Effect of race on the quantity and timing of end-of-life discussions in pediatric oncology

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20004-20004
Author(s):  
J. N. Baker ◽  
P. S. Hinds ◽  
C. A. Zawistowski ◽  
S. Rai ◽  
Y. Ma ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Pediatric Oncology ◽  
Retrospective Chart Review ◽  
Time Of Death ◽  
Oncology Patients ◽  
Eligibility Criteria ◽  
Tertiary Referral Center ◽  
Chi Squared ◽  
Eol Care

20004 Background: Clinicians and parents report that end-of-life (EoL) care discussions and decision making are complex, difficult and affected by personal, family, and disease and treatment factors. The influence of race on EoL discussions and decision making has not been carefully examined in a large pediatric oncology study. The purpose of this study was to assess if race (white, black, Hispanic) influenced the quantity or timing of end-of-life care discussions and decisions. Methods: This abstract represents a retrospective chart review leading to the creation of an EoL database of pediatric oncology patients at St Jude Children’s Research Hospital who died during the time period of July 01, 2001 to February 28, 2005. Eligibility criteria were oncologic diagnosis, and patient age less than 21.99 years of age at the time of death. After strict application of the eligibility criteria, a total of 380 patients met study inclusion criteria. The effect of race on the quantity and timing of EoL discussions and decision making was then analyzed from the database. All extracted data were validated by a different team member as was the accuracy of all entered data. The association of race with other factors was assessed using regression analysis and chi-squared testing statistics. Results: None of the following differed by race: the total number of EoL discussions before an EoL decision was made (p=0.58); the total time from the first such discussion to a specific EoL decision (p=0.23–0.68), the total time from the first discussion to the patient’s death (p=0.105), or having a DNR in place at the time of death (p=0.55). Conclusions: In this cohort of patients from a tertiary referral center, race is not a significant factor on the quantity and timing of EoL discussions and decision making in pediatric oncology patients. [Table: see text] No significant financial relationships to disclose.

Therapy discontinuation processes in a gynecologic oncology population.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11611-11611
Author(s):  
Catherine H. Watson ◽  
Allison Puechl ◽  
Tracy Truong ◽  
Stephanie Lim ◽  
Laura Jean Havrilesky ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Gynecologic Oncology ◽  
Retrospective Chart Review ◽  
Outpatient Setting ◽  
Post Intervention ◽  
Therapy Discontinuation ◽  
Oncology Patients ◽  
Improvement Project ◽  
Definitive Therapy

11611 Background: The decision to discontinue anti-cancer therapies in oncology patients is a complex one and may occur in several unique ways. We sought to understand the processes of therapy discontinuation in a gynecologic oncology population and to discern possible changes in the distribution of these processes after implementation of a palliative care (PC) quality improvement project. Methods: Women with incurable gynecologic malignancies seen in the outpatient setting at an academic center were identified with the recommendation for ‘goals of care’ discussion within 3 visits following identification. Processes of discontinuing chemotherapy for this population were assessed and categorized into 1 of 4 categories: definitive outpatient decision, definitive inpatient decision, interruption by hospitalization, treatment holiday, and “no decision.” Retrospective chart review identified a similar cohort of women prior to the implementation of our PC intervention. Univariate analyses were conducted to determine associations between characteristics and binary outcome of definitive outpatient decision versus all other decision processes. Results: 90/102 (88%) pre-intervention subjects and 83/157 (53%) post-intervention subjects had died at time of analysis. Of the total deceased cohort, 59/173 (34%) made a definitive decision to stop therapy in the outpatient setting. After implementation of the PC initiative, there was a trend towards fewer women identified as having made “no decision” (18.1% vs 30%). Those who made a definitive outpatient decision were less likely to die within 30 days of hospitalization than those who did not (OR 0.16 [95% CI 0.07,0.390], p < 0.0001). Conclusions: Discontinuation of therapy is a nuanced concept in gynecologic oncology patients that can be stratified into several processes. While our data demonstrates a possible increase in active decision-making with the PC initiative, a majority of patients near the end of life still did not make definitive therapy cessation decisions. This reveals an urgent need for the development of initiatives to enhance patient engagement and shared decision making for women near the end of life.

scholarly journals Transitions in decision-making authority at the end of life: a problem of law, ethics and practice in deceased donation

2020 ◽  
pp. medethics-2020-106572
Author(s):  
Shih-Ning Then ◽  
Dominique E Martin
Keyword(s):  
Decision Making ◽  
Organ Donation ◽  
End Of Life ◽  
Decision Maker ◽  
Legal Authority ◽  
Time Of Death ◽  
Medical Decisions ◽  
Ethical Concerns ◽  
Decision Making Capacity ◽  
Practical Implications

Where a person is unable to make medical decisions for themselves, law and practice allows others to make decisions on their behalf. This is common at the end of a person’s life where decision-making capacity is often lost. A further, and separate, decision that is often considered at the time of death (and often preceding death) is whether the person wanted to act as an organ or tissue donor. However, in some jurisdictions, the lawful decision-maker for the donation decision (the ‘donation decision-maker’) is different from the person who was granted decision-making authority for medical decisions during the person’s life. To date, little attention has been given in the literature to the ethical concerns and practical problems that arise where this shift in legal authority occurs. Such a change in decision-making authority is particularly problematic where premortem measures are suggested to maximise the chances of a successful organ donation. This paper examines this shift in decision-making authority and discusses the legal, ethical and practical implications of such frameworks.

Patient autonomy and participation in end-of-life decision-making: An interpretive-systemic focus group study on perspectives of Asian healthcare professionals

2019 ◽  
Vol 18 (4) ◽  
pp. 425-430 ◽  
Author(s):  
Oindrila Dutta ◽  
Priya Lall ◽  
Paul Victor Patinadan ◽  
Josip Car ◽  
Chan Kee Low ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Patient Autonomy ◽  
Healthcare Professionals ◽  
Program Effectiveness ◽  
Self Determination ◽  
Truth Telling ◽  
Focus Group Study ◽  
Eol Care ◽  
Care Decision

AbstractObjectivesAsia's first national advance care planning (ACP) program was established in Singapore in 2011 to enhance patient autonomy and self-determination in end-of-life (EoL) care decision-making. However, no known study has examined the extent to which ACP in Singapore successfully met its aims. The purpose of the current study was to examine the attitudes of local healthcare professionals on patients’ autonomy in decision-making at the EoL since they strongly influence the extent to which patient and family wishes are fulfilled.MethodsGuided by the Interpretive-Systemic Framework and Proctor's conceptual taxonomy of implementation research outcomes, an interview guide was developed. Inquiries focused on healthcare professionals’ attitudes towards ACP, their clinical experiences working with patients and families, and their views on program effectiveness. Sixty-three physicians, nurses, medical social workers, and designated ACP coordinators who were actively engaged in ACP facilitation were recruited from seven major hospitals and specialist centers in Singapore through purposive sampling. Twelve interpretive-systemic focus groups were conducted, recorded, transcribed, and analyzed using a thematic analysis.ResultsThe extent to which patients in Singapore can exert autonomy in EoL care decision-making is influenced by five themes: (i) collusion over truth-telling to patient, (ii) deferment of autonomy by patients, (iii) negotiating patient self-determination, (iv) relational autonomy as the gold standard and (v) barriers to realization of patient choices.Significance of resultsHealthcare practitioners in Asian communities must align themselves with the values and needs of patients and their family and jointly make decisions that are consistent and congruent with the values of patients and their families. Sensitivity towards such cross-cultural practices is key to enhancing ACP awareness, discourse, and acceptability in Asian communities.

scholarly journals Pediatric Cancer Outcomes in an Intensive Care Unit in Pakistan

2019 ◽  
pp. 1-5
Author(s):  
Gull Zareen Khan Sial ◽  
Saadiya Javed Khan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Developing Countries ◽  
Intensive Care ◽  
Pediatric Oncology ◽  
Retrospective Chart Review ◽  
Developed Countries ◽  
Therapeutic Interventions ◽  
Disease Stage ◽  
Oncology Patients

PURPOSE Although cancer is uncommon, it is a significant cause of pediatric morbidity and mortality in the developing world. The need for intensive care in pediatric oncology has increased with more intense chemotherapeutic interventions. It is important to identify patients who will benefit from management in the intensive care unit (ICU), given the resource limitation in developing countries. In this review, we examine our institutional experience with pediatric patients with cancer needing ICU care. METHODS A retrospective chart review from December 2015 to June 2017 was performed with institutional review board approval for all pediatric oncology patients admitted to the ICU. Data collection included age, diagnosis, disease stage, Pediatric Risk of Mortality (PRISM III) score, and therapeutic interventions. RESULTS We reviewed 59 pediatric oncology ICU medical records. There were 36 boys (61%) and 23 girls (39%). The median age was 4 years. Average stay in the ICU was 4.6 days. Three significant reasons for ICU referral were respiratory distress, sepsis, and circulatory collapse. There were 34 ICU survivors (57.6%). Among those who survived the ICU, 20 patients (58.8%) later died of therapy-related complications. Factors related to increased ICU mortality included the need for mechanical ventilation, the need for inotropic support, the number of failing organs, and a high PRISM III score. CONCLUSION The mortality rate for pediatric oncology patients admitted to the ICU in developing countries is higher than in developed countries. Mortality was significantly related to the need for mechanical ventilation. PRISM III scoring can help identify patients who can benefit from ICU treatment, which is expensive in resource-limited low- and middle-income countries such as Pakistan.

Gender Differences in End-of-Life Care in Older Mexican American Adults

2020 ◽  
Vol 35 (4) ◽  
pp. 256-266
Author(s):  
Evangeline M. Ortiz-Dowling ◽  
Janice D. Crist ◽  
Kimberly Shea ◽  
Linda R. Phillips
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Health Care Professionals ◽  
Mexican Americans ◽  
Mexican American ◽  
A Priori ◽  
The United States ◽  
Review Articles ◽  
And Gender ◽  
Eol Care

Mexican Americans (MAs), 1 of 10 subgroups of Latinos, are the largest and fastest growing Latino subgroup in the United States; yet, their access to end-of-life (EOL) care using hospice services is low. An investigation was needed into extant research-based knowledge about factors influencing EOL care decisions among MAs to guide health-care professionals in assisting MAs to make timely, acceptable, and satisfactory EOL care decisions. To determine whether gender was an influence on EOL decision-making among older MAs, CINAHL and PubMed were searched for articles published between 1994 and 2018. Relevant sources were also identified through the reference lists of review articles. Reports were included if they were written in English, involved participants aged 50 years and older who identified themselves as MA, and data derived directly from participants. Reports in which MAs were not equally represented in the sample, large databases, and instrumentation development and testing articles were excluded. Of the 345 unduplicated articles identified in our electronic search and the 47 identified through review articles, 22 met the inclusion criteria. Content analysis was conducted using a priori codes from the Ethno-Cultural Gerontological Nursing Model (ECGNM). Only 8 (36%) of the 22 articles reported on MA older adults’ gendered experiences related to EOL decision-making. Results indicate an association between gender and EOL decision-making. As the older MA population grows, tackling disparities in EOL services use requires attention to how culture and gender influence EOL decision-making and care.

Impact of palliative care on end-of-life management of cancer patients dying in the hospital.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20613-e20613
Author(s):  
Syed Mustafa Karim ◽  
Jamal M Zekri ◽  
Ehab Mosaad Abdelghany ◽  
Azhar Rizvi ◽  
Aboelkhair Al-Gahmi ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Healthcare Providers ◽  
Time Of Death ◽  
Chi Square ◽  
Palliative Care Teams ◽  
Palliative Care Services ◽  
Chi Square Test ◽  
Eol Care

e20613 Background: A substantial number of cancer patients receive inpatient care at the end-of-life (EoL). Involvement of palliative care teams during the course of cancer treatment has been shown to improve quality of life (QoL) in cancer patients. In this study, we compare the EoL care of cancer patients dying in the hospital under medical oncology (MO) and palliative care (PC) services. Methods: A retrospective review of medical records of adult cancer patients who received chemotherapy during their illness and died in our hospital between January 2010 and January 2012 was conducted. The quality metrics measured as endpoints were: chemotherapy given within 21 days of death, death in the ICU, CPR at time of death, and time from last chemotherapy to death (TLCD). These endpoints were compared between patients who died under the MO service (cohort A) and those dying under PC service (cohort B). Chi-square test and T-test were used to compare the endpoints between the two cohorts. Results: Of the 106 cancer patients who died in the hospital, 40 and 66 were in cohorts A and B respectively. 30% of all patients were 65 years of age or older, and were equally distributed between the two cohorts. Patients in cohort A were more likely to receive chemotherapy within last 3 weeks of life (27.5% versus 7.5%, p=0.012, 95% CI 4.16-37.15), to have CPR at time of death (15% versus 0%, p=0.005, 95% CI 4.2-29.8) and to die in the ICU (52.5% versus 1.5%, p=<0.001, 95% CI 33.3-67.1) as compared to patients in cohort B. The average time from last chemotherapy to death was significantly longer (221 days) for cohort B patients as compared to cohort A patients (96 days), p=0.01. Patients in cohort A who had PC consultation during their hospitalization had no differences in the measured endpoints when compared to patients in cohort B. Conclusions: Cancer patients who die in the hospital while under MO service without PC involvement tend to have more aggressive EoL care. This may impact negatively on some QoL features. Early referral to palliative care services may facilitate better understanding and fulfillment of the needs of cancer patients and their caregivers by the healthcare-providers.

End-of-life care decisions using Korean advance directives among cancer patient-caregiver dyads.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 11-11
Author(s):  
Su-Jin Koh ◽  
Shinmi Kim ◽  
JinShil Kim
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Directives ◽  
Adult Children ◽  
Hospice Care ◽  
Artificial Ventilation ◽  
Tube Feeding ◽  
Final Sample ◽  
Advanced Stage Cancer ◽  
Eol Care

11 Background: The Korean advance directives (K-ADs) consist of a value statement, treatment directives (cardiopulmonary resuscitation [CPR], preferences for artificial ventilation, tube feeding, and hospice care). K-ADs can facilitate a patient’s decision-making for end-of-life (EOL) care. This study aims to examine the extent to which patient-caregiver dyads agreed on decisions for EOL care using the K-ADs. Methods: Using a descriptive study design, 81 cancer patients were invited to participate. The final sample consisted of 44 patient-caregiver dyads who completed K-ADs; 36 (44.4%) of the initial 81 patients declined to participate. Results: Patient participants had different cancerdiagnoses: 29.5% colorectal cancer, 29.5% breast, and 15.9% liver/biliary tract cancers; 59% of the sample had advanced stage cancer. Spouse (70.5%) and adult children of the patient (20.4%) were primary caregivers with perceived bonding rated as fair (31.8%) or good (65.9%). Rejection of K-ADs was mainly because of difficulty in deciding EOL care (50%). Comfort in dying was the most common theme of the value statement for patients (73.8%) and caregivers (66.7%). For treatment directives, dyads advocated for hospice care (66.7%) and reduced support for aggressive treatments of CPR or artificial ventilation, k = .43, p = .004 and k = .28, p = .046, respectively. These approaches showed significantly mild to moderate concordance among the dyads. Sixteen out of the 21 dyads identified their spouses as a proxy, with others designating their adult children. Conclusions: The findings of the study are exploratory but suggest the need for ongoing EOL discussion where patient-caregiver dyads are encouraged to participate in the decision-making for EOL care.

scholarly journals Toward Optimal End-of-Life Care for Patients with Advanced Chronic Obstructive Pulmonary Disease: Insights from a Multicentre Study

2008 ◽  
Vol 15 (5) ◽  
pp. 249-254 ◽  
Author(s):  
Graeme M Rocker ◽  
Peter M Dodek ◽  
Daren K Heyland ◽  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Decision Making ◽  
End Of Life ◽  
Pulmonary Disease ◽  
Life Support ◽  
Symptom Relief ◽  
Symptom Control ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Eol Care

BACKGROUND: Understanding patients’ needs and perspectives is fundamental to improving end-of-life (EOL) care. However, little is known of what quality care means to patients who have advanced lung disease.OBJECTIVES: To describe ratings of importance and satisfaction with elements of EOL care, informational needs, decision-making preferences, obstacles to a preferred location of death, clinical outcomes, and health care use before and during an index hospital admission for patients who have advanced chronic obstructive pulmonary disease (COPD).METHODS: A questionnaire with regard to quality EOL care was administered to patients older than 55 years of age who had advanced medical disease in five Canadian teaching hospitals.RESULTS: For 118 hospitalized patients who had advanced COPD, the following items were rated as extremely important for EOL care: not being kept alive on life support when there is little hope for meaningful recovery (54.9% of respondents), symptom relief (46.6%), provision of care and health services after discharge (40.0%), trust and confidence in physicians (39.7%), and not being a burden on caregivers (39.6%). Compared with patients who had metastatic cancer, patients with COPD had lower (P<0.05) satisfaction with care, interest in information about prognosis, cardiopulmonary resuscitation or mechanical ventilation, and referral rates to palliative care, whereas use of acute care services was higher (P<0.05) for patients who had advanced COPD.CONCLUSION: Canadian patients who have advanced COPD identify several priorities for improving care. Avoidance of prolonged or unwanted life support requires more effective communication, decision making and goal setting. Patients also deserve better symptom control and postdischarge strategies to minimize perceived burdens on caregivers, emergency room visits and hospital admissions.

Pleurodesis for effusions in pediatric oncology patients at end of life

2007 ◽  
Vol 37 (3) ◽  
pp. 269-273 ◽  
Author(s):  
Fredric A. Hoffer ◽  
Michael L. Hancock ◽  
Pamela S. Hinds ◽  
Nikita Oigbokie ◽  
Shesh N. Rai ◽  
...  
Keyword(s):  
End Of Life ◽  
Pediatric Oncology ◽  
Oncology Patients

Factors that Influence End-Of-Life Decision Making Amongst Attending Physicians

2021 ◽  
pp. 104990912110638
Author(s):  
Suraj Pai ◽  
Tracy Andrews ◽  
Amber Turner ◽  
Aziz Merchant ◽  
Michael Shapiro
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Work Experience ◽  
Assisted Suicide ◽  
Online Survey ◽  
Care Physician ◽  
University Hospital ◽  
Physician Assisted Suicide ◽  
Eol Care ◽  
Attending Physicians

Background: Medical advances prolong life and treat illness but many patients have chronically debilitating conditions that prevent them from making end-of-life (EOL) decisions for themselves. These situations are difficult to navigate for both patient and physician. This study investigates physicians’ feelings and approach toward EOL care, physician-assisted suicide (PAS), and euthanasia. Methods: An anonymous, self-administered online survey was distributed through the New Jersey Medical School servers and American College of Surgeons forums. The survey presented clinical EOL vignettes and subjective questions regarding PAS and euthanasia. Results: We obtained 142 responses from attending physicians. Respondents were typically male (61%), married (85%), identified as Christian (54%), had more than 20 years of experience (55%), and worked at a university hospital (57%). Religious beliefs and years of work experience seemed to be significant contributors in EOL decision making, whereas gender and medical specialty were not significantly influential. Conclusion: Factors such as years of work experience and religious belief may influence medical professionals’ opinions about PAS and euthanasia and their subsequent actions regarding EOL care. In many cases, the boundaries are blurred and require further study before concrete conclusions can be made.

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