To Intubate or Not to Intubate: Emergency Medicine Physicians' Perspective on Intubating Critically Ill, Terminal Cancer Patients

Kim, Kenneth; Chakravarthy, Bharath; Anderson, Craig A.; Liao, Solomon

doi:10.1016/j.jpainsymman.2017.07.038

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…This inconsistency is expressed by the influencing factors of the professional’s religion, [ 15 , 16 , 21 , 25 , 46 ] his personal values, [ 21 , 28 , 63 ] his concepts of suffering [ 48 ] and quality of life, [ 28 , 56 ] his feelings of discomfort in the face of death and professional failure, [ 42 , 58 ] in addition to the professional’s personality [ 46 ] and respect for the patient’s autonomy. [ 21 , 44 ] On the other hand, there is a need for appreciation of the wishes of the patients or their surrogates , [ 23 , 25 , 26 , 32 , 33 , 62 , 63 ] characterized here as valuing the patient’s culture [ 22 , 48 , 62 ] and their concept of quality of life. [ 21 , 23 , 31 , 37 , 44 , 63 ]…”

Section: Discussionmentioning

confidence: 99%

“…Recognising that everyone has something to teach, with the possibility of opening new perspectives capable of making changes, revisions, enrichments, or additions of their points of view. [ 73 ] In this deliberating environment, influencing factors of ethical doubts, [ 29 ] the family member’s opinions [ 33 ] , and the patient’s or surrogates’ degree of ability to understand the disease [ 60 ] are dealt with.…”

Section: Discussionmentioning

confidence: 99%

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The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review

Silva

Corradi-Perini

2023

IJPC

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Decisions in end-of-life care are influenced by several factors, many of which are not identified by the decision maker. These influencing factors modify important decisions in this scenario, such as in decisions to adapt to therapeutic support. This presented scoping review aims to map the factors that influence end-of-life care decisions for adult and older adult patients, by a scoping review. The review was carried out in 19 databases, with the keyword ‘clinical decision-making’ AND ‘terminal care’ OR ‘end-of-life care’ and its analogues, including publications from 2017 to 2022. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The search resulted in 3474 publications, where the presence of influencing factors in end-of-life decision-making for adults and the elderly was applied as a selection criterion. Fifty-four (54) of them were selected, which means 1.5% of all the results. Among the selected publications, 89 influencing factors were found, distributed in 54 (60.6%) factors related to the health team, 18 (20.2%) to patients, 10 (11.2%) related to family or surrogates and 7 (7.8%) factors related to the decision environment. In conclusion, we note that the decision-making in end-of-life care is complex, mainly because there is an interaction of different characters (health team, patient, family, or surrogates) with a plurality of influencing factors, associated with an environment of uncertainty and that result in a critical outcome, with a great repercussion for the end of life, making it imperative the recognition of these factors for more competent and safe decision-making.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review

Silva

Corradi-Perini

2023

IJPC

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“…ICU patients are often incapable of making decisions themselves, and a surrogate decision-maker is required to provide the necessary explanation and consent for DNAR [ 11 – 13 ]. Therefore, healthcare providers and surrogate decision-makers often have compelling reasons to decide on transition from lifesaving to end-of-life medical care without any information on the patient’s wishes; the DNAR order speeds up this transition [ 14 – 16 ]. Another reason for the difficulty in supporting ACP for patients treated in acute-care hospitals and ICUs is the involvement of multiple practitioners.…”

Section: Introductionmentioning

confidence: 99%

Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

2022

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Background In acute-care hospitals, patients treated in an ICU for surgical reasons or sudden deterioration are treated in an outpatient ward, ICU, and other multiple departments. It is unclear how healthcare providers are initiating advance care planning (ACP) for such patients and assisting them with it. The purpose of this study is to clarify healthcare providers’ perceptions of the ACP support provided to patients receiving critical care in acute-care hospitals. Methods A cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACP support, the participants’ degree of confidence in providing ACP support, the patients’ treatment preferences, and the decision-making process, and whether any discussion was conducted on change of values. Results Responses were obtained from 598 participants from 157 hospitals, 41.4% of which reportedly supported ACP provision to ICU patients. The subjects with the highest level of ACP understanding were surgeons (45.8%), and differences in understanding were observed across specialties (P < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACP support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process. Conclusions Among the participating hospitals, 40% provided ACP support to patients receiving critical care. The low number is possibly because support providers lack understanding of the content of patients’ ACP or about how to support and use ACP. Second, it is sometimes too late to start providing ACP support after ICU admission. Third, healthcare providers differ in their perception of ACP, widely considered an ambiguous concept. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients.

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“…An essential aspect of ACPs is the process by which surrogate decision-makers and healthcare providers discuss and share DNAR and ADs regarding how patients live, what they value, and what they desire among themselves [15]. However, among patients receiving critical care, the process by which healthcare providers and patients share treatment values is currently inadequate, and DNAR decisions only have been focused [10][11][12][13]. Further, in acute-care hospitals, critically ill patients are treated by healthcare providers having different specialties and the treatment is generally not con ned to the outpatient, general ward, and ICU settings.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, healthcare providers and surrogate decision-makers often decide on a transition from lifesaving to end-of-life medical care without considering the patient's wishes. The DNAR order speeds up this transition [11][12][13]. Another reason for the di culty in supporting ACPs for patients treated in acutecare hospitals and ICUs is the involvement of multiple practitioners.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Providers' Perception of Advance Care Plans for Patients with Critical Illnesses in Acute-Care Hospitals: A Cross-Sectional Study

Yamamoto¹

2021

Preprint

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BackgroundIt is unclear how healthcare providers provide advance care plans (ACPs) support to the patients treated in ICUs. The purpose of this study is to clarify healthcare providers’ perceptions of the ACPs support provided to patients receiving critical care in acute-care hospitals.MethodsA cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACPS support, the participants’ degree of confidence in providing ACPS support, the patients’ treatment preferences and the decision-making process, and whether there was any discussion on and succession of values.ResultsResponses were obtained from 598 participants from 157 hospitals. Sixty-five hospitals (41.4%) reportedly supported ACPs provision to ICU patients. The subjects with the highest level of ACPs understanding were surgeons, 27 out of 59 (45.8%), and differences in understanding were observed across specialties (p < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACPs support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process.ConclusionsAmong the participating hospitals, 40% provided ACPs support to patients receiving critical care. This is probably because support providers lack ACPs knowledge and it is sometimes too late to start providing ACPs support after ICU admission. In addition, the perception of ACPs, widely considered an ambiguous concept, differs among healthcare providers. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients’ family members and healthcare providers.

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To Intubate or Not to Intubate: Emergency Medicine Physicians' Perspective on Intubating Critically Ill, Terminal Cancer Patients

Cited by 8 publications

References 26 publications

The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review

The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review

Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

Healthcare Providers' Perception of Advance Care Plans for Patients with Critical Illnesses in Acute-Care Hospitals: A Cross-Sectional Study

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