Sudden Advanced Illness

Barnett, Matthew; Williams, Beverly Rosa; Tucker, Rodney

doi:10.1177/1049909114565108

Cited by 14 publications

(3 citation statements)

References 22 publications

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“…The RToP suggests that in making decisions as to whether to withdraw futile treatment, physicians face catalysts in the form of doubts surrounding their roles in the provision of EoL care, the alleviation of suffering and their patient’s right to die [ 36 , 37 ]. The moral, existential, personal and professional conflict between ICs in their Innate Ring is also made manifest in their Individual Ring as they face anxiety and doubts over their knowledge, skills and ability to provide effective and empathic care for these dying patients and their families as they meet their clinical obligations [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review

Kuek

Ngiam

Kamal

et al. 2020

Philos Ethics Humanit Med

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Background Supporting physicians in Intensive Care Units (ICU)s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review (SSR) is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for ICU physicians. Methods An SSR adopts the Systematic Evidenced Based Approach (SEBA) to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis (Split Approach) is adopted. Results Eight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed. Conclusion This SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support.

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Section: Discussionmentioning

confidence: 99%

The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review

Kuek

Ngiam

Kamal

et al. 2020

Philos Ethics Humanit Med

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“…A sudden life changing event provides no ability to prepare unlike the slow worsening of a chronic condition which is common in medical illness as shown in figure 1 . 53 , 54 There is little evidence upon which to base best practice guidelines and reviews of palliative care literature generally focus on the paucity of evidence and need for study. As stated in 2018, “Seriously ill surgical patients have substantial palliative care needs that are often unrecognized and unaddressed.” 55 However, studies which define the gaps in surgical palliative care serve as important beacons to help focus the development of evidence to help guide and optimize future practice.…”

Section: Palliative Care Challenges In Surgical Patientsmentioning

confidence: 99%

Improving quality in colon and rectal surgery through palliative care

Rivet

Sullivan

Noreika

2020

Seminars in Colon and Rectal Surgery

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Palliative care is a medical discipline that emphasizes quality of life and can be provided in parallel with recovery-directed treatments in colon and rectal surgery. Palliative care is receiving increasing attention and investigation for its potential to improve quality and outcomes for a wide spectrum of patients by benefiting symptom management, supporting complex health care decision making and facilitating care transitions. Primary palliative care refers to the application of palliative care principles by clinicians of all disciplines whereas specialty palliative care is a multidisciplinary approach and includes a clinician with advanced training and experience.

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“…Not only were these physicians educating their colleagues and the public on clinical developments surrounding the COVID-19 infections, they also provided rare insights into the human aspects of caring for the dying during this trying time (Engelhart and Smith 2020 ; Ouyang 2020b ; Schmidt 2020 ). Perhaps nowhere has the impact of death and dying on physicians been as evident as in the intensive care unit (ICU) where stress, manpower shortages, evolving care conditions and complex treatment decisions (Barnett et al 2016 ; Brooks et al 2017b ; Donnelly and Psirides 2015 ; Laurent et al 2017 ; Pattison et al 2013 ; Trankle 2014 ; Wåhlin et al 2010 )—such as limiting care for the aged, those with poor mobility, cancer and other life-limiting illnesses—have created emotional, psychological, moral and existential distress amongst physicians (Engelhart and Smith 2020 ; Ouyang 2020b ; Schmidt 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units

Chan

Chia

et al. 2021

ABR

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It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician’s concept of personhood, or “what makes you, ‘you’”, we adopt Radha Krishna’s Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support.

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Sudden Advanced Illness

Abstract: The emerging concept of SAI is important for understanding how Palliative Care can enhance care for this subset of patients.

Cited by 14 publications

References 22 publications

The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review

The impact of caring for dying patients in intensive care units on a physician’s personhood: a systematic scoping review

Improving quality in colon and rectal surgery through palliative care

Extending the Ring Theory of Personhood to the Care of Dying Patients in Intensive Care Units

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