scholarly journals Paramedics and serious illness: communication training

2019 ◽  
pp. bmjspcare-2018-001734
Author(s):  
Nikki Jane Pease ◽  
Jenifer Jeba Sundararaj ◽  
Edward O'Brian ◽  
Joanne Hayes ◽  
Edward Presswood ◽  
...  
Keyword(s):  
Patient Care ◽  
End Of Life ◽  
Symptom Control ◽  
Death And Dying ◽  
Real Life ◽  
Ambulance Service ◽  
Serious Illness ◽  
Use Of Resources ◽  
Service Staff ◽  
The Impact

ObjectivesThe need to empower Ambulance Service staff at the point of delivery of end of life care (EoLC) is crucial. We describe the delivery, outcomes and potential impact of the Serious Illness Conversation project delivered to Welsh Ambulance Service Trust (WAST) staff. Over an 18-month period, 368 WAST staff attended face-to-face teaching, which included serious illness conversation communication skills, symptom control and ‘shared decision making’.MethodData collected from WAST staff were used to gain insight on perception of their role and challenges within the context of EoLC, understand the impact of teaching on self-confidence and identify impact on the wider service. A mixed methods approach was used for data analysis.ResultsWAST staff view themselves in several important roles, acting as ‘facilitators’ to patient-centred, seamless care, providing support, liaison between services and practical help in patient care at the end of life. The difficult questions and situations pertaining to EoLC were related to discussions on death and dying and managing expectation. The predominant barriers identified related to communication. Quantitative outcomes on the six communication domains indicate statistically significant improvement in self-assessed confidence. The overall impact to the wider ambulance service suggests a trend towards better use of resources.ConclusionThe perceived roles and challenges identified by paramedics can help in customising training objectives. The initial outcomes from the ongoing project with WAST demonstrate increased confidence in handling communication issues. Initial successive surveys suggest teaching is making a real life impact on patient care at end of life.

The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience

2019 ◽  
Vol 67 (4) ◽  
pp. 825-830 ◽  
Author(s):  
Timothy P. Daaleman ◽  
Natalie C. Ernecoff ◽  
Christine E. Kistler ◽  
Alfred Reid ◽  
David Reed ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare Utilization ◽  
Care Program ◽  
Community Based ◽  
Serious Illness ◽  
Care Experience ◽  
The Impact

scholarly journals Disposal and Recycle Economic Assessment for Aircraft and Engine End of Life Solution Evaluation

2020 ◽  
Vol 10 (2) ◽  
pp. 522
Author(s):  
Xiaojia Zhao ◽  
Wim J.C. Verhagen ◽  
Richard Curran
Keyword(s):  
End Of Life ◽  
Real Life ◽  
Economic Assessment ◽  
Aircraft Engine ◽  
Economic Indicator ◽  
Data Set ◽  
Core Concepts ◽  
Increasing Demand ◽  
R Process ◽  
The Impact

The present study proposes an economic indicator to support the evaluation of aircraft End of Life (EoL) strategies in view of the increasing demand with regards to aircraft decommissioning. This indicator can be used to evaluate an economic performance and to facilitate the trade-off studies among different strategies. First, Disposal and Recycle (D&R) scenarios related to stakeholders are investigated to identify the core concepts for the economic evaluation. Next, we extracted the aircraft D&R process from various real-life practices. In order to obtain the economic measure for the engineering process, a method of estimating the D&R cost and values are developed by integrating product, process and cost properties. This analysis is demonstrated on an averaged data set and two EoL aircraft cases. In addition, sensitivity analysis is performed to evaluate the impact of the D&R cost, residual value, and salvage value. Results show that the disassembly and dismantling of an aircraft engine possesses relatively more economic gains than that for the aircraft. The main factors influencing the proposed D&R economic indicator are the salvage value and D&R cost for economically efficient D&R cases. In addition, delaying the disposal and recycle process for EoL aircraft can lead to economically unfavorable solutions. The economic indicator combined with the evaluation methods is widely applicable for evaluations of engineering products EoL solutions, and implies a significant contribution of this research to decision making for such complex systems in terms sustainable policy.

Approaching end-of-life care in organ transplantation: the impact of transplant patients' death and dying

2007 ◽  
Vol 17 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Linda Wright ◽  
Deborah Pape ◽  
Kelley Ross ◽  
Michael Campbell ◽  
Kerry Bowman
Keyword(s):  
End Of Life ◽  
Organ Transplantation ◽  
End Of Life Care ◽  
Death And Dying ◽  
Life Care ◽  
Transplant Patients ◽  
The Impact

The serious illness care program.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 12-12 ◽  
Author(s):  
Rachelle Bernacki ◽  
Susan Block
Keyword(s):  
End Of Life ◽  
Controlled Trial ◽  
Clinical Care ◽  
Care Program ◽  
Depression Score ◽  
Serious Illness ◽  
Clinician Training ◽  
The Mean ◽  
Surprise Question ◽  
The Impact

12 Background: Conversations between patients and clinicians about end-of-life care allow patients to prepare and plan for the end of life and are associated with improved outcomes. Objective: To determine the impact of a structured, seven-item conversation guide on anxiety and depression in patients with an estimated prognosis under a year. Methods: A cluster, randomized controlled trial enrolled 81 clinicians and 272 patients (goal of 400 patients) at Dana Farber Cancer Institute. The intervention (integrated into regular clinical care by oncologists) consisted of a system to identify patients and trigger clinician discussions using the checklist, clinician training, and documentation template in the electronic medical record. Adult patients were identified by oncologists using the “surprise” question. Surveys measured key outcomes before and after administration of the checklist (for patients) and after training (for oncologists). Results: 1,299 patients were identified using the surprise question. Of patients contacted, 332 agreed to participate and 254 declined. To date, 62 conversations are complete with a median length of 20 minutes (range: 8-70 min). The mean anxiety level using the GAD-7 score for the participants with complete data prior to the checklist conversation was 4.0 and post-conversation 3.1 (p=0.04). The mean depression score using the PHQ-9 prior to the checklist conversation was 6.3 and post-conversation 5.7 (p=0.2). 51% of patients found the discussion ‘very’ or ‘extremely’ helpful; 21% found the discussion ‘somewhat’ helpful; and 14% ‘slightly’ or ‘not at all’ helpful. The majority of clinicians found the guide simple (79%) and easy to use (78%); 81% reported they would continue its use after the trial. Conclusions: These preliminary data demonstrate that use of the guide is feasible, acceptable to patients and clinicians, and does not lead to increased anxiety or depression. There is a trend towards a significant reduction in anxiety in patients who had the discussion with their oncologists. The Serious Illness Care Program is an acceptable intervention to support clinicians in conducting conversations about end-of-life values and goals with patients, allowing them to articulate their wishes about future medical care. Clinical trial information: NCT01786811.

scholarly journals Spiritual Care at The End Of Life: Western Views and Islamic Perspectives

2018 ◽  
Vol 2 (2) ◽  
pp. 65
Author(s):  
Wafa ‘a Qasem Ahmad
Keyword(s):  
Patient Care ◽  
End Of Life ◽  
Spiritual Care ◽  
End Of Life Care ◽  
Human Life ◽  
Death And Dying ◽  
The Past ◽  
Education Of Patients ◽  
Core Components ◽  
The Uk

The concept of spiritual and religious care, as core components of palliative care for patients at end of life stages, has achieved significant organized applications and advances in modes of intervention and tools. The past two decades have witnessed waves of secularization with impacts of the concepts of spirituality and chaplaincy that diverged away from religion, more so in the UK and some European countries as compared to US applications. Spirituality became more generic and broad that revealed itself in helping and education of patients and families to earth and think of meaning and purpose of life, suffering death and dying. The issues of spirituality and religiosity in the Islamic culture, teachings and attitudes towards patient care at terminal stages of life, is distinguished by clarity and harmony in view of clarity of Muslim beliefs and interpretations concerning purpose, meaning and mission of human life on this earth, end-of-life care and the afterlife. This paper will address the contemporary western diverse concepts of spirituality, its relationship with religiosity in terminal patient care, and will elaborate on the holistic Islamic views and attitudes towards this stage of human life.International Journal of Human and Health Sciences Vol. 02 No. 02 April’18. Page : 65-70

Approaching End-of-Life Care in Organ Transplantation: The Impact of Transplant Patients' Death and Dying

2007 ◽  
Vol 17 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Linda Wright ◽  
Deborah Pape ◽  
Kelley Ross ◽  
Michael Campbell ◽  
Kerry Bowman
Keyword(s):  
End Of Life ◽  
Organ Transplantation ◽  
End Of Life Care ◽  
Death And Dying ◽  
Life Care ◽  
Transplant Patients ◽  
The Impact

scholarly journals Exploring the Contemporary Stage and Scripts for the Enactment of Dying Roles: A Narrative Review of the Literature

2017 ◽  
Vol 76 (4) ◽  
pp. 328-350 ◽  
Author(s):  
Daniel Lowrie ◽  
Robin Ray ◽  
David Plummer ◽  
Matthew Yau
Keyword(s):  
End Of Life ◽  
Death Anxiety ◽  
Life Experiences ◽  
Death And Dying ◽  
Narrative Review ◽  
Review Of The Literature ◽  
Actual Experience ◽  
The Impact

This narrative review explores the literature regarding the drama of dying from several academic perspectives. Three key themes were identified including “The impact of blurred boundaries on roles and transitions,” “The orchestration of death and dying through time,” and “Contemporary dying and new machinery of control.” This review reveals the manner in which tightly scripted dying roles serve the needs of the living to a greater extent than those of the dying, by ensuring the depiction of both dying and death as phenomena which have been brought under the control of the living, thereby countering death anxiety. An incongruence between the actual experience of dying and contemporary dying scripts is also highlighted. The authors argue that this incongruence is hidden from the broader societal audience through the maintenance of a dying role that demands serenity and acceptance, thus downplaying or even hiding the actual end-of-life experiences of the dying themselves.

This Is Us: An Analysis of Mediated Family Communication at End-of-Life

2021 ◽  
pp. 003022282110363
Author(s):  
Bonnie M. Nickels ◽  
Kelly E. Tenzek ◽  
Tahleen A. Lattimer
Keyword(s):  
End Of Life ◽  
Family System ◽  
Real Life ◽  
Communication Analysis ◽  
Communication Behaviors ◽  
The Family ◽  
Life Issues ◽  
Popular Television ◽  
The Impact ◽  
End Of Life Communication

Death is a ubiquitous theme in television dramas and we argued that mediated depictions of end-of-life experiences have the potential to provide glimpses into the ways in which characters experience real-life issues and can serve as conversation starters within family viewers. The study aimed to identify how a popular television drama, This is Us, depicted end-of-life communication. Analysis of season one revealed 54 conversations about end-of-life, two explicit death scenes, and three implied death scenes. Results also illustrate how the storyline within the show clearly depicts the impact end-of-life has on the family system, emphasizing the ongoing interdependence, hierarchy, and boundary (re)negotiation as a result of death. Findings advance understanding of how mediated narratives can illustrate end-of-life scenarios and conversations within the family system and can provide observational opportunities for modeling end-of-life communication behaviors within their families.

A national survey of medical students and educators at Korean medical schools, examining the impact of end-of-life care education provided to Korean medical students based on their attitudes.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 55-55
Author(s):  
Do Yeun Kim ◽  
Kyong-Jee Kim ◽  
Sung Joon Shin ◽  
Dae Seog Heo ◽  
Soon-Nam Lee ◽  
...  
Keyword(s):  
Medical Students ◽  
End Of Life ◽  
Death And Dying ◽  
Medical Schools ◽  
Physical Symptoms ◽  
Advanced Directives ◽  
Care Education ◽  
Medical Educators ◽  
Eol Care ◽  
The Impact

55 Background: This study explored the current state of end-of-life (EoL) care education provided to Korean medical students and their self-rated attitudes toward EoL-related education. Methods: An anonymous survey was given to fourth year medical s tudents and the principle EoL care educators at all 41 Korean medical schools. The medical educators were asked to identify the EoL care-related topics that they usually teach students. Both students and medical educators completed seven items regarding self-perceived attitudes. Results: In total, 23 medical educators (56.1%) and 1,545 medical students (46.3%) responded. Of nine topics related to EoL care, the most frequently taught topics were delivering bad news (100%) and managing physical symptoms (74.1%), whereas setting treatment goals was taught the least frequently (37.0%). Approximately half of the educators taught the withdrawal of life-sustaining devices (59.3%), death and dying (55.6%), and advanced directives (55.6%). When the medical students were dichotomized into groups taught at least six topics (n = 815) versus five or fewer topics (n = 729), the group taught at least six topics expressed more satisfaction with EoL care education and they considered EoL care-related issues during their clerkship rotations. They also had fewer negative answers when they were asked about their readiness to practice EoL care. Conclusions: EoL education is inadequate for Korean medical students. However, medical students who were more fully instructed in this topic reported self-rated competency regarding EoL care-related issues. Further research should develop an education system that provides sufficient knowledge and training in EoL care for Korean medical students.

scholarly journals Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis

2018 ◽  
Vol 33 (2) ◽  
pp. 160-177 ◽  
Author(s):  
Ben Bowers ◽  
Richella Ryan ◽  
Isla Kuhn ◽  
Stephen Barclay
Keyword(s):  
End Of Life ◽  
Hospital Admissions ◽  
Symptom Relief ◽  
Symptom Control ◽  
Evidence Base ◽  
Research Quality ◽  
Cochrane Library ◽  
Narrative Synthesis ◽  
Published Evidence ◽  
The Impact

Background: The anticipatory prescribing of injectable medications to provide end-of-life symptom relief is an established community practice in a number of countries. The evidence base to support this practice is unclear. Aim: To review the published evidence concerning anticipatory prescribing of injectable medications for adults at the end of life in the community. Design: Systematic review and narrative synthesis. Registered in PROSPERO: CRD42016052108, on 15 December 2016 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=52108 ). Data sources: Medline, CINAHL, Embase, PsycINFO, Web of Science, Cochrane Library, King’s Fund, Social Care Online, and Health Management Information Consortium databases were searched up to May 2017, alongside reference, citation, and journal hand searches. Included papers presented empirical research on the anticipatory prescribing of injectable medications for symptom control in adults at the end of life. Research quality was appraised using Gough’s ‘Weight of Evidence’ framework. Results: The search yielded 5099 papers, of which 34 were included in the synthesis. Healthcare professionals believe anticipatory prescribing provides reassurance, effective symptom control, and helps to prevent crisis hospital admissions. The attitudes of patients towards anticipatory prescribing remain unknown. It is a low-cost intervention, but there is inadequate evidence to draw conclusions about its impact on symptom control and comfort or crisis hospital admissions. Conclusion: Current anticipatory prescribing practice and policy is based on an inadequate evidence base. The views and experiences of patients and their family carers towards anticipatory prescribing need urgent investigation. Further research is needed to investigate the impact of anticipatory prescribing on patients’ symptoms and comfort, patient safety, and hospital admissions.

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