Systemic Factors Impacting Mortality and End-of-Life Issues in Critical Care

2021 ◽  
pp. 295-312
Author(s):  
Leo C. Mercer ◽  
Valerie Canary ◽  
Michelle Maxson
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Relevant Literature ◽  
Interdisciplinary Teams ◽  
Life Planning ◽  
Life Issues ◽  
End Of Life Planning ◽  
Systemic Factors ◽  
End Of Life Issues ◽  
Withdrawal Of Support

This chapter reviews issues related to mortality in the intensive care setting. Relevant literature is summarized and emphasizes the common need patients have for more frequent assessment, dependency on technology support, and psychosocial intervention. The authors stress the importance of interdisciplinary teams and the unique staffing and workforce challenges they encounter. Despite agreement on its importance, the authors maintain that end-of-life care is associated with a lack of consensus around its implementation at the bedside. The diversity within patient groups, diseases and conditions, and health care providers results in an environment in which the interplay of a growing number of variables influences the engagement of patients and families in discussions about end-of-life planning and care, futility, palliation, or withdrawal of support.

Prevalence of written advance directives (AD) among cancer care providers at a community-based cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18563-18563
Author(s):  
B. A. Hammes ◽  
J. A. Lee ◽  
M. A. Mathiason ◽  
M. T. Ertz ◽  
L. L. Sheldon ◽  
...  
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Cancer Care ◽  
Medical Condition ◽  
Cancer Center ◽  
Care Providers ◽  
Community Based ◽  
Life Planning ◽  
End Of Life Planning

18563 Background: Cancer care providers frequently discuss AD with their patients. The providers’ own attitudes toward end-of-life planning likely influence the choices and actions of their patients. We investigated the prevalence of written AD among the care providers at our community-based cancer center. Methods: All cancer center employees who have face-to-face contacts with patients (N=170) were sent an email survey in October 2005. This included medical (physicians, 15), associate (physician assistants and nurse practitioners, 7), and support (nurses, radiation therapists, medical or nurse assistants, and patient liaisons; 148) staffs. We collected data on demographics, work history, and AD. Results: A reply was obtained from 136 (80%) individuals. There were more females (90.2%) and the median age was 43 years (range, 20–63). While 82.8% reported to have discussed their wishes regarding future life-sustaining medical care with those closest to them, only 35.1% had a written AD: medical (58.3%), associate (50%), and support staffs (32.2%). Among those with AD, only 66% had made their own care providers aware of this. The top 5 factors that influenced providers whether to have or not to have AD were: experience at work (36.6%), spouse/domestic partner (25.4%), time to complete written AD (23.9%), family members/friends (21.6%) and children (19.4%). Interestingly, no one considered medical condition or illness as a factor. Increased age was significantly associated with having AD (odds ratio: 1.068; 95% CI:1.029–1.108), while the sex, number of years working with cancer patients, provider role, and marital/living status were not. Among the medical and associate staffs, 55.6% reported routinely discussing AD with their patients. Although all medical/associate staffs rated themselves as knowledgeable about and comfortable with discussing AD, the group who had AD was more apt to rate themselves as very knowledgeable and very comfortable. Conclusions: Only about a third of all cancer care providers and about half of cancer physicians at our institution have a written AD. Despite work experience with a patient population having a high mortality rate, cancer care providers do not adequately communicate end-of-life planning to their own health care providers. No significant financial relationships to disclose.

scholarly journals Attitudes Toward End-Of-Life Decisions Other Than Assisted Death Amongst Doctors in Northern Portugal

2021 ◽  
Author(s):  
José António Ferraz Gonçalves
Keyword(s):  
End Of Life ◽  
Family Member ◽  
Progressive Disease ◽  
Treatment Withdrawal ◽  
Assisted Death ◽  
End Of Life Decisions ◽  
Life Issues ◽  
End Of Life Issues ◽  
Withdrawal Of Support ◽  
Lethal Doses

Abstract Background Doctors often deal with end-of-life issues other than assisted death, such as incompetent patients and treatment withdrawal, including food and fluids. Methods A link to a questionnaire was sent by email three times, at intervals of one week, to the doctors registered in the Northern Section of the Portuguese Medical Association. Results The questionnaire was returned by 1148 (9%) physicians. This study shows that only a minority of Portuguese doctors were willing to give one or more drugs in lethal doses to cognitively incompetent patients with an incurable, advanced, and progressive disease at the request of a family member or other close person, and even less would do it on their own initiative. Concerning the withdrawal of support of life measures in advanced and progressive diseases at the patient’s request, most doctors were in favor, but much fewer doctors agreed with the suspension of supportive life measures at the request of a family member, another close person, or by their own unilateral decision. However, concerning the suspension of food and fluids, fewer agreed with that action. Portuguese doctors favor the administration of drugs for suffering control, even foreseeing they could shorten life, Conclusion Most doctors in this study respect patients’ autonomy, but do not agree with measures decided by others that have an impact on patients’ survival. They also agree with the administration of drugs for suffering control, even considering the possibility of shortening life.

End of Life Care: The Experience of Seniors and Informal Caregivers

2002 ◽  
Vol 21 (1) ◽  
pp. 137-146 ◽  
Author(s):  
Margaret M. Ross ◽  
Michael J. MacLean ◽  
Roy Cain ◽  
Scott Sellick ◽  
Rory Fisher
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
End Of Life Care ◽  
Informal Caregivers ◽  
Life Care ◽  
Care Providers ◽  
Research Attention ◽  
Life Threatening Illness ◽  
Life Issues ◽  
End Of Life Issues

ABSTRACTAs Canada's elderly population grows, an increasing number of seniors will require care as they face the end of life. Relatively little research attention, however, has been given to end-of-life issues, including those related to treatment and care for persons who are both old and dying. Families and health care providers have little direction and guidance to ensure an optimum quality of life for seniors prior to death and during the period of bereavement. This article presents an abbreviated summary of the literature regarding end-of-life issues and challenges for seniors who face a life threatening illness and are at, or near, the end of their lives. The article is also informed by a series of focus groups with elderly and other informal caregivers regarding the giving of help and getting support while caring for persons who are dying. It concludes with a response to this evidence by making a series of recommendations aimed at ensuring optimal end-of-life care for seniors who are dying and their families.

End-of-Life Issues for People Who Use AAC

2005 ◽  
Vol 14 (3) ◽  
pp. 15-19 ◽  
Author(s):  
Melanie Fried-Oken ◽  
Lisa Bardach
Keyword(s):  
End Of Life ◽  
Life Issues ◽  
End Of Life Issues

End-of-Life Issues

2012 ◽  
Vol 42 (13) ◽  
pp. 53-54 ◽  
Author(s):  
S.Y. TAN
Keyword(s):  
End Of Life ◽  
Life Issues ◽  
End Of Life Issues
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