Distinguishing between Assisting and Substituting for Vital Organs

2016 ◽  
Vol 41 (9) ◽  
pp. 1-2
Author(s):  
Alfred Cioffi ◽  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
Moral Obligation ◽  
Life Support ◽  
Vital Organ ◽  
Vital Function ◽  
Know How ◽  
Futile Care ◽  
Extraordinary Means

When patients approach the end of life, their loved ones often do not know how much treatment is too much and struggle to decide when to stop intervening and allow them to die in peace. Conversely, health care professionals may tend to prescribe extraordinary means of life support, sometimes simply because of legal and fiscal concerns or a family’s request for futile care. It can be useful to refer to the general bioethical principle that, typically, there is no moral obligation to provide a substitute for vital organs. In this context, providing a substitute for a vital organ means wholly replacing the vital function of the dying organ by means of either a transplant or medical machinery. This article seeks to explain how this rule may be applied when a patient and his family are deciding at what point to stop treatment and allow the patient to die in peace.

Refining Patient-Centered Measures of End-of-Life Care Quality for Children With Cancer

2021 ◽  
Author(s):  
Prasanna Ananth ◽  
Sophia Mun ◽  
Noora Reffat ◽  
Soo Jung Kang ◽  
Sarah Pitafi ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Care Quality ◽  
Life Care ◽  
Children With Cancer ◽  
Symptom Screening ◽  
Palliative Care Consultation ◽  
Patient Reported

PURPOSE: There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS: We conducted an iterative, cross-sectional electronic survey, using a modified Delphi method to build consensus among clinician and family stakeholders. In each of the two rounds of surveys, stakeholders were asked to rate QMs on a 9-point Likert scale, on the basis of perceived importance. Health care professionals were additionally asked to rate measures on perceived feasibility. After each round, we computed median scores on importance and feasibility of measurement, retaining QMs with median importance scores ≥ 8. RESULTS: Twenty-five participants completed both rounds of the survey. In round 1, participants were asked to rate 26 QMs; nine QMs, including QMs pertaining to health care use, were removed because of median importance scores < 8. Two new measures were proposed for consideration in round 2, on the basis of participant feedback. Following round 2, 17 QMs were ultimately retained. QMs related to symptom screening and palliative care consultation were rated highly in importance and feasibility. QMs related to communication were rated highly important, yet less feasible. Measuring whether a patient's needs were heard by their health care team was rated among the least feasible. CONCLUSION: Childhood cancer stakeholders prioritized QMs pertaining to patient-reported outcomes, deeming measures of health care resource use less important. Future research should seek to develop novel tools for quality assessment to enhance feasibility of implementing priority measures.

scholarly journals A Study of awareness, attitude and practice of pharmacovigilance among health care professionals in a tertiary care teaching hospital in Bareilly, India

2017 ◽  
Vol 6 (7) ◽  
pp. 1784
Author(s):  
Krishna Singh ◽  
Kauser Sayedda ◽  
Richa Bhardwaj ◽  
Neha Yadav ◽  
Quazi Shahir Ahmed
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Response Rate ◽  
Tertiary Care ◽  
Faculty Members ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Know How ◽  
Attitude And Practice ◽  
Knowledge And Attitude

Background: Awareness towards Pharmacovigilance among health professionals in any hospital is an important part of health care system. So, the present study was conducted to know the extent of awareness of Pharmacovigilance among health care professionals.Methods: A cross-sectional questionnaire based study about knowledge, attitude and practices towards adverse drugs reaction (ADRs) and Pharmacovigilance was carried out at Shri Ram Murti Smarak Institue of Medical Sciences, Bareilly (U.P). 153 questionnaires were distributed among the Post graduate students, faculties, interns, nurses and pharmacists. 2-3 days time was given to fill the questionnaire.Results: Out of 153 questionnaires distributed, 99 filled forms were turned up for evaluation. Hence, response rate was 64.70%. 73.33% PGs, 100% faculty members, 53.33% interns, 36% nurses and 18.75% pharmacists were aware of adverse drugs reactions (ADRs) and Pharmacovigilance. Regarding reporting of ADRs, 86.66% PGs, 91.66% faculties, 73.33% interns, 88% nurses and 81.25% pharmacists were agreed to report ADR as it is mandatory and related to increased patients’ safety. Regarding discouraging factors for practice of reporting ADRs, 20% PGs, 16.66% faculties, 80% interns, 40% nurses and 68.75% pharmacists found ADR forms difficult to be filled. According to 66% faculties, 80% PGs, 66.66% interns managing patients are more important than reporting ADRs while 93.75% nurses and 76% pharmacists did not know how to report and where to report.Conclusions: The results of our study indicate that the acceptable number of health-care professionals had a good knowledge and attitude towards pharmacovigilance. There was a huge gap between the ADR experienced, and ADR reported by the health-care professionals. So, there is need of conductance of CMEs, workshops and seminars related to pharmacovigilance for all heaith care professionals especially nurses and pharmacists so, that whole community can be benefitted.

Health Care Professionals’ Awareness of a Child’s Impending Death

2020 ◽  
Vol 30 (9) ◽  
pp. 1314-1325
Author(s):  
Kathie Kobler ◽  
Cynthia Bell ◽  
Karen Kavanaugh ◽  
Agatha M. Gallo ◽  
Colleen Corte ◽  
...  
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Life Care ◽  
Structured Interviews ◽  
Study Approach ◽  
Multiple Data ◽  
Impending Death ◽  
Record Review

Health care professionals’ (HCPs) experiences during early pediatric end-of-life care were explored using a theory-building case study approach. Multiple data collection methods including observation, electronic medical record review, and semi-structured interviews were collected with 15 interdisciplinary HCPs across four cases. Within- and across-case analyses resulted in an emerging theory. HCPs’ initial awareness of a child’s impending death is fluid, ongoing, and informed through both relational and internal dimensions. Initial cognitive awareness is followed by a deeper focus on the child through time-oriented attention to the past, present, and future. HCPs engage in a “delicate dance of figuring out” key issues. Awareness was exemplified through four themes: professional responsibility, staying connected, grounded uncertainty, and holding in. The emerging theoretical model provides a framework for HCPs to assess their ongoing awareness, identify personal assumptions, and inform gaps in understanding when facilitating early end-of-life care discussions with families.

scholarly journals Establishment of Palliative and End-of-Life Care Services in Sri Lanka

2019 ◽  
Vol 34 (s1) ◽  
pp. s127-s128
Author(s):  
Clifford Perera ◽  
Udayangani Ramadasa ◽  
Chandrika Wijeratne ◽  
Panduka Karunanayake ◽  
Thashi Chang ◽  
...  
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Sri Lanka ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Task Force ◽  
Steering Committee ◽  
Life Care ◽  
Care Services

Introduction:Sri Lanka has a rapidly aging population with an exponential rise in chronic morbidity. There had been no parallel development of palliative and end-of-life care-specific approach in health care.Aim:To implement sustainable palliative and end-of-life care services in Sri Lanka through the existing systems and resources by advocacy, collaboration, and professional commitment.Methods:Sri Lanka Medical Association established a volunteer task force for palliative and end-of-life care (PCTF) in October 2016, which comprised of multi-disciplinary health care professionals, legal fraternity, and civil society. PCTF identified the need for sensitizing the general public on the importance of palliative care, for standard guidelines and formal training for practicing health care professionals engaged in hospital and community-based palliative care. These needs are addressed through activities of PCTF in collaboration with the Ministry of Health.Results:Representing the National Steering Committee of Palliative Care, the members of the PCTF were instrumental in developing the National Strategic Framework to fill the major gap of affordable quality palliative care in the country. PCTF also published the “Palliative Care Manual for Management of Non-Cancer Patients” as a preliminary guide for health care professionals. The draft document on the End-of-Life Care Guidelines has been formulated and is currently being reviewed by the relevant medical and legal stakeholders. PCTF has organized CME lectures on palliative care all over the country for health care professionals, and also conducted lectures, exhibitions, and mass media programs to sensitize the public on palliative care.Discussion:Within a brief period, PCTF has played a key role to recognize palliative care by contributing to policy making, training, and public sensitization in palliative and end-of-life care in Sri Lanka.

scholarly journals The culture of hope and ethical challenges in clinical trials: A qualitative study of oncologists and haematologists’ views

2019 ◽  
Vol 15 (1) ◽  
pp. 29-38 ◽  
Author(s):  
Tove E Godskesen ◽  
Suzanne Petri ◽  
Stefan Eriksson ◽  
Arja Halkoaho ◽  
Margrete Mangset ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
Qualitative Study ◽  
Empirical Research ◽  
Health Care Professionals ◽  
Therapeutic Misconception ◽  
Ethical Challenges ◽  
Know How ◽  
Ethical Concerns ◽  
Clinical Cancer

We do not know how much clinical physicians carrying out clinical trials in oncology and haematology struggle with ethical concerns. To our knowledge, no empirical research exists on these questions in a Nordic context. Therefore, this study aims to learn what kinds of ethical challenges physicians in Sweden, Denmark and Finland (n = 29) face when caring for patients in clinical trials; and what strategies, if any, they have developed to deal with them. The main findings were that clinical cancer trials pose ethical challenges related to autonomy issues, unreasonable hope for benefits and the therapeutic misconception. Nevertheless, some physicians expressed that struggling with such challenges was not of great concern. This conveys a culture of hope where health care professionals and patients uphold hope and mutually support belief in clinical trials. This culture being implicit, physicians need opportunities to deliberately reflect over the characteristics that should constitute this culture.

scholarly journals Adapting the Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP) course for emergency care education in Rwanda

2011 ◽  
Vol 3 (1) ◽  
Author(s):  
William E. Cayley Jr
Keyword(s):  
Health Care ◽  
Emergency Care ◽  
Health Care Professionals ◽  
Life Support ◽  
Advanced Cardiac Life Support ◽  
Training Programme ◽  
Lessons Learned ◽  
Care Education ◽  
African Setting ◽  
Case Based

The Advanced Cardiac Life Support for the Experienced Provider (ACLS-EP) course uses a case-based curriculum to teach emergency resuscitation principles to experienced health care professionals. This article describes the adaptation of the ACLS-EP curriculum to be used in a family medicine training programme in Rwanda, including lessons learned and recommendations for future use of this material for emergency care education in the African setting.

scholarly journals Health Care Professionals’ Views Associated with the Barriers and Facilitators of Advance Care Planning (ACP) for Community Dwelling Older Adults with Palliative and End-of-Life Care Needs Towards Achieving a ‘Good’ Death: Findings from a Qualitative, Exploratory Pilot Study

2018 ◽  
Author(s):  
Gary Bellamy ◽  
Jennifer Stock ◽  
Patricia Schofield
Keyword(s):  
Older Adults ◽  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Face To Face ◽  
Telephone Interviews ◽  
Advance Care

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons&rsquo; Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants&rsquo; views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.

PERCEPTIONS OF NURSING HOME HEALTH CARE PROFESSIONALS INFLUENCING END-OF-LIFE DISCUSSIONS

2005 ◽  
Vol 6 (2) ◽  
pp. B15
Author(s):  
B Ricke ◽  
A Shmookler ◽  
T J McCallum ◽  
S Reddy ◽  
B J Messinger-Rapport
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
End Of Life ◽  
Home Health Care ◽  
Health Care Professionals ◽  
Home Health

Eating, Drinking, and Comfort at End-of-Life: Promoting a Quality of Death

2020 ◽  
Vol 5 (4) ◽  
pp. 1015-1020
Author(s):  
Annette N. Askren ◽  
Marnie Kershner
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Workers ◽  
Health Care Professionals ◽  
Human Condition ◽  
Comprehensive Understanding ◽  
Comfort Care ◽  
Care Workers ◽  
Quality Of Death

Purpose Dysphagia is common in the last days of life (Bogaardt et al., 2015). Patients themselves, their families and caregivers, and health care professionals often struggle to deploy best practices in dysphagia management during this stage. Despite agreement that one's end-of-life should promote comfort, whether or not this is achieved can be unintentionally negatively impacted by the values of loved ones and health care workers, as well as health care workers' practice patterns. Importantly, we have yet to establish a comprehensive understanding of the patient experience at end-of-life to determine what truly entails “comfort” surrounding eating and drinking. Speech-language pathologists are increasingly consulted to address swallowing at end-of-life. It behooves the skilled clinician to have an understanding of the human condition in the final days to hours of life. Method In this piece, we explore the effects of food, drink, and the fasted state in both healthy adults and adults at end-of-life. We pose the thought-provoking question: Do food and drink contribute to a quality of death? Conclusion With this information, we work at the top of our license as providers who bring a unique, comprehensive understanding of such patients to the multidisciplinary comfort care team.

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