scholarly journals IMPACT OF PATIENT- AND FAMILY-CENTRED CARE MEETINGS ON INTENSIVE CARE RESOURCE UTILISATION IN TERMINALLY ILL PATIENTS: A SINGLE-CENTRE RETROSPECTIVE OBSERVATIONAL STUDY IN TAIWAN

Respirology ◽  
2018 ◽  
Vol 23 ◽  
pp. 144-144
Keyword(s):  
Intensive Care ◽  
Observational Study ◽  
Terminally Ill ◽  
Retrospective Observational Study ◽  
Resource Utilisation ◽  
Single Centre ◽  
Terminally Ill Patients ◽  
Intensive Care Resource

scholarly journals Impact of patient-centred and family-centred care meetings on intensive care and resource utilisation in patients with terminal illness: a single-centre retrospective observational study in Taiwan

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e021561 ◽  
Author(s):  
Nin-Chieh Hsu ◽  
Chun-Che Huang ◽  
Wei-Chun Chen ◽  
Chong-Jen Yu
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Terminal Illness ◽  
Invasive Mechanical Ventilation ◽  
Terminally Ill ◽  
Medical Expenditures ◽  
Medical Expenditure ◽  
Secondary Outcome ◽  
Resource Utilisation ◽  
Terminally Ill Patients

ObjectiveShared decision making is essential for patients and their families when facing serious and life-threatening diseases. This study aimed to evaluate the impact of patient-centred and family-centred care meetings (PFCCM) on intensive measures and resource utilisation during end-of-life (EOL) hospitalisation among terminally ill patients.Design and settingA retrospective cross-sectional study using electronic medical records was conducted in a tertiary referral medical centre in Taiwan.ParticipantsWe identified 6843 deceased patients with terminal illness who either received or did not receive PFCCM during EOL hospitalisation between January 2013 and December 2015.Primary and secondary outcome measuresPatients who were transferred to the intensive care unit (ICU). Those who underwent invasive or non-invasive mechanical ventilation, tracheostomy, haemodialysis and surgical intervention during the final hospitalisation were determined by the use of intensive care measures; secondary measures were individual total and daily medical expenditures. A generalised estimating equation (GEE) model was used to compare the differences between the two groups. OR and beta coefficients (β) with 95% CI were estimated.ResultsThis study identified 459 patients (6.7%) who received PFCCM during EOL hospitalisation. Multivariate analyses showed that patients who received PFCCM were less likely to have ICU admissions (OR 0.44, 95% CI 0.34 to 0.57), undergo surgical interventions (OR 0.74, 95% CI 0.58 to 0.95) and invasive mechanical ventilation (OR 0.50, 95% CI 0.38 to 0.66) during the final hospitalisation, after adjusting for patient demographics, clinical conditions and year of admission. Additionally, a significant decrease in daily medical expenditures was observed in PFCCM patients (β −0.18, 95% CI −0.25 to −0.12) than in non-PFCCM patients.ConclusionsPatient–physician discussion through PFCCM is associated with less intensive care utilisation and daily medical expenditure during EOL hospitalisation in terminally ill patients.

Promoting the Best Possible Death

2020 ◽  
pp. 111-136
Author(s):  
Christopher Newdick ◽  
Christopher Danbury
Keyword(s):  
Intensive Care ◽  
Clinical Practice ◽  
Terminally Ill ◽  
Best Interests ◽  
Subjective Beliefs ◽  
Sanctity Of Life ◽  
The Past ◽  
Terminally Ill Patients ◽  
Patient Will ◽  
Considerable Range

What are the best interests of terminally ill patients in intensive care who lack capacity to decide for themselves? At what stage should their care be considered futile? Although this important question arises at a crucial moment in a person’s life, there is room for a considerable range of responses. What is the relevance, for example, of a belief in the sanctity of life, the likelihood that the patient will get better, the suffering and indignity caused by treatment, the wishes of patients and their relatives, or the interests of other needy patients? In the past, these difficulties were often quietly settled by doctors, guided, when possible, by patients and by their relatives. Now, when disagreement leads to dispute, the courts have been required to provide solutions of their own. In doing so, they grapple with the balance between the patient’s subjective beliefs and wishes (assisted by their relatives), and doctors’ experience of the challenges further treatment may cause the patient. We consider how the law and clinical practice have evolved and the framework of procedures and values within which these troubling cases should be considered.

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