scholarly journals The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis

2017 ◽  
Vol 189 (13) ◽  
pp. E484-E493 ◽  
Author(s):  
James Downar ◽  
Russell Goldman ◽  
Ruxandra Pinto ◽  
Marina Englesakis ◽  
Neill K.J. Adhikari
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Seriously Ill Patients ◽  
Surprise Question ◽  
Seriously Ill

The Surprise Question and Serious Illness Conversations: A pilot study

2021 ◽  
pp. 096973302098339
Author(s):  
Kathy Le ◽  
Jenny Lee ◽  
Sameer Desai ◽  
Anita Ho ◽  
Holly van Heukelom
Keyword(s):  
Pilot Study ◽  
Healthcare Professionals ◽  
Post Intervention ◽  
Acute Medicine ◽  
Serious Illness ◽  
Patient Goals ◽  
Ethical Approval ◽  
Seriously Ill Patients ◽  
Surprise Question ◽  
Seriously Ill

Background: Serious Illness Conversations aim to discuss patient goals. However, on acute medicine units, seriously ill patients may undergo distressing interventions until death. Objectives: To investigate the feasibility of using the Surprise Question, “Would you be surprised if this patient died within the next year?” to identify patients who would benefit from early Serious Illness Conversations and study any changes in the interdisciplinary team’s beliefs, confidence, and engagement as a result of asking the Surprise Question. Design: A prospective cohort pilot study with two Plan-Do-Study-Act cycles. Participants/context: Fifty-eight healthcare professionals working on Acute Medicine Units participated in pre- and post-intervention questionnaires. The intervention involved asking participants the Surprise Question for each patient. Patient charts were reviewed for Serious Illness Conversation documentation. Ethical considerations: Ethical approval was granted by the institutions involved. Findings: Equivocal overall changes in the beliefs, confidence, and engagement of healthcare professionals were observed. Six out of 23 patients were indicated as needing a Serious Illness Conversation; chart review provided some evidence that these patients had more Serious Illness Conversation documentation compared with the 17 patients not flagged for a Serious Illness Conversation. Issues were identified in equating the Surprise Question to a Serious Illness Conversation. Discussion: Appropriate support for seriously ill patients is both a nursing professional and ethical duty. Flagging patients for conversations may act as a filtering process, allowing healthcare professionals to focus on conversations with patients who need them most. There are ethical and practical issues as to what constitutes a “serious illness” and if answering “no” to the Surprise Question always equates to a conversation. Conclusion: The barriers of time constraints and lack of training call for institutional change in order to prioritise the moral obligation of Serious Illness Conversations.

Living goals: Prepare to die.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 157-157
Author(s):  
Zankhana Mehta ◽  
Susan Smith ◽  
Jane Henrichs ◽  
Andrea Berger ◽  
Loreen Comstock ◽  
...  
Keyword(s):  
Palliative Medicine ◽  
Timely Manner ◽  
Median Length ◽  
Serious Illness ◽  
Home Based ◽  
Hospice Patients ◽  
One Year ◽  
Seriously Ill Patients ◽  
Surprise Question ◽  
Seriously Ill

157 Background: Living Goals (LGs), a home-based program, is a collaboration between Geisinger Health Plan, Geisinger Home care and Hospice and Palliative Medicine. Program investigated an early intervention in those with serious illness and transition to hospice in a timely manner during FY 2015- 2017. Methods: LGs visits were led by a registered nurse after referral from physicians based on the surprise question (it would not be a surprise if this patient died within one year). Nurse facilitated end-of-life discussions and provided resources available for supportive care. LGs visits were free up to 10 visits to each patient. Results: 94 patients were enrolled in LGs from 128 referrals.59 (63%) patients transitioned to hospice and 41 (69%) were transitioned within first month of LGs visit averaging 1.4 visits. 59 patients enrolled in hospice. The median length of time between LG Start of care (SOC) and Hospice SOC is 9 days (IQR: 3-73).57 LGs patients discharged from hospice had a median length of stay (LOS) of 39 days (IQR: 10-85). For the subset of patients in FY 2015 (n = 13) median LOS was 26 days (IQR: 10-57)), in FY 2016 (n = 26) the median LOS was 27 days (IQR: 7-73), in FY 2017 (n = 18) the median LOS is 66 days (IQR: 28-144). In FY 2014, 513 hospice patients were discharged before initiation of LGs and the median LOS was 19 days (IQR: 6-61). As of now, there is a significantly longer stay for LG patients than FY 2014 hospice patients (p = 0.0130). Conclusions: This innovative home based program, appears to have a great potential in the future for delivering ongoing hospice and palliative needs to seriously ill patients.

scholarly journals Partnering with frail or seriously ill patients in research: a systematic review

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Claire Ludwig ◽  
Ian D. Graham ◽  
Wendy Gifford ◽  
Josee Lavoie ◽  
Dawn Stacey
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Lived Experience ◽  
Narrative Analysis ◽  
Mixed Methods Research ◽  
Well Being ◽  
Research Partnerships ◽  
Research Teams ◽  
Seriously Ill Patients ◽  
Seriously Ill

Abstract Background The expectation to include patients as partners in research has steadily gained momentum. The vulnerability of frail and/or seriously ill patients provides additional complexity and may deter researchers from welcoming individuals from this patient population onto their teams. The aim was to synthesize the evidence on the engagement of frail and/or seriously ill patients as research partners across the research cycle. Methods A systematic review was conducted using PRISMA guidelines. A search strategy included MEDLINE®, EMBASE®, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO from database inception to April, 2019. Eligible studies were peer-reviewed qualitative, quantitative, and mixed methods research reporting on the engagement of frail and/or seriously ill patients as partners on research teams. The Mixed Methods Appraisal Tool was used to appraise study quality. Narrative analysis was conducted. Results Of 8763 citations, 30 were included. Most studies included individuals with cancer on the research team (60%). Barriers included: lack of time and resources (50%), discontinuity in contribution (37%), and concerns for well-being (33%). Facilitators included: trust and mutual respect (60%), structural accessibility (57%), flexibility in timing and methods of engagement (43%), and attention to care and comfort, (33%). Perceived impacts for patients included: renewed personal sense of agency (37%) and emotional/peer support (37%). Impacts for researchers included sensitization to the lived experience of disease (57%) and an increased appreciation of the benefits of patient engagement (23%). Research design, execution, and outcomes, developed with patients, were deemed more suitable, relevant and reflective of patients’ priorities. Conclusions There is emerging evidence to suggest that research partnerships with frail and/or seriously ill patients can be achieved successfully. Patients mostly report benefit from partnering with research teams. Frailty and/or serious illness do present legitimate concerns for their well-being but appear to be successfully mitigated when researchers ensure that the purpose of engagement is well-defined, the timing and methods of engagement are flexible, and the practical and emotional needs of patient partners are addressed throughout the process. Systematic review registration The systematic review protocol was registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).

scholarly journals Ethical considerations for engaging frail and seriously ill patients as partners in research: sub-analysis of a systematic review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Claire Ludwig ◽  
Ian D. Graham ◽  
Josee Lavoie ◽  
Wendy Gifford ◽  
Dawn Stacey
Keyword(s):  
Systematic Review ◽  
Ethical Issues ◽  
Financial Burden ◽  
Value Added ◽  
Analysis Data ◽  
Biomedical Ethics ◽  
Ethical Considerations ◽  
Ethical Implications ◽  
Seriously Ill Patients ◽  
Seriously Ill

Abstract Background The commitment to engage patients as partners in research has been described as a political, moral and ethical imperative. Researchers feel ill-equipped to deal with potential ethical implications of engaging patients as partners. The aim of this study is to identify the ethical considerations related to engaging frail and seriously ill (FSI) patients as partners in research. Methods We conducted a sub-analysis of a prior systematic review of 30 studies that engaged FSI patients as partners in research. Studies were included if they reported ethical considerations associated with partnering. We performed deductive content analysis, data were categorized according to Beauchamp and Childress’ Principles of Biomedical Ethics (2019): autonomy, non-maleficence, beneficence, and justice. Results Twenty-five studies were included. Common ethical considerations reported in relation to the principles were: autonomy – promoting desired level of involvement, addressing relational and intellectual power, facilitating knowledge and understanding of research; non-maleficence – protection from financial burden, physical and emotional suffering; beneficence – putting things right for others, showing value-added, and supporting patient-partners; and, justice – achieving appropriate representation, mutual respect for contributions, and distributing risks and benefits. Conclusions When partnering with FSI patients, research teams need to establish shared values and ensure processes are in place to identify and address ethical issues. Researchers and patients should work together to clarify the intent and outcomes of the partnership, actively address power differentials, recognize and minimize the potential for unintended harm, and strive to maximize the benefits of partnership. Systematic review registration The protocol for the original systematic review has been registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).

The effects of low-ratio n-6/n-3 PUFA on biomarkers of inflammation: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Yali Wei ◽  
Yan Meng ◽  
Na Li ◽  
Qian Wang ◽  
Liyong Chen
Keyword(s):  
Systematic Review ◽  
Fatty Acid ◽  
Polyunsaturated Fatty Acid ◽  
Meta Analysis ◽  
Chain Polyunsaturated Fatty Acid ◽  
Inflammation Markers ◽  
Pufa Supplementation ◽  
Long Chain

The purpose of the systematic review and meta-analysis was to determine if low-ratio n-6/n-3 long-chain polyunsaturated fatty acid (PUFA) supplementation affects serum inflammation markers based on current studies.

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