Early Intervention in Planning End-of-Life Care With Ambulatory Geriatric Patients&lt;subtitle&gt;Results of a Pilot Trial&lt;/subtitle&gt;

Schwartz, Carolyn E.; Wheeler, H. Brownell; Hammes, Bernard J.; Basque, Noreen; Edmunds, Jean; Reed, George W.; Ma, Yunsheng; Li, Lynn; Tabloski, Patricia A.; Yanko, Julianne

doi:10.1001/archinte.162.14.1611

Cited by 122 publications

(139 citation statements)

References 37 publications

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“…[48][49][50][51] Furthermore, discussions between patients and their substitute decisionmakers about advance care planning are associated with higher levels of agreement. [48][49][50][51] Therefore, clinicians should ask patients to invite substitute decision-makers to be involved in these discussions so that they are accurately informed about patients' values and preferences for care at the end of life. Because substitute decisionmakers may be required to make in-the-moment decisions under conditions of uncertainty, they should be involved in goals-of-care discussions so that patients can establish leeway in substitute decision-making.…”

Section: Reaching a Decisionmentioning

confidence: 99%

Just ask: discussing goals of care with patients in hospital with serious illness

You

Fowler

Heyland

2013

CMAJ

101

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CMAJ, April 1, 2014, 186(6) 425 O ur population is aging, and older patients are living longer with chronic illness. Technology-laden end-of-life care is associated with poorer quality of life, lower satisfaction with care and increased anxiety and depression for family members.1 Ad vance care planning can increase the quality of life of dying patients, improve the experience of family members and decrease health care costs. 1-3Advance care planning is a process by which patients consider options for future health care decisions and identify their wishes. These decisions and wishes can vary depending on the setting. For example, during an acute stay in hospital, the plan may pertain to the goals of care for the current stay in addition to any care that may be required after discharge. In other settings, the plan may result in an advance care directive -a verbal or written instruction de scribing what kind of care a patient would want (or not want) if he or she were no longer able to speak for him or herself, and the values that guide the patient in making important health care decisions. Advance care planning may also result in the nomination of a substitute decision-maker -someone who makes decisions for the pa tient if the patient is incapable of doing so.Patients in hospital with serious illness and their family members have identified improvements in end-of-life communication and decision-making as high-priority targets for quality improvement; 4,5 however, hospital-based health care providers infrequently engage patients and families in such conversations.6 Accordingly, the focus of our review is to provide guidance for advance care planning as it pertains to the inpatient setting (i.e., determination of goals of care for the patient in hospital). Although health care providers in the outpatient setting (e.g., family physicians, consultant physicians) play a key role in advance care planning, hospital-based providers share this responsibility. In fact, a stay in hospital presents an important opportunity for engaging in discussions about goals of care, because it signals a change in the trajectory of the patient's illness, giving in creased relevance to these conversations, and because potential substitute decision-makers (e.g., the most involved family members) are often present.To organize our review, we use a communication and decision-making framework consisting of the following components: identifying patients at high risk of dying who need to have a discussion about goals of care; information exchange (regarding prognosis, values, and the risks and expected outcomes of various treatment options); and reaching a decision through discussion and deliberation.7 By providing structured guidance, specific advice and practical tools, our aim is to increase clinicians' confidence in engaging in meaningful end-of-life communication with patients in hospital and their family members. To inform this review, we drew on a broad range of evidence, from expert opinion to randomized controlled trials and systematic...

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Section: Reaching a Decisionmentioning

confidence: 99%

Just ask: discussing goals of care with patients in hospital with serious illness

You

Fowler

Heyland

2013

CMAJ

101

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“…Successful interventions to increase advance directive completion in other patient populations have advocated direct clinician-patient communication, [25][26][27] education of health care providers, 28 and discussions with trained nursing or social work staff. 29 Similar strategies need to be applied to CF care, particularly by including discussions of advance care planning into routine medical visits.…”

Section: Sawicki Et Al 1138mentioning

confidence: 99%

Advance Care Planning in Adults with Cystic Fibrosis

Sawicki

Dill

Asher

et al. 2008

Journal of Palliative Medicine

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Background: Because many patients with cystic fibrosis (CF) continue to survive into adulthood, discussion of end-of-life care decisions between clinicians and patients becomes a crucial part of CF adult care. Advance care planning (ACP) promotes alignment of patient care at the end of life with an individual's goals, however minimal research exists on ACP in CF. Methods: We surveyed adults enrolled in the Project on Adult Care in Cystic Fibrosis (PAC-CF). We assessed experiences with ACP processes and communication and sought to identify factors associated with completion of an advance directive. Results: The mean age of respondents (n ϭ 234) was 34 years and the mean forced expiratory volume in 1 second (FEV 1 ) was 64% predicted. Seventy-four percent reported that they had spoken to someone, generally a family member, about the care they would want if they became too ill to make decisions for themselves. However, only 30% reported completing an advance directive. Although 79% reported feeling comfortable talking to their clinician about ACP, only 28% said that their CF clinicians have asked about ACP. Having specific wishes about treatment decisions (odds ratio [OR] 7.8, 95% confidence interval [CI] 1.9-32.1) and reporting that a clinician had discussed ACP (OR 4.4, 95% CI 1.5-12.6) were significantly associated with reporting the completion of an advance directive. Discussion: Though the majority of adults with CF report thinking about and communicating with family about advance care wishes, only a minority report completing an advance directive. Few adults with CF report being asked about ACP by their clinicians. Formulating specific wishes and discussing ACP with a clinician are strongly associated with completing an advance directive. Efforts to improve clinician communication with CF adults around ACP are needed to ensure that discussion of advance directives becomes an integral component of adult CF care.

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“…Claramente, argumenta Schwatz 54 , para o propósito de planejamento de cuidado o profissional de saúde deseja saber, com bastante antecedência, as preferências dos pacientes e representantes para contrato ou pacto e no que eles concordam. Além disso, ajudaria saber se, em geral, as preferências expressas por contrato ou pacto comportam a probabilidade de o paciente mudar de ideia a respeito do tratamento de suporte de vida, caso descubra que a doença em estado avançado é mais suportável que o previsto 55 .…”

Section: A Terminologia Ambígua Utilizada Na Davunclassified

Diretivas antecipadas de vontade: benefícios, obstáculos e limites

Nunes

Anjos

2014

Rev. Bioét.

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Resumo Resumen Directivas anticipadas de voluntad: beneficios, obstáculos y limitacionesEl concepto de directivas anticipadas de voluntad surgió en respuesta al avance tecnológico y al tratamiento médico agresivo, utilizándoselo en situaciones ambiguas, como ante un pronóstico negativo. El núcleo de este documento consiste en el ejercicio de la autonomía del enfermo. La Resolución 1.995/2012 del Consejo Federal de Medicina establece los criterios para que cualquier persona -mayor de edad y plenamente consciente -pueda definir, junto con su médico, los límites terapéuticos en la fase final de su vida. El documento es opcional y puede llevarse a cabo en cualquier momento de la vida y la misma manera modificada o revocada en cualquier forma y tiempo. El propósito de este artículo es discutir los beneficios, obstáculos y las limitaciones considerando la gran cantidad de investigaciones realizada sobre el tema y las experiencias positivas y negativas de otros países, con el fin de aportar a la discusión sobre su utilización de manera efectiva en Brasil. Palabras-clave: Directivas anticipadas. Autonomía personal. Bioética. AbstractThe advance directive: benefits, obstacles and limits The concept of advance directives emerged in response to the technological progress and aggressive medical treatment being employed in ambiguous situations, as in the case of a bad prognosis. The core of this document is the exercise of the patients´ autonomy. The Federal Council of Medicine´s 1.995/2012 Resolution establishes the criteria for anyone -provided that the patient is legally old enough and fully aware -to be able to choose together with his/her doctor the therapeutic limits at the end of life. The document is optional and may be completed at any time in life and, in the same way it can be modified or cancelled at any time. The purpose of this article is to consider its benefits, obstacles and limits considering the vast amount of researches carried out on this theme and the positive and negative experiences from other countries in order to contribute to the discussion about its effective use in Brazil.

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Early Intervention in Planning End-of-Life Care With Ambulatory Geriatric Patients<subtitle>Results of a Pilot Trial</subtitle>

Abstract: A facilitated discussion about end-of-life care between patients and their health care agents helps define and document the patient's wishes for both patient and agent.

Cited by 122 publications

References 37 publications

Just ask: discussing goals of care with patients in hospital with serious illness

Just ask: discussing goals of care with patients in hospital with serious illness

Advance Care Planning in Adults with Cystic Fibrosis

Diretivas antecipadas de vontade: benefícios, obstáculos e limites

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