Can You Go Change the Family’s Mind?

2020 ◽  
pp. 27-34
Author(s):  
Toluwalase Ajayi
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Negative Emotions ◽  
Course Of Disease ◽  
Code Status ◽  
Legal Guardians ◽  
The Common ◽  
Seriously Ill

Parents and legal guardians of seriously ill children are often faced with challenging decisions regarding code status and cardiopulmonary resuscitation. There is commonly a certain amount of discomfort and negative emotions surrounding these conversations. Unfortunately, because of this, when clinicians do initiate these conversations, it is often too late in the course of disease, and opportunities for the children and their families to have their preferred end-of-life wishes may be missed. This chapter reviews the common myths and misconceptions surrounding the code status conversation by addressing the emotions associated with it. In addition, the chapter provides a step-by-step guideline on how to approach this topic.

Full Code to Do-Not-Resuscitate: Culturally Adapted Palliative Care Consultations and Code Status Change Among Seriously Ill Hispanic Patients

2021 ◽  
pp. 104990912110423
Author(s):  
Neela K. Patel ◽  
Stacey A. Passalacqua ◽  
Kylie N. Meyer ◽  
Gabriel A. de Erausquin
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Palliative Care Service ◽  
Do Not Resuscitate ◽  
Code Status ◽  
Palliative Care Consultation ◽  
Culturally Adapted ◽  
Hispanic Patients ◽  
The Impact ◽  
Seriously Ill

Background: Palliative care and hospice services are disproportionately underutilized by ethnic minority patients. Addressing barriers to utilization of these services is critical to reducing disparities. The purpose of this study was to assess the impact of a culturally adapted palliative care consultation service for Hispanics on end-of-life decisions, specifically likelihood of changing from full code to do-not-resuscitate (DNR) status during index admission for serious illness. Methods: A cross-sectional study design was applied to data extracted from electronic health records (EHR) of patients seen by a Geriatric Palliative Care service during inpatient stays between 2018 and 2019. The majority of referrals came from critical care sites. Culturally adapted palliative care consultations using the SPIKES tool featured a Spanish-speaking team member leading discussions, involvement of multiple and key family members, and a chaplain who is a Catholic Priest. Results: The analytic sample included 351 patients who were, on average, 72 years old. 54.42% were female, 59.54% were Hispanic, and of Hispanic patients, 47.37% spoke primarily Spanish. Culturally adapted consults resulted in higher rates of conversion to DNR status in palliative cases of the target population. Both primary language and ethnicity were associated with likelihood of change from full code to DNR status, such that Spanish speakers and those of Hispanic ethnicity were more likely to switch to DNR than non-Hispanics and English-Speakers. Conclusion: This study illustrates how culturally adapted palliative care consultations can help reduce barriers and improve end-of-life decision-making, and can be applied with similar populations of seriously ill Hispanic patients.

Informed consent and the aftermath of cardiopulmonary resuscitation: Ethical considerations

2017 ◽  
Vol 26 (1) ◽  
pp. 84-95 ◽  
Author(s):  
Pamela Bjorklund ◽  
Denise M Lund
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Cardiopulmonary Resuscitation ◽  
Survival Rates ◽  
Hospital Setting ◽  
Ethical Considerations ◽  
Communicative Skills ◽  
Code Status ◽  
Seriously Ill Patients ◽  
Seriously Ill

Background: Patients often are confronted with the choice to allow cardiopulmonary resuscitation (CPR) should cardiac arrest occur. Typically, informed consent for CPR does not also include detailed discussion about survival rates, possible consequences of survival, and/or potential impacts on functionality post-CPR. Objective: A lack of communication about these issues between providers and patients/families complicates CPR decision-making and highlights the ethical imperative of practice changes that educate patients and families in those deeper and more detailed ways. Design: This review integrates disparate literature on the aftermath of CPR and the ethics implications of CPR decision-making as it relates to and is affected by informed consent and subsequent choices for code status by seriously ill patients and their surrogates/proxies within the hospital setting. Margaret Urban Walker’s moral philosophy provides a framework to view informed consent as a practice of responsibility. Ethical considerations: Given nurses’ communicative skills, ethos of care and advocacy, and expertise in therapeutic relationships, communication around DNAR decision-making might look quite different if institutional norms in education, healthcare, law, and public policy held nurses overtly responsible for informed consent in some greater measure. Findings: Analysis from this perspective shows where changes in informed consent practices are needed and where leverage might be exerted to create change in the direction of deeper and more detailed discussions about CPR survival rates and possible consequences of survival.

Choices of seriously ill patients about cardiopulmonary resuscitation: Correlates and outcomes

Resuscitation ◽  
1996 ◽  
Vol 33 (1) ◽  
pp. 87 ◽  
Author(s):  
RS Phillips ◽  
NS Wenger ◽  
J Teno ◽  
RK Oye ◽  
S Youngner ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Seriously Ill Patients ◽  
Seriously Ill

scholarly journals Decision-making styles of seriously ill male Veterans for end-of-life care: Autonomists, Altruists, Authorizers, Absolute Trusters, and Avoiders

2014 ◽  
Vol 94 (3) ◽  
pp. 334-341 ◽  
Author(s):  
Ursula K. Braun ◽  
Rebecca J. Beyth ◽  
Marvella E. Ford ◽  
Donna Espadas ◽  
Laurence B. McCullough
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Male Veterans ◽  
Decision Making Styles ◽  
Seriously Ill

scholarly journals End-Of-Life Discussions Reduce The Utilization of Life-Sustaining Treatments During The Last Three Months of Life in Cancer Patients : A Nationwide Population-Based Cohort Study

2021 ◽  
Author(s):  
Shang-Yih Chan ◽  
Yun-Ju Lai ◽  
Yu-Yen Hsin Chen ◽  
Shuo-Ju Chiang ◽  
Yi-Fan Tsai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiopulmonary Resuscitation ◽  
End Of Life ◽  
Cancer Patients ◽  
Medical Records ◽  
Population Based ◽  
Lower Likelihood ◽  
The Mean ◽  
The Impact ◽  
To Receive

Abstract Purpose Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death were limited and had inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. Methods This cohort study included adult cancer patients from 2012–2018, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Results Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects utilized life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR]: 0.82; 95% confidence interval [CI]: 0.80–0.84). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.43, 95% CI: 0.41–0.45), endotracheal intubation (AOR = 0.87, 95%CI: 0.85–0.89), and defibrillation (AOR = 0.52, 95%CI: 0.48–0.57). Conclusion EOL discussions correlated with a lower utilization of life-sustaining treatments during the last three months of life among cancer patients. Our study supports the importance of providing these discussions to cancer patients to better align care with preferences during the EOL treatment.

Fatigue

2019 ◽  
pp. 132-139
Author(s):  
Edith O’Neil-Page ◽  
Grace E. Dean ◽  
Paula R. Anderson
Keyword(s):  
End Of Life ◽  
Side Effect ◽  
Healthcare Providers ◽  
Self Care ◽  
Significant Others ◽  
Daily Activities ◽  
Course Of Disease ◽  
Cancer Related Fatigue ◽  
Care Requirements ◽  
The Impact

Individuals suffering from chronic or malignant disease may experience overwhelming and debilitating symptoms of extensive tiredness or sleepiness or an inability to meet daily self-care requirements and maintain personal interaction with significant others. However, they may be unable to verbalize the impact of fatigue on their daily activities. Fatigue is both personal and communal, affecting all aspects of life. Fatigue is often unrecognized by family and healthcare providers or is accepted as a “side effect” of disease and treatment. Cancer-related fatigue affects all aspects of life, at all ages, and may remain unacknowledged by healthcare providers. Yet with recognition and intervention, fatigue can be successfully managed throughout the course of disease, recovery, or through end of life.

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