Eleven-year Retrospective Study Characterizing Patients With Severe Brain Damage and Poor Neurological Prognosis -Role of Physicians’ Attitude Toward Life-Sustaining Treatment

2021 ◽  
Author(s):  
Haruaki Wakatake ◽  
Koichi Hayashi ◽  
Yuka Kitano ◽  
Hsiang-Chin Hsu ◽  
Toru Yoshida ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
End Of Life ◽  
Brain Damage ◽  
End Of Life Care ◽  
Life Care ◽  
Aggressive Treatment ◽  
Life Sustaining Treatment ◽  
Neurological Prognosis ◽  
Treatment Policies ◽  
Length Of Hospitalization

Abstract BackgroundSevere brain hemorrhage/infarction and cardiac arrest constitute the most critical situations leading to poor neurological prognosis. Characterization of these patients is required to offer successful end-of-life care, but actual practice is affected by multiple confounding factors, including ethicolegal issues, particular in Japan and Asia. The aim of this study is to evaluate the clinical courses of patients with severe brain damage and to assess the preference of end-of-life care for these patients in Japanese hospitals.MethodsA retrospective observational study was conducted between 2008 and 2018. All intracranial hemorrhage/infarction and cardiac arrest out-patients (n=510) who were admitted to our two affiliated hospitals and survived but with poor neurologic outcomes were included. Demographic characteristics as well as prognosis and treatment policies were also assessed. Results Patients were divided into two categories; cases with absent brainstem reflex (BSR) (BSR[-]) and those with preserved BSR (BSR[+]). The survival rate was higher and the length of hospitalization was longer in patients with BSR[+] than in those with BSR[-]. Among three life-sustaining policies (i.e., aggressive treatment, withdrawal of treatment, and withholding of treatment), withholding of treatment was adopted to most patients. In BSR[-], the proportion of three treatment policies performed at the final decision did not differ from that at the initial diagnosis on neurological status (p=0.432). In contrast, this proportion tended to be altered in BSR[+] (p=0.072), with a decreasing tendency of aggressive treatment and a modest increasing tendency of withdrawal of treatment. Furthermore, the requests from patients’ families to withdraw life-sustaining treatment, including discontinuation of mechanical ventilation, increased, but actual implementation of withdrawal by physicians was less than half of the requests. ConclusionsBSR constitutes a crucial determinant of mortality and length of hospitalization in comatose patients with severe brain damage. Although the number of withdrawal of life-sustaining treatment tends to increase over time in BSR[+] patients, there are many more requests from patients’ families for withdrawal. Since physicians has a tendency to desist from withdrawing life-sustaining treatment, more in-depth communication between medical staff and patients’ families will facilitate mutual understanding over ethicolegal and religious issues and may thus improve end-of-life care.

scholarly journals Physician Preferences for Aggressive Treatment at the End of Life and Area-Level Health Care Spending: The Johns Hopkins Precursors Study

2017 ◽  
Vol 3 ◽  
pp. 233372141772232 ◽  
Author(s):  
Joseph J. Gallo ◽  
Martin S. Andersen ◽  
Seungyoung Hwang ◽  
Lucy Meoni ◽  
Ravishankar Jayadevappa
Keyword(s):  
Health Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Latent Class ◽  
Health Care Spending ◽  
Life Care ◽  
Aggressive Treatment ◽  
Life Sustaining Treatment ◽  
Policy Measures ◽  
The Mean

Objective: To determine whether physician preferences for end-of-life care were associated with variation in health care spending. Method: We studied 737 physicians who completed the life-sustaining treatment questionnaire in 1999 and were linked to end-of-life care data for the years 1999 to 2009 from Medicare-eligible beneficiaries from the Dartmouth Atlas of Health Care (in hospital-related regions [HRRs]). Using latent class analysis to group physician preferences for end-of-life treatment into most, intermediate, and least aggressive categories, we examined how physician preferences were associated with health care spending over a 7-year period. Results: When all HRRs in the nation were arrayed in quartiles by spending, the prevalence of study physicians who preferred aggressive end-of-life care was greater in the highest spending HRRs. The mean area-level intensive care unit charges per patient were estimated to be US$1,595 higher in the last 6 months of life and US$657 higher during the hospitalization in which death occurred for physicians who preferred the most aggressive treatment at the end of life, when compared with average spending. Conclusions: Physician preference for aggressive end-of-life care was correlated with area-level spending in the last 6 months of life. Policy measures intended to minimize geographic variation in health care spending should incorporate physician preferences and style.

scholarly journals Honoring Preferences—The Consistency Between End-of-Life Care and a Veteran’s Goal for Comfort Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 752-752
Author(s):  
Joan Carpenter ◽  
Winifred Scott ◽  
Mary Ersek ◽  
Cari Levy ◽  
Jennifer Cohen ◽  
...  
Keyword(s):  
Palliative Care ◽  
Logistic Regression ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Multivariate Logistic Regression ◽  
Comfort Care ◽  
Lower Odds ◽  
Medicare Data ◽  
Life Sustaining Treatment

Abstract This study examined the alignment between Veterans’ end-of-life care and a Life-Sustaining Treatment (LST) goal “to be comfortable.” It includes Veterans with VA inpatient or community living center stays overlapping July 2018--January 2019, with a LST template documented by January 31, 2019, and who died by April 30, 2019 (N = 18,163). Using VA and Medicare data, we found 80% of decedents with a comfort care goal received hospice and 57% a palliative care consult (compared to 57% and 46%, respectively, of decedents without a comfort care goal). Using multivariate logistic regression, a comfort care goal was associated with significantly lower odds of EOL hospital or ICU use. In the last 30 days of life, Veterans with a comfort care goal had 43% lower odds (AOR 0.57; 95% CI: 0.51, 0.64) of hospitalization and 46% lower odds of ICU use (AOR 0.54; 95% CI: 0.48, 0.61).

scholarly journals We Want More Than Life-Sustaining Treatment during End-of-Life Care: Focus-Group Interviews

2021 ◽  
Vol 18 (9) ◽  
pp. 4415
Author(s):  
Mirinae Kim ◽  
Minju Kim
Keyword(s):  
Focus Group ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Treatment Needs ◽  
Focus Group Interviews ◽  
Care Needs ◽  
Basic Care ◽  
Life Sustaining Treatment ◽  
Group Interviews

We qualitatively investigated end-of-life care needs. Data were collected via focus-group interviews with three groups: young adults, middle-aged adults, and older adults. The key question was, “What kind of care would you like to receive at the end of life?” Interview data were transcribed and analyzed using content analysis. End-of-life care needs were classified into six categories: life-sustaining treatment needs, physical care needs, emotional care needs, environmental needs, needs for respect, and needs for preparation for death. Because the Korean culture is family-oriented and talking about death is taboo, Korean patients at the end of their life do not make decisions about life-sustaining treatment or actively prepare for death. Therefore, to provide proper end-of-life care, conversations and shared decision-making among patients and their families are crucial. Further, we must respect patients’ dignity and help them achieve a good death by understanding patients’ basic care preferences. Future research should continue examining end-of-life care needs that reflect the social and cultural context of Korea to inform instrument development.

End-of-Life Care and Survival without Major Brain Damage in Newborns at the Limit of Viability

Neonatology ◽  
2016 ◽  
Vol 111 (3) ◽  
pp. 234-239
Author(s):  
Fermín García-Muñoz Rodrigo ◽  
Lourdes Urquía Martí ◽  
José Ángel García Hernández ◽  
Josep Figueras Aloy ◽  
Alfredo García-Alix Pérez ◽  
...  
Keyword(s):  
End Of Life ◽  
Brain Damage ◽  
End Of Life Care ◽  
Life Care ◽  
Limit Of Viability

A descriptive report of end-of-life care practices occurring in two neonatal intensive care units

2016 ◽  
Vol 30 (10) ◽  
pp. 971-978 ◽  
Author(s):  
Vanessa Lam ◽  
Nicole Kain ◽  
Chloe Joynt ◽  
Michael A van Manen
Keyword(s):  
Congenital Anomaly ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Neonatal Intensive Care ◽  
Neonatal Intensive Care Units ◽  
Life Care ◽  
Life Sustaining Treatment ◽  
Care Practices

Background: In Canada and other developed countries, the majority of neonatal deaths occur in tertiary neonatal intensive care units. Most deaths occur following the withdrawal of life-sustaining treatments. Aim: To explore neonatal death events and end-of-life care practices in two tertiary neonatal intensive care settings. Design: A structured, retrospective, cohort study. Setting/participants: All infants who died under tertiary neonatal intensive care from January 2009 to December 2013 in a regional Canadian neonatal program. Deaths occurring outside the neonatal intensive care unit in delivery rooms, hospital wards, or family homes were not included. Overall, 227 infant deaths were identified. Results: The most common reasons for admission included prematurity (53.7%), prematurity with congenital anomaly/syndrome (20.3%), term congenital anomaly (11.5%), and hypoxic ischemic encephalopathy (12.3%). The median age at death was 7 days. Death tended to follow a decision to withdraw life-sustaining treatment with anticipated poor developmental outcome or perceived quality of life, or in the context of a moribund dying infant. Time to death after withdrawal of life-sustaining treatment was uncommonly a protracted event but did vary widely. Most dying infants were held by family members in the neonatal intensive care unit or in a parent room off cardiorespiratory monitors. Analgesic and sedative medications were variably given and not associated with a hastening of death. Conclusion: Variability exists in end-of-life care practices such as provision of analgesic and sedative medications. Other practices such as discontinuation of cardiorespiratory monitors and use of parent rooms are more uniform. More research is needed to understand variation in neonatal end-of-life care.

End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment

2000 ◽  
Vol 28 (8) ◽  
pp. 3060-3066 ◽  
Author(s):  
Jeffrey P. Burns ◽  
Christine Mitchell ◽  
Kristan M. Outwater ◽  
Maggie Geller ◽  
John L. Griffith ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
Pediatric Intensive Care Unit ◽  
End Of Life Care ◽  
Pediatric Intensive Care ◽  
Life Care ◽  
Life Sustaining Treatment

Proxy, Health, and Personal Care Preferences: Implications for End-of-Life Care

1999 ◽  
Vol 8 (2) ◽  
pp. 200-210 ◽  
Author(s):  
PETER J. AIKMAN ◽  
ELAINE C. THIEL ◽  
DOUGLAS K. MARTIN ◽  
PETER A. SINGER
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Robert Wood Johnson Foundation ◽  
Focused Attention ◽  
Life Care ◽  
Personal Care ◽  
Dying Patients ◽  
Care Project ◽  
Life Sustaining Treatment ◽  
Advance Care

The Institute of Medicine's report, “Approaching Death: Improving Care at the End of Life,” the American Medical Association's “Education for Physicians on End-of-Life Care” project, the Open Society Institute's “Project on Death in America,” and the “Last Acts” initiative sponsored by the Robert Wood Johnson Foundation have focused attention on improving the care of dying patients. These efforts include advance care planning and the use of written advance directives (ADs). Although previous studies have provided quantitative descriptions of patient preferences for life-sustaining treatment, including those documented in written ADs, to our knowledge open-ended written preferences have not been studied. Studies of these open-ended preferences could highlight issues with respect to quality end-of-life care. The purpose of this study was to explore the open-ended proxy, health, and personal care preferences of people with HIV as expressed in a written AD form.

scholarly journals Advance Care Planning and End-Of-Life Communications: Practical Tips for Oncology Advanced Practitioners

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Poonam Goswami, DNP, FNP-C, AOCNP
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Aggressive Treatment ◽  
Advanced Practitioner ◽  
Advance Care ◽  
Patients Wishes

Advance care planning discussions ensure patients’ values and goals of care, including the freedom to choose their place of death, are respected. The benefits of advance care planning and early end-of-life care discussions are often delayed, as these discussions are not initiated early in patients’ cancer trajectories. As a result, patients’ wishes often remain unknown until the last phase of their life. Evidence suggests that many patients inappropriately receive aggressive treatment near the end of life, which leads to higher resource utilization, decreased quality of life, and increased cost. The purpose of this article is to provide practical tips to the oncology advanced practitioner on initiating advance care planning and end-of-life care discussions with patients and their families or caregivers.

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