Update in Palliative Medicine and End-of-Life Care

Abrahm, Janet L.

doi:10.1146/annurev.med.54.101601.152218

Cited by 78 publications

(8 citation statements)

References 66 publications

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“…Despite provider goals for patient‐centred care and SDM, patients with advanced serious illness are generally not well informed about the available care options or their prognosis . A host of research suggests that patients want their doctors to discuss prognosis, advance directives and end‐of‐life care; this is not happening as often as it should …”

Section: Introductionmentioning

confidence: 99%

Shared decision making and the use of a patient decision aid in advanced serious illness: provider and patient perspectives

Jones

Nowels

Kutner

et al. 2014

Health Expectations

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Objective Patients with advanced serious illness face many complex decisions. Patient decision aids (PtDAs) can help with complex decision making but are underutilized. This study assessed barriers and facilitators to the use of a PtDA designed for serious illness.Methods Providers and patients were asked about their experiences in making decisions around serious illness and their opinions towards the PtDA. Seven focus groups were digitally recorded, transcribed and analysed using a general qualitative inductive method.Results Domain 1 -clinical context within which the PtDA would be utilized including three themes: (1a) role: PtDA might compete with the physician's role; (1b) logistics: it was unclear when and how such a PtDA should be implemented; and (1c) meaning: what it will mean to the patient if the physician recommends viewing of this PtDA. Domain 2 -broader global context: (2a) death-denying culture; and (2b) physician concerns that the PtDA was biased towards palliative care.Conclusion Physicians' concerns were rooted in deeper concerns about palliative care and a death-denying culture. Patients were more open to using the PtDA than physicians, suggesting 'it's never too early'.Practice Implications PtDAs for serious illness can maximize early opportunities for goals of care conversations and shared decision making.

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Section: Introductionmentioning

confidence: 99%

Shared decision making and the use of a patient decision aid in advanced serious illness: provider and patient perspectives

Jones

Nowels

Kutner

et al. 2014

Health Expectations

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“…It offers relief of suffering even when the disease processes cannot be slowed, and it extends past the death of the patient to provide comfort and care to the bereaved family [4]. Palliative care is applicable to patients with significant disease, but whose prognosis is too unsure to consider hospice.…”

Section: Discussionmentioning

confidence: 99%

Hospice care for 86 year old male with recurrent breast cancer: a case report

Gonzalez

Marcelo

Stringer

2009

Cases J

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Terminal illness poses a tremendous challenge to patients, their families and their health care providers. It is often difficult to determine when hospice is appropriate. Timely referrals are beneficial to both patient and caregivers as a way to offer improved care and support at end of life; when multiple, complicated, co-morbid states affect care. This is especially true when a patient’s psychosocial background would otherwise make it difficult to ensure proper comfort and quality of life. In this report, we present an 86 year old man with a history of right-sided breast cancer, bipolar disorder and dementia. Patient is 20 years status-post a total mastectomy. He declined adjuvant radiation, chemotherapy, and hormone therapy, and did not pursue any further medical follow-up. Patient now presented with a rapidly enlarging, ulcerating right anterior chest wall tumor. Surgical biopsy revealed recurrent infiltrating ductal carcinoma of the breast. Patient was started on tamoxifen and palliative radiation. An oncology evaluation determined that he is not a candidate for curative treatment. Patient’s primary caregiver (wife) concurrently suffers from dementia, one son is Bipolar, and the second son is out of state. A full geriatric assessment concluded that based on the patient’s medical and socioeconomic history, he is an ideal candidate for hospice. With the family’s consent, he was enrolled in one of our local hospice organizations. Currently, he is in a skilled nursing facility with hospice.

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“…Palliative care is interdisciplinary care that provides support for the physical, emotional, psychological suffering of patients and their families with any advanced illness, regardless of age, diagnosis or life expectancy [4].…”

Section: What Is Palliative Care?mentioning

confidence: 99%