End-of-Life Preferences in Older US Adults—Bridging the “What Matters” Chasm

Iyer, Anand S; Brown, Cynthia J.

doi:10.1001/jamanetworkopen.2021.42279

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…The home environment, as a second skin, mitigates fears, strengthens interactions and facilitates the proximity of the patient and their family members. Being at home, or in the environment where you want to be cared for, ensures and encourages the sick person’s autonomy, a basic characteristic and one of the most significant benefits of EoL care, as it enables individuals to make decisions and thus maintain take control of their lives [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study

Prado

Marcon

Kalinke

et al. 2022

IJERPH

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This study explored the meanings and experiences of patients with terminal chronic diseases and their caregivers, who face the imminence of death in the home environment after hospital discharge. The qualitative study used constructivist grounded theory. The participants were individuals with a terminal chronic illness, discharged to home, and their family caregivers. Data were gathered from in-depth interviews and field notes, and a comparative analysis was conducted to identify categories and codes, according to Charmaz’s theory. The sample consisted of 21 participants. Three inter-related data categories emerged: “Floating between acceptance and resistance: Perceiving the proximity of death”, “Analysing the end from other perspectives: it is in the encounter with death that life is understood” and “Accepting the path: between the love of letting go and the love of wanting to stay”. The categories translate the reconstruction of those facing end-of-life occurring in the home environment. It is amid the imminence of death that life gains intensity and talking about the finitude of life configures an opportunity to see life from other perspectives. Giving voice to individuals facing the mishaps of a terminal illness fosters the path to a comfortable death. For health professionals, it is an opportunity to provide structured and humanized care with an ethical attitude, in defence of human dignity.

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Section: Discussionmentioning

confidence: 99%

Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study

Prado

Marcon

Kalinke

et al. 2022

IJERPH

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show abstract

“…Aging in place and dying at home are increasingly preferred options for people worldwide, including in the United States. 1 This trend has been evident since 2017, when dying at home surpassed dying in the hospital for the first time among Americans, 2 and it has continued to gain momentum, especially during and after COVID-19. 3 However, despite this growing preference, a significant disparity remains between the preferred and actual place of death.…”

Section: Introductionmentioning

confidence: 99%

The determinants of actual place of death among noncancer patients with end-stage chronic health conditions: a scoping review

Ginggeaw,

LeBlanc

2024

Palliat�Care

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A home is a preferred place of death by most people. Nurses play a key role in supporting end-of-life home care, yet less is known about the factors that determine home as a place of death. This scoping review describes the percentage of actual places of death and determines social factors related to home as the place of death among noncancer patients with end-stage chronic health conditions. Inclusion criteria included (1) noncancer chronic illness conditions, (2) outcomes of place of death, and (3) factors that determine home as a place of death. Sources of evidence included PubMed, CINAHL, and Web of Science databases, which were searched in May 2022, and additional searches from May 2022 to November 2023.The JBI scoping review guide (2020) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension were used. Twenty-eight studies were included in this analysis. The range of percentages is varied within the same place of death among the sample. Two major constructs that determine a home as a place of death were identified: preceding factors and social capital. The results suggest that the place of death among noncancer patients with end-stage chronic health conditions should be continued to be understood. Two constructs determined home as a place of death and are considered as a fundamental to increasing equal accessibility in the initiation of palliative care services to promote home death and meet end-of-life care goals.

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“…Traditionally, AP and warfarin were the primary agents used for patients with thromboembolic disease. However, given the pharmacologic profile of DOACs, ease of use, lack of routine monitoring, or drug/food interaction, the proportion of patients on a DOAC has increased from 0% in 2010 to as high as 92% in 2020 5 . Given this exponential rise over the last decade, limited options for reversal, and lack of data surrounding operative bleeding risk, our group recently assessed the perioperative bleeding complication risk in EGS patients presenting with a history of DOAC use compared with traditional therapy (defined as patients on warfarin or AP therapy).…”

mentioning

confidence: 99%

Warfarin, not direct oral anticoagulants or antiplatelet therapy, is associated with increased bleeding risk in emergency general surgery patients: Implications in this new era of novel anticoagulants: An EAST multicenter study

Anandalwar,

O'Meara,

Vesselinov

et al. 2024

J Trauma Acute Care Surg

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INTRODUCTION This study aimed to assess perioperative bleeding complications and in-hospital mortality in patients requiring emergency general surgery presenting with a history of antiplatelet (AP) versus direct oral anticoagulant (DOAC) versus warfarin use. METHODS A prospective observational study across 21 centers between 2019 and 2022 was conducted. Inclusion criteria were age 18 years or older, and DOAC, warfarin, or AP use within 24 hours of an emergency general surgery procedure. Outcomes included perioperative bleeding and in-hospital mortality. The study was conducted using analysis of variance, χ2, and multivariable regression models. RESULTS Of the 413 patients, 221 (53.5%) reported AP use, 152 (36.8%) DOAC use, and 40 (9.7%) warfarin use. The most common indications for surgery were obstruction (23% [AP], 45% [DOAC], and 28% [warfarin]), intestinal ischemia (13%, 17%, and 23%), and diverticulitis/peptic ulcers (7%, 7%, and 15%). Compared with DOAC use, warfarin use was associated with significantly higher perioperative bleeding complication (odds ratio [OR], 4.4 [95% confidence interval (CI), 2.0–9.9]). There was no significant difference in perioperative bleeding complication between DOAC and AP use (OR, 0.7 [95% CI, 0.4–1.1]). Compared with DOAC use, there was no significant difference in mortality between warfarin use (OR, 0.7 [95% CI, 0.2–2.5]) or AP use (OR, 0.5 [95% CI, 0.2–1.2]). After adjusting for confounders, warfarin use (OR, 6.3 [95% CI, 2.8–13.9]), medical history, and operative indication were associated with an increase in perioperative bleeding complications. However, warfarin was not independently associated with risk of mortality (OR, 1.3 [95% CI, 0.39–4.7]), whereas intraoperative vasopressor use (OR, 4.7 [95% CI, 1.7–12.8]), medical history, and postoperative bleeding (OR, 5.5 [95% CI, 2.4–12.8]) were. CONCLUSION Despite ongoing concerns about the increase in DOAC use and lack of readily available reversal agents, this study suggests that warfarin, rather than DOACs, is associated with higher perioperative bleeding complications. However, that risk does not result in an increase in mortality, suggesting that perioperative decisions should be dictated by patient disease and comorbidities rather than type of AP or anticoagulant use. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.

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End-of-Life Preferences in Older US Adults—Bridging the “What Matters” Chasm

Cited by 5 publications

References 5 publications

Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study

Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study

The determinants of actual place of death among noncancer patients with end-stage chronic health conditions: a scoping review

Warfarin, not direct oral anticoagulants or antiplatelet therapy, is associated with increased bleeding risk in emergency general surgery patients: Implications in this new era of novel anticoagulants: An EAST multicenter study

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