such as work and other caring responsibilities, and they are likely to have practical questions (Box 3). Ensure contact details are up to date, identify who should be contacted if there is a sudden change, and if they want to be contacted in the middle of the night, and clearly document this in the notes. Ascertain any specific religious or cultural practices that need to be observed. For example, in the Jewish faith burial traditionally takes place within 24 hours of death. A question that might be asked is: "Are there any particular arrangements or instructions that you or your relative would want followed?" 12Emotional support starts with providing clear, honest information. Careful documentation of conversations helps to ensure consistency and reduce confusion. Make time for family meetings and allow relatives space and time to ask questions. Encourage relatives to express their feelings; acknowledge their loss, and listen to their concerns. Avoid platitudes, and recognise that silence might be appropriate when sitting with a grieving relative.
A retrospective cohort study, using the electronic medical records of Kaiser Permanente Northern California (2011)(2012)(2013)(2014)(2015), included 560 robotic and 6785 conventional laparoscopic cases with 1836 "complex" patients (25%). The average operative time was 152 minutes (robotic) vs 157 minutes (conventional) laparoscopic hysterectomy. Complex surgical cases averaged 190 minutes and noncomplex cases averaged 144 minutes. For women with complex disease, the robotic approach, when used by a higher-volume surgeon, may be associated with shorter operative time and slightly less blood loss, but not with lower risk of complications.
No abstract
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.