scholarly journals Physicians’ and Nurses’ perspectives on the importance of advance directives in tertiary care hospitals

2019 ◽  
Vol 1 (1) ◽  
pp. 3-9
Author(s):  
Nasreen Panjwani ◽  
Raisa Gul ◽  
Fauziya Ali ◽  
Robyna Khan
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Tertiary Care ◽  
Study Data ◽  
Life Care ◽  
Structured Interviews ◽  
Palliative Care Services ◽  
Tertiary Care Hospitals

Objective: This study aimed to explore and identify the nurses’ and physicians’ views about Advance Directives and identified their perspectives on its importance, in the context of Pakistan. Methodology: Using a purposive sample, six physicians and seven nurses from two tertiary care hospitals in Karachi participated in the study. Data was collected using semi structured interviews that were transcribed verbatim. The interviews were coded and categorized manually. Analysis of the data drew four categories: roles of physicians and nurses in the End of life care, challenges they faced while taking end of life care decisions; their perspectives about Advance Directives, and the scope of acceptability of Advance Directives in the context of a Pakistani society. Results: This study revealed that patients’ families and physicians usually take decisions for patients’ End of Life care. Although majority of participants acknowledged the usefulness of Advance Directives, they explicated several issues that may be encountered in implementing it. The issues included non-disclosure of diagnosis to the patient in Pakistani culture, the tedious legalization process involved, and the potential problem of forged documents. Conclusion: Participants recommended establishment of Palliative Care services before execution of Advance Directives. This study indicated viability of Advance Directives; however, a wider exploration would be required in terms of study population. Reforms to support this concept would be required in systems, structure, legal policy, and training of Health care professionals. Besides these transformations, promotion of public education about the advantages of Advance Directives could enhance their acceptability among the general population.

Health Care Professionals’ Awareness of a Child’s Impending Death

2020 ◽  
Vol 30 (9) ◽  
pp. 1314-1325
Author(s):  
Kathie Kobler ◽  
Cynthia Bell ◽  
Karen Kavanaugh ◽  
Agatha M. Gallo ◽  
Colleen Corte ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Life Care ◽  
Structured Interviews ◽  
Study Approach ◽  
Multiple Data ◽  
Impending Death ◽  
Record Review

Health care professionals’ (HCPs) experiences during early pediatric end-of-life care were explored using a theory-building case study approach. Multiple data collection methods including observation, electronic medical record review, and semi-structured interviews were collected with 15 interdisciplinary HCPs across four cases. Within- and across-case analyses resulted in an emerging theory. HCPs’ initial awareness of a child’s impending death is fluid, ongoing, and informed through both relational and internal dimensions. Initial cognitive awareness is followed by a deeper focus on the child through time-oriented attention to the past, present, and future. HCPs engage in a “delicate dance of figuring out” key issues. Awareness was exemplified through four themes: professional responsibility, staying connected, grounded uncertainty, and holding in. The emerging theoretical model provides a framework for HCPs to assess their ongoing awareness, identify personal assumptions, and inform gaps in understanding when facilitating early end-of-life care discussions with families.

Refining Patient-Centered Measures of End-of-Life Care Quality for Children With Cancer

2021 ◽  
Author(s):  
Prasanna Ananth ◽  
Sophia Mun ◽  
Noora Reffat ◽  
Soo Jung Kang ◽  
Sarah Pitafi ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Care Quality ◽  
Life Care ◽  
Children With Cancer ◽  
Symptom Screening ◽  
Palliative Care Consultation ◽  
Patient Reported

PURPOSE: There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS: We conducted an iterative, cross-sectional electronic survey, using a modified Delphi method to build consensus among clinician and family stakeholders. In each of the two rounds of surveys, stakeholders were asked to rate QMs on a 9-point Likert scale, on the basis of perceived importance. Health care professionals were additionally asked to rate measures on perceived feasibility. After each round, we computed median scores on importance and feasibility of measurement, retaining QMs with median importance scores ≥ 8. RESULTS: Twenty-five participants completed both rounds of the survey. In round 1, participants were asked to rate 26 QMs; nine QMs, including QMs pertaining to health care use, were removed because of median importance scores < 8. Two new measures were proposed for consideration in round 2, on the basis of participant feedback. Following round 2, 17 QMs were ultimately retained. QMs related to symptom screening and palliative care consultation were rated highly in importance and feasibility. QMs related to communication were rated highly important, yet less feasible. Measuring whether a patient's needs were heard by their health care team was rated among the least feasible. CONCLUSION: Childhood cancer stakeholders prioritized QMs pertaining to patient-reported outcomes, deeming measures of health care resource use less important. Future research should seek to develop novel tools for quality assessment to enhance feasibility of implementing priority measures.

scholarly journals An Individual Housing-Based Socioeconomic Status Measure Predicts Advance Care Planning and Nursing Home Utilization

2018 ◽  
Vol 36 (5) ◽  
pp. 362-369 ◽  
Author(s):  
Amelia Barwise ◽  
Young J. Juhn ◽  
Chung-Il Wi ◽  
Paul Novotny ◽  
Carolina Jaramillo ◽  
...  
Keyword(s):  
Decision Making ◽  
Socioeconomic Status ◽  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Composite Index ◽  
Life Care ◽  
Individual Housing ◽  
Lower Likelihood ◽  
Multiple Variables

Background: Socioeconomic status (SES) is an important determinant of disparities in health care and may play a role in end-of-life care and decision-making. The SES is difficult to retrospectively abstract from current electronic medical records and data sets. Objective: Using a validated SES measuring tool derived from home address, the HOUsing-based SocioEconomic Status index, termed HOUSES we wanted to determine whether SES is associated with differences in end-of-life care and decision-making. Design/Setting/Participants: This cross-sectional study utilized a cohort of Olmsted County adult residents admitted to 7 intensive care units (ICUs) at Mayo Rochester between June 1, 2011, and May 31, 2014. Measurements: Multiple variables that reflect decision-making and care at end of life and during critical illness were evaluated, including presence of advance directives and discharge disposition. The SES was measured by individual housing-based SES index (HOUSES index; a composite index derived from real property as a standardized z-score) at the date of admission to the ICU which was then divided into 4 quartiles. The greater HOUSES, the higher SES, outcomes were adjusted for age, 24-hour Acute Physiology and Chronic Health Evaluation III score, sex, race/ethnicity, and insurance. Results: Among the eligible 4134 participants, the addresses of 3393 (82%) were successfully geocoded and formulated into HOUSES. The adjusted odds ratios comparing HOUSES 1 versus 2, 3, and 4 demonstrated lower likelihood of advance directives −0.77(95% CI: 0.63-0.93) and lower likelihood of discharge to home −0.60(95% CI: 1.0.5-0.72). Conclusion: Lower SES, derived from a composite index of housing attributes, was associated with lower rates of advance directives and lower likelihood of discharge to home.

Frequency and determinants of advance directives concerning end-of-life care in The Netherlands

2006 ◽  
Vol 62 (6) ◽  
pp. 1552-1563 ◽  
Author(s):  
Mette L. Rurup ◽  
Bregje D. Onwuteaka-Philipsen ◽  
Agnes van der Heide ◽  
Gerrit van der Wal ◽  
Dorly J.H. Deeg
Keyword(s):  
The Netherlands ◽  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Life Care

scholarly journals Last Chance to Care: An Autoethnography of End-of-Life Care in Indonesia

2018 ◽  
Author(s):  
Petra Wessner
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Service ◽  
Health Care Service ◽  
World Health ◽  
Life Care ◽  
Possible World ◽  
Palliative Care Services ◽  
Health Organization

In Australia, palliative care is an accepted and expected part of contemporary health care service provision. Efficacious palliative care focusses on managing pain and symptoms and making the patient as comfortable as possible (World Health Organization Definition of Palliative Care (WHO, 2010). As well, palliative care focusses on the spiritual and psycho-social dimensions of life (Martina, 2017), providing the opportunity for the patient and their family to continue to be engaged with life and self-determined decision making throughout palliation. In this account, utilizing the qualitative research method of autoethnography the Australian author describes her experience of caring for her Indonesian father-in-law in the last week of his life. She explores emerging tensions associated with local end-of-life care and Western care which trigger deeper feelings associated with losing a loved one, complicated by the recent and sudden loss of her own parents. Narration is a powerful tool for capturing the verisimilitude of everyday experiences, evoking in the reader a powerful resonance into a very personal inner life which is often not spoken about in academic texts. This account, a cultural story of dying in East Java, Indonesia, also provides insight into the author’s expectations, as an Australian and concludes with some reflections about the emerging position of palliative care services in Indonesia.

scholarly journals Preferences for Advance Directives in Korea

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
So-Sun Kim ◽  
Won-Hee Lee ◽  
JooYoung Cheon ◽  
Jung-Eun Lee ◽  
KiSun Yeo ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Healthcare Providers ◽  
Tube Feeding ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Korean People ◽  
End Stage

Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea.Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0.Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care.Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

scholarly journals The facilitators and challenges of dying at home with dementia: A narrative synthesis

2018 ◽  
Vol 32 (6) ◽  
pp. 1042-1054 ◽  
Author(s):  
Caroline Mogan ◽  
Mari Lloyd-Williams ◽  
Karen Harrison Dening ◽  
Christopher Dowrick
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Narrative Synthesis ◽  
Life Care ◽  
Eligibility Criteria ◽  
People With Dementia ◽  
Care At Home ◽  
At Home

Background: It is reported that, given the right support, most people would prefer to die at home, yet a very small minority of people with dementia do so. At present, knowledge gaps remain on how best to support end-of-life care at home for people with dementia. Aim: To identify and understand the challenges and facilitators of providing end-of-life care at home for people with dementia. Design: Narrative synthesis of qualitative and quantitative data. Data sources: The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search was conducted across six electronic databases (AMED, BNI, CINAHL, EMBASE, MEDLINE and PsycINFO) and reference lists of key journals were searched up to July 2017. Results: Searches returned 1949 unique titles, of which seven studies met all the eligibility criteria (four quantitative and three qualitative). Six key themes were identified – four facilitators and two challenges. Facilitators included ‘support from health care professionals’, ‘informal caregiver resilience and extended social networks’, ‘medications and symptom management’ and ‘appropriate equipment and home adaptations’. Challenges included ‘issues with professional services’ and ‘worsening of physical or mental health’. Conclusion: People with dementia may not always require specialist palliative care at the end of life. Further research is required to overcome the methodological shortcomings of previous studies and establish how community development approaches to palliative care, such as compassionate communities, can support families to allow a greater number of people with dementia to die at home.

Oscillations, boundaries and ethical care: Social work practitioner-researcher experiences with qualitative end-of-life care research

2021 ◽  
pp. 147332502110451
Author(s):  
Felicity Moon ◽  
Christine Mooney ◽  
Fiona McDermott ◽  
Peter Poon ◽  
David W Kissane
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Psychosocial Care ◽  
General Medicine ◽  
Visual Methods ◽  
Life Care ◽  
Structured Interviews ◽  
Research Issues ◽  
Health Network ◽  
Human Research Ethics

Policy and research acknowledge that the quality of end-of-life care in hospitals can be poor, with families reporting significant concerns regarding physical and psychosocial care. In order to design appropriate evidenced-based care approaches, we conducted qualitative research examining the perspectives of bereaved families of patients who received end-of-life care in our health network. This paper reports on ethical dilemmas facing practitioner-researchers conducting interviews with bereaved families. We recruited 40 bereaved family members to participate in semi-structured interviews discussing the care a loved one received while a patient under the general medicine units. Bereaved participants expressed grief, humour and anger regarding their experience, and several reported perceptions of negligent and harmful care. Irrespective of the protocols in place to mitigate distress, this posed an ethical dilemma for the practitioner-researcher as a member of the health network, who needed to balance clinical and research roles when responding to distress. The practitioner-researcher’s own bias and assumptions emerged when analysing families’ distressing recollections. More broadly, the issues discussed have clinical implications for models of hospital bereavement support. Participants’ use of photos and mementos jointly served to include the presence of the deceased in the research interview, but also highlighted the potential to utilise visual methods to examine sensitive research issues. It helps every practitioner-researcher to distinguish between research-oriented goals and clinical responsibilities to care provision as they consider their human research ethics application before beginning any research.

Sign in / Sign up

Export Citation Format

Share Document