Dying in Canada: Is It an Institutionalized, Technologically Supported Experience?

Heyland, Daren K.; Lavery, James V.; Tranmer, Joan; Shortt, Sam; Taylor, Stuart R.

doi:10.1177/082585970001601s04

Cited by 108 publications

(77 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, despite the best efforts of the multidisciplinary ICU team, the use of advanced life support technology and evidence-based practice, a significant proportion of critically ill patients will die. In Canada and the United States, up to 25% of all hospital deaths occur in critical care units such as the ICU, coronary care unit, or step-down unit (1,2).…”

mentioning

confidence: 99%

Understanding and changing attitudes toward withdrawal and withholding of life support in the intensive care unit

Cook

Rocker

Giacomini

et al. 2006

Critical Care Medicine

View full text Add to dashboard Cite

A careful examination of our attitudes toward end-of-life care is critical to our understanding of where change is needed to improve patient outcomes. The objectives of our narrative review are 1) to review why the intensive care unit setting presents particular challenges for the delivery of optimal end-of-life care, 2) to outline how four different research methods can provide insights into our understanding of attitudes about withdrawal of life support, and 3) to suggest seven different approaches to changing prevailing attitudes toward withdrawal of life support in the intensive care unit. To better understand attitudes about end-of-life care in general and withdrawal of life support in particular, we reviewed four different sources of data: 1) decision support tools, 2) qualitative research, 3) surveys, and 4) observational studies. Understanding these attitudes offers valuable insights about strategies that may help to improve the care of dying patients and their families. There are several ways to change attitudes; the approaches we reviewed are 1) promoting social change professionally, 2) legitimizing end-of-life research, 3) determining what families of dying patients need, 4) initiating quality improvement locally, 5) evaluating the benefits and harms of new initiatives, 6) modeling quality end-of-life care for future clinicians, and 7) using narratives. Attitudes toward end-of-life care are influenced by many factors and change slowly. Our attitudes have social and personal origins; they are grounded in values that are collective and community based. Different research methods provide insights into attitudes toward death in the intensive care unit and withdrawal of life support in particular. Understanding these attitudes may offer valuable insights about strategies that should help improve the care for dying patients and their families.

show abstract

mentioning

confidence: 99%

Understanding and changing attitudes toward withdrawal and withholding of life support in the intensive care unit

Cook

Rocker

Giacomini

et al. 2006

Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…Given that the majority of decedents in Canada are older patients with advanced medical disease or cancer who die in the hospital, 11,12 the primary aim of this study was to provide comprehensive descriptions of this population's views on communication and decision-making issues related to CPR choices. A priori, we postulated that patients with different illnesses might have very different perspectives on these discussions and decisions.…”

mentioning

confidence: 99%

Understanding Cardiopulmonary Resuscitation Decision Making

Heyland

Frank

Groll

et al. 2006

Chest

Self Cite

162

View full text Add to dashboard Cite

“…The focus of such units tends to be on the management of complex physical and psychosocial symptoms, with a large proportion of patients being discharged home with appropriate support and others being transferred to longer-term units or hospices for terminal care. Although approximately 70% of deaths in Canada still occur in hospitals [12], most of these patients die on acute care wards rather than on palliative care units. Inpatient palliative care consultation teams offer advice to attending teams about symptom management and psychosocial care at the end of life and assist with discharge planning for terminally ill patients.…”

Section: Palliative Care In Canadamentioning

confidence: 99%

Bringing palliative care to a Canadian cancer center: the palliative care program at Princess Margaret Hospital

Zimmermann

Seccareccia

Clarke

et al. 2006

Support Care Cancer

View full text Add to dashboard Cite

Centre was created to allow the rapid banking of metastatic tumors from end-of-life patients to enhance our understanding of tumor development. Research tissue sampling is done on consented patients as soon as possible after death, but may be delayed for 24 hours or more. The purpose of this study was to determine the effect of time between patient death and tissue processing on RNA integrity. Design: RNA integrity number (RIN) scores were determined for primary tumors, metastatic lesions and normal uninvolved tissues from patients consenting to the Tissue Procurement Program. The time between patient death and tissue processing was recorded. RIN scores were determined on snap frozen tissue using a bioanalyzer (Agilent) and reported on a scale of 1-10, with 10 indicating fully intact RNA, 5 indicating partially degraded RNA, and 3 indicating fully degraded RNA. Results: RIN scores of the primary tumor, a liver metastasis and normal kidney from a patient with lung cancer sampled 5 hours post mortem were 5.6, 7.6 and 4.8 respectively. Tumor tissues collected from a second patient with lung cancer sampled 18 hours postmortem had RIN scores of 6.6 (primary) and 6.9 (liver metastasis). Normal kidney had a reading of N/A (completely degraded). RNA quality differed between tissue sites in one patient with pancreatic cancer, with RIN scores that ranged from 8.6 (peritoneum metastasis) to N/A (hepatic lymph node metastasis). A RIN analysis has since become routine QC for all patients in our rapid autopsy program (3-5 new patients per week). Conclusions: The results of this study indicate that RNA integrity of metastatic tumors can be maintained more than 18 hours after death, whereas normal tissues may be more sensitive to RNA degradation post mortem. Results also indicate that some tissue sites within the body preserve RNA quality better than others. Analysis of RNA from metastatic lesions of patients participating in the Tissue Procurement Program may provide valuable insights into tumor evolution and resistance to treatment. Background: January 2014 was a hallmark in autopsy registry in Portugal. A national electronic online-only death certificate platform was established. This led to the creation and implementation of a national standardized protocol, which could be used internationally, for reporting the clinical autopsy. In October 2014, this protocol was integrated in the electronic platform. Design: A national core panel of pathology residents, under the supervision of the Portuguese College of Pathologists, gathered to develop a reference database for adult clinical autopsy reporting. This online platform was aimed to be a user-friendly scheme, easy to fill, structured as a conventional autopsy report and divided by organ systems; it is pre-loaded with a minimal "normal" default data and a selectable pathology field, loaded with the most common pathological findings; however it always offers a free-text option, whenever necessary or as an alternative. In the end, the data is submitted to the death certificate re...

show abstract

Dying in Canada: Is It an Institutionalized, Technologically Supported Experience?

Cited by 108 publications

References 22 publications

Understanding and changing attitudes toward withdrawal and withholding of life support in the intensive care unit

Understanding and changing attitudes toward withdrawal and withholding of life support in the intensive care unit

Understanding Cardiopulmonary Resuscitation Decision Making

Bringing palliative care to a Canadian cancer center: the palliative care program at Princess Margaret Hospital

Contact Info

Product

Resources

About