Time for change in culture

A Qualitative Investigation of Cross-domain Influences on Medical Decision Making and the Importance of Social Context for Understanding Barriers to Hospice Use

“…Extant research has identified multiple, interconnected categories of barriers to integrated palliative care, ranging from individual education (patients and providers) to implementation of healthcare services, to constraints stemming from health policy and regulations (Aldridge et al 2016). For example, geographic variation in access and utilization (Carlson et al 2010; Teno et al 2014), staffing constraints (Kramer, Cleary, and Mahoney 2014; McNeal et al 2013), prohibitive enrollment policies (Aldridge Carlson et al 2012), and practice culture (Teno 2012) have all been shown to influence EOL healthcare. Aldridge et al (2016) pointed to the challenges of identifying patients appropriate for palliative care referral, improving distorted perceptions of palliative care, and working with a fragmented healthcare system as critical barriers to the provision of palliative care, calling for a multipronged approach.…”

Physician Approaches to Conflict with Families Surrounding End-of-Life Decision-making in the Intensive Care Unit. A Qualitative Study

“…described contributors to lower-intensity care near the end of life: a broader definition of the "dying" patient, concern for harms of commission rather than of omission, high decision-making self-efficacy, and a view of family requests for continued aggressive treatment as part of a normal response to a loved one's critical illness rather than obdurate resistance to de-escalating care (19,20). Tailoring information delivery and the decision-making role according to the family's preference, making recommendations, allowing families time to process and come to terms with overwhelming emotions, and shouldering decision-making burden when appropriate are strategies our participants used to achieve their goals.…”

Eluding Meaninglessness: A Note to Self in Regard to Camus, Critical Care, and the Absurd

“…In other words, every laboratory test and every number is corrected, regardless of any apparent futility (there are low-intensity care units where goals of care take priority and the end of life is not based on a lab test, but is a failure to achieve the aforementioned goals of care). 3 The ICU team wades in against the inevitable, waiting for a condition of unity and order that will never appear. Therefore, in regard to Camus's view of revolt, he will find a sympathetic ear on my part.…”