scholarly journals Advanced cancer and COVID-19 comorbidity: medical oncology-palliative medicine ethics meetings in a comprehensive cancer centre

2021 ◽  
pp. bmjspcare-2021-002946
Author(s):  
Laura Thery ◽  
Pauline Vaflard ◽  
Perrine Vuagnat ◽  
Ophélie Soulie ◽  
Sylvie Dolbeault ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Advanced Cancer ◽  
Ethics Committee ◽  
Decision Making Process ◽  
Ethical Guidelines ◽  
Institutional Ethics ◽  
Palliative Care Teams

ObjectivesIn managing patients with cancer in the COVID-19 era, clinical oncologists and palliative care practitioners had to face new, disrupting and complex medical situations, challenging the quality of the shared decision-making process. During the first lockdown in France, we developed an onco-palliative ethics meeting to enhance the quality of the decision-making process for patients with advanced cancer treated for COVID-19.MethodsA least one of the institutional ethics committee members was present along with oncologists, palliative care teams, psycho-oncologists, radiologists and intensive care specialists. Specific medical parameters were systematically collected to form a standardised framework for the discussions.ResultsThe main raised issues were the definition of new criteria for the implementation of invasive resuscitation techniques, optimal ways to adapt or delay anticancer treatment and best procedures to address terminal respiratory failure and end-of-life care. The main clinical and ethical guidelines that emerged during these debates are presented. The palliative care team played a major role in assessing and reporting patients’ awareness of cancer-related prognosis and their wishes concerning invasive therapies or transfer to intensive care units, enabling an individualised benefit–risk balance assessment. The ethics committee members ensured continuous monitoring during the discussions. Their function was to recall the main ethical principles including dignity, which is conferred on people when there are treated as having equal status.ConclusionsThe onco-palliative ethics meeting provided a powerful avenue for improvement of collegiality and reinforcement of teamwork, which could be a major protection against burnout for healthcare professionals facing an epidemic onslaught.

Decision-making process, outcome, and 1-year quality of life of octogenarians referred for intensive care unit admission

2006 ◽  
Vol 32 (7) ◽  
pp. 1045-1051 ◽  
Author(s):  
Maité Garrouste-Orgeas ◽  
Jean-François Timsit ◽  
Luc Montuclard ◽  
Alain Colvez ◽  
Olivier Gattolliat ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Decision Making Process

scholarly journals Advance care planning in patients with advanced cancer: A 6-country, cluster-randomised clinical trial

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003422
Author(s):  
Ida J. Korfage ◽  
Giulia Carreras ◽  
Caroline M. Arnfeldt Christensen ◽  
Pascalle Billekens ◽  
Louise Bramley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Care Planning ◽  
Shared Decision ◽  
Specialist Palliative Care ◽  
Cluster Randomised ◽  
Advance Care

Background Advance care planning (ACP) supports individuals to define, discuss, and record goals and preferences for future medical treatment and care. Despite being internationally recommended, randomised clinical trials of ACP in patients with advanced cancer are scarce. Methods and findings To test the implementation of ACP in patients with advanced cancer, we conducted a cluster-randomised trial in 23 hospitals across Belgium, Denmark, Italy, Netherlands, Slovenia, and United Kingdom in 2015–2018. Patients with advanced lung (stage III/IV) or colorectal (stage IV) cancer, WHO performance status 0–3, and at least 3 months life expectancy were eligible. The ACTION Respecting Choices ACP intervention as offered to patients in the intervention arm included scripted ACP conversations between patients, family members, and certified facilitators; standardised leaflets; and standardised advance directives. Control patients received care as usual. Main outcome measures were quality of life (operationalised as European Organisation for Research and Treatment of Cancer [EORTC] emotional functioning) and symptoms. Secondary outcomes were coping, patient satisfaction, shared decision-making, patient involvement in decision-making, inclusion of advance directives (ADs) in hospital files, and use of hospital care. In all, 1,117 patients were included (442 intervention; 675 control), and 809 (72%) completed the 12-week questionnaire. Patients’ age ranged from 18 to 91 years, with a mean of 66; 39% were female. The mean number of ACP conversations per patient was 1.3. Fidelity was 86%. Sixteen percent of patients found ACP conversations distressing. Mean change in patients’ quality of life did not differ between intervention and control groups (T-score −1.8 versus −0.8, p = 0.59), nor did changes in symptoms, coping, patient satisfaction, and shared decision-making. Specialist palliative care (37% versus 27%, p = 0.002) and AD inclusion in hospital files (10% versus 3%, p < 0.001) were more likely in the intervention group. A key limitation of the study is that recruitment rates were lower in intervention than in control hospitals. Conclusions Our results show that quality of life effects were not different between patients who had ACP conversations and those who received usual care. The increased use of specialist palliative care and AD inclusion in hospital files of intervention patients is meaningful and requires further study. Our findings suggest that alternative approaches to support patient-centred end-of-life care in this population are needed. Trial registration ISRCTN registry ISRCTN63110516.

The Ethical Dilemmas Experienced by Nurses: an Approach from the Philosophy of Max Scheler

2009 ◽  
Vol 3 (4) ◽  
pp. 1246
Author(s):  
Marlise Silva Barros ◽  
Rose Mary Costa Rosa Andrade Silva ◽  
Eliane Ramos Pereira ◽  
Marcos Andrade Silva
Keyword(s):  
Intensive Care ◽  
Ethical Dilemmas ◽  
Care Center ◽  
Ethics Committee ◽  
University Hospital ◽  
Decision Making Process ◽  
Max Scheler ◽  
Consent Forms ◽  
Theory Of Value

Objective: this study intends reflect philosophically about the ethical dilemmas experienced by nurses from the Intensive Care Center at University Hospital Antonio Pedro, from the Theory of Value of Max Scheler. Methods: this is a descriptive study with a qualitative approach. The population shall be defined by the technique of saturation, consisting of nurses of the sector, to be interviewed after the signing of the Free Informed Consent forms, if they wish participate spontaneously in the study. The information will be transcribed, categorized in order of significance and analyzed from the theoretical framework of Max Scheler who looks on the objectivity of values and the process of seizure of emotional character. The project has received approval from the Research Ethics Committee of the Faculty of Medicine / University Hospital Antonio Pedro. Expected results: through the analysis of data, based on theoretical referential, the study intends to contribute to the decision making process of nurses, in front of the possible ethical dilemmas experienced with regard to practical work and, moreover, with the quality of care provided by nurses in the Intensive Care Center. Descriptors: ethics; bioethics; philosophy nursing; intensive care units.

End-of-life discussions with advanced cancer patients and their effects on bereaved families’ mental health.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 3-3
Author(s):  
Takashi Yamaguchi ◽  
Isseki Maeda ◽  
Yutaka Hatano ◽  
Masanori Mori ◽  
Yasuo Shima ◽  
...  
Keyword(s):  
Mental Health ◽  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Complicated Grief ◽  
Advanced Cancer Patients ◽  
Palliative Care Teams ◽  
Prevalence Of Depression

3 Background: End-of-life (EOL) discussions are important for providing appropriate care to patients with advanced cancer at the end of their life. To explore the relationship between EOL discussions and bereaved families’ mental health, as well as the quality of the patient’s death and quality of care at the end of life. Methods: This was a nationwide questionnaire survey of bereaved families of deceased cancer patients who died at 75 sites (20 inpatient palliative care teams in acute hospitals, 33 palliative care units/inpatient hospices, and 22 outpatient clinics that provide home palliative care service) in Japan. 13,711 bereaved family members of cancer patients who died before January 2014 in each of the participating institutions were potential participants. We evaluated the prevalence and details of EOL discussions which were defined as “a discussion with physicians about the preferred place of death or resuscitation”. We also evaluated the prevalence of depression (defined as the Patient Health Questionnaire-9 ≥ 10) and complicated grief (defined as the Brief Grief Questionnaire ≥ 8) in bereaved families. Results: 9123 questionnaires returned (response rate 67%). Of those, 80.6% had EOL discussions. After propensity score weighted adjustment, bereaved families with EOL discussion less frequently developed depression (17.3% and 21.6% ; P < 0.001) and complicated grief (13.7% and 15.9% ; P = 0.03) than without. There were significant differences in the trend test among families without and in those with EOL discussions < 1, 1–3, and > 3 months before the patient’s death, for the prevalence of depression (21.6%, 20.6%, 16.8%, and 15.5%, respectively; P trend < 0.001) and complicated grief (15.9%, 16.4%, 12.8%, and 12.9%, respectively; P trend < 0.001). Conclusions: EOL discussions may contribute to decrease depression and complicated grief in bereaved families. EOL discussions should be initiated with advanced cancer patients when physicians expect a patient’s prognosis is limited to several months.

scholarly journals Transforming the Intensive Care Culture Using the Palliative Approach

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Diane Guay ◽  
Cécile Michaud ◽  
Luc Mathieu ◽  
Jacinthe Pepin
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Intensive Care ◽  
Human Life ◽  
Qualitative Inquiry ◽  
Decision Making Process ◽  
Innovative Strategy ◽  
Care Approach ◽  
Main Components ◽  
Care Culture

Introduction: Although the ultimate goal of the intensive care unit (ICU) is to save and prolong human life, the integration of palliative care approach in this fast-paced highly technologic environment is increasingly recognized as a means of restoring the global nature of care and enhances the integrity of the person. In this perspective, a recent study showed that three conditions promote the integration of palliative care in the ICU: sharing a common vision, a collaborative decision-making process and a proper environment.Objective: In light of these findings, this study proposes to develop, implement and evaluate an intervention to integrate these previously identified conditions. The purpose of this communication is to present our approach and its main results.Method: Based on the premise that research and action can coexist to improve practice, a qualitative inquiry of action research was chosen for this study. Valuing the consensual decision-making process, this research method provides an organizational structure allowing success and sustainability of this intervention.Results: The intervention aims to improve the quality of interdisciplinary communication and consisted of two main components. The first propose to enhance the skills and leadership of nurses through interactive training and the second focused on the improvement of intra and inter disciplinary intervention plan.Conclusions: The integration of the palliative care approach in the ICU is definitely an innovative strategy to transform the mission of the ICU caregivers and improve the care of the whole person.

Supportive and Palliative Oncology—A New Paradigm for Comprehensive Cancer Care

2013 ◽  
Vol 09 (01) ◽  
pp. 68 ◽  
Author(s):  
David Hui ◽  
Eduardo Bruera ◽  
◽  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Life Quality ◽  
Symptom Burden ◽  
Tumor Burden ◽  
Cost Of Care ◽  
New Paradigm ◽  
Interprofessional Teamwork

Patients with advanced cancer often experience symptoms related to increasing tumor burden, cancer treatments, and psychosocial stressors. They also have significant social, informational, and decision-making needs. Palliative care practitioners have developed expertise to address many of these supportive care concerns through interprofessional teamwork, validated assessments, multidimensional interventions, and frequent communication. In this article, we aim to provide an evidence-based update on several important palliative care topics, including management of pain, fatigue, anorexia–cachexia, depression, and anxiety, as well as patient–clinician communication and decision-making. Multiple randomized controlled trials have demonstrated that palliative care can improve symptom burden, quality of life, quality of care, satisfaction, and possibly survival and cost of care. To enhance the level of care for patients with advanced cancer, oncologists need to have a good working knowledge of the major palliative care principles, and to refer patients to palliative care programs often and early in the disease trajectory.

Applied Pervasive Patient Timeline in Intensive Care Units

2017 ◽  
Vol 6 (2) ◽  
pp. 17-28
Author(s):  
André Braga ◽  
Filipe Portela ◽  
Manuel Filipe Santos ◽  
António Abelha ◽  
José Machado ◽  
...  
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Daily Activity ◽  
Vital Signs ◽  
Decision Making Process ◽  
Care Environment ◽  
Laboratory Results ◽  
Future Condition

This study has the objective of introducing an innovative way of presenting and representing information concerning patients in Intensive Care Units. Therefore, the Pervasive Patient Timeline, which has the purpose of offering support to intensivists' decision-making process, by providing access to a real-time environment, was developed. The solution is patient-centred as it can be accessed from anywhere, at any time and it contains patients' clinical data since they are admitted to the ICU until their discharge. The environment holds data concerning vital signs, laboratory results, therapeutics, and data mining predictions, which can be analysed to have a better understanding of patients' present and future condition. Due to the nature of the critical care environment, the pervasive aspect is crucial because it allows intensivists make decisions when they have to be made. The Pervasive Patient Timeline is focused on improving the quality of care by helping the intensivists perform better in their daily activity.

Decisional control preferences of patients with advanced cancer receiving palliative care

2017 ◽  
Vol 16 (5) ◽  
pp. 544-551 ◽  
Author(s):  
Colombe Tricou ◽  
Sriram Yennu ◽  
Murielle Ruer ◽  
Eduardo Bruera ◽  
Marilène Filbet
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Advanced Cancer ◽  
Outpatient Setting ◽  
Decision Making Process ◽  
Advanced Cancer Patients ◽  
Decisional Control ◽  
Decision Control ◽  
Decision Making Processes ◽  
Understanding Of Illness

ABSTRACTObjective:Understanding patients' decisional control preferences (DCPs) is important to improving the quality of care and the satisfaction of patients who have advanced cancer with their care. In addition to passive decisional control (i.e., the patient prefers his/her doctor or family caregiver to make a decision on their behalf) and active decisional control (i.e., the patient decides alone), shared decisional control, where patients and caregivers decide together, could be more appropriate. The primary aim of our study was to describe the decision-making process and the DCPs of patients with advanced cancer receiving palliative care in France.Method:We conducted a prospective survey with advanced cancer patients referred to a palliative care team in an outpatient setting. We collected information about patients' demographic and clinical characteristics using the Decision Control Preference Scale, the Satisfaction with the Decisions and Care questionnaire, and the Understanding of Illness questionnaire.Results:A total of 200 patients were evaluable. The median age was 63.5 years and 53.5% female. The cancers most commonly represented were gastrointestinal and breast. A total of 72 patients (36.2%) preferred active decisional control, 52 (26.1%) preferred shared decisional control, and 75 (37.7%) preferred passive decisional control. Younger age (p = 0.003), higher education (p < 0.001), and employment status (p = 0.046) were found to be associated with active or shared DCPs. Some 82% of patients were satisfied with the decision-making process, 35% of whom expressed wishes that did not match the actual decision-making process. Only 23% of patients thought they could be cured of their illness, and 47% thought that their treatment would “get rid of ” their disease.Significance of Results:The decision-making processes are shared in the three models of DCPs in our cohort of French patients with advanced cancer. Further prospective studies are needed.

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