scholarly journals Understanding and usage of Do Not Resuscitate(DNR) order and the guidelines for the end of life discussion. Mailed survey in Japan

2020 ◽  
Vol 27 (2) ◽  
pp. 129-149
Author(s):  
Keyword(s):  
End Of Life ◽  
Do Not Resuscitate ◽  
Mailed Survey

Defining and Timing of Palliative Opportunities in Children with Central Nervous System Tumors

2021 ◽  
Author(s):  
A McCauley Massie ◽  
Jonathan Ebelhar ◽  
Kristen E Allen ◽  
Nicholas P DeGroote ◽  
Karen Wasilewski-Masker ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
End Of Life ◽  
Phase 1 ◽  
Marrow Transplant ◽  
Cns Tumors ◽  
Do Not Resuscitate ◽  
Intensive Care Admission ◽  
Repeated Events

Abstract Background Children with brain and central nervous system (CNS) tumors experience substantial challenges to their quality of life during their disease course. These challenges are opportunities for increased subspecialty palliative care (PC) involvement. Palliative opportunities have been defined in the pediatric oncology population, but the frequency, timing, and factors associated with palliative opportunities in pediatric patients with CNS tumors are unknown. Methods A single-institution retrospective review was performed on children ages 0-18 diagnosed with a CNS tumor who died between 01/01/2012-11/30/2017. Nine palliative opportunities were defined prior to data collection (progression; relapse; admission for severe symptoms; intensive care admission; bone marrow transplant; phase 1 trial; hospice; do-not-resuscitate (DNR) order). Demographic, disease, treatment, palliative opportunity, and end-of-life data were collected. Opportunities were evaluated over quartiles from diagnosis to death. Results Amongst 101 patients with a median age at death of eight years (Interquartile range, IQR=8.0, range 0-22), there was a median of seven (IQR=6) palliative opportunities per patient, which increased closer to death. PC consultation occurred in 34 (33.7%) patients, at a median of 2.2 months before death, and was associated with having a DNR order (p=0.0028). Hospice was involved for 72 (71.3%) patients. Conclusion Children with CNS tumors suffered repeated events warranting PC yet received PC support only one-third of the time. Mapping palliative opportunities over the cancer course promotes earlier timing of PC consultation which can decrease suffering and resuscitation attempts at the end-of-life.

The effect of practice toward do-not-resuscitate among Taiwanese nursing staff using path modeling

2020 ◽  
Author(s):  
Li-Fen Wu ◽  
Li-Fang Chang ◽  
Yu-Chun Hung ◽  
Chin Lin ◽  
Shiow-Jyu Tzou ◽  
...  
Keyword(s):  
End Of Life ◽  
Nursing Staff ◽  
Religious Belief ◽  
Self Efficacy ◽  
Statistical Significance ◽  
Further Education ◽  
Path Modeling ◽  
Do Not Resuscitate ◽  
Attitude And Practice ◽  
Knowledge Attitude And Practice

Abstract Background: Do-Not-Resuscitate (DNR) is signed to prevent patients from receiving invalid treatment at the end of life or near death. Nurses play an important role to discuss the DNR with patients or the patients’ family members. However, research focusing on the relationship between the knowledge, attitude and practice of a DNR using path modeling in nursing staff is limited. Therefore, this study aimed to elucidate the effect of path modeling on the knowledge, attitude, and practice toward DNR among the Taiwanese nursing staff.Methods: This was a cross-sectional, descriptive design using a simple random sampling. Data on demographics, knowledge, attitude, and practice as measured by the DNR inventory (KAP-DNR), Mindful Attention Awareness Scale, General Self-Efficacy Scale, and Dispositional Resilience Scale was collected. Participants were 194 nursing staff from a medical center in northern Taiwan in 2019. We performed descriptive statistics, regression analysis, and path modeling using SPSS 22.0 and set p <0.05 as the statistical significance threshold. Results: The results showed that participation in DNR signature and education related to palliative care were positive significant predictors of knowledge towards DNR. The DNR predictors toward attitude included DNR knowledge, mindfulness, self-efficacy, dispositional resilience, and religious belief of nurses. Generally, the key predictors of DNR practice were DNR attitude, dispositional resilience, and male nurses. In path modeling, we identified that self-efficacy, dispositional resilience, master’s degree, and religious belief directly influenced practices constituting DNR. Conclusion: Based on the findings of this study, it is proposed that nurses should improve their self-efficacy and dispositional resilience. Encouraging staff to undertake further education and have religious beliefs can improve the practice of DNR and provide better end of life care.

scholarly journals The Experience of Do-Not-Resuscitate Orders and End-of-Life Care Discussions among Physicians

2020 ◽  
Vol 17 (18) ◽  
pp. 6869
Author(s):  
Sheng-Yu Fan ◽  
Jyh-Gang Hsieh
Keyword(s):  
End Of Life ◽  
Hospice Care ◽  
Family Members ◽  
Multiple Roles ◽  
Best Interests ◽  
Do Not Resuscitate ◽  
Time Urgency ◽  
Care Surgery ◽  
Eol Care ◽  
Analyze Data

Physicians have a responsibility to discuss do-not-resuscitate (DNR) decisions and end-of-life (EOL) care with patients and family members. The aim of this study was to explore the DNR and EOL care discussion experience among physicians in Taiwan. A qualitative study was conducted with 16 physicians recruited from the departments of hospice care, surgery, internal medicine, emergency, and the intensive care unit. The interview guidelines included their DNR experience and process and EOL care discussions, as well as their concerns, difficulties, or worries in discussions. Thematic analysis was used to analyze data. Four themes were identified. First, family members had multiple roles in the decision process. Second, the characteristics of the units, including time urgency and relationships with patients and family members, influenced physicians’ work. Third, the process included preparation, exploration, information delivery, barrier solution, and execution. Fourth, physicians shared reflections on their ability and the conflicts between law, medical professionals, and the best interests of patients. Physicians must consider not only patients’ but also family members’ opinions and surmount several barriers in decision-making. They also experienced negative and positive impacts from these discussions.

scholarly journals Illness Understanding, Prognostic Awareness, and End-of-Life Care in Patients With GI Cancer and Malignant Bowel Obstruction With Drainage Percutaneous Endoscopic Gastrostomy

2020 ◽  
pp. OP.20.00035
Author(s):  
Jessica I. Goldberg ◽  
Debra A. Goldman ◽  
Sarah McCaskey ◽  
Douglas J. Koo ◽  
Andrew S. Epstein
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Bowel Obstruction ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Malignant Bowel Obstruction ◽  
Do Not Resuscitate ◽  
Future Expectations ◽  
Endoscopic Gastrostomy ◽  
Gi Cancer ◽  
Additional Chemotherapy

PURPOSE: Malignant bowel obstruction (MBO) is common in advanced GI cancer, and MBO management, including drainage percutaneous endoscopic gastrostomy (dPEG), is palliative. How patients understand the goals of dPEG and its impact on disease is inadequately understood in the literature. Therefore, we analyzed these issues in patients with GI cancer. METHODS: Demographics, clinical variables, and patient outcomes were abstracted from the medical record. Illness understanding and future expectations were retrieved from palliative care notes. We described additional treatment and outcomes after dPEG and estimated overall survival (OS). RESULTS: From January 2015 to June 2017, 125 admitted patients with metastatic GI cancer underwent dPEG for MBO. Cancers were most commonly colorectal (34%) and pancreatic/ampullary (25%). During the dPEG admission, 32% (40 of 125) of patients had a palliative care consultation, and 22% (28 of 125) were asked about illness understanding and future expectations. All (28 of 28) reported good understanding of the advanced nature of their disease, but few were accurate about prognosis given their stage IV disease (10 of 28). Of the 117 (94%) discharged, 13% (15 of 117) received additional chemotherapy, which rarely prevented progression; half (63 of 117) had a do-not-resuscitate order; and most (101 of 117) were enrolled in hospice at death. Median time to death was 37 days (95% CI, 29 to 45 days); 6-month OS was 3.7% (95% CI, 1.2% to 8.4%). CONCLUSION: dPEGs are placed close to end of life in patients with advanced GI cancer. A minority of patients receive additional chemotherapy post-dPEG. Many have adequate disease understanding, but chemotherapy benefit is low, and future expectations vary. This may be an opportunity for improved communication regarding palliative procedures in advanced cancer.

Easing of Suffering in Children With Cancer at the End of Life: Is Care Changing?

2008 ◽  
Vol 26 (10) ◽  
pp. 1717-1723 ◽  
Author(s):  
Joanne Wolfe ◽  
Jim F. Hammel ◽  
Kelly E. Edwards ◽  
Janet Duncan ◽  
Michael Comeau ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Care Service ◽  
Geometric Mean ◽  
Symptom Control ◽  
Palliative Care Service ◽  
Do Not Resuscitate ◽  
Children With Cancer ◽  
Adjusted Risk

Purpose In the past decade studies have documented substantial suffering among children dying of cancer, prompting national attention on the quality of end-of-life care and the development of a palliative care service in our institutions. We sought to determine whether national and local efforts have led to changes in patterns of care, advanced care planning, and symptom control among children with cancer at the end of life. Methods Retrospective cohort study from a US tertiary level pediatric institution. Parent survey and chart review data from 119 children who died between 1997 and 2004 (follow-up cohort) were compared with 102 children who died between 1990 and 1997 (baseline cohort). Results In the follow-up cohort, hospice discussions occurred more often (76% v 54%; adjusted risk difference [RD], 22%; P < .001) and earlier (adjusted geometric mean 52 days v 28 days before death; P = .002) compared with the baseline cohort. Do-not-resuscitate orders were also documented earlier (18 v 12 days; P = .031). Deaths in the intensive care unit or other hospitals decreased significantly (RD, 16%; P = .024). Parents reported less child suffering from pain (RD, 19%; P = .018) and dyspnea (RD, 21%; P = .020). A larger proportion of parents felt more prepared during the child's last month of life (RD, 29%; P < .001) and at the time of death (RD, 24%; P = .002). Conclusion Children dying of cancer are currently receiving care that is more consistent with optimal palliative care and according to parents, are experiencing less suffering. With ongoing growth of the field of hospice and palliative medicine, further advancements are likely.

scholarly journals Race Does Not Influence Do-Not-Resuscitate Status or the Number or Timing of End-of-Life Care Discussions at a Pediatric Oncology Referral Center

2009 ◽  
Vol 12 (1) ◽  
pp. 71-76 ◽  
Author(s):  
Justin N. Baker ◽  
Shesh Rai ◽  
Wei Liu ◽  
Kumar Srivastava ◽  
Javier R. Kane ◽  
...  
Keyword(s):  
End Of Life ◽  
Pediatric Oncology ◽  
End Of Life Care ◽  
Life Care ◽  
Do Not Resuscitate ◽  
Referral Center
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