Ethical Theories Applied to End-of-Life Medical Care

2019 ◽  
pp. 15-27
Author(s):  
H. Russell Searight
Keyword(s):  
Medical Care ◽  
End Of Life ◽  
Ethical Theories

End‐of‐life care for children with complex congenital heart disease: Parents' and medical care givers' perceptions

2020 ◽  
Author(s):  
Caterina Agosto ◽  
Francesca Benedetti ◽  
Valentina De Tommasi ◽  
Ornella Milanesi ◽  
Giovanni Stellin ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Medical Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Congenital Heart ◽  
Complex Congenital Heart Disease ◽  
Life Care ◽  
Care Givers

Aggressive Medical Care at the End of Life

JAMA ◽  
1997 ◽  
Vol 278 (12) ◽  
pp. 1025 ◽  
Author(s):  
J. Randall Curtis
Keyword(s):  
Medical Care ◽  
End Of Life

scholarly journals Medical Care at the End of Life: Diseases, Treatment Patterns, and Costs

10.3386/w6748 ◽  
1998 ◽  
Author(s):  
Alan Garber ◽  
Thomas MaCurdy ◽  
Mark McClellan
Keyword(s):  
Medical Care ◽  
End Of Life ◽  
Treatment Patterns

The pyramid of treatment levels: A tool to convey goal-based treatment options.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 147-147
Author(s):  
Heather Leeper ◽  
Andrew Kamell
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Life Care ◽  
Care Providers ◽  
Goals Of Care ◽  
Code Status ◽  
Wide Range

147 Background: 60% of Americans die in acute care hospitals and under 40% of advanced cancer patients have end-of-life care discussions with their health care providers. Didactic methods and tools to teach about symptom management, navigation of treatment decisions, code status, and end-of-life care decisions within an inpatient setting are a necessity to meet this high demand. Methods: A model of medical care systematically dividing clinical management decisions into escalating levels of medical care relative to illness severity, treatment goals, and code status was created. The model is illustrated as a pyramid with a base of symptom management as the initial level of medical care. The second level represents disease-focused medical care including antibiotics, disease-modifying drugs, and chemotherapy administration. Hospitalization with increasingly complex and invasive interventions represents the third level followed by critical illness care including ICU admission and vasopressors as the fourth level. Intubation comprises the fifth level and CPR forms the top of the pyramid. Results: This model has been used extensively at our institution in educating medical students, residents, fellows, and faculty. All groups reported it was helpful in understanding POLST forms, code status, and collaboratively developing appropriate goal-based care plans with their patients. Symptom management remaining as a non-negotiable foundation of care emphasizes its importance. This depiction of medical care may facilitate goals of care and code status discussions and is particularly helpful for determining appropriate care goals or options when considering de-escalation of medical therapies. Used implicitly or explicitly in patient and family discussions, it has facilitated decision-making and discerning the appropriateness of the overall treatment plan relative to patient goals of care. Conclusions: This model of care with its companion pyramid accommodate a wide range of clinical scenarios, is an effective, high yield didactic device for patients, families, and healthcare providers alike, and has applications as supportive tool to optimize goal-based clinical decision making in the context of serious illness.

scholarly journals End-of-life costs of medical care for advanced stage cancer patients

2015 ◽  
Vol 72 (4) ◽  
pp. 334-341 ◽  
Author(s):  
Aleksandra Kovacevic ◽  
Viktorija Dragojevic-Simic ◽  
Nemanja Rancic ◽  
Milena Jurisevic ◽  
Florian Gutzwiller ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Medical Care ◽  
End Of Life ◽  
Health Care Services ◽  
Distant Metastases ◽  
Medical Personnel ◽  
Malignant Neoplasms ◽  
Hospital Inpatient ◽  
Care Hospital ◽  
Hospital Inpatient Care

Background/Aim. Cancer, one of the leading causes of mortality in the world, imposes a substantial economic burden on each society, including Serbia. The aim of this study was to evaluate the major cancer cost drivers in Serbia. Methods. A retrospective, indepth, bottom-up analysis of two combined databases was performed in order to quantify relevant costs. End-of-life data were obtained from patients with cancer, who deceased within the first year of the established diagnose, including basic demographics, diagnosis, tumour histology, medical resource use and related costs, time and cause of death. All costs were allocated to one of the three categories of cancer health care services: primary care (included home care), hospital outpatient and hospital inpatient care. Results. Exactly 114 patients were analyzed, out of whom a high percent (48.25%) had distant metastases at the moment of establishing the diagnosis. Malignant neoplasms of respiratory and intrathoracic organs were leading causes of morbidity. The average costs per patient were significantly different according to the diagnosis, with the highest (13,114.10 EUR) and the lowest (4.00 EUR) ones observed in the breast cancer and melanoma, respectively. The greatest impact on total costs was observed concerning pharmaceuticals, with 42% of share (monoclonal antibodies amounted to 34% of all medicines and 14% of total costs), followed by oncology medical care (21%), radiation therapy and interventional radiology (11%), surgery (9%), imaging diagnostics (9%) and laboratory costs (8%). Conclusion. Cancer treatment incurs high costs, especially for end-of-life pharmaceutical expenses, ensued from medical personnel tendency to improve such patients? quality of life in spite of nearing the end of life. Reimbursement policy on monoclonal antibodies, in particular at end-stage disease, should rely on cost-effectiveness evidence as well as documented clinical efficiency.

End-of-life care for Medicare beneficiaries with ovarian cancer: Evaluation of intensity and rate of hospitalizations.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9523-9523
Author(s):  
Alexi A. Wright ◽  
Craig Earle ◽  
Nancy Lynn Keating
Keyword(s):  
Ovarian Cancer ◽  
Medical Care ◽  
End Of Life ◽  
Cancer Patients ◽  
High Intensity ◽  
Population Based ◽  
Medicare Beneficiaries ◽  
National Cohort ◽  
Ed Visits ◽  
Over Time

9523 Background: Patients with advanced cancer are receiving increasingly aggressive medical care at the end-of-life (EOL). Population-based studies have not examined the medical care that ovarian cancer patients receive near death. Methods: We identified a national cohort of 6,956 Medicare beneficiaries who were living in Surveillance, Epidemiology, and End Results (SEER) areas, were diagnosed with epithelial ovarian cancer between 1996 and 2007, and died from ovarian cancer by December 2007. Using multivariable models, we examined rates of aggressive medical care within 30 days of death over time and examined indications for hospitalizations near death. Results: Adjusted rates of intensive care unit (ICU) admissions and emergency department (ED) visits increased significantly between 1996 and 2007 (ICU: 6.4% to 16.6%, p<0.0001 and ≥2 ED visits: 19.7% to 32.1%, p<0.0001). In contrast, late (within 7 days death) or absent hospice referrals decreased (63.1% to 47.8%, p<0.001) and chemotherapy use within 30 days of death decreased slightly (8.1% vs. 7.1%; p=0.04). Although terminal hospitalizations decreased (28.0% to 19.1%, p=0.001), rates of hospitalizations near death increased over time (41.4% vs. 45.3%, p=0.01). The most common indications for hospitalization included: bowel obstructions (20.0%), infections (10.4%), fluid or electrolyte abnormalities (9.2%), and malignant effusions (8.1%). Conclusions: Despite significant increases in the use of hospice near death, utilization of ICUs, EDs, and acute inpatient care at the EOL rose significantly between 1997 and 2007 for older ovarian cancer patients. Future studies should examine whether this high-intensity health care is avoidable given evidence that high-intensity care is associated with lower patient quality-of-life near death and increased complications in bereaved caregivers.

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