Deferred Decision Making: patients’ reliance on family and physicians for cpr decisions in critical care

2005 ◽  
Vol 12 (5) ◽  
pp. 493-506 ◽  
Author(s):  
Su Hyun Kim ◽  
Diane Kjervik
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Odds Ratio ◽  
Daily Living ◽  
Psychological Variables ◽  
Factors Associated ◽  
Decision Making Capacity ◽  
Seriously Ill Patients ◽  
Seriously Ill

The aim of this study was to investigate factors associated with seriously ill patients’ preferences for their family and physicians making resuscitation decisions on their behalf. Using SUPPORT II data, the study revealed that, among 362 seriously ill patients who were experiencing pain, 277 (77%) answered that they would want their family and physicians to make resuscitation decisions for them instead of their own wishes being followed if they were to lose decision-making capacity. Even after controlling for other variables, patients who preferred the option of undergoing cardiopulmonary resuscitation (CPR) in the future were twice as likely, and those who had had ventilator treatment were four-fifths less likely, to rely on their family and physicians than those who did not want CPR (odds ratio (OR)-2.28; 95% confidence interval (CI) 1.18-4.38) or those who had not received ventilator treatment (OR-0.23; 95% CI 0.06-0.90). Psychological variables (anxiety, quality of life, and depression), symptomatic variables (severity of pain and activities of daily living) and the existence of surrogates were not significantly associated with patients’ preferences for having their family and physicians make resuscitation decisions for them. Age was not a significant factor for predicting the decision-making role after controlling for other variables.

scholarly journals 320 - Barriers to Deprescribing in Older Adults with Dementia

2020 ◽  
Vol 32 (S1) ◽  
pp. 78-78
Author(s):  
Mariana Duarte-Mangas ◽  
Gonçalo A. Santos ◽  
Beatriz Jorge ◽  
Catarina Pedro Fernandes
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Chronic Illnesses ◽  
Negative Consequences ◽  
Inappropriate Drugs ◽  
People With Dementia ◽  
Decision Making Capacity ◽  
Multiple Morbidities ◽  
Over Time

Individuals with dementia usually have multiple chronic illnesses, most of whom are medicated with five or more medications. However, as dementia progresses and the goal of care moves from prolonging life to optimizing quality of life, the risk of taking certain medications may outweigh its benefit. Therefore, it is necessary to reassess the medication over time.The objective of this work was to explore the barriers to optimising prescribing and deprescribing (withdrawing) of medications and the benefits of this procedure. Optimizing pharmacological treatment for people with dementia usually requires the prescription of inappropriate drugs and the initiation of other drugs. Several obstacles to the optimization of treatment have been identified in elderly people with multiple morbidities, related to the doctor, the health system, the patient and the caregiver, including: inadequate guidelines, incomplete medical history, prevention of negative consequences and established beliefs in the benefits and harms medication. Desprescribing older people with dementia is made even more difficult by the decrease in decision-making capacity, difficulties in understanding and communicating, increased involvement of caregivers and difficulties in setting goals.

scholarly journals Effect of occupation-based interventions in patients with haematopoietic malignancies undergoing chemotherapy: A pilot randomised controlled trial

2018 ◽  
Vol 31 (2) ◽  
pp. 97-105
Author(s):  
Akira Sagari ◽  
Yuta Ikio ◽  
Nobuko Imamura ◽  
Kayoko Deguchi ◽  
Toko Sakai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Randomised Controlled Trial ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Controlled Trial ◽  
Intervention Group ◽  
Pilot Randomised Controlled Trial ◽  
Randomised Controlled

Background/objective Chemotherapy for cancer negatively affects activities of daily living and quality of life. This study aimed to validate and compare the efficacy of two different interventions in patients with haematopoietic malignancies undergoing chemotherapy: (1) occupation-based interventions, designed using the Aid for Decision-making in Occupation Choice (ADOC) (an iPAD application) and (2) impairment-based interventions. ADOC helps promote decision-making during activities and participation in occupation-based goal setting. The impairment-based intervention group served as the comparison group and underwent impairment-based interventions focusing on dysfunction. Methods In this single-blinded pilot randomised controlled trial, 19 participants received an occupation-based intervention (n = 9) or an impairment-based intervention (n = 10). The treatment period comprised two sessions. Recruitment, compliance and outcome completion rates were calculated for the study. Effect sizes were examined for outcomes regarding physical performance, instrumental activities of daily living and quality of life as evaluated by a blinded assessor. Results In this study, 24.8% (28/113) of the eligible patients with haematopoietic malignancies were enrolled, and 67.9% (19/28) of these were retained up to the post-assessment stage. Recruitment (25%) and compliance (68%) rates were satisfactory. The Functional Assessment of Cancer Therapy-General emotional well-being and total scores were significantly higher for the occupation-based intervention group than for the impairment-based intervention group (both p < 0.05; d = 0.54, d = 0.51, respectively). Other outcomes showed no significant differences. Conclusion Occupation-based interventions designed using the ADOC application were useful for patients with haematopoietic malignancies.

scholarly journals Treatment Decision Regret Among Long-Term Survivors of Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study

2017 ◽  
Vol 35 (20) ◽  
pp. 2306-2314 ◽  
Author(s):  
Richard M. Hoffman ◽  
Mary Lo ◽  
Jack A. Clark ◽  
Peter C. Albertsen ◽  
Michael J. Barry ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Localized Prostate Cancer ◽  
Factors Associated ◽  
Decision Regret ◽  
Long Term Survivors

Purpose To determine the demographic, clinical, decision-making, and quality-of-life factors that are associated with treatment decision regret among long-term survivors of localized prostate cancer. Patients and Methods We evaluated men who were age ≤ 75 years when diagnosed with localized prostate cancer between October 1994 and October 1995 in one of six SEER tumor registries and who completed a 15-year follow-up survey. The survey obtained demographic, socioeconomic, and clinical data and measured treatment decision regret, informed decision making, general- and disease-specific quality of life, health worry, prostate-specific antigen (PSA) concern, and outlook on life. We used multivariable logistic regression analyses to identify factors associated with regret. Results We surveyed 934 participants, 69.3% of known survivors. Among the cohort, 59.1% had low-risk tumor characteristics (PSA < 10 ng/mL and Gleason score < 7), and 89.2% underwent active treatment. Overall, 14.6% expressed treatment decision regret: 8.2% of those whose disease was managed conservatively, 15.0% of those who received surgery, and 16.6% of those who underwent radiotherapy. Factors associated with regret on multivariable analysis included reporting moderate or big sexual function bother (reported by 39.0%; OR, 2.77; 95% CI, 1.51 to 5.0), moderate or big bowel function bother (reported by 7.7%; OR, 2.32; 95% CI, 1.04 to 5.15), and PSA concern (mean score 52.8; OR, 1.01 per point change; 95% CI, 1.00 to 1.02). Increasing age at diagnosis and report of having made an informed treatment decision were inversely associated with regret. Conclusion Regret was a relatively infrequently reported outcome among long-term survivors of localized prostate cancer; however, our results suggest that better informing men about treatment options, in particular, conservative treatment, might help mitigate long-term regret. These findings are timely for men with low-risk cancers who are being encouraged to consider active surveillance.

Do Preparation and Life Completion Discussions Improve Functioning and Quality of Life in Seriously Ill Patients? Pilot Randomized Control Trial

2008 ◽  
Vol 11 (9) ◽  
pp. 1234-1240 ◽  
Author(s):  
Karen E. Steinhauser ◽  
Stewart C. Alexander ◽  
Ira R. Byock ◽  
Linda K. George ◽  
Maren K. Olsen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Control Trial ◽  
Randomized Control ◽  
Seriously Ill Patients ◽  
Pilot Randomized Control Trial ◽  
Seriously Ill

scholarly journals Self-reported activities of daily living, health and quality of life among older adults in South Africa and Uganda: a cross sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sanni Yaya ◽  
Dina Idriss-Wheeler ◽  
N’doh Ashken Sanogo ◽  
Maude Vezina ◽  
Ghose Bishwajit
Keyword(s):  
Quality Of Life ◽  
South Africa ◽  
Activities Of Daily Living ◽  
Odds Ratio ◽  
Daily Living ◽  
Good Health ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Reported Health

Abstract Background Difficulties in performing the activities of daily living (ADL) are common among middle-aged and older adults. Inability to perform the basic tasks as well as increased healthcare expenditure and dependence on care can have debilitating effects on health and quality of life. The objective of this study was to examine the relationship between self-reported difficulty in activities of daily living (ADL), health and quality of life among community-dwelling, older population in South Africa and Uganda. Methods We analyzed cross-sectional data on 1495 men and women from South Africa (n = 514) and Uganda (n = 981) which were extracted from the SAGE Well-Being of Older People Study (WOPS 2011–13). Outcome variables were self-reported health and quality of life (QoL). Difficulty in ADL was assessed by self-reported answers on 12 different questions covering various physical and cognitive aspects. The association between self-reported health and quality of life with ADL difficulties was calculated by using multivariable logistic regression models. Results Overall percentage of good health and good quality of life was 40.4% and 20%, respectively. The percentage of respondents who had 1–3, 3–6, > 6 ADL difficulties were 42.4%7, 30.97% and 14.85%, respectively. In South Africa, having > 6 ADL difficulties was associated with lower odds of good health among men [Odds ratio = 0.331, 95%CI = 0.245,0.448] and quality of life among men [Odds ratio = 0.609, 95%CI = 0.424,0.874] and women [Odds ratio = 0.129, 95%CI = 0.0697,0.240]. In Uganda, having > 6 ADL difficulties was associated lower odds of good health [Odds ratio = 0.364, 95%CI = 0.159,0.835] and quality of life [Odds ratio = 0.584, 95%CI = 0.357,0.954]. Conclusion This study concludes that difficulty in ADL has a significant negative association with health and quality of life among community-dwelling older population (> 50 years) in South Africa and Uganda. The sex differences support previous findings on differential health outcomes among men and women, and underline the importance of designing sex-specific health intervention programs.

Factors associated with quality of life in dementia patients in long-term care

2012 ◽  
Vol 25 (4) ◽  
pp. 577-585 ◽  
Author(s):  
María Crespo ◽  
Carlos Hornillos ◽  
Mónica Bernaldo de Quirós
Keyword(s):  
Quality Of Life ◽  
Nursing Home ◽  
Nursing Homes ◽  
Functional Capacity ◽  
Daily Living ◽  
Close Relative ◽  
Term Care ◽  
Factors Associated ◽  
Staff Members

ABSTRACTBackground: The aim of this study is to describe and determine the factors associated with the quality of life (QoL) of patients with dementia living in nursing homes as perceived by themselves and by proxies (both family and staff).Method: Data on residents with dementia were collected in 11 nursing homes. The Quality of Life-Alzheimer's Disease Scale (QoL-AD) residential version was directly applied to residents with dementia diagnosis and Mini-Mental State Examination score of less than 27, randomly selected in each center. Residents’ QoL was further assessed from the perspective of some close relative and staff member. Altogether, 102 data sets from residents, 184 from relatives, and 197 from staff members were collected.Results: Stepwise multiple linear regression analysis showed that depression and cognitive function were the best predictors of self-rated QoL. Predictors of family-rated QoL were resident's functional capacity to carry out activities of daily living (ADL), the family member paying for the nursing home fees, and use of feeding tubes as part of the resident's care. Predictors of staff-rated QoL were resident's functional capacity to carry out ADL, cognitive impairment and depression, staff-member's work pattern of shifts (rotating vs. permanent) and type of center administration (public vs. private). Explained variance for the three models was 42%, 25% and 41% respectively.Conclusions: The QoL perception by persons with dementia living in a nursing home is mainly affected by their emotional state (depression level), while proxies’ perceptions (both family and staff) are mainly associated with patients’ functional autonomy in daily living. Therefore, perspectives of persons with dementia and their informants are not congruent. Moreover, facility features and family and staff members’ personal features do not affect QoL ratings.

scholarly journals Family Caregivers’ Characterization of Conversations Following an ACP Event

2018 ◽  
Vol 35 (9) ◽  
pp. 1161-1167 ◽  
Author(s):  
Jane R. Schubart ◽  
Jean M. Reading ◽  
Janice Penrod ◽  
Renee R. Stewart ◽  
Ramya Sampath ◽  
...  
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Family Caregivers ◽  
Controlled Trial ◽  
Advanced Illness ◽  
Medical Treatments ◽  
Advance Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

Background: Advance care planning (ACP) has been shown to benefit patients and families, yet little is known about how an ACP event impacts communication and conversation about end-of-life treatment wishes and the content of such conversations between patients and family caregivers. Objective: To characterize post-ACP conversations regarding medical wishes between seriously ill patients and their family caregivers. Participants: Patients with advanced illness and family caregivers. Outcome Measured: Post-ACP conversations. Design: As part of a larger randomized controlled trial, dyads consisting of seriously ill patients and their identified family caregiver engaged in ACP and created an advance directive for the patient. Approximately 4 to 6 weeks later, semistructured interviews were conducted with the family caregivers to elucidate the subsequent communications regarding medical wishes. If the dyad did not have any conversations post-ACP, reasons and barriers were explored. Results: The majority of dyads (131/188, 69.7%) had 2 to 3 conversations lasting 3 to 5 minutes each in the weeks immediately following ACP. These conversations most commonly addressed general patient wishes about quality of life and specific medical treatments. The most common reasons for not having conversations were a general discomfort with the topic (13/57, 22.8%) and previously having discussed medical wishes (16/57, 28.1%). Conclusion: The ACP events promote conversation regarding quality of life, general wishes at the end of life, and specific medical wishes. Barriers to conversation following ACP were similar to barriers to ACP in general, suggesting that a more intentional focus on addressing these barriers pre- and post-ACP may be necessary to improve communication.

scholarly journals Compulsory Interventions in Severe and Persistent Mental Illness: A Survey on Attitudes Among Psychiatrists in Switzerland

2021 ◽  
Vol 12 ◽  
Author(s):  
Julia Stoll ◽  
Martina A. Hodel ◽  
Florian Riese ◽  
Scott A. Irwin ◽  
Paul Hoff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Mental Illness ◽  
Anorexia Nervosa ◽  
Cross Sectional Survey ◽  
Persistent Mental Illness ◽  
Decision Making Capacity ◽  
Case Vignettes ◽  
Persistent Depression

Background: Some psychiatric patients develop severe and persistent mental illness (SPMI), which, for a variety of reasons, can be therapy-refractory. Sometimes, treatment is not considered helpful by the patients themselves and does not improve their subjective quality of life. Furthermore, many SPMI patients experience compulsory interventions such as seclusion, restraint, or treatment against their will, which can cause harm.Methods: In a cross-sectional survey of 1,311 German-speaking psychiatrists in Switzerland, participants were asked about the care of SPMI patients in general, and about their attitudes with regard to compulsory interventions in particular, using three case vignettes of patients with severe and persistent anorexia nervosa, schizophrenia and depression.Results: Out of 1,311 contacted psychiatrists, 457 (34.9%) returned the completed survey. In general, 91.0% found it important or very important to respect SPMI patients' autonomy in decision making. However, based on three different clinical case vignettes, 36.8% of psychiatrists would act against the wishes of the patient with severe and persistent schizophrenia, 34.1% against the wishes of the patient with severe and persistent depression, and 21.1% against the wishes of the patient with severe and persistent anorexia nervosa, although all patients were stated to have preserved decision-making capacity. With regard to the case vignettes, 41.1% considered compulsory interventions leading to a temporary reduction of quality of life acceptable in the patient with severe and persistent schizophrenia, 39.4% in the patient with severe and persistent depression, and 25.6% in the patient with severe and persistent anorexia nervosa, although it was stated in all three case vignettes that two independent experts ascribed the patients decision-making capacity regarding their illness and further treatment.Conclusions: Many psychiatrists in our sample found themselves in an ethical dilemma between autonomy and the provision of medical care. While most respondents respect the autonomy of SPMI patients, many saw the need to perform compulsory interventions even though it was clearly and prominently stated that two independent psychiatrists had ascribed the patients in the case vignettes decision-making capacity. Further examination of these conflicting views is warranted, perhaps along with the development of guidelines for such situations.

Fact file 9: Palliative care

2017 ◽  
Author(s):  
Daisy Fancourt
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Improve Quality ◽  
Spiritual Support ◽  
Life Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

Palliative care is support for seriously ill patients and their families. The aim of palliative care is to minimize pain and discomfort as much as possible and provide psychological, social, and spiritual support. An important part of palliative care is end-of-life care, which aims to improve quality of life as much as possible while patients are alive and then help them to die with dignity....

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