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.

Improving code status documentation as a marker of advanced care planning at an outpatient academic cancer center: A pilot project.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 38-38 ◽  
Author(s):  
Anjana Ranganathan ◽  
James J. Sauerbaum ◽  
Katie Green ◽  
Heather Sheaffer ◽  
Mary Coniglio ◽  
...  
Keyword(s):  
Pilot Study ◽  
End Of Life ◽  
End Of Life Care ◽  
Pilot Project ◽  
Cancer Center ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Code Status ◽  
Group A

38 Background: Advanced care planning can significantly impact the quality of end of life care. Readily accessible documentation of goals of care for patients (pts) known to have a high morbidity and mortality provides a concrete means for practitioners to discuss and guide advanced care planning. We previously reported a surprisingly small proportion of established pts in our oncology clinic with a documented code status (CS), and undertook a pilot project aimed at improving this rate. Methods: Query of the outpatient electronic medical record (EMR) at the Abramson Cancer Center for established pts revealed an average of 2% with a documented CS. Our pilot study focused on 8 providers in thoracic and gastrointestinal oncology. We established provider agreement on the importance of CS documentation, and analyzed the mechanisms in place for documentation. We educated providers on the method of documentation, raised visibility and importance of advanced directives, implemented a system of normalizing conversations for all new pts, reported weekly to providers on upcoming established pts without documentation and provided monthly report cards, indicating provider rates within the pilot group. Results: Prior to intervention, a median of 499-established pts per month were seen by our pilot group. A median of 50 pts (10%) had a documented CS with documentation rates by provider ranging from 0 – 91%. 5 of 8 providers had no established pts with a documented CS. After intervention, a median of 494-established pts per month were seen by the same group. A median of 197 pts (40%) (p < 0.05) had a documented CS with provider rates ranging from 26 – 94%. All providers had documented a CS on at least some of their established pts; improvements ranged from an increase of 0 to 26%, to an increase of 1 to 43%. Conclusions: Previously, at our institution, only a small minority of established patients with an oncologic diagnosis had documentation of CS in the readily available EMR. Our pilot study resulted in a statistically significant increase in the documentation rates for all providers over a 2-month period. We have yet to analyze the clinical significance of this, with attention to quality and cost of end of life care.

Prescribing in end-of-life care

2019 ◽  
Vol 1 (6) ◽  
pp. 284-288
Author(s):  
Amanda Armstrong
Keyword(s):  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Limiting Condition

End-of-life care aims to support a person in the last stages of a life-limiting condition to live as well as possible until they die. Prescribing at the end-of-life presents many challenges. Advanced care planning can be carried out so that health professionals are aware and supportive of the patient's and their family's wishes. This article discusses the care and management of patients as they receive care at the end of their life as well as any anticipatory medication that may be needed.

scholarly journals Determining the Impact of COVID-19 on End-of-Life Experiences of Family Caregivers for People Living With Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 321-321
Author(s):  
Sameer Mithani ◽  
Gwen McGhan ◽  
Deirdre McCaughey ◽  
Kristin Flemons
Keyword(s):  
Public Health ◽  
Focus Group ◽  
End Of Life ◽  
Family Caregivers ◽  
End Of Life Care ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
The Impact

Abstract COVID-19 has impacted all of our lives, but the population most at risk are older adults. Family caregivers (FCGs) for people living with dementia (PLWD) face challenges in providing care, which are compounded with the introduction of COVID-19 public health policies. The purpose of this study was to examine the experiences of FCGs where the PLWD died during the COVID-19 pandemic. FCGs were invited to participate in an online survey to examine their caregiving experiences during the COVID-19 pandemic, with the option of participating in a follow-up focus group. Sixteen FCGs whose family members with dementia died during the pandemic participated in the survey. A follow-up focus group was conducted to further examine how COVID-19 policies impacted their role as a caregiver in long-term care (LTC) and affected their ability to grieve. The results of the survey and focus group suggest that a lack of role clarity and inadequate communication channels between the FCG and LTC due to COVID-19 increased the strain FCGs faced during end-of-life care. At the end of life, public policies, such as reduced or no visitation, led to feelings of inadequacy and regret. Several participants also expressed appreciation for completing Advanced Care Planning documentation prior to COVID-19. Based on these results, policymakers can help ease the increased turmoil faced by FCGs during end-of-life care in future public health emergencies by involving FCGs of PLWD in the decision-making process. The completion of Advanced Care Planning documentation can also ease the burden FCGs may experience during end-of-life care.

Ethical and moral dilemmas including do not attempt resuscitation orders, advanced care planning, and end-of-life care

2020 ◽  
pp. 283-296
Author(s):  
Rowan H. Harwood
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Moral Dilemmas ◽  
Mental Capacity ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Life Care ◽  
Resuscitation Orders ◽  
Course Of Action

‘Ethical and moral dilemmas including do not attempt resuscitation orders, advanced care planning, and end-of-life care’ examines the difficulties of decision-making in stroke medicine, the definitions of ‘ethics’, laws’, ‘profession’, and ‘culture’; ethical systems (consequentialism, rights and duties, virtues, communication and relationships; practical ethics), principlism (autonomy, beneficence, non-maleficence, and justice), communication, and relationship-based ethics; consent, mental capacity, best interests, quantified decision-making, cardiopulmonary resuscitation, difficulties in feeding decisions, end-of-life care; proxy and substitute decision-making, advance care planning, and shared decision-making. Stroke care raises situations where the best course of action is not clear. Ethical theory helps to understand these dilemmas, but applying them in practice needs knowledge (about stroke and about people), time, skills in communication, teamwork, and managing situations, compassion and sensitivity, and broad-mindedness. This only comes from experience, professionalism, and the support of teams and colleagues. Practitioners must be adept at thinking about benefits, burdens, autonomy, mental capacity, developing communication skills, and building trusting relationships, should respect fundamental rights, and show virtues of honesty, compassion, and courage.

Sign in / Sign up

Export Citation Format

Share Document