Factors associated with the goal of treatment in the last week of life in old compared to very old patients: a population-based death certificate survey

Smets, Tinne; Verhofstede, Rebecca; Cohen, Joachim; Noortgate, Nele Van Den; Deliens, Luc

doi:10.1186/1471-2318-14-61

Cited by 7 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The fact that patient age did not affect physicians' likelihood of recommending aggressive treatment or hospice is inconsistent with a previous study investigating this question, although the previous study examined this in an older population, with participants between 75 and 85 years of age. 7 It is possible that given the aging population in the U.S. and perceptions of better health in the elderly, findings would have been different if the age variable included an individual of 84 years old instead of 74, for example.…”

Section: Discussionmentioning

confidence: 99%

“…Both early 1,3,4 and more recent 5,6 works in this area have sought to systematize and standardize how such clinical decisions are made, but evidence indicates that these clinical decisions are still heavily influenced by the characteristics of individual physicians and how they interpret details of a clinical situation. Physicians' recommendations have been found to vary by patient age 7 and illness trajectory. 8,9 In addition, physicians' own religious beliefs, 10e12 as well as their perceptions of the patient's quality of life 10,13 and patients' religious beliefs, 14 have been shown to impact this decision-making process.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness

Frush

Brauer

Yoon

et al. 2018

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

Context. Little is known about patient and physician factors that affect decisions to pursue more or less aggressive treatment courses for patients with advanced illness. Objectives. This study sought to determine how patient age, patient disposition, and physician religiousness affect physician recommendations in the context of advanced illness. Methods. A survey was mailed to a stratified random sample of U.S. physicians, which included three vignettes depicting advanced illness scenarios: 1) cancer, 2) heart failure, and 3) dementia with acute infection. One vignette included experimental variables to test how patient age and patient disposition affected physician recommendations. After each vignette, physicians indicated their likelihood to recommend disease-directed medical care vs. hospice care. Results. Among eligible physicians (n ¼ 1878), 62% (n ¼ 1156) responded. Patient age and stated patient disposition toward treatment did not significantly affect physician recommendations. Compared with religious physicians, physicians who reported that religious importance was ''not applicable'' were less likely to recommend chemotherapy (adjusted odds ratio [OR] 0.39, 95% CI 0.23e0.66) and more likely to recommend hospice (OR 1.90, 95% CI 1.15e3.16) for a patient with cancer. Compared with physicians who ever attended religious services, physicians who never attended were less likely to recommend left ventricular assist device placement for a patient with congestive heart failure (OR 0.57, 95% CI 0.35e0.92). In addition, Asian ethnicity was independently associated with recommending chemotherapy (OR 1.72, 95% CI 1.13e2.61) and being less likely to recommend hospice (OR 0.59, 95% CI 0.40e0.91) for the patient with cancer; and it was associated with recommending antibiotics for the patient with dementia and pneumonia (OR 1.64, 95% CI 1.08e2.50). Conclusion. This study provides preliminary evidence that patient disposition toward more and less aggressive treatment in advanced illness does not substantially factor into physician recommendations. Non-religious physicians appear less likely to recommend disease-directed medical treatment in the setting of advanced illness, although this finding was not uniform and deserves further research.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness

Frush

Brauer

Yoon

et al. 2018

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

show abstract

“…30 It is worth noting that some patients did not have any care goal at baseline, or even on the day of death, whereas establishing a goal is important for guaranteeing continuity of care, and to guide current and future care. 2,[6][7][8] Communication is a key element in ACP discussions.…”

Section: Discussionmentioning

confidence: 99%

Factors Related to Establishing a Comfort Care Goal in Nursing Home Patients with Dementia: A Cohort Study among Family and Professional Caregivers

Soest‐Poortvliet

Steen

Vet

et al. 2014

Journal of Palliative Medicine

View full text Add to dashboard Cite

Initially, over half of the patients had a care goal focused on comfort, increasing to the large majority of the patients at death. Optimizing patient-family-physician communication upon admission may support the early establishing of a comfort care goal. Patient condition and family views play a role, and physicians should be aware that religious affiliation and education may also affect the (timing of) setting a comfort care goal.

show abstract

“…The fact that the information is available 'somewhere' is not enough for caregivers, because every situation is different in terms of stage of disease, severity of the condition, support network, geographical location, etc. In this respect, studies in Australia have identified that one third of families who care for people with dementia do not use dementia services because of lack of effective directions to the accessing of services (Stirling et al, 2010;Xiao et al, 2014). Söderström et al (2016) reported how a more trustworthy relationship can be built between patients and healthcare providers (HCPs) via clear and satisfying communications.…”

Section: Introductionmentioning

confidence: 99%

The information trust formation process for informal caregivers of people with dementia: a qualitative study

Sbaffi

Hargreaves

2021

View full text Add to dashboard Cite

PurposeThis paper provides new insights on trust formation during information-seeking processes of informal caregivers of people with dementia and identifies the sources of information deemed as trustworthy by caregivers.Design/methodology/approachThe study adopts a phenomenological qualitative approach in the form of in-depth, semi-structured interviews with a sample of 20 informal caregivers.FindingsCaregivers trust sources that are perceived as authoritative and particularly value the information and advice provided by other caregivers. Trust in information can be divided into subjective and objective, but both are important precursors to the actual use of the information. The information available to caregivers is sufficient in quantity but inadequate in terms of ease of use, clarity and usefulness. Often, some key information needs remain unsatisfied due to the lack of timeliness, relevance and personalisation of the information.Practical implicationsThis paper provides recommendations for information and healthcare providers on how to improve communication and information relevance for informal caregivers of people with dementia.Originality/valueThis paper contributes to a more comprehensive perspective on caregivers’ information trust formation processes, which takes into account both the characteristics of the information and caregivers’ individual factors.

show abstract

Factors associated with the goal of treatment in the last week of life in old compared to very old patients: a population-based death certificate survey

Cited by 7 publications

References 21 publications

Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness

Physician Decision-Making in the Setting of Advanced Illness: An Examination of Patient Disposition and Physician Religiousness

Factors Related to Establishing a Comfort Care Goal in Nursing Home Patients with Dementia: A Cohort Study among Family and Professional Caregivers

The information trust formation process for informal caregivers of people with dementia: a qualitative study

Contact Info

Product

Resources

About