Short Report: Preferences for location of death of seriously ill hospitalized patients: perspectives from Canadian patients and their family caregivers

Abstract Family caregivers often serve as unpaid members of the home- and community-based care workforce for individuals with serious illness; as key partners in the home-clinic continuum, they should be included in healthcare teams. Without formal recognition, inconsistent identification of caregivers will remain, engendering communication gaps between caregivers and providers and difficulty connecting with supportive services. The Campaign for Inclusive Care is an initiative within the Veterans Administration Health Care System to improve practices for including caregivers in treatment planning and decisions. We define inclusive care using literature review, provider interviews, and a caregiver survey. We found that inclusive care involves clear definition of caregiver role, system policies for inclusion, assessment of caregiver capacity, explicit involvement of caregivers, and mutuality in caregiver/provider communication. We recommend solutions based on the definition, informative for development of a national caregiver strategy, required by the 2018 Recognize, Assist, Include, Support, and Engage Family Caregivers Act.

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A randomized controlled trial of a cardiopulmonary resuscitation (CPR) video decision support tool for seriously ill hospitalized patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.29_suppl.7 ◽

2015 ◽

Vol 33 (29_suppl) ◽

pp. 7-7

Author(s):

Areej El-Jawahri ◽

Jennifer S. Temel ◽

Kavitha Ramchandran ◽

Vicki A. Jackson ◽

Yuchiao Chang ◽

...

Keyword(s):

Decision Support ◽

Advanced Cancer ◽

Controlled Trial ◽

Decision Support Tool ◽

Hospitalized Patients ◽

Support Tool ◽

Randomized Controlled ◽

End Of Life Decision ◽

Seriously Ill ◽

Life Decision

7 Background: Discussing CPR preferences with patients with advanced cancer who are hospitalized is a critical component of end-of-life decision making. However, these discussions are challenging and often avoided by clinicians. We examined the impact of a CPR video decision tool on patients’ choices and knowledge about CPR, and their comfort with watching the video. Methods: We conducted a multi-center randomized controlled trial of 116 patients with advanced cancer hospitalized at two academic oncology centers. We randomized patients to either a 3-minute video describing CPR (n = 52) or standard-oncology care (n = 64). The primary outcome was participants’ preferences for CPR (immediately after viewing the video in the intervention arm). Secondary outcomes included patients’ knowledge (using 5-item questionnaire with higher score reflects greater knowledge), and intervention participants’ comfort with watching the video. Results: The mean age was 66 years (SD = 12); 50% were women, 84% were white, and 48% had lung or gastrointestinal cancer. Only 47% of study participants reported having a discussion about their CPR preferences at the time of admission to the hospital. At baseline, there were no differences in patients’ preferences for not wanting CPR between the intervention and control arms (63% vs. 58%, P = 0.79). After the intervention, participants randomized to the video were more likely not to want CPR (81% vs. 58%, P = 0.03) and were more knowledgeable (mean knowledge score 4.3 vs. 3.2, P < 0.0001) versus control participants. In the intervention arm, 81% of participants found the video helpful, and 94% felt comfortable watching it and would recommend it to others. Conclusions: Seriously ill hospitalized patients with advanced cancer who watched a CPR video decision support tool were more likely not to want CPR and were better informed about their options. Participants reported feeling comfortable watching the video and would recommend it to others facing similar decisions. Video decision support tools can facilitate end-of-life decision-making for hospitalized patients with advanced cancer. Clinical trial information: NCT01527331.

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An Insight to ncovid-19 associated coagulopathy

Current Drug Research Reviews ◽

10.2174/2589977513666211119110148 ◽

2021 ◽

Vol 13 ◽

Author(s):

Sumel Ashique ◽

Tahamina Khatun

Keyword(s):

Clinical Presentation ◽

Degradation Products ◽

Hospitalized Patients ◽

Low Molecular Weight ◽

Hemorrhagic Events ◽

Coagulation Tests ◽

Severe Difficulty ◽

Seriously Ill ◽

Vessel Thrombosis ◽

D Dimer

: Several current studies have highlighted the high occurrence of coagulopathy in nCOVID-19 infection. The corona virus often prompts hypercoagulability along with both microangiopathy and local thrombus development, and systemic coagulation limitation which causes large vessel thrombosis and key thromboembolic issues such as pulmonary embolism in seriously ill hospitalized patients. Based on recent reports, the most severely ill patients present with coagulopathy, and disseminated intravascular coagulation (DIC)-like massive intravascular clot formation is frequently seen in this cohort. Therefore, coagulation tests may be considered useful to discriminate severe cases of nCOVID-19. The clinical presentation of nCOVID-19-associated coagulopathy is organ dysfunction primarily, while hemorrhagic events are less frequent. Changes in hemostatic biomarkers represented by increase in D-dimer and fibrin/fibrinogen degradation products indicate the essence of coagulopathy is massive fibrin formation. Overall, the patients have an increase in venous and arterial thrombotic events especially in ICU patients. Routine thromboprophylaxis with low molecular weight heparin is recommended in all hospitalized patients to reduce the incidence of thrombosis. Though, the importance of thromboembolic impediments has not been extensively spotlighted, thus the rationale of this article is to provide recent information about this severe difficulty. In this article the mechanism of coagulopathy, associated problems and possible therapeutics has been reviewed.

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