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End-of-life Decision Making (end-of-life + decision_making)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

End-of-Life Decision Making: Practical and Ethical Issues for Health Professionals

AUSTRALASIAN JOURNAL ON AGEING, Issue 2 2000
Colleen Cartwright
Life-extending changes in medical technology and an ageing population pose practical and ethical problems relating to end-of-life decision making. Health professionals need to understand the fears and concerns of their patients, their preferred place to die, and to respect patient autonomy. Such wishes may be expressed verbally by a competent patient or through an advance directive (living will) or proxy by an incompetent patient. There is an urgent need for increased and improved training of health professionals in pain management and palliative care, and for the development of practical, ethical policies and guidelines with respect to withdrawing/withholding life-sustaining treatment. In addition, physician-assisted suicide and euthanasia, two of the important moral issues of the 90s, will continue to require open community debate as we move into the new millennium. Australia, in company with most other countries, has many challenges ahead in relation to end-of-life decision making. [source]

Working toward consensus: Providers' strategies to shift patients from curative to palliative treatment choices

RESEARCH IN NURSING & HEALTH, Issue 4 2001
Sally A. Norton
Abstract End-of-life decision making is a complex phenomenon and providers, patients, and families often have different views about the appropriateness of treatment choices. The results presented here are part of a larger grounded-theory study of reconciling decisions near the end of life. In particular, we examined how providers (N,=,15) worked near the end of patients' lives toward changing the treatment decisions of patients and families from those decisions that providers described as unrealistic (i.e., curative) to those that providers described as more realistic (i.e., palliative). According to providers, shifting patients' and families' choices from curative to palliative was usually accomplished by changing patients' and families' understanding of the patient's overall "big picture" to one that was consistent with the providers' understanding. Until patients and families shifted their understanding of the patient's condition,the big picture,they continued to make what providers judged as unrealistic treatment choices based on an inaccurate understanding of what was really going on. These unrealistic choices often precluded possibilities for a "good death." According to providers, the purpose of attempting to shift the patient or proxy's goals was that realistic goals lead to realistic palliative treatment choices that providers associated with a good death. In this article we review strategies used by providers when they believed a patient's death was imminent to attempt to shift patients' and families' understandings of the big picture, thus ultimately shifting their treatment decisions. © 2001 John Wiley & Sons, Inc. Res Nurs Health 24:258,269, 2001 [source]

End-of-life decision making , where have all the surgeons gone?,

ANZ JOURNAL OF SURGERY, Issue 12 2009
FRACS, Heather Cleland MBBS
No abstract is available for this article. [source]

Randomized controlled trial of SPIRIT: An effective approach to preparing African-American dialysis patients and families for end of life,

RESEARCH IN NURSING & HEALTH, Issue 3 2009
Mi-Kyung Song
Abstract This randomized controlled trial tested an intervention, Sharing Patients' Illness Representations to Increase Trust (SPIRIT), designed to enhance communication regarding end-of-life care between African Americans with end-stage renal disease (ESRD) and their chosen surrogate decision makers (N,=,58 dyads). We used surveys and semi-structured interviews to determine the feasibility, acceptability, and preliminary effects of SPIRIT on patient and surrogate outcomes at 1 week and 3 months post-intervention. We also evaluated patients' deaths and surrogates' end-of-life decision making to assess surrogates' perceptions of benefits and limitations of the SPIRIT while facing end-of-life decisions. We found that SPIRIT promoted communication between patients and their surrogates and was effective and well received by the participants. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:260,273, 2009 [source]

Family Decision-Making for Nursing Home Residents With Dementia: Rural-Urban Differences

THE JOURNAL OF RURAL HEALTH, Issue 1 2006
Charles E. Gessert MD
ABSTRACT:,Context: Research has demonstrated substantial differences between end-of-life care in rural and urban settings. As the end of life approaches, rural elders are less likely to be hospitalized, to be placed in an intensive care unit, or to have a feeding tube, compared to their urban counterparts. These differences cannot be fully explained by rural-urban differences in access to medical services. Purpose: To describe and understand rural-urban differences in attitudes toward death and in end-of-life decision making. Methods: Eight focus groups were convened in rural and urban Minnesota nursing homes. The 38 focus group participants were family members of nursing home residents with severe cognitive impairment. Findings: Most rural focus group participants voiced unqualified acceptance of death and placed few conditions on death, beyond their hope that it would be quick and peaceful. Urban respondents presented a wider range of attitudes toward death, from unambiguous acceptance of immediate death to evident discomfort with welcoming death under any circumstances. These rural-urban differences had practical implications. Rural respondents were much less likely to endorse interventions that would impede death, compared to their urban counterparts. Conclusions: Rural respondents tended to express confidence in natural forces; death was seen as neutral or beneficent. Resistance to the approach of death was more characteristic of urban respondents, some of whom insisted upon aggressive medical care in advanced dementia. [source]