scholarly journals Inappropriate hemodialysis treatment and palliative care

2020 ◽  
Vol 10 (1-2) ◽  
pp. 48-58
Author(s):  
Rudolf Novotný ◽  
Zuzana Novotná ◽  
Štefánia Andraščíková
Keyword(s):  
Palliative Care ◽  
Terminal Condition ◽  
Clinical Bioethics ◽  
Hemodialysis Treatment ◽  
Inappropriate Treatment ◽  
Patient’S Autonomy ◽  
Futile Treatment ◽  
Definition Of ◽  
Clinical Conditions ◽  
Palliative Patients

AbstractThe paper discusses inappropriate (futile) treatment by analyzing the casuistics of palliative patients in the terminal stage of illness who are hospitalized at the Department of Internal Medicine and Geriatrics of the Faculty hospital with policlinic (FNsP). Our research applies the principles of palliative care in the context of bioethics. The existing clinical conditions of healthcare in Slovakia are characteristic of making a taboo of the issues of inappropriate treatment of palliative patients. Inductive-deductive and normative clinical bioethics methods of palliative care and ethical strategy are applied for defining issues found in inappropriate hemodialysis treatment. An algorithm of hemodialysis treatment requires the definition of those lege artis criteria which, in the context of a patient’s autonomy and his/her decision, precondition the avoidance of the situation in which hemodialysis treatment is inappropriate (futile). Futile treatment in a terminal condition is ethically inappropriate medical treatment that extends the suffering of patients and their relatives. Its definition is determined by the relevant legislation and the methods of bioethics. An active palliative strategy is aimed at managing the process of incurable diseases in the patient’s bio-psycho-socio-spiritual continuity in the process of special bioethics. The global bioethical objective of general bioethics for palliative care is based on the paradigm of social harmony and solidarity in the context of an authentic modus of the patient’s existence as a constitutive principle for the phenomenon of the patient’s being to finite being (death).

scholarly journals Futility of Medical treatment

2018 ◽  
Vol 2 (1) ◽  
pp. 13 ◽  
Author(s):  
Albar Mohammed Ali ◽  
Chamsi Pasha Hassan
Keyword(s):  
Medical Futility ◽  
Health Sciences ◽  
Best Interests ◽  
End Of Life Decisions ◽  
Ethical Implications ◽  
Patient’S Autonomy ◽  
Wide Range ◽  
Futile Treatment ◽  
Definition Of ◽  
To Receive

Medical and technological resources allow many patients affected by advanced diseases to receive more aggressive and expensive treatments than ever before. This wide range of available options can frequently lead to complex end-of-life decisions, such as when to start palliative care programs. Medical futility refers to interventions that are unlikely to produce any significant benefit for the patient. Medical futility is a daily problem, with significant ethical implications and concerns about the respect of the main ethics principles: beneficence, non-maleficence, patient’s autonomy, and justice. Proceeding with futile treatment is neither in the best interests of the patient nor of the healthcare system. This paper examines the definition of futility, applications of the concept of medical futility, the complexities of management when care is considered futile.International Journal of Human and Health Sciences Vol. 02 No. 01 Jan’18. Page : 13-17

scholarly journals OPEN QUESTIONS ABOUT THE USE AND DEFINITION OF THE STATUS OF A PALLIATIVE PATIENT

2018 ◽  
Vol 5 (1) ◽  
pp. 19-24
Author(s):  
Yu. Zhogno ◽  
O. Riga
Keyword(s):  
Palliative Care ◽  
Differential Diagnosis ◽  
Clinical Practice ◽  
Collective Consciousness ◽  
National System ◽  
Open Questions ◽  
The Status ◽  
Palliative Patient ◽  
Definition Of ◽  
Palliative Patients

OPEN QUESTIONS ABOUT THE USE USE AND DEFINITION OF THE STATUS OF A PALLIATIVE CARE PATIENTYu. Zhogno, O.RigaThe article discusses the issue of determining the status of a palliative patient in the context of institutionalization of the national system of palliative care in Ukraine and the statistical obscurity of palliative patients. The definition of "palliative status of a patient" is studied using the materials of scientific Ukrainian and foreign sources. Semantics  of the concepts of "status", "patient" and "palliative" are featured. The criteria for determining the patient's palliative status and its differential diagnosis are discussed using modern approaches to its categorization. Recommendations for determining the patient's palliative status, including that of a child, were developed.Conclusion. The question of the status of a palliative patient still remains unanswered in practice, especially when palliative care is not finally institutionalized as an integral part of both clinical practice and collective consciousness of Ukrainian society.Key words: palliative care, status of a palliative patient, discrimination.ВІДКРИТІ ПИТАННЯ ВИКОРИСТАННЯ ТА ВИЗНАЧЕННЯ СТАТУСУ ПАЛІАТИВНОГО ПАЦІЄНТАЮ. Жогно, О. РігаУ статті дискутуються питання визначення статусу паліативного хворого в контексті інституалізації національної системи паліативної допомоги в Україні та статистичної непомітності паліативних пацієнтів. Дефініція «паліативний статус пацієнта» досліджується на матеріалі наукових вітчизняних та закордонних джерел. Розглянута семантика понять «статус», «пацієнт» та «паліативний». Обговорюються критерії визначення паліативного статусу пацієнта та його диференціальна діагностика, використовуючи сучасні підходи до його категоризації. Розроблено рекомендації щодо визначення паліативного статусу пацієнта, в тому числі, дитячого віку. Висновки. Визначення статусу паліативного пацієнта досі залишається на практиці без відповіді, особливо коли паліативна допомога остаточно не інституалізовано невід'ємною складовою як клінічної практики, так і колективної свідомості українського суспільства.Ключові слова: паліативна допомога, статус паліативного пацієнта пацієнта, дискримінація. ОТКРІТІЕ ВОПРОСІ ИСПОЛЬЗОВАНИЯ И ОПРЕДЕЛЕНИЯ СТАТУСА ПАЛЛИАТИВНОГО ПАЦИЕНТАЮ. Жогно, Е. РигаВ статье дискутируются вопросы определения статуса паллиативного больного в контексте институционализации национальной системы паллиативной помощи в Украине и статистической незаметности паллиативных пациентов. Дефиниция «паллиативный статус пациента» исследуется на материале научных отечественных и зарубежных источников. Рассмотрена семантика понятий «статус», «пациент» и «паллиативный». Обсуждаются критерии определения паллиативного статуса пациента и его дифференциальная диагностика, используя современные подходы к его категоризации. Разработаны рекомендации по определению паллиативного статуса пациента, в том числе, детского возраста. Выводы. Определение статуса паллиативного пациента до сих пор остается на практике без ответа, особенно когда паллиативная помощь окончательно не институализирована неотъемлемой составляющей как клинической практики, так и коллективного сознания украинского общества.Ключевые слова: паллиативная помощь, статус паллиативного пациента пациента, дискриминация.

scholarly journals Effects of dignity therapy on palliative patients’ family members: A systematic review

2021 ◽  
pp. 1-10
Author(s):  
Leonor Grijó ◽  
Carolina Tojal ◽  
Francisca Rego
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
End Of Life ◽  
Meaning In Life ◽  
Family Members ◽  
Cochrane Library ◽  
Publication Date ◽  
Dignity Therapy ◽  
Bibliographic Search ◽  
Palliative Patients

Abstract Objective Dignity therapy (DT) is a kind of psychotherapy that identifies the main concerns of end-of-life patients that affect their perception of dignity and helps them to find a new meaning in life. Most prior studies on DT analyze outcomes for palliative care patients. The aim of this systematic review is to explore the outcomes of DT in palliative care patients’ family members. Method In June 2020, a bibliographic search was performed using the terms “Dignity Therapy” and “Palliative Care” in the following databases: Cochrane library, TRIP database, PUBMED, Scopus, and Web of Knowledge. Of the 294 articles found, 8 met the selection criteria and were considered in the present study. No articles were excluded based on their publication date. Results Family members generally believe that DT helps them to better prepare the patient's end-of-life and overcome the bereavement phase. The legacy document was considered a source of comfort, and most would recommend DT to other people in their situation. DT is generally considered as important as any other aspect of the patient's treatment. Significance of results There is evidence of the benefits of DT for palliative patients’ family members. However, there are still few studies that evaluate these outcomes. The existing evidence is poorly generalized, and thus, further studies are needed to deeply explore the benefits of this therapy both for patients and their families.

Influence of measurement error on assessment of response to anticancer chemotherapy: proposal for new criteria of tumor response.

1984 ◽  
Vol 2 (9) ◽  
pp. 1040-1046 ◽  
Author(s):  
D Warr ◽  
S McKinney ◽  
I Tannock
Keyword(s):  
Partial Response ◽  
Tumor Response ◽  
Costal Margin ◽  
Cross Sectional ◽  
Anticancer Chemotherapy ◽  
Inappropriate Treatment ◽  
Metastatic Lung ◽  
Hepatic Lesions ◽  
Definition Of ◽  
New Criteria

The decision to use a given type of chemotherapy to treat cancer patients is often based on the prior demonstration that a proportion of similar patients has "responded" in a clinical trial. Most responses are recorded as a partial shrinkage of tumor, defined usually as a greater than 50% shrinkage of the sum of cross-sectional areas of index lesions for at least one month. The errors in categorization of response have been estimated by comparing measurements of several physicians on real or simulated malignant lesions. False categorization of partial response based on a comparison of two measurements of the same lesion was 1.3% and 12.6% for large and small simulated nodules, respectively, 13.1% for malignant neck nodes, and 0.8% for metastatic lung nodules. Partial response for hepatic lesions has been defined by a 50% or 30% decrease in liver span below the costal margin; these definitions led to a false categorization of partial response of 8.5% and 18.4%, respectively. Larger errors are evident when using the current definition of disease progression that requires only a 25% increase in area. False categorization of response is increased by comparing any of serial measurements with the initial lesions, as is usually done clinically. Many published trials have used criteria for response that are subject to large errors; an uncritical interpretation of their results may lead to inappropriate treatment of patients. Based on the results, new criteria for evaluating tumor response are proposed.

PP41 British columbia emergency health services assess, see treat and refer palliative clinical pathway

2021 ◽  
Vol 38 (9) ◽  
pp. A17-A17
Author(s):  
Jennie Helmer ◽  
Leon Baranowski ◽  
Richard Armour ◽  
John Tallon ◽  
David Williscroft ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Pathway ◽  
Community Care ◽  
Lessons Learned ◽  
Symptom Improvement ◽  
Retrospective Case ◽  
Home And Community Care ◽  
Palliative Care Teams ◽  
Acute Crisis ◽  
Palliative Patients

Background/Research ObjectivesParamedic services have experienced a steadily increasing demand from palliative patients accessing 911 during times of acute crisis, and not wishing subsequent conveyance to ED. Early data indicates that many of these patients are NOT already connected to palliative care teams.To address this demand and to connect patients to care, BCEHS introduced the Assess, See, Treat and Refer (ASTAR)-Palliative Clinical Pathway. Objectives are to reduce patient conveyance to ED, reduce hospitalizations and improve patient care through referral after non-conveyance.InterventionParamedic activation of the ASTaR Palliative Clinical Pathway results in referral of non-conveyed palliative patients to local Home and Community Care teams and BCEHS paramedics. The referral occurs within 1-6 hours of paramedic contact and follow up occurs over the next 24-48 hours by telephone. This referral action provides safe, effective, patient-centred care for non-conveyed patients, and also fills a gap for connecting patients to local palliative care teams.ImpactA retrospective case review of 183 cases was conducted. Symptom improvement was achieved in 70% of cases, the ED non-conveyance rate was 19%, and the time on task when palliative patients were treated at home and not conveyed was 37% less (52 minutes) than if palliative patients were transported (82 minutes). All 183 patients were connected to either the local home and community care team or BCEHS Rural Advanced Care Community Paramedics (RACCP).Lessons LearnedPalliative patients frequently call 911 for help during acute crisis events and many of these patients do not wish conveyance to ED. The introduction of the ASTaR palliative clinical pathway provided safety netting and referral to appropriate care teams.

The Role of the Information Contained in School Physical Evaluation Forms in Preventing the Development of Severe Clinical Conditions in Physical Education Classes

2020 ◽  
pp. 29-36
Author(s):  
Zhanna Vladimirovna Gudinova ◽  
Galina Nikolaevna Zhernakovа ◽  
Irina Vladimirovna Gegechkori ◽  
Elena Ivanovna Tolkova ◽  
Yuliya Sergeevna Vaskovskaya
Keyword(s):  
Public Schools ◽  
Physical Education ◽  
Russian Federation ◽  
Ministry Of Health ◽  
Physical Evaluation ◽  
Conflicting Information ◽  
The Russian Federation ◽  
Definition Of ◽  
Clinical Conditions ◽  
Development Assessment

This research analyses school physical evaluation forms obtained from one of Omsk public schools’ roll books as well as the physical development assessment of 820 students of this school. The findings uncovered a violation of the requirements of SanPiN, the provisions of the Russian Federation Ministry of Health orders regarding the maintenance of physical evaluation forms, the definition of medical groups for students in physical education, and conflicting information about the children’s health, which may cause severe clinical conditions in physical education classes. The noncompliance of the regulatory framework for RPN (in terms of the Health List) and the Russian Federation Ministry of Health (in terms of physical education regulation for children with accommodations) was also uncovered.

scholarly journals 關於放棄臨床無效治療的倫理學思考

2000 ◽  
Vol 3 (1) ◽  
pp. 127-140
Author(s):  
Yongsong GUO
Keyword(s):  
Social Situation ◽  
Final Decision ◽  
Moral Pluralism ◽  
Medical Progress ◽  
Digital Commons ◽  
The Family ◽  
Futile Treatment ◽  
Definition Of ◽  
The Right ◽  
Other Regarding

LANGUAGE NOTE | Document text in Chinese; abstract also in English.對於沒有臨床救治希望的病人，要不要繼續治療？誰有最終的決定權？這既是臨床醫療問題，又是一個涉及社會倫理法規的問題。對於這樣的病人，不放棄治療可能意味著要消耗更多的醫療資源但又無法挽救病人，但是如果放棄治療，可能會遇到更多的來自社會傳統的、倫理法規的問題。筆者認為，在社會多元化發展的今天，面對臨床無效治療，應在尊重病人或病人家屬有最終決定權的前提下，以一定道德、法規為依據，按照一定的醫療程式和法律手續進行處理，可能是更為符合人道和社會公眾利益的理性選擇。There has not been a clear medical definition of futility. The concept of futile treatment involves not only medical, but also social, ethical, and legal components. This paper argues that in today's pluralistic moral circumstances, the patient and/or the family should have the final right to decision regarding futile treatment.Some are opposed to renouncing futile treatment, whatever futility is defined. For them, first, abandoning treatment is in conflict with the physician's basic duty of offering treatment. Second, giving up treatment also gives up the chance of making medical progress by attempting to treat the patient. Third, the patient would thereby lose the opportunity of prolonging the life. And finally, it would change the good image of the physician (as taking care of the patient). On the other hand, those who support renouncing futile treatment offer different reasons. First, giving up futile treatment will turn out to be respecting the value of the patient's life. Second, It would help people recognize the natural limit of contemporary medical development. Third, it would facilitate a reasonable pattern of distributing scarce medical resources. And finally, it could reduce the suffering of the patient. As a result, we face a social situation of moral pluralism: people disagree with each other regarding renouncing futile treatment.A difficult practical issue is who has the right to decide renouncing futile treatment. This paper argues that, giving individuals hold conflicting views of life, valoue and morality, the patient should have the final decision power regarding his/her own treatment. If the patient is incompetent, then the family should have the deciding right. In this respect we should overcome the longstanding medical paternalism. In addition, society should establish a prcocedure to regulate and facilitate the decision-mading of renouncing futile treatment.DOWNLOAD HISTORY | This article has been downloaded 16 times in Digital Commons before migrating into this platform.

Is trained communication about desire to die harmful for patients receiving palliative care? A cohort study

2021 ◽  
pp. 026921632110656
Author(s):  
Raymond Voltz ◽  
Kathleen Boström ◽  
Thomas Dojan ◽  
Carolin Rosendahl ◽  
Leonie Gehrke ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Health Professionals ◽  
Professional Relationship ◽  
Cohen’S D ◽  
Patient Health ◽  
Wish To Hasten Death ◽  
Desire To Die ◽  
Cohen's D ◽  
Palliative Patients

Background: Palliative patients frequently express a desire to die. Health professionals report uncertainty regarding potential risks of addressing it. Aim: We aim to evaluate effects of desire to die-conversations on palliative patients. Design: Within a prospective mixed-methods cohort study, we trained health professionals in dealing with desire to die. Afterwards, they held conversations about it with patients. Effects on depressiveness, hopelessness, wish to hasten death, death anxiety, patient-health professional-relationship, and will to live were evaluated at baseline (t0), 1 (t1), and 6 weeks afterwards (t2). Results were analyzed descriptively. Setting/participants: From April 2018 to March 2020, 43 health professionals asked 173 patients from all stationary and ambulatory palliative care settings (within 80 km radius) for participation. Complete assessments were obtained from n = 85 (t0), n = 64 (t1), and n = 46 (t2). Results: At t1, patients scored significantly lower on depressiveness (med = 8, M = 8.1, SD = 5.4) than at t0 (med = 9.5, M = 10.5, SD = 5.8) with Z = −3.220, p = 0.001 and Cohen’s d = 0.42. This was due to medium-severely depressed patients: At t1, their depressiveness scores decreased significantly (med = 9, M = 9.8; SD = 5.1) compared to t0 (med = 14, M = 15.2; SD = 3.9) with Z = −3.730, p ⩽ 0.000 and Cohen’s d = 1.2, but others’ did not. All other outcomes showed positive descriptive trends. Conclusions: Desire to die-conversations through trained health professionals do not harm palliative patients. Results cautiously suggest temporary improvement.

scholarly journals How timely is access to palliative care medicines in the community? Amixed methods study in a UK city

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e029016 ◽  
Author(s):  
Elizabeth Jane Miller ◽  
Julie D Morgan ◽  
Alison Blenkinsopp
Keyword(s):  
Palliative Care ◽  
Information Transfer ◽  
Care Service ◽  
Phase 1 ◽  
Palliative Care Service ◽  
Community Pharmacists ◽  
Community Pharmacies ◽  
Inadequate Information ◽  
Timely Access ◽  
Palliative Patients

ObjectiveTo investigate timely access to palliative medicines/drugs (PMs) from community pharmacies to inform palliative care service delivery.DesignMixed methods in two sequential phases: (1) prospective audit of prescriptions and concurrent survey of patients/representatives collecting PMs from pharmacy and (2) interviews with community pharmacists (CPs) and other healthcare professionals (HCPs).SettingFive community pharmacies in Sheffield, UK and HCPs that deliver palliative care in that community.ParticipantsPhase 1: five CPs: two providing access to PMs within a locally commissioned service (LCS) and three not in the LCS; 55 patients/representatives who completed the survey when accessing PMs and phase 2: 16 HCPs, including five phase 1 CPs, were interviewed.ResultsThe prescription audit collected information on 75 prescriptions (75 patients) with 271 individual PMs; 55 patients/representatives (73%) completed the survey. Patients/representatives reported 73% of PMs were needed urgently. In 80% of cases, patients/representatives received all PMs on the first pharmacy visit. One in five had to travel to more than one pharmacy to access PMs. The range of PMs stocked by pharmacies was the key facilitating factor. CPs reported practical issues causing difficulty keeping PMs in stock and playing a reactive role with palliative prescriptions. Confidentiality concerns were cited by other HCPs who were reluctant to share key patient information proactively with pharmacy teams. Inadequate information transfer, lack of CP integration into the care of palliative patients and poor HCP knowledge of which pharmacies stock PMs meant patients and their families were not always able to access PMs promptly.ConclusionsConsistent routine information transfer and integration of pharmacy teams in the care of palliative patients are needed to achieve timely access to PMs. Commissioners of PM access schemes should review and monitor access. HCPs need to be routinely made aware and reminded about the service and its locations.

The significance of fatigue in relatives of palliative patients

2010 ◽  
Vol 8 (2) ◽  
pp. 137-142 ◽  
Author(s):  
Maria E. Carlsson
Keyword(s):  
Palliative Care ◽  
Pilot Study ◽  
Psychosocial Support ◽  
Clinical Settings ◽  
Cross Sectional ◽  
Study Population ◽  
Cross Sectional Design ◽  
Palliative Phase ◽  
Close Family ◽  
Palliative Patients

AbstractObjective:The aim of this study was to explore the significance of fatigue among relatives of palliative patients.Method:This pilot study has a descriptive and cross-sectional design and is the report of four open-ended questions focusing on the relatives' experiences of fatigue. The study population consisted of relatives of patients who were cared for in palliative care settings either at home or in an institution in Uppsala County during a specific day.Results:The relatives were very tired and identified worries, uncertainty, the patient's suffering, and many demands as the causes for the fatigue. The most obvious consequences of the tiredness were a lack of motivation, feelings of insufficiency and apathy, and putting their own interests aside. Many relatives expressed that having the company of close family members, taking exercise and spending time outdoors gave them strength to carry on. The health care system could make the situation easier for relatives of patients in palliative care by providing good care for the patient, and psychosocial support and respite care for the relatives.Significance of results:The result of the pilot study is only preliminary, but it showed that relatives caring for patients in a late palliative phase suffer from great fatigue and require more attention, both scientifically and in the clinical settings.

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