scholarly journals Registration Attendants Show Poor Readiness to Handle Advanced Care Planning Discussions

2021 ◽  
Vol 2 (1) ◽  
pp. 340-348
Author(s):  
Kevin D. Webster ◽  
Sabrina Webster ◽  
Suzanne Michelle Rhodes
Keyword(s):  
Care Planning ◽  
Advanced Care Planning

The timing and the dose of advanced care planning in patients with resectable pancreatic cancer: Who makes the call?

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 397-397 ◽  
Author(s):  
Lyudmyla Demyan ◽  
Grace Wu ◽  
Dina Moumin ◽  
Gary B Deutsch ◽  
William Nealon ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Median Number ◽  
Ductal Adenocarcinoma ◽  
Care Planning ◽  
Theory Approach ◽  
Advanced Care Planning ◽  
Curative Intent ◽  
Convenience Sample ◽  
Potential Benefits ◽  
Preoperative Counseling

397 Background:The timing and the extent of Advanced Care Planning (ACP) in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing curative-intent resection are generally dictated by the surgeon performing the operation. The aim of this study is to evaluate surgeons’ insights, perceptions, and biases regarding preoperative ACP. We hypothesize that many surgeons harbor significant reservations about extensive preoperative ACP. Methods:A qualitative investigation using 1:1 interviews with 40 open-ended questions were conducted with convenience sample. Data accrual continued until theme saturation was achieved. Grounded theory approach was used for data coding and analysis. Results:A total of 10 interviews were conducted with expert pancreatic surgeons from 6 medical centers—6 males and 4 females. The median number of years in practice was 15 (IQR 13-30) and the median number of pancreatic cancer cases performed per year was 52 (IQR 39-75). During preoperative counseling all surgeons discuss the possibility of recurrence and postoperative complications but attempt to motivate patients by emphasizing hope, optimism, and fact that surgery offers the only opportunity for cure. 90% of surgeons report no formal training in ACP. All surgeons report comfort with end of life conversations when death is imminent, but most lack experience with in-depth preoperative ACP. All surgeons emphasized that ACP should be led by a physician that both knows the patient well and understands the complexity of PDAC management. All surgeons recognized potential benefits of ACP, including delivery of goal-concordant care (60%), increased prognostic awareness (40%), and better life planning (40%). 50% report discussing in-depth ACP related to perioperative complications, but not long-term oncologic outcome. 80% of surgeons report that they actively steer away from in-depth ACP during preoperative counseling. Barriers to in-depth ACP reported by surgeons include taking away hope (70%), lack of time (50%) and concern for sending “mixed messages” (50%). Further, 50% of surgeons perceived that extensive preoperative ACP is not appropriate for patients with PDAC undergoing curative-intent resection. Most surgeons (60%) believe that ACP should occur as a process throughout the disease and in-depth discussions were more appropriate during postoperative visits (30%) and/or recurrence (60%). Conclusions:Despite recognizing potential benefits, most pancreatic surgeons report actively avoiding in-depth ACP conversations prior to curative-intent surgery. Surgeons had difficulty articulating the best time for ACP and felt that ACP should occur as a continuum throughout the course of treatment, with the depth of the discussion echoing the disease progression and patients’ readiness for such conversation. Future studies could evaluate patients’ perspective on the timing and the dose of ACP.

Communication and advanced care planning in palliative and end-of-life care

2012 ◽  
Vol 60 (6) ◽  
pp. 365-369 ◽  
Author(s):  
Deborah P. Waldrop ◽  
Mary Ann Meeker
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care

scholarly journals 64 Evaluating the Acute use of Rotigotine Patch for Dopaminergic Replacement in An Inpatient Population

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
H Ibrahim ◽  
A Cavanagh ◽  
E W Richfield
Keyword(s):  
Median Survival ◽  
Gold Standard ◽  
Poor Prognosis ◽  
Recommended Dose ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Rotigotine Patch ◽  
Red Flag ◽  
Inpatient Population ◽  
Eol Care

Abstract Introduction Rotigotine, a trans-dermal dopamine agonist (DA), can be used acutely for inpatient populations and is an option in end of life (EoL) care for people with Parkinson’s disease (PD) where enteral (oral or naso-gastric) routes are no longer available or appropriate. Concerns regarding acute use of DAs in hospital include: i) difficulty achieving dopaminergic equivalence; ii) promotion of delirium; and iii) promotion of terminal agitation at EoL. Methods We retrospectively evaluated acute inpatient Rotigotine use in a UK teaching hospital. Prescriptions between January-June 2018 were identified from the pharmacy database and relevant inpatient records were analysed. The OPTIMAL calculator was used as a gold standard for dopaminergic conversion. Results 33 eligible inpatients were identified. 13 (39%) patients were prescribed the recommended dose of Rotigotine; 7 (21%) higher and 13 (39%) lower than recommended dose. Of 22 (66%) patients with delirium, 18 (82%) inappropriately received the higher dose. 12 (36%) patients developed new or worsening delirium; and 6 (18%) developed new or worsening hallucinations. 19 (58%) patients were dead at time of evaluation with median survival of 22 days (range 1-207). For patients prescribed Rotigotine for EoL (n=13), median survival was 15 days (range 1-62); for patients not prescribed Rotigotine for EoL (n=20), median survival was 81 days (range 6-207). Of 13 (39%) patients prescribed Rotigotine for EoL, 9 (69%) had evidence of terminal agitation. Conclusions Acute conversion to Rotigotine remains problematic, despite availability of validated tools. Inappropriate dosing may precipitate or worsen delirium. Acute prescription of Rotigotine appears to act as a proxy marker for poor prognosis and could be a red flag for triggering advanced care planning. Little is published regarding use of Rotigotine at EoL, this data raises concerns regarding risk of terminal agitation and is an important area for further study.

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