Opening the lines of communication: towards shared decision making and improved end‐of‐life care in the Top End

2020 ◽  
Vol 213 (1) ◽  
pp. 10
Author(s):  
Emma Spencer ◽  
Eswaran Waran
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
Shared Decision ◽  
Life Care

How individual ethical frameworks shape physician trainees’ experiences providing end-of-life care: a qualitative study

2021 ◽  
pp. medethics-2020-106690
Author(s):  
Sarah Rosenwohl-Mack ◽  
Daniel Dohan ◽  
Thea Matthews ◽  
Jason Neil Batten ◽  
Elizabeth Dzeng
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
The United States ◽  
Ethical Framework ◽  
Shared Decision ◽  
Life Care ◽  
Best Interest ◽  
Ethical Frameworks

ObjectivesThe end of life is an ethically challenging time requiring complex decision-making. This study describes ethical frameworks among physician trainees, explores how these frameworks manifest and relates these frameworks to experiences delivering end-of-life care.DesignWe conducted semistructured in-depth exploratory qualitative interviews with physician trainees about experiences of end-of-life care and moral distress. We analysed the interviews using thematic analysis.SettingAcademic teaching hospitals in the United States and United Kingdom.ParticipantsWe interviewed 30 physician trainees. We purposefully sampled across three domains we expected to be associated with individual ethics (stage of training, gender and national healthcare context) in order to elicit a diversity of ethical and experiential perspectives.ResultsSome trainees subscribed to a best interest ethical framework, characterised by offering recommendations consistent with the patient’s goals and values, presenting only medically appropriate choices and supporting shared decision-making between the patient/family and medical team. Others endorsed an autonomy framework, characterised by presenting all technologically feasible choices, refraining from offering recommendations and prioritising the voice of patient/family as the decision-maker.ConclusionsThis study describes how physician trainees conceptualise their roles as being rooted in an autonomy or best interest framework. Physician trainees have limited clinical experience and decision-making autonomy and may have ethical frameworks that are dynamic and potentially highly influenced by experiences providing end-of-life care. A better understanding of how individual physicians’ ethical frameworks influences the care they give provides opportunities to improve patient communication and advance the role of shared decision-making to ensure goal-aligned end-of-life care.

scholarly journals Shared Decision Making to Support the Provision of Palliative and End-of-Life Care in the Emergency Department: A Consensus Statement and Research Agenda

2016 ◽  
Vol 23 (12) ◽  
pp. 1394-1402 ◽  
Author(s):  
Naomi R. George ◽  
Jennifer Kryworuchko ◽  
Katherine M. Hunold ◽  
Kei Ouchi ◽  
Amy Berman ◽  
...  
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
Research Agenda ◽  
Consensus Statement ◽  
Shared Decision ◽  
Life Care

scholarly journals Effect of shared decision-making education on physicians’ perceptions and practices of end-of-life care in Korea

2021 ◽  
Author(s):  
Byung Chul Yu ◽  
Miyeun Han ◽  
Gang-Jee Ko ◽  
Jae Won Yang ◽  
Soon Hyo Kwon ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
End Of Life Care ◽  
Shared Decision ◽  
Life Care

The known unknowns of assisted hydration at the end of life

2021 ◽  
Vol 26 (6) ◽  
pp. 284-285
Author(s):  
Arjun Kingdon ◽  
Anna Spathis ◽  
Ben Bowers ◽  
Stephen Barclay
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Shared Decision ◽  
Life Care ◽  
High Quality ◽  
Home Setting ◽  
Known Unknowns ◽  
The Impact

Much is unknown about assisted hydration at the end of life: why rates of usage vary so highly between institutions, cultures and countries, what beneficial or burdensome effects this treatment has, whether there is a place for subcutaneous hydration in the home setting, and how best to communicate about this difficult topic with dying people and their families. In light of a recently published systematic review concerning the impact of assisted hydration at the end of life, this article explores these questions and related issues, concluding that individualisation and shared decision-making are essential aspects of high-quality end-of-life care.

Sign in / Sign up

Export Citation Format

Share Document