Section 11 Ethics and Law in Clinical Practice: End of Life

2016 ◽  
pp. 206-241
Keyword(s):  
Clinical Practice ◽  
End Of Life

End-of-life antimicrobial usage in lung cancer: current perpectives and clinical practice

2021 ◽  
Author(s):  
Ana Cláudia Santos Camelo Pimenta ◽  
Inês Rodrigues ◽  
Luísa Nascimento ◽  
Sara Raimundo ◽  
Teresa Gomes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Clinical Practice ◽  
End Of Life ◽  
Antimicrobial Usage

scholarly journals Development of a Dementia-Focused End-of-Life Planning Tool: The LEAD Guide (Life-Planning in Early Alzheimer’s and Dementia)

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Kara Dassel ◽  
Rebecca Utz ◽  
Katherine Supiano ◽  
Sara Bybee ◽  
Eli Iacob
Keyword(s):  
Older Adults ◽  
Clinical Practice ◽  
Focus Groups ◽  
End Of Life ◽  
Family Caregivers ◽  
Early Stage ◽  
Healthy Adults ◽  
Planning Tool ◽  
Healthy Older Adults ◽  
Life Planning

Abstract Background and Objectives To address the unique characteristics of Alzheimer’s disease and related dementias (ADRD) that complicate end-of-life (EOL), we created, refined, and validated a dementia-focused EOL planning instrument for use by healthy adults, those with early-stage dementia, family caregivers, and clinicians to document EOL care preferences and values within the current or future context of cognitive impairment. Research Design and Methods A mixed-method design with four phases guided the development and refinement of the instrument: (1) focus groups with early-stage ADRD and family caregivers developed and confirmed the tool content and comprehensiveness; (2) evaluation by content experts verified its utility in clinical practice; (3) a sample of healthy older adults (n = 153) and adults with early-stage ADRD (n = 38) completed the tool, whose quantitative data were used to describe the psychometrics of the instrument; and (4) focus groups with healthy older adults, family caregivers, and adults with early-stage ADRD informed how the guide should be used by families and in clinical practice. Results Qualitative data supported the utility and feasibility of a dementia-focused EOL planning tool; the six scales have high internal consistency (α = 0.66–0.89) and high test–rest reliability (r = .60–.90). On average, both participant groups reported relatively high concern for being a burden to their families, a greater preference for quality over length of life, a desire for collaborative decision-making process, limited interest in pursuing life-prolonging measures, and were mixed in their preference to control the timing of their death. Across disease progression, preferences for location of care changed, whereas preferences for prolonging life remained stable. Discussion and Implications The LEAD Guide (Life-Planning in Early Alzheimer’s and Dementia) has the potential to facilitate discussion and documentation of EOL values and care preferences prior to loss of decisional capacity, and has utility for healthy adults, patients, families, providers, and researchers.

scholarly journals Communicating with patients and families about difficult matters: A rapid review in the context of the COVID-19 pandemic

2020 ◽  
Author(s):  
Stuart Ekberg ◽  
Ruth Parry ◽  
Victoria Land ◽  
Katie Ekberg ◽  
Marco Pino ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
End Of Life ◽  
Rapid Review ◽  
Synthesis Methods ◽  
Eligibility Criteria ◽  
Previous Systematic Review ◽  
The Future ◽  
Communication Practices ◽  
Illness Progression

BackgroundPandemics pose significant challenges for healthcare systems, including an increase in difficult discussions about future illness progression and end of life.ObjectivesTo synthesise existing evidence about communication practices used to discuss difficult matters, including prognosis and end of life, and to use this evidence to make recommendations for clinical practice. The aim of this study was to use rapid review methods to update findings from a previous systematic review published in 2014.Data sourcesMEDLINE, EMBASE, CINAHL, PsycINFO, Sociological Abstracts, Web of Science, Scopus, ASSIA and Amed.Study eligibility criteriaStudies using conversation analysis or discourse analysis to examine recordings of actual conversations about difficult matters relating to future illness progression and end of life.Study appraisal and synthesis methodsData appraisal and extraction procedures used in the 2014 review were modified for this rapid review.ResultsFollowing screening, 18 sources were deemed to meet eligibility criteria, which were added to the 19 sources included in the 2014 systematic review. Synthesis of study findings identified 11 communication practices: providing opportunities for patient or family members to propose matters to discuss (7 out of 37 included sources); seeking a patient or family member’s perspective (6/37); discussing the future indirectly (11/37); discussing the future explicitly (7/37) linking to something previously said or done (11/37); using hypothetical scenarios (13/37); framing a difficult matter as universal (5/37); acknowledging uncertainty (3/37); exploring options (2/37); displaying sensitivity (7/37); emphasising the positive (7/37).LimitationsDividing work amongst the study authors to enable rapid review may have created inconsistencies.Conclusions and implications of key findingsThis synthesis of high-quality evidence from actual clinical practice supports a series of recommendations for communicating about difficult matters during and beyond the COVID-19 pandemic.

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