Redefining the “Planning” in Advance Care Planning: Preparing for End-of-Life Decision Making

Sudore, Rebecca L.; Fried, Terri R.

doi:10.7326/0003-4819-153-4-201008170-00008

Cited by 724 publications

(679 citation statements)

References 99 publications

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“…Both FC and DNR patients often reported being shocked or upset by the conversation, either because of the timing or the content, or simply being confronted with their own mortality. Advance Care Planning may help reduce this negative response; by normalizing the subject and raising it before an acute illness, physicians may help reduce anxiety and shock when it is raised during a deterioration 18,23 .Both FC and DNR patients emphasized the importance of honesty, clarity, and sensitivity when discussing this issue. Previous studies have highlighted the deficiencies of resuscitation conversations 7,[24][25][26] , and others have proposed techniques to improve them 11,19,25,[27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

et al. 2011

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BACKGROUND:The majority of patients who die in hospital have a "Do Not Resuscitate" (DNR) order in place at the time of their death, yet we know very little about why some patients request or agree to a DNR order, why others don't, and how they view discussions of resuscitation status. METHODS:We conducted semi-structured interviews of English-speaking medical inpatients who had clearly requested a DNR or full code (FC) order after a discussion with their admitting team, and analyzed the transcripts using a modified grounded-theory approach. RESULTS:We achieved conceptual saturation after conducting 44 interviews (27 DNR, 17 FC) over a 4-month period. Patients in the DNR group were much older than those in the FC group, but they had broadly similar admission diagnoses and comorbidities. DNR patients reported much greater familiarity with the subject and described a more positive experience than FC patients with their resuscitation discussions. Participants typically requested FC or DNR orders based on personal, relational or philosophical considerations, but these considerations manifested differently depending on the participant's preference for resuscitation. Most FC patients stated that would not want a prolonged period of life support, and they would not want resuscitation in the event of a poor quality of life. FC and DNR patients understood resuscitation and DNR orders differently. DNR patients described resuscitation in graphic, concrete terms that emphasized suffering and futility, and DNR orders in terms of comfort or natural processes. FC patients understood resuscitation in an abstract sense as something that restores life, while DNR orders were associated with substandard care or even euthanasia.CONCLUSION: Our study identified important differences and commonalities between the perspectives of DNR and FC patients. We hope that this information can be used to help physicians better understand the needs of their patients when discussing resuscitation.

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Section: Discussionmentioning

confidence: 99%

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

et al. 2011

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“…36,37 As iterative discussions between patients and their health care providers are central to advanced care planning, health information technologies that facilitate more inclusive and transparent documentation of patient-provider interactions could better prepare family members who are called to serve as surrogate decision-makers in critical or end-of-life care. [38][39][40] Stronger Family Caregiver-Health Care Professional Partnerships. Clarifying patients' desires to involve family members or friends in their care through consumer health information technology would provide greater legitimacy, convenience, and timeliness in family caregivers' health system interactions, and facilitate stronger partnerships with health care professionals.…”

Section: Capturing and Executing Patient Preferences For Familymentioning

confidence: 99%

Family Caregivers and Consumer Health Information Technology

2015

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Health information technology has been embraced as a strategy to facilitate patients' access to their health information and engagement in care. However, not all patients are able to access, or are capable of using, a computer or mobile device. Although family caregivers assist individuals with some of the most challenging and costly health needs, their role in health information technology is largely undefined and poorly understood. This perspective discusses challenges and opportunities of engaging family caregivers through the use of consumer-oriented health information technology. We compile existing evidence to make the case that involving family caregivers in health information technology as desired by patients is technically feasible and consistent with the principles of patient-centered and family-centered care. We discuss how more explicit and purposeful engagement of family caregivers in health information technology could advance clinical quality and patient safety by increasing the transparency, accuracy, and comprehensiveness of patient health information across settings of care. Finally, we describe how clarifying and executing patients' desires to involve family members or friends through health information technology would provide family caregivers greater legitimacy, convenience, and timeliness in health system interactions, and facilitate stronger partnerships between patients, family caregivers, and health care professionals.KEY WORDS: health information technology; electronic health records; family caregivers.

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“…Early engagement of the patient in conversations regarding advance care planning is critical [25]. By normalizing the language of these discussions during routine conversations with the patient, we will have an opportunity to learn the patient's preferences before often critical decisions must be made urgently.…”

Section: Suggestions For Improvementmentioning

confidence: 99%

Surgical Informed Consent Revisited: Time to Revise the Routine?

Skowron

Angelos

2016

World j. surg.

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All surgery carries risk. Both surgeon and patient enter into an agreement acknowledging a certain level of risk for a belief in benefit. The surgeon, with considerably more experience on the subject, proposes the operation. The patient, often stressed by a life-changing diagnosis, consents to proceed. Upon hearing about risks of surgery, many patients would rather ''die trying'' than do nothing [1]. Patients commonly trust that the surgeon will achieve the best possible outcome and agree to proceed with surgery.Every operation has a known possibility of complication, which cannot be completely prevented even in the best of hands. A complication can be defined as ''any undesirable, unintended, and direct result of an operation affecting the patient, which would not have occurred had the operation gone as well as could reasonably be hoped'' [2]. Despite a careful process of informed consent, surgeons can never convey the full scope of possible complications to a patient who is considering surgery.Every surgeon can recall a case when a patient agreed to a high-risk emergency operation, suffered a complication, and after only a few days in the intensive care unit, the patient or the family requested to withdraw treatment. The surgeon is then faced with a difficult situation. Should he or she acquiesce to this request to withdraw treatment? The scenario raises an important question: Was consent truly ''informed'' in such a case? Has the surgeon somehow failed, not in the technical aspects of the operation, but in the communication with the patient? In the following paragraphs, we will explore the forces which may lead to such complicated situations.

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Redefining the “Planning” in Advance Care Planning: Preparing for End-of-Life Decision Making

Cited by 724 publications

References 99 publications

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

Why Do Patients Agree to a “Do Not Resuscitate” or “Full Code” Order? Perspectives of Medical Inpatients

Family Caregivers and Consumer Health Information Technology

Surgical Informed Consent Revisited: Time to Revise the Routine?

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