Do patients with lung cancer recall physician-initiated discussions about planning for end-of-life care following disclosure of a terminal prognosis?

2016 ◽  
Vol 9 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Gillian Horne ◽  
Sheila Payne ◽  
Jane Seymour
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
End Of Life Care ◽  
Family Members ◽  
Terminally Ill ◽  
Care Planning ◽  
Life Care ◽  
Goals Of Care ◽  
Terminally Ill Patients ◽  
Terminal Prognosis

BackgroundCommunicating with patients about their prognosis and goals of care, including offering opportunities to engage in advance care planning (ACP) is widely recognised as best practice. Little is known about terminally ill patients’ perceptions of communication and ACP practice following disclosure of their terminal prognosis.ObjectivesTo examine whether terminally ill patients with lung cancer and their relatives recall conversations with disclosing physicians, about their concerns, goals of care or any offers to engage in ACP.MethodsQualitative study using semistructured interviews with patients and their family members. The study setting was a cancer centre and cancer unit in northern England.Results25 patients with advanced lung cancer (18 men and 7 women, aged 47–85) and 19 family members, mainly from lower social economic classes, took part in the study. Participants had little or no recall of physicians initiating discussions about their concerns, or goals of care and did not perceive that they had been provided with either information about or opportunities to engage in ACP. Some participants reported a sense of abandonment following the disclosure of a terminal prognosis. This sense was compounded by a range of difficult emotional experiences following the disclosure.ConclusionsIt may be inappropriate to initiate discussions about end-of-life care planning immediately following the disclosure of a terminal prognosis. To avoid patients feeling abandoned physicians need to consider how they or another appropriate person can provide information and opportunities for terminally ill patients to engage in a process of ACP.Trial registration number06/Q2307/22.

Nursing Home Resident, Family, and Staff Perspectives on Hospital Transfers for End-of-Life Care

2021 ◽  
pp. 003022282199770
Author(s):  
Janet Sopcheck ◽  
Ruth M. Tappen
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Family Members ◽  
Terminally Ill ◽  
South Florida ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Residents who are terminally ill often experience transfers to the emergency department resulting in hospitalizations, which may be potentially avoidable with treatment in the nursing home. This qualitative study explored the perspectives of 15 residents, 10 family members, and 20 nursing home staff regarding end-of-life care and the circumstances prompting resident transfers. Data analysis of participant interviews conducted January to May 2019 in a South Florida nursing home identified four themes related to transfer to the hospital: time left to live, when aggressive treatments would be unavailing, not knowing what the nursing home can do, and transfer decisions are situation-dependent. Study findings underscore the importance of increasing resident and family awareness of treatments available in the nursing home and person-centered advance care planning discussions. Further research should explore the reasons for residents’ and family members’ choice of aggressive therapies and their goals for care at the end of life.

Morphine prescription to terminally ill patients with lung cancer and dyspnea: French physicians’ attitudes

2005 ◽  
Vol 1 (1) ◽  
pp. 25 ◽  
Author(s):  
Marc K. Bendiane, MSC ◽  
Patrick Peretti-Watel, PhD ◽  
Herve Pegliasco, MD ◽  
Roger Favre, PhD ◽  
Anne Galinier, MD ◽  
...  
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
End Of Life Care ◽  
Terminally Ill ◽  
Life Care ◽  
Factors Associated ◽  
Terminally Ill Patients ◽  
Line Therapy ◽  
Back Ground ◽  
Analgesic Use

This study aimed to investigate factors associated with analgesic use of morphine in end-of-life care. French general practitioners (GPs) and oncologists (N = 719) were asked whether they would prescribe morphine asfirst-line therapy to patients with terminal lung cancer suffering from dyspnea associated with cough and great anxiety. Overall, 54 percent of oncologists and 40percent of GPs stated that they would prescribe morphine in the presented case. This prescriptive attitude correlated with physicians’ age, professional back-ground, communication skills, and attitude toward terminally ill patients. The findings of this study indicate that improving analgesic use of opioids in end-of-life care is not only a matter of enhancing technical skills acquired through training or experience but also a matter of improving communication and empathy between physicians and patients.

scholarly journals Considerations and recommendations for conducting qualitative research interviews with palliative and end-of-life care patients in the home setting: a consensus paper

2015 ◽  
Vol 9 (1) ◽  
pp. e14-e14 ◽  
Author(s):  
Stephanie Sivell ◽  
Hayley Prout ◽  
Noreen Hopewell-Kelly ◽  
Jessica Baillie ◽  
Anthony Byrne ◽  
...  
Keyword(s):  
Qualitative Research ◽  
End Of Life ◽  
Home Environment ◽  
End Of Life Care ◽  
Terminally Ill ◽  
Well Being ◽  
Research Centre ◽  
Life Care ◽  
Home Setting ◽  
Terminally Ill Patients

ObjectivesTo present and discuss the views of researchers at an academic palliative care research centre on research encounters with terminally ill patients in the home setting and to generate a list of recommendations for qualitative researchers working in palliative and end-of-life care.MethodsEight researchers took part in a consensus meeting to discuss their experiences of undertaking qualitative interviews. The researchers were of varying backgrounds and all reported having experience in interviewing terminally ill patients, and all but one had experience of interviewing patients in their home environment.ResultsThe main areas discussed by researchers included: whether participation in end-of-life research unintentionally becomes a therapeutic experience or an ethical concern; power relationships between terminally ill patients and researchers; researcher reflexivity and reciprocity; researchers’ training needs. Qualitative methods can complement the home environment; however, it can raise ethical and practical challenges, which can be more acute in the case of research undertaken with palliative and patients at the end-of-life.ConclusionsThe ethical and practical challenges researchers face in this context has the potential to place both participant and researcher at risk for their physical and psychological well-being. We present a set of recommendations for researchers to consider prior to embarking on qualitative research in this context and advocate researchers in this field carefully consider the issues presented on a study-by-study basis.

Association Between Advance Directives and Quality of End-of-Life Care (DRAFT)

2018 ◽  
Author(s):  
Donna S. Zhukovsky
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Family Members ◽  
Care Planning ◽  
Life Care ◽  
Care Providers ◽  
Advance Care

Advance care planning is a complex process whereby an individual reflects on future care options at the end of life after reflecting on his or her values and goals for care. These values, goals, and preferences are then communicated to key stakeholders in the process (i.e., proxy and surrogate decision-makers, family members, and health care providers). It is unclear how well the completion of advance directives and a written outcome of advance care planning affect desired patient outcomes. In this chapter, a critical review is provided of a mortality follow-back survey that evaluates the association of advance directives with quality of end-of-life care from the perspective of bereaved family members. Study strengths and limitations are described, as are directions for future research.

Planning End-of-Life Care for Patients with Dementia: Roles of Families and Health Professionals

2001 ◽  
Vol 42 (4) ◽  
pp. 273-291 ◽  
Author(s):  
Charles E. Gessert ◽  
Sarah Forbes ◽  
Mercedes Bern-Klug
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Health Professionals ◽  
End Of Life Care ◽  
Family Members ◽  
Care Planning ◽  
Life Care ◽  
Dementia Patients ◽  
Advance Care ◽  
Surrogate Decision

We examined families' end-of-life decision making and their interactions with health professionals. Twenty-eight family members of institutionalized dementia patients participated in four focus groups. We found that participating family members were not well prepared for their decision-making roles, and that they: 1) experienced substantial burdens and loss in caring for institutionalized elders; 2) had limited understanding of the natural progression of dementing conditions; 3) were uncomfortable in setting goals for their relatives' end-of-life care; 4) had little experience with death, and were ambivalent about the anticipated death of their relative; and (5) reported that they had little substantive communication with health professionals regarding end-of-life care planning. We concluded that many of the needs of such families could be addressed through improved application of the principles of advance care planning, including regular structured discussions, involvement of surrogate decision-makers, and anticipation of clinical decisions. Health professionals should take the lead in ‘normalizing’ the discussion of death.

scholarly journals COMPARISON OF DOCUMENTED PATIENT CARE BEFORE AND AFTER IMPLEMENTATION OF END OF LIFE CARE PATHWAY FOR TERMINALLY ILL PATIENTS AT SHAUKAT KHANUM MEMORIAL CANCER HOSPITAL AND RESEARCH CENTRE

2018 ◽  
Vol 4 (3) ◽  
Author(s):  
Irum Ghafoor ◽  
Haroon Hafeez ◽  
Farhat Naz ◽  
Muhammad Abu Baker
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Care Pathway ◽  
Symptom Control ◽  
Terminally Ill ◽  
Research Centre ◽  
Life Care ◽  
Terminally Ill Patients ◽  
Cancer Hospital ◽  
Before And After

Purpose: Shaukat Khanum Memorial Cancer Hospital and Research Cancer primarily deals with cancer patients and has various departments which provide best-integrated lifesaving care. However, when patients who have been given all possible medical and oncological treatment still progress their disease, they are then referred for best supportive care to palliative care department. The aim of this paper was to audit documented care for palliative patients before and after implementation of end of life care (ELC) pathway.Materials and Methods: We used a retrospective method to audit 45 terminally ill patients over a period of 3 months. Then, a re-audit was done over a period of 3 months and data were collected for patients who were started on SKM-ELC pathway.Results: Results show that the implementation of ELC pathway, 67% of the patients were not prescribed PRN medications for symptom control, 20% of the patients were not reviewed for the need of assisted nutrition and for 20% of the patient’s primary team were not even notified that the patient is dying. After the ELC pathway implementation, it was found that 100% of patients were reviewed for PRN medications and assisted nutrition. Oncologists were timely notified that the patient is dying.Conclusion: In summary, we can say that implantation of ELC pathway has significantly improved documented patients care in all aspects.Key words: Cancer, care for dying, end of life care, goals of care pathway

End-of-life care: Empowering cancer patients with information and choices

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20739-e20739
Author(s):  
K. Tucker
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Negative Impact ◽  
Terminally Ill ◽  
Life Care ◽  
Terminally Ill Patients ◽  
Aid In Dying ◽  
Practice Review ◽  
Life Options ◽  
End Of Life Decision

e20739 Background: Terminally ill patients want information and choices, including aid in dying, as they confront death due to cancer and other terminal illnesses. Physicians treating such patients want to feel safe in having candid conversations with patients about their wishes and to provide aid in dying when appropriate. Methods: Review the law governing end of life decision making, including aid in dying. Review the data from Oregon, which has more than 10 years experience with a regulated practice. Review what has been learned in OR, and how that is transferring to other states making aid in dying an end of life option. Results: Oregon's experience shows that when aid in dying is a legal option for mentally competent terminally ill patients overall end of life care improves. Conversations between physicians and patients are more open and candid; Referrals to hospice increase and occur earlier; clinician enrollment in CE for pain and symptom management increase; rx of strong pain medication increase; more patients die at home; patients are comforted to have aid in dying as an option; there is no negative impact on the practice of medicine. Conclusions: Terminally ill patients should be able to recieve comprehensive counseling about all end of life options. There is a growing trend of support for expanding end of life options to include aid in dying for mentally competent terminally ill patients who find themselves trapped in an unbearable dying process. No significant financial relationships to disclose.

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