scholarly journals Nursing strategies to reduce the risk of therapeutic obstinacy in artificial nutrition

2019 ◽  
Vol 25 (5) ◽  
pp. 224-231 ◽  
Author(s):  
Tânia dos Santos Afonso ◽  
Filipa Veludo ◽  
Patrícia Pontífice Sousa
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Critical Role ◽  
Disease Process ◽  
Specific Area ◽  
Oral Feeding ◽  
Artificial Nutrition ◽  
Nursing Interventions ◽  
Patient Advocate

Background: Nurses have an important role in maintaining a patient's nutrition near the end of life. Aims: To define nursing nutrition strategies with the person near the end of life and their families; systematise the elements to be considered in artificial nutrition decision-making and evaluate the nursing interventions' influence on therapeutic obstinacy risk. Methods: A sample of 11 articles were selected and the results considered strategies to promote oral feeding before artificial nutrition; the follow-up of the health-disease process by nurses and described the nurse's role as a privileged patient advocate in the defence of the ethical principles of decision-making. These principles consider symptomatology, prognosis, psychology and the emotional significance of nutrition. Conclusion: Nurses are qualified professionals with a critical role in the patient's care due to the proximity they have with the patient; the evidence seems to show a relationship between nursing interventions and the reduction of the risk of therapeutic obstinacy; however, there are no studies in this specific area.

What parents want from doctors in end-of-life decision-making for children

2013 ◽  
Vol 99 (3) ◽  
pp. 216-220 ◽  
Author(s):  
J Sullivan ◽  
P Monagle ◽  
L Gillam
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Decision Maker ◽  
Semistructured Interview ◽  
End Of Life Decisions ◽  
Parental Autonomy ◽  
End Of Life Decision ◽  
Life Decision

ObjectiveEnd-of-life decision-making is difficult for everyone involved, as many studies have shown. Within this complexity, there has been little information on how parents see the role of doctors in end-of-life decision-making for children. This study aimed to examine parents’ views and experiences of end-of-life decision-making.DesignA qualitative method with a semistructured interview design was used.SettingParent participants were living in the community.ParticipantsTwenty-five bereaved parents.Main outcomesParents reported varying roles taken by doctors: being the provider of information without opinion; giving information and advice as to the decision that should be taken; and seemingly being the decision maker for the child. The majority of parents found their child's doctor enabled them to be the ultimate decision maker for their child, which was what they very clearly wanted to be, and consequently enabled them to exercise their parental autonomy. Parents found it problematic when doctors took over decision-making. A less frequently reported, yet significant role for doctors was to affirm decisions after they had been made by parents. Other important aspects of the doctor's role were to provide follow-up support and referral.ConclusionsUnderstanding the role that doctors take in end-of-life decisions, and the subsequent impact of that role from the perspective of parents can form the basis of better informed clinical practice.

Disrupting end-of-life cancer care delivery: Results from the engagment of patients with advanced cancer trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6525-6525
Author(s):  
Manali I. Patel ◽  
Vandana Sundaram ◽  
Manisha Desai ◽  
VJ Periyakoil ◽  
James Kahn ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Healthcare Utilization ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Cancer Care ◽  
Care Planning ◽  
Patient Reported ◽  
Advance Care

6525 Background: Sustainable approaches to improve quality and safety of care of patients with advanced cancer while concurrently reducing costs is a growing national need. As part of the Veterans Administration Engagement of Patients with Advanced Cancer (EPAC) trial, we trained a lay health worker (LHW) to engage patients with stage 3 and 4 cancer in early advance care planning (ACP). The goal of this follow-up study was to examine the effect of the LHW intervention on patient-reported care experiences, healthcare utilization, and costs in the last 30 days of life for patients who died within 15 months of enrollment. Methods: We evaluated patient-reported experiences with decision-making, healthcare utilization, and total healthcare costs 30 days prior to death. A T-test was used to compare patient experiences with decision-making. To compare ED use and hospitalizations, we utilized an exact Poisson regression. A generalized linear model with gamma link-log function was used to compare total costs. The latter methods adjusted for length of follow-up. Results: In the 30 days prior to death, 60 patients died in each arm within 15 months of enrollment (difference not statistically significant). Patients in the intervention had significantly improved rates of ACP documentation (98% versus 18% p < 0.001), improved experiences with decision-making as measured by an index ranging from 0-5 with higher values representing more favorable experience (4.73 (SD 0.61) vs 4.15 (SD 1.02)) p < 0.001), higher utilization of hospice (77% vs 52%, p < 0.005), lower rates of any emergency department use (5% versus 45% p < 0.001) and any hospitalization (5% versus 43% p < 0.001), and significantly lower total costs of care ($1,048 versus $23,482 p < 0.001) compared to the patients randomized to the usual care arm. Conclusions: Integrating a LHW into oncology care to engage patients in early advance care planning resulted in significantly improved patient experience, decreased utilization and decreased total costs in the last month of life. LHWs may represent a sustainable resource to facilitate optimal patient-centered cancer care at the end-of-life. Clinical trial information: NCT02966509.

Effectiveness of end-of-life education among community-dwelling older adults

2010 ◽  
Vol 17 (3) ◽  
pp. 363-372 ◽  
Author(s):  
Miho Matsui
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Intervention Group ◽  
Community Dwelling ◽  
Living Wills ◽  
Artificial Nutrition ◽  
Control Group ◽  
Quasi Experimental ◽  
Life Education

The purpose of this study was to evaluate the effectiveness of an educational intervention regarding end-of-life discussion directed at older Japanese adults and their attitude to and acceptance of this intervention. A quasi-experimental design was used. A total of 121 older adults, aged 65 years and over, consented to participate. Data from 55 intervention and 57 control participants were used for the analysis. The intervention consisted of an education program comprising a video, a lecture using a handout, and discussion among participants. The control group received only the handout. Both groups were followed up after one month. The intervention group’s attitude became more favorable towards advance directives, especially living wills (P = 0.024). In addition, their expression of preference for life-sustaining treatment by means of artificial nutrition was less at follow up, demonstrating that these older adults had become more autonomous (P = 0.008). There was greater acceptance of the intervention as a whole by the intervention group compared with the control group (P = 0.011). Although few participants overall completed living wills, at follow up twice as many in the intervention group had discussed end-of-life matters with family members and/or their physician.

Artificial nutrition and hydration at the end of life: Ethics and evidence

2006 ◽  
Vol 4 (2) ◽  
pp. 135-143 ◽  
Author(s):  
LINDA GANZINI
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Medical Treatments ◽  
Legal Principles ◽  
Feeding Tubes ◽  
Endoscopic Gastrostomy ◽  
Decision Making Capacity ◽  
Nutrition And Hydration

The case of Terri Schiavo resulted in substantial media attention about the use of artificial nutrition and hydration (ANH) especially by percutaneous endoscopic gastrostomy (PEG). In this article, I review ethical and legal principles governing decisions to choose or forgo ANH at the end of life, including issues of autonomy and decision-making capacity, similarities and differences between ANH and other medical treatments, the role of proxies when patients lack decision-making capacity, and the equivalence of withholding and withdrawing treatment. Evidence for palliative or life-sustaining benefits for ANH are reviewed in three disease processes: amyotrophic lateral sclerosis (ALS), cancer, and dementias, including Alzheimer's disease. Although more recent studies suggest a possible palliative role for ANH in ALS and terminal cancer, feeding tubes do not appear to prolong survival or increase comfort in advanced dementia of the Alzheimer's type.

scholarly journals Practice and problems with gastrostomies

2005 ◽  
Vol 64 (3) ◽  
pp. 335-337 ◽  
Author(s):  
Gill McHattie
Keyword(s):  
Acute Care ◽  
Disease Process ◽  
Nutrition Support ◽  
Artificial Nutrition ◽  
Care Community ◽  
Enteral Access ◽  
Mixed Messages ◽  
Definition Of

The development of gastrostomy placement has been an important technological advance in the enteral-access field. However, its rapid growth in popularity could be viewed as problematic. The endoscopist or intervention radiologist can no longer act as a technician but requires to follow-up this group of patients in order to determine outcomes that will inform future practice. There has been emphasis on the importance of the multidisciplinary team in informing and assessing patients referred for gastrostomy insertion. Communication between all the professionals caring for a patient and between the carers and the patient allows information to be collated that will determine the benefits and burdens of long-term gastrostomy feeding. At present much of the published experience is limited to the acute care setting. The incidence of complications varies, depending on the investigator's definition of complication and the diagnosis of the patient group. Many reported studies are retrospective, which puts limitations on documentation. Increasing numbers of patients with diverse needs are now being discharged into the community with gastrostomy tubes in place. Whilst the hospital should ensure that written protocols are provided and that all carers involved should have adequate training, it is not unusual for patients to receive mixed messages from the different care teams responsible for their care. In South Glasgow NHS Hospital Division key members of all teams caring for these patients (acute care, community district nurses, learning disabilities team, physical disabilities team and commercial homecare companies) meet regularly to discuss equipment and protocols. The members of this group feel that this approach has improved communication, standardised practice and reduced complications by providing a service that delivers artificial nutrition support but is primarily suited to the patient's disease process.

scholarly journals Evaluation of exosomal non-coding RNAs in cancer using high-throughput sequencing

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Kamran Hosseini ◽  
Maryam Ranjbar ◽  
Abbas Pirpour Tazehkand ◽  
Parina Asgharian ◽  
Soheila Montazersaheb ◽  
...  
Keyword(s):  
Tumor Markers ◽  
Extracellular Vesicles ◽  
High Throughput Sequencing ◽  
Critical Role ◽  
Disease Process ◽  
Stable Form ◽  
Non Invasive ◽  
Non Coding Rnas ◽  
Next Generation Sequencing Ngs

AbstractClinical oncologists need more reliable and non-invasive diagnostic and prognostic biomarkers to follow-up cancer patients. However, the existing biomarkers are often invasive and costly, emphasizing the need for the development of biomarkers to provide convenient and precise detection. Extracellular vesicles especially exosomes have recently been the focus of translational research to develop non-invasive and reliable biomarkers for several diseases such as cancers, suggesting as a valuable source of tumor markers. Exosomes are nano-sized extracellular vesicles secreted by various living cells that can be found in all body fluids including serum, urine, saliva, cerebrospinal fluid, and ascites. Different molecular and genetic contents of their origin such as nucleic acids, proteins, lipids, and glycans in a stable form make exosomes a promising approach for various cancers’ diagnoses, prediction, and follow-up in a minimally invasive manner. Since exosomes are used by cancer cells for intercellular communication, they play a critical role in the disease process, highlighting the importance of their use as clinically relevant biomarkers. However, regardless of the advantages that exosome-based diagnostics have, they suffer from problems regarding their isolation, detection, and characterization of their contents. This study reviews the history and biogenesis of exosomes and discusses non-coding RNAs (ncRNAs) and their potential as tumor markers in different types of cancer, with a focus on next generation sequencing (NGS) as a detection method. Moreover, the advantages and challenges associated with exosome-based diagnostics are also presented.

End-of-Life Nutrition Considerations: Attitudes, Beliefs, and Outcomes

2020 ◽  
pp. 104990912096012
Author(s):  
Tyler S. Loofs ◽  
Kevin Haubrick
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Health Outcomes ◽  
End Of Life ◽  
Meta Analysis ◽  
Artificial Nutrition ◽  
Decision Making Process ◽  
Artificial Nutrition And Hydration ◽  
Palliative Care Teams ◽  
Nutrition And Hydration

Objective: To assess the physiological outcomes and interpersonal influences that should be considered when making the decision to provide artificial nutrition and hydration (AN&H) for patients in hospice/palliative programs. Methods: A systematic review was conducted using items from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Distinct search strategies were employed to find primary research articles that addressed: General health outcomes of artificial nutrition and hydration interventions and nutrition therapy interventions (n = 16), nutrition-related symptoms in end-of-life care (n = 8), and the attitudes of patients and providers toward artificial nutrition and hydration (n = 21). Results: The effect of AN&H on health outcomes, quality-of-life measures and nutrition-related symptoms is limited and may vary by patient setting and diagnosis. In the absence of consistent evidence for specific health outcomes, decisions regarding AN&H should be made in context of the desires and beliefs of a patient, their family, and their medical providers. These beliefs may not be consistent with likely outcomes or may be inconsistent between individuals involved in the decision-making process, and individuals of different cultures or geographic regions may approach AN&H decisions from different perspectives. To help navigate the intersection of nutrition-related health outcomes and patient/provider beliefs, palliative care teams may employ a variety of strategies for approaching the decision-making process, and may benefit from specific involvement of a Registered Dietitian to help contribute to or lead these discussions.

scholarly journals End of Life, Food, and Water: Ethical Standards of Care

2021 ◽  
pp. 261-271
Author(s):  
Stefano Eleuteri ◽  
Arianna Caruso ◽  
Ranjeev C. Pulle
Keyword(s):  
End Of Life ◽  
Tube Feeding ◽  
Oral Intake ◽  
Nutrition Therapy ◽  
Oral Feeding ◽  
Standards Of Care ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Substitute Decision Maker ◽  
Nutrition And Hydration

AbstractEnd-of-life care constitutes an important situation of extreme nutritional vulnerability for older adults. Feeding decisions in late-stage dementia often provoke moral and ethical questions for family members regarding whether or not to continue hand-feeding or opt for tube-feeding placement. Despite the knowledge that starvation and dehydration do not contribute to patient suffering at the end of life and in fact may contribute to a comfortable passage from life, the ethics of not providing artificial nutrition and hydration (ANH) continue to be hotly debated. However, in the past two decades, voluntary stopping of eating and drinking (VSED) has moved from a palliative option of last resort to being increasingly recognized as a valid means to intentionally hasten death for cognitively intact persons dealing with a serious illness. Across many settings globally, when oral intake is deemed unsafe, decisions to withhold oral feeding and to forgo artificial means of providing nutrition are deemed to be ethically and legally sanctioned when the decision is made by a capable patient or their legally recognized substitute decision-maker. Decision-making at the end of life involves knowledge of and consideration of the legal, ethical, cultural, religious, and personal values involved in the issue at hand. This chapter attempted to illustrate the unique complexities when considering nutrition therapy (by oral and artificial means) at the end of life.

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