Sexuality

2015 ◽  
pp. 410-421
Author(s):  
Marianne Matzo
Keyword(s):  
Sexual Health ◽  
End Of Life ◽  
Sexual Functioning ◽  
End Of Life Care ◽  
Life Care ◽  
Leading Role ◽  
Significant Difference ◽  
The One

Healthcare practitioners should assume a leading role in the assessment and remediation of potential or identified alterations in sexual functioning. Not all couples will be concerned about their sexual health at this point of their life together. However, people may find that being physically close to the one they love is life-affirming and comforting. Assessment of sexual health should occur for all patients to determine whether these needs and hopes include maintenance of their sexual health. The healthcare practitioner’s offer of information and support can make a significant difference in a couple’s ability to adjust to the changes in sexual health during end-of-life care.

Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study

2021 ◽  
pp. 082585972110365
Author(s):  
Serdar Ceylan ◽  
Merve Guner Oytun ◽  
Arzu Okyar Bas ◽  
Zeynep Kahyaoglu ◽  
Burcu B. Dogu ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
University Hospital ◽  
Place Of Death ◽  
Public Health Issue ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
Life Care ◽  
Geriatric Population ◽  
Significant Difference

Background End-of-life care has become an important public health issue in recent years. Place of death is a major component of end-of-life care. Despite attempts to improve end-of-life care, there has not been published any data about place of deaths in Turkey. Aim: This retrospective, cross-sectional study investigates the place of death and trends over the years in geriatric age groups in Turkey. Methods: Patients who were admitted to geriatric outpatient clinic of a university hospital during a 7-year period were included. Place and date of death information were received from the death notification system and recorded as hospital or out-of-hospital death. Demographic and clinical data were collected from the hospital information system. Deaths occurring after March 1, 2020 were not included to eliminate the effect of coronavirus disease-2019 pandemic. Results: A total of 4025 (20.7%) patients were determined to be dead. Approximately three-quarters of deaths (73.0%) occurred in hospital. The number of deaths reported from nursing homes was only 13 (3.0%). Patients with dementia less frequently died in hospital, however, it was not statistically significant (12.4% vs 14.7%, P = .05). The prevalence of death in hospital was significantly higher in patients with chronic renal failure (3.1% vs 1.7%, P = .02). The presence of comorbid conditions such as heart failure, cerebrovascular disease, Parkinson's disease, chronic obstructive pulmonary disease/asthma, and cancer did not affect the place of death ( P = .24, .21, .24, .51, and .18). Out-of-hospital mortality increased with advanced age ( P < .001). No significant difference was found in the place of death over the years ( P = .41). Conclusion: To the best of our knowledge, this is the first study examining the place of death in Turkey, an aging country. Our results may help to establish policies about end-of-life care in elderly people to improve quality of life by using resources effectively.

scholarly journals Vulnerable Dignity, Dignified Vulnerability: Intertwining of Ethical Principles in End-of-Life Care

2021 ◽  
Vol 18 (2) ◽  
pp. 482
Author(s):  
José María Muñoz Terrón
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Analytical Framework ◽  
The Other ◽  
Life Care ◽  
Ethical Theories ◽  
Embodied Subjectivity ◽  
The One ◽  
Equitable Treatment ◽  
Phenomenological Conception

The aim of this article is to analyze how dignity and vulnerability, as declared principles of bioethics, both can be seen in a new light when they are thought of together, in their intertwining, in order to outline a proposal for an analytical framework for end-of-life care. It is thus shown, on the one hand, that the demand for respect for the equal dignity of every person, linked by the different anthropological and ethical theories to their autonomy as a rational agent, also refers to their fragile, vulnerable, and interdependent character, as an embodied subjectivity, sustained by a complex web of care. On the other hand, the vulnerability of these selves as others, constituted by the radical appeal of everything that affects them socially, emotionally, sensitively, and by their need for recognition and attention, would be pathological if it did not include the impulse towards autonomy, which, although precarious and connotative, requires dignified and equitable treatment. This intertwining of both principles points to a phenomenological conception of the person as a corporeal social existence, from which a number of studies on the attention to dignity and vulnerability at the end of life are analyzed.

Planning for End of Life

Pained ◽  
2020 ◽  
pp. 217-218
Author(s):  
Michael D. Stein ◽  
Sandro Galea
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
College Education ◽  
Growing Up ◽  
Life Care ◽  
Treatment Paradigm ◽  
Life Sustaining Treatment ◽  
The One ◽  
Seriously Ill Patients ◽  
Seriously Ill

This chapter discusses the planning for end-of-life care. Results of a 2017 survey show that older adults are likelier than younger people to have documented their end-of-life wishes. Yet few adults with or without written documents have discussed end-of-life care with their doctors. Age, education, and discussions about death were predictors of having such a plan. Those with a college education or higher were most likely to have a written document, compared to those with some college, high school, or less education. Also, talking about death while growing up correlated with having written documents about wishes for medical care. Care settings encouraging or mandating doctors to use an advanced directive toolkit, such as the one created by the National Physician Orders for Life-Sustaining Treatment Paradigm, can improve the communication gap with providers and help seriously ill patients better express their wishes for end-of-life care.

scholarly journals Dying like a dog: the convergence of concepts of a good death in human and veterinary medicine

2021 ◽  
Author(s):  
Felicitas Selter ◽  
Kirsten Persson ◽  
Johanna Risse ◽  
Peter Kunzmann ◽  
Gerald Neitzke
Keyword(s):  
Veterinary Medicine ◽  
End Of Life ◽  
End Of Life Care ◽  
Hospice Care ◽  
Good Death ◽  
Life Care ◽  
Negative Consequences ◽  
Pet Owners ◽  
Recent Developments ◽  
The One

AbstractStandard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be ‘put to sleep’, while veterinarians have begun to integrate principles and practices from hospice care. We will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the (dis)analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the (animal and human) patients’ wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care.

Changes in attitudes of first-year dental school students toward end of life care after a lecture

2018 ◽  
Author(s):  
N Sonoi ◽  
Y Soga ◽  
J Asaumi
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Dental Students ◽  
Dental School ◽  
Rank Test ◽  
First Year ◽  
Life Care ◽  
School Students ◽  
Significant Difference ◽  
Students Attitudes

Objective: End-of-life care is important to improve the quality of life of terminally ill patients. However, dental school students have few opportunities to learn about such care. The present study was performed to allow future curriculum planning by chronologically examining the influence of an end-of-life care lecture on students’ attitudes toward end-of-life care. Methods:The participants were 48 first-year dental school students (25 men and 23 women; medianage, 19.5y; range, 18 – 26y). The students’ attitudes toward end-of-life care were measured using a shortened version of the Frommelt Attitude Toward Care of the Dying Scale, Form B, Japanese version.The survey was carried out three times—prior to the lecture, immediately after the lecture, and 7 months after the lecture to capture changes over time. The Wilcoxon signed-rank test was used for statistical analysis. Results: A 100% collection rate/valid response rate was achieved before and immediately after the lecture. Furthermore, 91.7% of those who responded to the survey returned valid responses 7 months after the lecture. Of the six items, the post-lecture score for “it is meaningful for me to care for dying patients” increased significantly from the pre-lecture score (p < 0.05), but that recorded 7 months after the lecture did not show a significant difference from the pre-lecture score (p > 0.05). Conclusion: One-off lectures have limited influence on attitudes and awareness regarding end-of-life care among first-year dental students. Thus, a systematic curriculum over 6 years is necessary.

The Influence of Geography, Religion, Religiosity and Institutional Factors on Worldwide End-of-Life Care for the Critically Ill: The WELPICUS Study

2021 ◽  
pp. 082585972110023
Author(s):  
Charles L. Sprung ◽  
Ann L. Jennerich ◽  
Gavin M. Joynt ◽  
Andrej Michalsen ◽  
J. Randall Curtis ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Western Europe ◽  
Institutional Factors ◽  
Life Care ◽  
Modified Delphi ◽  
Geographical Regions ◽  
Consensus Statements ◽  
Significant Difference ◽  
End Of Life Issues

Purpose: To evaluate the association between provider religion and religiosity and consensus about end-of-life care and explore if geographical and institutional factors contribute to variability in practice. Materials and Methods: Using a modified Delphi method 22 end-of-life issues consisting of 35 definitions and 46 statements were evaluated in 32 countries in North America, South America, Eastern Europe, Western Europe, Asia, Australia and South Africa. A multidisciplinary, expert group from specialties treating patients at the end-of-life within each participating institution assessed the association between 7 key statements and geography, religion, religiosity and institutional factors likely influencing the development of consensus. Results: Of 3049 participants, 1366 (45%) responded. Mean age of respondents was 45 ± 9 years and 55% were females. Following 2 Delphi rounds, consensus was obtained for 77 (95%) of 81 definitions and statements. There was a significant difference in responses across geographical regions. South African and North American respondents were more likely to encourage patients to write advance directives. Fewer Eastern European and Asian respondents agreed with withdrawing life-sustaining treatments without consent of patients or surrogates. While respondent’s religion, years in practice or institution did not affect their agreement, religiosity, physician specialty and responsibility for end-of-life decisions did. Conclusions: Variability in agreement with key consensus statements about end-of-life care is related primarily to differences among providers, with provider-level variations related to differences in religiosity and specialty. Geography also plays a role in influencing some end-of-life practices. This information may help understanding ethical dilemmas and developing culturally sensitive end-of-life care strategies.

Advance care planning and place of death, hospitalisation and actual place of death in lung, heart and cancer disease: a randomised controlled trial

2019 ◽  
Vol 10 (4) ◽  
pp. e37-e37 ◽  
Author(s):  
Marianne Hjorth Skorstengaard ◽  
Anders Bonde Jensen ◽  
Pernille Andreassen ◽  
Trine Brogaard ◽  
Elisabeth Brendstrup ◽  
...  
Keyword(s):  
Usual Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Controlled Trial ◽  
Intervention Group ◽  
Place Of Death ◽  
Life Care ◽  
Significant Difference ◽  
Advance Care ◽  
Randomised Controlled

ObjectivesAdvance care planning (ACP) can be a way to meet patients’ end-of-life preferences and enhance awareness of end-of-life care. Thereby it may affect actual place of death (APOD) and decrease the rate of hospitalisations. The aim was to investigate if ACP among terminally ill patients with lung, heart and cancer diseases effects fulfilment of preferred place of death (PPOD), amount of time spent in hospital and APOD.MethodsThe study was designed as a randomised controlled trial. Patients were assessed using general and disease-specific criteria and randomised into groups: one received usual care and one received usual care plus ACP. The intervention consisted of a discussion between a healthcare professional, the patient and their relatives about preferences for end-of-life care. The discussion was documented in the hospital file.ResultsIn total, 205 patients were randomised, of which 111 died during follow-up. No significant differences in fulfilment of PPOD (35% vs 52%, p=0.221) or in amount of time spent in hospital among deceased patients (49% vs 23%, p=0.074) were found between groups. A significant difference in APOD was found favouring home death in the intervention group (17% vs 40%, p=0.013).ConclusionConcerning the primary outcome, fulfilment of PPOD, and the secondary outcome, time spent in hospital, no differences were found. A significant difference concerning APOD was found, as more patients in the intervention group died at home, compared with the usual care group.Trial registration numberNCT01944813.

scholarly journals End-of-Life Care of Women With Gynecologic Malignancies: A Pilot Study

2013 ◽  
Vol 23 (3) ◽  
pp. 546-552 ◽  
Author(s):  
Nicole S. Nevadunsky ◽  
Lori Spoozak ◽  
Sharon Gordon ◽  
Enid Rivera ◽  
Kimala Harris ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Palliative Medicine ◽  
Hospice Care ◽  
Relevant Information ◽  
Life Care ◽  
Gynecologic Malignancies ◽  
Family Meeting ◽  
Pilot Data ◽  
Significant Difference

ObjectiveThere are limited data regarding the end-of-life care for women with gynecologic malignancies. We set out to generate pilot data describing the care that women with gynecologic malignancies received in the last 6 months of life. Patient demographics, patterns of care, and utilization of palliative medicine consultation services were evaluated.MethodsOne hundred patients who died of gynecologic malignancies were identified in our institutional database. Only patients who had received treatment with a gynecologic oncologist within 1 year of death were included. Medical records were reviewed for relevant information. Data were abstracted from the electronic medical record, and analyses were made using Studentttest and Mann-WhitneyUtest with SPSS software.ResultsThe mean age of patients was 60 years (range, 30–94 years). Racial/ethnic distribution was as follows: 38%, white; 34%, black; and 15%, Hispanic. Seventy-five percent of patients received chemotherapy within the last 6 months of life, and 30% received chemotherapy within the last 6 weeks of life. The median number of days hospitalized during the last 6 months of life was 24 (range, 0–183 days). During the last 6 months of life, 19% were admitted to the intensive care unit, 17% were intubated, 5% had terminal extubation, and 13% had cardiopulmonary resuscitative efforts. Sixty-four percent had a family meeting, 50% utilized hospice care, and 49% had palliative medicine consultations. There was a significant difference in hospice utilization when comparison was made between patients who had 14 days or more from consultation until death versus patients who had 14 days or less or no consultation, 21 (72%) versus 29 (41%),P= 0.004. Patients who were single were less likely to have a palliative medicine consultation,P= 0.005.ConclusionsEnd-of-life care for patients with gynecologic malignancies often includes futile, aggressive treatments and invasive procedures. It is unknown whether these measures contribute to longevity or quality of life. These pilot data suggest that factors for implementation of timely hospice referral, family support, and legacy building should include specialists trained in palliative medicine.

Nurses attitudes towards death, dying patients and euthanasia: A descriptive study

2018 ◽  
Vol 26 (5) ◽  
pp. 1442-1457 ◽  
Author(s):  
Melike Ayça Ay ◽  
Fatma Öz
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Death And Dying ◽  
Descriptive Study ◽  
Attitude Scale ◽  
Life Care ◽  
Adult Intensive Care Unit ◽  
Dying Patients ◽  
Significant Difference ◽  
Dying Patient

Background: Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses’ views and attitudes towards these concepts and the factors that affect them are necessary to ensure quality end-of-life care. Objectives: The purpose of this study was to determine nurses’ views and attitudes about death, dying patient, euthanasia and the relationships between nurses’ characteristics. Methods: Participants consist of the nurses who volunteered to take part in this descriptive study from 25 hospitals (n = 340) which has a paediatric or adult intensive care unit and located within the boundaries of Ankara, Turkey. ‘Nurse Information Form’ and ‘Attitude Scale about Euthanasia, Death and Dying Patients (DAS)’ were used as data collection tool. Ethical consideration: Written permissions were received from the ‘Noninterventional Clinical Researches Ethics Board’ of authors’ university and education councils of each hospital. Informed consent was obtained from participants. Findings: It is found that there are statistically significant difference among the factors of marital status, having a child, years of experience, bereavement experience, affected by working with dying patient, definition of euthanasia, views about patients who are appropriate for euthanasia, views about patients who desire to die and feeling need for counselling on these concepts according to the mean total score of nurses’ attitudes about euthanasia, death and dying patient (p < 0.05). Conclusion: The results indicate that nurses are negatively affected to face the concepts of death, euthanasia and work with dying patient. This is reflected in their attitude. In order to gain positive attitude towards death, dying patient and euthanasia, the implementation of training and consulting services to nurses at appropriate intervals during both education and professional life are required.

Liverpool Care Pathway for Hospitalized Cancer Patients (DRAFT)

2018 ◽  
Author(s):  
Carlos Eduardo Paiva ◽  
André Filipe Junqueira dos Santos
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Best Practice ◽  
Care Pathway ◽  
General Medicine ◽  
Cluster Randomized Trial ◽  
Physical Structure ◽  
Care Practice ◽  
Life Care ◽  
Significant Difference

The Liverpool Care Pathway (LCP) for patients who are dying was developed in the UK with the aim of transferring the best practice of hospices to hospitals. In this chapter, an important cluster randomized trial is dissected. Sixteen Italian general medicine hospital wards were randomly assigned to implement the Italian LCP (LCP-I) program or standard health care practice. The results of this trial did not show a significant difference in the overall quality of end-of-life care between the wards in which the LCP-I program was implemented and the control wards (primary aim). Of the nine secondary outcomes investigated, only two showed significant improvements. At the end of the chapter, the authors present a real situation where one hospital CEO, after identifying end-of-life care as a weakness of his institution, evaluates the possibility to implement the LCP or to build a new physical structure dedicated to palliative care.

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