Nutrition support at the end of life- a systematic review of the view toward decision making among cancer patients, family and medical staffs

2020 ◽  
Vol 40 ◽  
pp. 571
Author(s):  
Y.A.A. Shih ◽  
Q. Lu ◽  
S. Jin
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
End Of Life ◽  
Cancer Patients ◽  
Nutrition Support

scholarly journals End-of-life decision making for cancer patients in an intensive care unit

2015 ◽  
Vol 3 (S1) ◽  
Author(s):  
M Tavares ◽  
I Neves ◽  
F Coelho ◽  
O Afonso ◽  
A Martins ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Decision ◽  
Life Decision

scholarly journals Relational autonomy: what does it mean and how is it used in end-of-life care? A systematic review of argument-based ethics literature

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Carlos Gómez-Vírseda ◽  
Yves de Maeseneer ◽  
Chris Gastmans
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Real Life ◽  
Care Ethics ◽  
Relational Autonomy ◽  
Life Care ◽  
Philosophical Foundations ◽  
Respect For Autonomy

Abstract Background Respect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics. Methods Using PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced. Results Fifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations. Conclusions Three main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations.

scholarly journals Changes in End-of-Life Discussion for Patients with Advanced Cancer after the Life- Sustaining Treatment Decisions-Making Act in Korea

2021 ◽  
Author(s):  
Hyeyoung Kim ◽  
Hyeon-Su Im ◽  
Kyong Og Lee ◽  
Young Joo Min ◽  
Jae-Cheol Jo ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Cancer Patients ◽  
Multivariable Analysis ◽  
Terminally Ill ◽  
Self Determination ◽  
Do Not Resuscitate ◽  
Life Sustaining Treatment ◽  
Group 2 ◽  
Group 1

Abstract Background: Cancer is a leading cause of death in Korea. To protect the autonomy and dignity of terminally ill patients, the Life-Sustaining Treatment Decision-Making Act (LST-Act) came into full effect in Korea in February 2018. However, it is unclear whether the LST-Act influences end-of-life (EOL) discussion and decision-making processes for terminally ill cancer patients. Methods: This was a retrospective study conducted with a medical record review of cancer patients who died at Ulsan University Hospital between July 2015 and May 2020. Patients were divided into two groups: those who died in the period before the implementation of the LST-Act (from July 2015 to October 2017, Group 1) and after the implementation of the LST-Act (from February 2018 to May 2020, Group 2). We measured the self-determination rate and the timing of documentation of Do-Not-Resuscitate (DNR) or Physician Orders for Life-Sustaining Treatment (POLST) in both groups. Results: A total of 1,834 patients were included in the analysis (Group 1, n=943; Group 2, n=891). Documentation of DNR or POLST was completed by patients themselves in 1.5% and 63.5% of patients in Groups 1 and 2, respectively (p<0.001). The mean number of days between documentation of POLST or DNR and death was higher in Group 2 than in Group 1 (21.2 days vs. 14.4 days, p=0.001). The rate of late discussion, defined as documentation of DNR or POLST within seven days prior to death, decreased significantly in Group 2 (46.6% vs. 41.4%, p=0.027). In the multivariable analysis, hospice palliative care referral (OR [odds ratio] 0.25, p<0.001) and patients’ years of education (OR 0.68, p=0.027) were positively related to self-determination. However, physicians with clinical experience of less than three years had a higher rate of surrogate decision-making (OR 5.1, p=0.029) and late discussion (OR 2.53, p=0.019). Conclusions: After the implementation of the LST-Act, the rate of self-determination increased and EOL discussion occurred earlier than in the era before the implementation of the LST-Act.

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