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Ng IKS, Hooi BMY, See KC, Teo DB. Goals-of-care discussion in older adults: a clinical and ethical approach. Singapore Med J 2024; 65:295-301. [PMID: 39075875 PMCID: PMC11182453 DOI: 10.4103/singaporemedj.smj-2023-166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/17/2023] [Indexed: 07/31/2024]
Affiliation(s)
- Isaac Kah Siang Ng
- NUHS Internal Medicine Residency Programme, Department of Medicine, National University Hospital, Singapore
| | - Benjamin Ming-Yew Hooi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kay Choong See
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
| | - Desmond B Teo
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Fast and Chronic Programme, Alexandra Hospital, Singapore
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de Boer J, Barnett R, Cardin A, Cimoli M, Davies L, Delany C, Dixon BJ, Evans SM, Findlay MW, Fox C, Ftanou M, Hart CD, Howard M, Iseli TA, Jackson A, Kranz S, Le BH, Lekgabe E, Lennox R, McLean LS, Neeson PJ, Ng SP, O’Reilly LA, Ramakrishnan A, Rowe D, Service C, Singh A, Thai AA, Tiong A, Yap T, Wiesenfeld D. Optimising Patient Outcomes in Tongue Cancer: A Multidisciplinary Approach. Cancers (Basel) 2024; 16:1277. [PMID: 38610956 PMCID: PMC11010906 DOI: 10.3390/cancers16071277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
A multidisciplinary approach to the management of tongue cancer is vital for achieving optimal patient outcomes. Nursing and allied health professionals play essential roles within the team. We developed symposia comprising a series of online lectures offering a detailed perspective on the role each discipline and consumer perspective has in the management of patients with tongue cancer. The topics, including epidemiology and prevention, diagnosis, treatment planning, surgery, adjuvant care, and the management of recurrent or metastatic disease, were thoroughly examined. The symposia highlighted the significance of fostering collaboration and continuous learning through a multidisciplinary approach. This initiative should be relevant to healthcare professionals, researchers, and policymakers striving to enhance patient outcomes in tongue cancer care through innovative collaboration.
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Affiliation(s)
| | - Rebecca Barnett
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Anthony Cardin
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Michelle Cimoli
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Lauren Davies
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Clare Delany
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Benjamin J. Dixon
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
- Department of Surgery, University of Melbourne, Melbourne 3010, Australia
| | - Sue M. Evans
- Victorian Cancer Registry, Cancer Council Victoria School of Public Health and Preventive Medicine, Monash University, Melbourne 3002, Australia;
| | - Michael W. Findlay
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3010, Australia;
| | - Carly Fox
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Christopher D. Hart
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Megan Howard
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Tim A. Iseli
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
- Department of Surgery, University of Melbourne, Melbourne 3010, Australia
| | - Andrea Jackson
- St. Vincent’s Hospital Melbourne, Melbourne 3065, Australia; (R.B.); (C.D.H.); (A.J.)
| | - Sevastjan Kranz
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Brian H. Le
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Ernest Lekgabe
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Rachel Lennox
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Luke S. McLean
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Paul J. Neeson
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne 3010, Australia;
| | - Sweet Ping Ng
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Lorraine A. O’Reilly
- The Walter and Eliza Hall of Medical Research (WEHI), Melbourne 3052, Australia;
| | - Anand Ramakrishnan
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - David Rowe
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Carrie Service
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
| | - Ankur Singh
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne 3010, Australia;
| | - Alesha A. Thai
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
- Austin Health, Heidelberg 3084, Australia; (M.C.); (R.L.); (S.P.N.)
| | - Albert Tiong
- Peter MacCallum Cancer Centre, Melbourne 3000, Australia (C.D.); (M.W.F.); (M.F.); (M.H.); (B.H.L.); (A.A.T.); (A.T.)
| | - Tami Yap
- The Royal Melbourne Hospital, Melbourne 3052, Australia; (L.D.); (C.F.); (T.A.I.); (S.K.); (E.L.); (A.R.); (C.S.); (T.Y.)
- Melbourne Dental School, University of Melbourne, Melbourne 3010, Australia
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Speyer R, Balaguer M, Cugy E, Devoucoux C, Morinière S, Soriano G, Vérin E, Woisard V. Expert Consensus on Clinical Decision Making in the Disease Trajectory of Oropharyngeal Dysphagia in Adults: An International Delphi Study. J Clin Med 2023; 12:6572. [PMID: 37892711 PMCID: PMC10607151 DOI: 10.3390/jcm12206572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
To date, no consensus exists on the complex clinical decision-making processes involved in oropharyngeal dysphagia, or swallowing disorders. This study aimed to develop an international consensus on a clinical decision tree for the disease trajectory of oropharyngeal dysphagia in adults, taking into account physiological impairments of swallowing, risk factors for the development of complications from oropharyngeal dysphagia, and prognostic factors for treatment outcomes. Using the Delphi technique, consensus was achieved among dysphagia experts across 31 countries, resulting in a total of 10 physiological impairments, 23 risk factors and 21 prognostic factors identified as relevant factors in the clinical decision-making process. Factors most contributing to the severity of oropharyngeal dysphagia were 'Aspiration', 'Incomplete ejection or failure to eject aspirated materials from the airways', 'Weak or absent cough', 'Choking' and 'Sensory deficits in the oropharynx'. To connect the existing theoretical framework to clinical practice, future research will develop the current findings by corroborating the domains based on relevant factors for clinical decision making and those that contribute to the severity of oropharyngeal dysphagia.
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Affiliation(s)
- Renée Speyer
- Department Special Needs Education, University of Oslo, 0318 Oslo, Norway
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Mathieu Balaguer
- Institut de Recherche en Informatique de Toulouse, Centre national de la Recherche Scientifique, University of Toulouse, 31062 Toulouse, France;
- Department of Medicine, Maieutic and Allied Health, Faculty of Health, University of Toulouse, Paul Sabatier Toulouse III, 133 Route de Narbonne, 31062 Toulouse, France; (C.D.); (V.W.)
| | - Emmanuelle Cugy
- Department of Physical and Rehabilitation Medicine, Arcachon Hospital, 33260 La Teste de Buch, France;
- Department of Physical and Rehabilitation Medicine, Tastet Girard Hospital, CEDEX, 33076 Bordeaux, France
| | - Clémence Devoucoux
- Department of Medicine, Maieutic and Allied Health, Faculty of Health, University of Toulouse, Paul Sabatier Toulouse III, 133 Route de Narbonne, 31062 Toulouse, France; (C.D.); (V.W.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Larrey Hospital, University Hospital of Toulouse, 31400 Toulouse, France
| | - Sylvain Morinière
- Department of Otorhinolaryngology and Head and Neck Surgery, Tours University Hospital, 37000 Tours, France;
- Otorhinolarygology Department, University François Rabelais of Tours, 10 Bd Tonnellé, 37032 Tours, France
| | - Gaëlle Soriano
- Department of Geriatrics, Toulouse University Hospital, 31000 Toulouse, France;
| | - Eric Vérin
- GRHVN UR 3830, Research Group on Ventilatory and Neurological Handicap, Laboratoire de Chirurgie Experimentale, University of Rouen Normandie, 76000 Rouen, France;
- Department of Pulmonary Rehabilitation, CHU Rouen, UR 3830, Normandie University, UNIROUEN, 76000 Rouen, France
| | - Virginie Woisard
- Department of Medicine, Maieutic and Allied Health, Faculty of Health, University of Toulouse, Paul Sabatier Toulouse III, 133 Route de Narbonne, 31062 Toulouse, France; (C.D.); (V.W.)
- Department of Otorhinolaryngology and Head and Neck Surgery, Larrey Hospital, University Hospital of Toulouse, 31400 Toulouse, France
- Neuro-Psycho-Linguistic Lab UR 4156, University of Toulouse, Jean Jaurès Toulouse II, 5, Allée Antonio Machado, CEDEX 9, 31058 Toulouse, France
- Department of Supportive Care, Cancer University Institute of Toulouse Oncopole, 1 avenue Irène Joliot-Curie, CEDEX 9, 31059 Toulouse, France
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Yoo SH, Kim Y, Choi W, Shin J, Kim MS, Park HY, Keam B, Yim JJ. Ethical Issues Referred to Clinical Ethics Support at a University Hospital in Korea: Three-Year Experience After Enforcement of Life-Sustaining Treatment Decisions Act. J Korean Med Sci 2023; 38:e182. [PMID: 37337807 DOI: 10.3346/jkms.2023.38.e182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/06/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Clinical ethics support is a form of preventive ethics aimed at mediating ethics-related conflicts and managing ethical issues arising in the healthcare setting. However, limited evidence exists regarding the specific ethical issues in clinical practice. This study aimed to explore the diverse ethical issues of cases referred to clinical ethics support after the new legislation on hospice palliative care and end-of-life decision-making was implemented in Korea in 2018. METHODS A retrospective study of cases referred to clinical ethics support at a university hospital in Korea from February 2018 to February 2021 was conducted. The ethical issues at the time of referral were analyzed via qualitative content analysis of the ethics consultation-related documents. RESULTS A total of 60 cases of 57 patients were included in the study, of whom 52.6% were men and 56.1% were older than 60 years of age. The majority of cases (80%) comprised patients from the intensive care unit. One-third of the patients were judged as being at the end-of-life stage. The most frequent ethical categories were identified as goals of care/treatment (78.3%), decision-making (75%), relationship (41.7%), and end-of-life issues (31.7%). More specifically, best interests (71.7%), benefits and burdens/harms (61.7%), refusal (53.3%), and surrogate decision-making (33.3%), followed by withholding or withdrawal (28.3%) were the most frequent ethical issues reported, which became diversified by year. In addition, the ethical issues appeared to differ by age group and judgment of the end-of-life stage. CONCLUSION The findings of this study expand the current understanding of the diverse ethical issues including decision-making and goals of care/treatment that have been referred to clinical ethics support since the enforcement of the new legislation in Korea. This study suggests a need for further research on the longitudinal exploration of ethical issues and implementation of clinical ethics support in multiple healthcare centers.
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Affiliation(s)
- Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Wonho Choi
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
| | - Jeongmi Shin
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Min Sun Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Yoon Park
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Brucki SMD, Aprahamian I, Borelli WV, Silveira VCD, Ferretti CEDL, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Nitrini R, Schultz RR, Morillo LS. Management in severe dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s107en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Alzheimer’s disease (AD) and other neurodegenerative dementias have a progressive course, impairing cognition, functional capacity, and behavior. Most studies have focused on AD. Severe dementia is associated with increased age, higher morbidity-mortality, and rising costs of care. It is fundamental to recognize that severe dementia is the longest period of progression, with patients living for many years in this stage. It is the most heterogeneous phase in the process, with different abilities and life expectancies. This practice guideline focuses on severe dementia to improve management and care in this stage of dementia. As it is a long period in the continuum of dementia, clinical practice should consider non-pharmacological and pharmacological approaches. Multidisciplinary interventions (physical therapy, speech therapy, nutrition, nursing, and others) are essential, besides educational and support to caregivers.
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Affiliation(s)
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Brasil; University of Groningen, The Netherlands; Universidade de São Paulo, Brasil
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brazil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Brucki SMD, Aprahamian I, Borelli WV, Silveira VCD, Ferretti CEDL, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Nitrini R, Schultz RR, Morillo LS. Manejo das demências em fase avançada: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:101-120. [DOI: 10.1590/1980-5764-dn-2022-s107pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/04/2021] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
RESUMO A doença de Alzheimer (DA) e outras demências neurodegenerativas têm um curso progressivo com comprometimento da cognição, capacidade funcional e comportamento. A maioria dos estudos enfocou a DA. A demência grave está associada ao aumento da idade, maior morbimortalidade e aumento dos custos de cuidados. É fundamental reconhecer que a demência grave é o período mais longo de progressão, com o paciente vivendo muitos anos nesta fase. É a fase mais heterogênea do processo, com diferentes habilidades e expectativa de vida. Esta diretriz de prática concentra-se na demência grave para melhorar o manejo e o cuidado nessa fase da demência. Como um longo período no continuum da demência, as abordagens não farmacológicas e farmacológicas devem ser consideradas. Intervenções multidisciplinares (fisioterapia, fonoaudiologia, nutrição, enfermagem, entre outras) são essenciais, além de educacionais e de apoio aos cuidadores.
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Affiliation(s)
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Brasil; University of Groningen, The Netherlands; Universidade de São Paulo, Brasil
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brazil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Jenkins SP. Is the four quadrant approach to military medical ethics a cargo cult? A call for more unity between philosophers and practitioners. J ROY ARMY MED CORPS 2019; 165:270-272. [PMID: 30850436 DOI: 10.1136/jramc-2019-001183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/04/2022]
Abstract
Moral theory should be practically useful, but without oversight from the philosophical community, the practical application of ethics by other institutions such as the military may drift into forms that are not theoretically robust. Ethical approaches that drift in this way run the risk of becoming 'cargo cults': simulations that will never properly fulfil their intended purpose. The four quadrant approach, a systematic method of ethical analysis that applies moral principles to clinical cases, has gained popularity in the last 10 years in a variety of medical contexts, especially the military. This paper considers whether the four quadrant approach is a cargo cult or whether it has theoretical value, with particular reference to the more popular four principles approach. This analysis concludes that the four quadrant approach has theoretical advantages over the four principles approach, if used in the right way (namely, with all four quadrants being used). The principal advantage is that the four quadrant approach leaves more room for clinical judgement, and thus avoids the charge of being too algorithmic, which has been levelled at the four principles approach. I suggest that it is the fourth quadrant, which invites the user to consider wider, contextual features of the case, which gives the approach this key advantage. Finally, I make a more general proposal that theoretical ethicists should work closely with those practitioners who apply ethics in the world, and I call for a symbiotic relationship between these two camps.
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