scholarly journals Using behavioral economics to promote advanced directives for end of life care: a national study on message framing

2020 ◽  
Vol 8 (1) ◽  
pp. 501-525
Author(s):  
Christy Spivey ◽  
Tara L. Brown ◽  
Maureen R. Courtney
Keyword(s):  
Behavioral Economics ◽  
End Of Life ◽  
End Of Life Care ◽  
Message Framing ◽  
National Study ◽  
Life Care ◽  
Advanced Directives

scholarly journals CAREGIVER BURDEN, BENEFIT, AND PERCEPTIONS OF END-OF-LIFE CARE QUALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S668-S668
Author(s):  
Elizabeth A Luth ◽  
Teja Pristavec
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Quality Care ◽  
Care Quality ◽  
National Study ◽  
Life Care ◽  
Care Needs ◽  
Caregiving Burden ◽  
High Burden

Abstract End-of-life care quality (EOLCQ) gauges our success in providing quality care to dying individuals. EOLQC measures rely on reports from bereaved family members who provide care for dying loved ones, but analyses seldom account for how caregivers’ experiences influence their EOLCQ perceptions. Caregivers frequently experience burden, which is linked to poor health outcomes and may negatively bias EOLCQ reports. Individuals may also perceive caregiving benefits that can offset deleterious burden effects, but potentially encourage overly positive EOLCQ perceptions. This paper links National Study of Caregivers (2011) and National Health and Aging Trends Study (2011-2016) data, using regression analysis and a sample of 380 EOL caregivers to examine how caregiving burden and benefits perceptions shape and moderate EOLCQ reports. Caregiving burden is unrelated to EOLCQ in adjusted models. Benefits are associated with marginally greater odds of being informed about the dying person’s condition and reporting their personal care needs were met. Burden and benefits moderate these two measures. Despite benefits, low burden caregivers report they were informed about the dying person’s condition with 90% probability. Regardless of burden, high benefits caregivers report the same with 90% probability. Low burden and benefits caregivers report met care needs with 90% probability. High burden and benefits caregivers have 90% probability of such reports. Given these reports are used in formal hospice care evaluations by CMS, additional research should explore why caregiving burden and benefit are associated with some EOLCQ measures and why individuals reporting high burden and benefits provide more positive EOLCQ appraisals.

A National Study of End‐of‐Life Care among Older Veterans with Hearing and Vision Loss

2019 ◽  
Vol 68 (4) ◽  
pp. 817-825
Author(s):  
Joan G. Carpenter ◽  
Mary Ersek ◽  
Francis Nelson ◽  
Daniel Kinder ◽  
Melissa Wachterman ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Vision Loss ◽  
National Study ◽  
Life Care

Dialogues in Diversity: An Invited Series of Papers, Advance Directives, DNRs, and End-of-Life Care for African Americans

2006 ◽  
Vol 52 (3) ◽  
pp. 249-261 ◽  
Author(s):  
Ronald Keith Barrett
Keyword(s):  
African American ◽  
African Americans ◽  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Clinical Care ◽  
Life Care ◽  
Advanced Directives ◽  
Culturally Sensitive Care ◽  
Care Giving

The article utilizes a meta-analysis of the existing empirical research and theory on health care directives to provide some insights into the documented pattern of African Americans to use advance directives less than Whites. A number of relevant factors are highlighted and examined. In addition the article attempts to provide some insights into African American family life and traditional values regarding the care of the elderly and end-of-life care. The African American tradition of employing a family-centered decision making process during family crisis, as well as a significant cultural mistrust of institutionalized care is also explored. The article also attempts to offer some practical suggestions for clinical care givers working with African Americans to enhance culturally sensitive care giving and the utilization of advanced directives among African Americans at the end-of-life.

Factors Associated With Implementation of the POLST Paradigm: Results From a Survey of Florida Physicians

2013 ◽  
Vol 14 (4) ◽  
pp. 247-253 ◽  
Author(s):  
Juliana J. Matthews ◽  
Carly Elizabeth Souther
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Planning Process ◽  
Treatment Options ◽  
Life Care ◽  
Cross Sectional ◽  
Advanced Directives ◽  
Life Planning ◽  
Barriers And Opportunities ◽  
June July

Objectives: To investigate physicians’ awareness and attitudes regarding the Physician Orders for Life-Sustaining Treatment (POLST) concept and to identify barriers and opportunities for its expansion.Design: Cross-sectional questionnaire, using electronic survey instrument.Setting: Community.Patients: 212 physicians from three Florida medical associations and the Florida State University College of Medicine clinical faculty responded to the survey. Of those, 67.9% were familiar with the concept of POLST.Measurements and Main Results: Data were collected using a web-based survey, completed in June–July 2012, consisting of qualitative and quantitative questions. Most (95.8%) agreed or strongly agreed that it was a physician’s responsibility to discuss end-of-life care and treatment options with patients. Satisfaction with current advanced directives was highly variable. However, a consensus about potential benefits of POLST exists, including assisting the discussion of end-of-life care, decreasing unwanted treatment, and lowering costs. More than 70% of respondents reported they would be more likely to use the POLST form if provided civil and criminal immunity; however, data analysis rendered the apparent association statistically insignificant. Qualitative data were also collected in the form of respondents’ recommendations and additional comments.Conclusions: Physicians vary in their knowledge and opinions regarding the POLST paradigm. Broad opportunities may exist to improve physician knowledge and attitudes toward POLST. Dissemination of educational materials to physicians involved in the end-of-life planning process may increase physician support and use of POLST.

scholarly journals General Practitioner Residents and Patients End-of Life: Involvement and Consequences

2020 ◽  
Author(s):  
Victoire Haardt ◽  
Amélie Cambriel ◽  
Sidonie Hubert ◽  
Marc Tran ◽  
Cédric Bruel ◽  
...  
Keyword(s):  
General Practitioner ◽  
End Of Life ◽  
End Of Life Care ◽  
Private Life ◽  
Personal Life ◽  
Life Care ◽  
Advanced Directives ◽  
Dying Patients ◽  
Perception Management ◽  
Close Relatives

Abstract The ageing of the population and the increased number of chronicle diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training.Our aim was to know how they feel about this kind of work, very different from the one they are training to do.MethodWe surveyed all GP trainees of “Ile de France”. The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients’ care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days. Results:525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were unreasonable obstinacy (59.6%), patient’s (210 answers, 40%) relative’s communication (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychological follow up should be instituted for those working in “at risk” hospital settings. Conclusion:Self-perception management of dying patients by MG resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life.

Community prescribing for cancer patients at the end of life: a national study

2021 ◽  
pp. bmjspcare-2021-002952
Author(s):  
Gabrielle Emanuel ◽  
Julia Verne ◽  
Karen Forbes ◽  
Luke Hounsome ◽  
Katherine E Henson
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Best Practice ◽  
Care Home ◽  
Symptom Control ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Service Planning ◽  
National Study ◽  
Life Care

BackgroundGood end-of-life care is essential to ensure dignity and comfort in death. To our knowledge, there has not been a national population-based study in England of community prescribing of all drugs used in end-of-life care for patients with cancer.Methods57 632 people who died from malignant cancer in their own home or in a care home in 2017 in England were included in this study. National routinely collected data were used to examine community prescriptions dispensed for drugs for symptom control and anticipatory prescribing by key sociodemographic factors in the last 4 months of life.Results94% of people who died received drugs to control their symptoms and 65% received anticipatory prescribing. Prescribing increased for the symptom control drug group (53% to 75%) and the anticipatory prescribing group (4% to 52%) over the 4-month period to death.ConclusionsMost individuals who died of cancer in their own home or a care home were dispensed drugs commonly used to control symptoms at the end of life, as recommended by best-practice guidance. Lower prescribing activity was found for those who died in a care home, highlighting a potential need for improved end-of-life service planning.

A National Study of End-of-Life Care Among Older Veterans with Hearing and Vision Loss (RP508)

2020 ◽  
Vol 60 (1) ◽  
pp. 233
Author(s):  
Joan Carpenter ◽  
Mary Ersek ◽  
Francis Nelson ◽  
Daniel Kinder ◽  
Melissa Wachterman ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Vision Loss ◽  
National Study ◽  
Life Care

scholarly journals A National Study Comparing End-of-life Care for Men and Women Veterans (S721)

2013 ◽  
Vol 45 (2) ◽  
pp. 429-430
Author(s):  
Mary Ersek ◽  
Dawn Smith ◽  
Diane Richardson ◽  
Carolyn Cannuscio ◽  
Denise Moore
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Women Veterans ◽  
National Study ◽  
Life Care ◽  
Men And Women

scholarly journals Role of Nativity in End of Life Care Planning

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 959-959
Author(s):  
Kay Thwe Kyaw ◽  
Elizabeth Helzner ◽  
Carl Rosenberg ◽  
Michael Reinhardt
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Cox Proportional Hazards ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Foreign Born ◽  
Comfort Care ◽  
Advanced Directives ◽  
Weibull Models

Abstract Given the rapidly aging population, optimal end-of-life (EOL) consistent with individual wishes is a public health priority. Advanced Care Planning (ACP) involves Advanced Directives (AD) and establishing a Power of Attorney (POA). AD describe EOL Care preferences including options to limit treatment, withhold treatment, provide comfort care, and prolong treatments. Nativity can provide meaningful guidance in decision-making at the end of life. Data from this study came from the Health and Retirement Study, nationally representative longitudinal study of U.S. residents. The sample included 4,015 older adults, 65 and above years of age who died during study follow-up. Nativity was categorized as U.S born and Foreign born. ACP variables included presence of AD and POA, and EOLC preferences included provide comfort care, limit, withhold, or prolong treatment. Covariates included age, gender, race, marital status, education, and subjective health at baseline. Cox Proportional Hazards (Cox PH) and Weibull Models were used to identify associations between nativity and end of life care. Results: Compared to U.S born, Foreign born participants were less likely to have POA (HR: 0.75; 95% CI:0.64-0.89) in Cox PH and POA (HR: 0.63; 95 % CI:0.53-0.75) Weibull models in unadjusted models, limited treatment (HR: 1.58; 95 % CI: 1.2, 2.1), and prolong treatment (HR: 0.23; 95 % CI:0.06-0.99) and Cox PH and (HR: 0.20; 95 % CI: 0.05-0.83) in Weibull modes. Conclusion: There are differences in Advanced Care Planning by nativity. Country of origin should be considered when helping individuals plan for end-of-life care.

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