Final Thoughts (DRAFT)

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Palliative Care ◽  
Moral Distress ◽  
Ethical Dilemmas ◽  
Economic Resources ◽  
Emotional Challenges ◽  
Seriously Ill Patients ◽  
External Forces ◽  
The Right ◽  
Developed World ◽  
Seriously Ill

It is not enough to know how to respond to ethical dilemmas in palliative care. Sufficient resources are required to implement the nuanced approach to ethical dilemmas presented in this textbook. In the developed world, there exists a profound shortage of palliative care clinicians, as well as regulatory barriers which may impede the provision of optimal palliative care. The situation is far more serious in the developing world, where access to symptomatic medications may be severely restricted due to lack of economic resources or bureaucratic barriers. Even when a qualified team is available and necessary tools are at hand, the emotional challenges inherent in caring for seriously ill patients may negatively impact team dynamics. This is particularly true in situations where members of the team believe they know what the “right” thing to do is, but external forces prevent them from doing it, thus causing moral distress.

Ethics in Palliative Care

2018 ◽  
Author(s):  
Robert C. Macauley
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Moral Distress ◽  
Clinical Medicine ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Age Groups ◽  
Life Threatening Illness ◽  
Unique Nature ◽  
The Right

No specialty faces more diverse and challenging ethical dilemmas than palliative medicine. What is the best way to plan ahead for the end of life? How should physicians respond when patients refuse treatments likely to be beneficial or demand treatments not likely to be? Who makes medical decisions for patients who are too ill to decide for themselves? Do patients have the “right to die” (and, if so, what exactly does that mean)? Other ethics texts have explored these issues but often from an academic perspective that overlooks the practical realities of clinical medicine. Conversely, medical textbooks frequently lack sufficient philosophical depth to fully explore the complexities of these issues. This complete guide to the ethics of palliative care combines clinical experience with philosophical rigor to provide a comprehensive analysis of this fascinating field. Using relevant case studies, core subjects such as intensive symptom management at the end of life, physician-assisted dying, and palliative sedation are examined from historical, legal, clinical, and ethical perspectives. Whereas pediatric issues are often an afterthought in palliative care textbooks, this guide explores the unique nature of ethical dilemmas in the prenatal, neonatal, and adolescent age groups. Other important topics such as neuro-palliative care, organ donation, research, and moral distress are also covered in detail. Written with clinical nuance for medical professionals—and clear language as well as a glossary for lay readers—this guide offers all readers an opportunity to explore and understand the fascinating ethical issues facing patients suffering from life-threatening illness.

Weekly Rounding With the MICU Team: Description of a Clinical Ethics Project

2018 ◽  
Vol 36 (4) ◽  
pp. 290-293 ◽  
Author(s):  
Elizabeth K. Vig
Keyword(s):  
Palliative Care ◽  
Moral Distress ◽  
Patient Goals ◽  
Project Description ◽  
Life Sustaining Treatment ◽  
Medical Intensive Care ◽  
Seriously Ill Patients ◽  
Attending Physicians ◽  
Seriously Ill

Context: Patients in medical intensive care units (MICUs) are medically complex. This complexity can lead to uncertainty about patient goals and prognosis. Ethical dilemmas arise when there is uncertainty about the clinically and ethically appropriate actions for managing seriously ill patients. Ethics and palliative care involvement may promote improved quality of care and reduced staff moral distress. Project Description: In this clinical project, a physician with ethics, palliative care, and geriatrics expertise attended morning rounds with the MICU team weekly. Data on the logistics and impact from the first 2 years of the project were collected. Project Logistics and Preliminary Impact: Rounds lasted approximately 1.75 hours per week. The rounder was present for discussion of approximately 200 patients per year and made comments on nearly half of the patients. The comments were categorized as 25% ethics, 40% palliative care, 10% geriatrics, and 25% a combination or other topic. Attending physicians rated the project as helpful. The number of ethics and palliative care consults from the MICU increased in the first 2 years. Downstream impact has included a dietician reviewing Physician Orders for Life Sustaining Treatment forms with teams throughout the hospital and routine review of advance directives of newly admitted patients. Discussion: Weekly MICU rounding provides an opportunity to briefly teach staff and trainees about relevant ethics, palliative care, and geriatrics issues. It also provides a forum for discussion of ethically challenging cases. Considerations when starting a similar program are discussed.

Principles of care for seriously ill patients in palliative office

2020 ◽  
pp. 15-18
Author(s):  
Nina Tishchenko
Keyword(s):  
Palliative Care ◽  
The State ◽  
State Budget ◽  
Oncological Patients ◽  
Seriously Ill Patients ◽  
Seriously Ill

The article reflects the importance and importance of the work of nurses of the Department of Palliative Care for Oncological Patients of the State Budget Health Establishment «Samara Regional Clinical Oncological Clinic». Important stages and features of care when dealing with seriously ill patients.

scholarly journals Priming the System for Primary Palliative Care: More, Better, and Earlier Conversations with Seriously Ill Patients (P10)

2017 ◽  
Vol 53 (2) ◽  
pp. 308-309 ◽  
Author(s):  
Justin Sanders ◽  
Joshua Lakin ◽  
Rachelle Bernacki ◽  
Catherine Arnold ◽  
Joanna Paladino
Keyword(s):  
Palliative Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

Earlier identification of seriously ill patients: an implementation case series

2019 ◽  
Vol 10 (4) ◽  
pp. e31-e31 ◽  
Author(s):  
Joshua R Lakin ◽  
Meghna Desai ◽  
Kyle Engelman ◽  
Nina O'Connor ◽  
Winifred G Teuteberg ◽  
...  
Keyword(s):  
Palliative Care ◽  
Patient Selection ◽  
Case Series ◽  
Healthcare Systems ◽  
Ongoing Research ◽  
Starting Point ◽  
Seriously Ill Patients ◽  
Analytical Approaches ◽  
Seriously Ill ◽  
Over Time

ObjectiveTo describe the strategies used by a collection of healthcare systems to apply different methods of identifying seriously ill patients for a targeted palliative care intervention to improve communication around goals and values.MethodsWe present an implementation case series describing the experiences, challenges and best practices in applying patient selection strategies across multiple healthcare systems implementing the Serious Illness Care Program (SICP).ResultsFive sites across the USA and England described their individual experiences implementing patient selection as part of the SICP. They employed a combination of clinician screens (such as the ‘Surprise Question’), disease-specific criteria, existing registries or algorithms as a starting point. Notably, each describes adaptation and evolution of their patient selection methodology over time, with several sites moving towards using more advanced machine learning–based analytical approaches.ConclusionsInvolving clinical and programme staff to choose a simple initial method for patient identification is the ideal starting place for selecting patients for palliative care interventions. However, improving and refining methods over time is important and we need ongoing research into better patient selection methodologies that move beyond mortality prediction and instead focus on identifying seriously ill patients—those with poor quality of life, worsening functional status and medical care that is negatively impacting their families.

Perception of Benefits and Harms of Medical Cannabis among Seriously Ill Patients in an Outpatient Palliative Care Practice

2020 ◽  
Vol 23 (4) ◽  
pp. 558-562 ◽  
Author(s):  
Ali John Zarrabi ◽  
Justine W. Welsh ◽  
Roman Sniecinski ◽  
Kimberly Curseen ◽  
Theresa Gillespie ◽  
...  
Keyword(s):  
Palliative Care ◽  
Care Practice ◽  
Medical Cannabis ◽  
Seriously Ill Patients ◽  
Seriously Ill

Providing Palliative Care to Seriously Ill Patients With Nonhealing Wounds

2010 ◽  
Vol 37 (3) ◽  
pp. 277-282 ◽  
Author(s):  
MariJo Letizia ◽  
Jonathan Uebelhor ◽  
Elizabeth Paddack
Keyword(s):  
Palliative Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

“There were more decisions and more options than just yes or no”: Evaluating a decision aid for advanced cancer patients and their family caregivers

2016 ◽  
Vol 15 (1) ◽  
pp. 44-56 ◽  
Author(s):  
Marie Bakitas ◽  
J. Nicholas Dionne-Odom ◽  
Lisa Jackson ◽  
Jennifer Frost ◽  
Margaret F. Bishop ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Advance Care Planning ◽  
Decision Aid ◽  
Care Planning ◽  
Serious Illness ◽  
Early Palliative Care ◽  
Advance Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

AbstractObjective:Few decision aids are available for patients with a serious illness who face many treatment and end-of-life decisions. We evaluated the Looking Ahead: Choices for Medical Care When You're Seriously Ill® patient decision aid (PtDA), one component of an early palliative care clinical trial.Method:Our participants included individuals with advanced cancer and their caregivers who had participated in the ENABLE (Educate, Nurture, Advise, Before Life Ends) early palliative care telehealth randomized controlled trial (RCT) conducted in a National Cancer Institute-designated cancer center, a U.S. Department of Veterans Affairs medical center, and affiliated outreach clinics in rural New England. ENABLE included six weekly patient and three weekly family caregiver structured sessions. Participants watched the Looking Ahead PtDA prior to session 3, which covered content on decision making and advance care planning. Nurse coaches employed semistructured interviews to obtain feedback from consecutive patient and caregiver participants approximately one week after viewing the Looking Ahead PtDA program (booklet and DVD).Results:Between April 1, 2011, and October 31, 2012, 57 patients (mean age = 64), 42% of whom had lung and 23% gastrointestinal cancer, and 20 caregivers (mean age = 59), 80% of whom were spouses, completed the PtDA evaluation. Participants reported a high degree of satisfaction with the PtDA format, as well as with its length and clarity. They found the format of using patient interviews “validating.” The key themes were: (1) “the earlier the better” to view the PtDA; (2) feeling empowered, aware of different options, and an urgency to participate in advance care planning.Significance of results:The Looking Ahead PtDA was well received and helped patients with a serious illness realize the importance of prospective decision making in guiding their treatment pathways. We found that this PtDA can help seriously ill patients prior to the end of life to understand and discuss future healthcare decision making. However, systems to routinely provide PtDAs to seriously ill patients are yet not well developed.

Potential Perils to the Promise of Specialty Palliative Care

2016 ◽  
Author(s):  
Robert M. Arnold
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Health Care System ◽  
Specialist Palliative Care ◽  
The Past ◽  
Seriously Ill Patients ◽  
Seriously Ill ◽  
Generalist Palliative Care ◽  
Care System

Despite the growth of specialty palliative care over the past twenty years, the experience of most seriously ill patients in America has not changed. Although some have argued that the solution to this problem is to increase specialist palliative care (SPC), the author argues that this is a mistake. The growth of SPC may distract attention from solutions that are more likely to improve care for most seriously ill patients. SPC may decrease the quality and quantity of palliative care provided by nonspecialists by allowing the health care system to continue to deny death and “ghetto-izing” and deskilling generalist palliative care. This chapter presents these two arguments and tries to determine what changes are required to ensure that all seriously ill patients receive good palliative care, regardless of who provides the care.

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