End-of-Life Care of Persons With Alzheimer Disease: An Update for Clinicians

2019 ◽  
Vol 37 (4) ◽  
pp. 314-317
Author(s):  
Eric Trinh ◽  
Andrew Lee ◽  
Kye Y. Kim
Keyword(s):  
Alzheimer Disease ◽  
End Of Life ◽  
End Of Life Care ◽  
Behavioral Symptoms ◽  
Terminal Cancer ◽  
Food Refusal ◽  
Life Care ◽  
Clinical Issues ◽  
End Stage ◽  
Eol Care

While end-of-life (EOL) care has been a relatively common option for patients with terminal cancer, the utilization of EOL care in Alzheimer disease and other dementias has become available more recently. By the time end-stage dementia is present, the clinicians and caregivers become faced with multiple clinical issues—their inability to provide subjective complaints of pain and discomfort, behavioral symptoms, delirium, food refusal, and so on. In addition to providing quality EOL care to the patients, clinicians need to work with their families in an open and empathic manner, assuring that their loved ones will receive supportive measures to keep them comfortable.

scholarly journals Preferences for End-of-life Care among Terminal Cancer Patients in China: A Discrete Choice Experiment

2021 ◽  
Author(s):  
Anli Leng ◽  
Elizabeth Maitland ◽  
Siyuan Wang ◽  
Stephen Nicholas ◽  
Kuixu Lan ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
End Of Life Care ◽  
Life Extension ◽  
Terminal Cancer ◽  
Life Care ◽  
Patient Centered ◽  
Terminal Cancer Patients ◽  
Eol Care

Abstract Background Knowing terminal cancer patients’ treatment preferences will improve patient-centered health care, better inform surrogates and medical staff of patient preferences and enhance the quality of end-of-life (EoL) care. In China, little is known about terminal cancer patients’ preferences. We aimed to examines the preferences for EoL care of terminal cancer patients. Methods Data on 183 terminal cancer patients aged over 50 years old was collected by discrete choice experiment (DCE). Each DCE scenario described six attributes: hospitalization days,life extension, quality of life (QoL), adverse treatment reactions, place of death preference and out-of-pocket payments.Patient preferences were derived using a mixed logit model and the marginal willingness to pay (WTP) were estimated from the regression coefficients. Results Patients’ preferences for moderate survive time, better quality of life, lower risk of adverse reaction, home death and lower payments were all statistically significant in driving choice between treatment models. Extending life and QoL were the most important attributes. Patients were willing to pay RMB256,895.45 to improve QoL from a bad level to a very good level, significantly higher than their willingness to pay for half additional life year (RMB233,446.16) and one additional life year (RMB182,298.76). This indicates that patients were not willing to blindly pursue life extension and neglect the QoL,but preferred to trade off life extension for QoL. The predicted uptake of optimal end-of-life care scenario was 91.04%. Conclusions Our study contributes to the development of patient-centered preferences for end-of-life care models that improve advanced terminal patient’s care and provide empirical evidence for physicians and surrogates to operationalize end-of-life care trade-offs.

End of Life Care: A Curricular and Practice Need

2012 ◽  
Vol 46 (3) ◽  
pp. 117-121 ◽  
Author(s):  
SK Jindal
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Symptomatic Relief ◽  
Terminal Phase ◽  
Life Care ◽  
Secondary Importance ◽  
Moral Principles ◽  
Stage Disease ◽  
End Stage ◽  
Eol Care

ABSTRACT End of life (EOL) care is a subset of palliative care during the terminal phase of an illness. It primarily aims to provide psychosocial supports and symptomatic relief employing a step-ladder approach to management of physical pain, breathlessness and other distressing symptoms. Futile aggressive and invasive treatments are either withheld or withdrawn. The EOL care accepts the principles of stopping disease-modifying therapy after all possible reversible factors of the illness are excluded. It does not imply the non-use of curative treatment whenever it is considered useful. In case of the ‘double-effect’ of a drug, it gives preference to symptomrelieving over the harmful effects, which are accepted as of secondary importance. EOL care is governed by well established moral principles and individual's freedom of choice. It allows the normal and natural process of death to happen for an incurable and end-stage disease. How to cite this article Jindal SK. End of Life Care: A Curricular and Practice Need. J Postgrad Med Edu Res 2012;46(3): 117-121.

Serious Mental Illness and Hospice Care

2021 ◽  
pp. 082585972110220
Author(s):  
Gwen Levitt
Keyword(s):  
Mental Health ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychiatric Illness ◽  
Hospice Care ◽  
Treatment Options ◽  
Life Care ◽  
Case Review ◽  
Health Community ◽  
End Stage

There are a small number of articles in the literature discussing palliative and end-of-life care in the SMI population. Most tackle the questions relating to competency to refuse care in end-stage anorexia or terminal medical conditions. This is a case review of a 55 year old patient with a complex psychiatric and medical history, who despite extensive treatment and long hospitalizations has failed to regain any ability to care for her basic needs. She has exhausted all available treatment options and her prognosis is extremely poor. The mental health community is resistant to discussing and/ or confronting the fact that such a patient faces with the need for end-of-life care directly related to chronic psychiatric illness.

scholarly journals Caregiver evaluation of the quality of end-of-life care (CEQUEL) scale: The caregiver’s perception of patient care near death.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6573-6573
Author(s):  
Philip C Higgins ◽  
Holly Gwen Prigerson
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Convergent Validity ◽  
Risk Indicator ◽  
Life Care ◽  
Trauma Symptoms ◽  
Prospective Longitudinal Study ◽  
Eol Care ◽  
Prospective Longitudinal

6573 Background: End-of-life (EOL) measures are limited in capturing caregiver assessment of the quality of EOL care. None include caregiver perception of patient suffering and prolongation of death. We developed and validated the Caregiver Evaluation of Quality of End-of-Life Care (CEQUEL) scale, a more comprehensive measure of caregiver-perceived quality of EOL care. Methods: Data were derived from Coping with Cancer (CwC), a multisite, prospective, longitudinal study of advanced cancer patients and their caregivers (N=275 dyads). Caregivers were assessed before and after patient deaths. CEQUEL’s factor structure was examined; reliability was evaluated using Cronbach’s α, and convergent validity by the strength of associations between CEQUEL scores and key EOL outcomes. Results: Factor analysis revealed four distinct factors: Prolongation of Death, Perceived Suffering, Shared Decision-Making, and Preparation for the Death. Each item loaded strongly on only a single factor. The 13-item CEQUEL and its subscales showed moderate to acceptable Cronbach’s α (range: 0.52-0.78). 53% of caregivers reported patients suffering more than expected. Higher CEQUEL scores were positively associated with therapeutic alliance (r=.13; p≤.05) and hospice enrollment (z=-2.09; p≤.05), and negatively associated with bereaved caregiver regret (r=-.36, p≤.001) and trauma symptoms (z=-2.06; p≤.05). Conclusions: CEQUEL is a brief, valid measure of quality of EOL care from the caregiver’s perspective. It is the first scale to include perceived suffering and prolongation of death. If validated in future work, it may prove a useful quality indicator for the delivery of EOL care and a risk indicator for poor bereavement adjustment.

scholarly journals Preferences for Advance Directives in Korea

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
So-Sun Kim ◽  
Won-Hee Lee ◽  
JooYoung Cheon ◽  
Jung-Eun Lee ◽  
KiSun Yeo ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Healthcare Providers ◽  
Tube Feeding ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Korean People ◽  
End Stage

Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea.Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0.Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care.Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

scholarly journals Low Socioeconomic Status Is Associated With More Aggressive End‐of‐Life Care for Working‐Age Terminal Cancer Patients

2014 ◽  
Vol 19 (12) ◽  
pp. 1241-1248 ◽  
Author(s):  
Chun‐Ming Chang ◽  
Chin‐Chia Wu ◽  
Wen‐Yao Yin ◽  
Shiun‐Yang Juang ◽  
Chia‐Hui Yu ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
End Of Life ◽  
Cancer Patients ◽  
Low Socioeconomic Status ◽  
End Of Life Care ◽  
Terminal Cancer ◽  
Life Care ◽  
Low Socioeconomic ◽  
Terminal Cancer Patients ◽  
Working Age

Hospice Use and End-of-Life Care for Patients With End-stage Renal Disease

2018 ◽  
Vol 178 (6) ◽  
pp. 799 ◽  
Author(s):  
Margaret L. Schwarze ◽  
Kate Schueller ◽  
R. Allan Jhagroo
Keyword(s):  
Renal Disease ◽  
End Of Life ◽  
End Stage Renal Disease ◽  
End Of Life Care ◽  
Life Care ◽  
Hospice Use ◽  
Stage Renal Disease ◽  
End Stage
Sign in / Sign up

Export Citation Format

Share Document