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Alnaeem MM, Shehadeh A, Nashwan AJ. The experience of patients with hematological malignancy in their terminal stage: a phenomenological study from Jordan's perspective. BMC Palliat Care 2024; 23:36. [PMID: 38336650 PMCID: PMC10854087 DOI: 10.1186/s12904-024-01373-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Patients diagnosed with hematological malignancies residing in low-middle-income countries undergo significant physical and psychological stressors. Despite this, only 16% of them receive proper care during the terminal stages. It is therefore crucial to gain insight into the unique experiences of this population. AIM To have a better understanding of the needs and experiences of adult patients with advanced hematological malignancy by exploring their perspectives. METHODS A qualitative interpretive design was employed to collect and analyze data using a phenomenological approach. The study involved in-depth interviews with ten participants aged between 49 and 65 years, utilizing a semi-structured approach. RESULTS Two primary themes emerged from the participants' experiences of reaching the terminal stage of illness: "Pain, Suffering, and Distress" and "Spiritual Coping." The first theme encompassed physical and emotional pain, suffering, and distress, while the second theme was centered on the participants' spiritual coping mechanisms. These coping mechanisms included seeking comfort in religious practices, relying on spiritual support from family and friends, and finding solace in their beliefs and faith. CONCLUSION Patients with hematological malignancies in the terminal stages of their disease experience severe pain, considerable physical and psychosocial suffering, and spiritual distress. While they require support to cope with their daily struggles, their experiences often go unnoticed, leading to disappointment and loss of dignity. Patients mainly rely on their spirituality to cope with their situations. Healthcare providers must acknowledge these patients' needs and provide more holistic and effective care.
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Affiliation(s)
- Mohammad M Alnaeem
- Palliative Care and Pain Management Program, School of Nursing, Al-Zaytoonah University of Jordan, Airport Street, 11733, Amman, Jordan
| | - Anas Shehadeh
- Community Health Nursing, School of Nursing, Al-Zaytoonah University of Jordan, Airport Street, 11733, Amman, Jordan
| | - Abdulqadir J Nashwan
- Director of Nursing for Education and Practice Development, Nursing Department, Hamad Medical Corporation, Doha, Qatar.
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Alwazzeh MJ, Aljoudi AS, Subbarayalu AV, Alharbi AF, Aldowayan AK, Alshahrani SF, Alamri AM, Almuhanna FA. Knowledge gaps, attitudes, and practices regarding end-of-life medical care among physicians in an academic medical center. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
<b>Introduction:</b> End-of-life medical care (ELMC) plans and do-not-resuscitate (DNR) decision-making are usually affected by multiple factors compared to other medical care decisions.<b> </b>ELMC and DNR policy implementation are still diversified and heterogeneous, especially in Saudi Arabia, because policymakers have adopted no guidelines. Thus, this study investigated physicians’ knowledge, attitude, and practice regarding ELMC and DNR.<br />
<b>Methods:</b> A cross-sectional study design was adopted. Three hundred physicians working at King Fahad Hospital of the University, Khobar, Saudi Arabia, were randomly selected and administered an anonymous self-administered questionnaire using the Likert scale. Data analysis was carried out using SPSS 23.0.<br />
<b>Results: </b>Of 300 distributed questionnaires, 264 (88%) were completed and analysed. Knowledge gaps and negative attitudes were observed, a quarter of the participants were opposed to issuing a DNR order, and 29.0% considered DNR as equal to euthanasia as they practice. The participants’ patient age and religious factors were the most critical factors in the ELMC plan and DNR decision. The physician’s level of acceptance regarding a set of ELMC interventions and DNR decisions showed heterogenicity and uncertainty among participants.<br />
<b>Conclusions:</b> The ELMC plan and DNR decision-making should be appropriately addressed in the medical residents’ training programs to bridge the knowledge gap and the physicians’ negative attitudes during their practice. Additionally, there is a need to update and unify the DNR policies at the national level, considering the patient’s right to be informed and involved actively during the decision process making. Finally, more prospective research is needed for the global standardization of ELMC.
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Affiliation(s)
- Marwan Jabr Alwazzeh
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
- King Fahad Hospital of the University, Al-Khobar, SAUDI ARABIA
| | - Abdullah Srour Aljoudi
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Arun Vijay Subbarayalu
- Deanship of Quality and Academic Accreditation, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Abdulelah Fawzi Alharbi
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Ali Khalid Aldowayan
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Saad Falah Alshahrani
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
| | - Ali Mohammad Alamri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
- King Fahad Hospital of the University, Al-Khobar, SAUDI ARABIA
| | - Fahd Abdulaziz Almuhanna
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAUDI ARABIA
- King Fahad Hospital of the University, Al-Khobar, SAUDI ARABIA
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Decision Making Near End of Life: A Qualitative Exploration of the Lived Experiences of Jordanian Healthcare Providers. Cancer Nurs 2023; 46:152-158. [PMID: 35398869 DOI: 10.1097/ncc.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Discussions related to a patient's prognosis and interventions near end of life are challenging and stressful for healthcare providers. Many reported experiencing emotional distress and discomfort during the decision-making process. OBJECTIVES The aim of this study was to describe the lived experience of nurses and physicians who participate in decision making near the end of a patient's life. METHODS A descriptive, phenomenological approach was used with a purposive sample of 7 nurses and 6 physicians from 2 palliative and end-of-life care institutions in Jordan. Data derived from focus group discussions conducted online via the ZOOM video communication application, and analysis followed Colaizzi's qualitative methodology. RESULTS Three major themes emerged from the healthcare providers' experiences. Initially, the participants described how they "strive toward optimal decision-making near end of life," "the overwhelming experience of decision making near end of life," and finally, their struggle in sharing details about the end of life when patients ask and whether to tell or not to tell them as "the time for hard talk." CONCLUSIONS The healthcare providers' experiences revealed several issues of decision making near a patient's end of life, such as a lack of appropriate training and administrative support, emotional distress, fear of legal liability, and the burden of a hard talk with patients. These findings necessitate institutional support of setting appropriate policies and guidelines, staff counseling, and healthcare provider support. IMPLICATIONS FOR PRACTICE Institutions providing palliative and end-of-life care can use this study's findings to support their staff by setting appropriate practice guidelines and providing staff training and counseling.
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Alnamlah MS, Itani SA, Alqahtani MM, Al Abdrabalnabi AA, Muammar A, Menezes RG. Common medical ethics dilemmas: Few reflections from a Saudi perspective. J Forensic Leg Med 2022; 90:102394. [PMID: 35803118 DOI: 10.1016/j.jflm.2022.102394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/07/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
Medical ethics plays a crucial role in physicians' daily practice, as it reflects on themselves, their institution, and, most importantly, the outcome of the treatment they provide to their patients. Common medical ethics dilemmas faced in Saudi Arabia include: end-of-life care, patient rights, which comprise autonomy, informed consent, and confidentiality, reproductive ethics, and equity of resources. The identification of flaws within the healthcare system and the implementation of clear guidelines are important to overcome the risk of malpractice and flawed judgment, and ensure the delivery of the best possible care to patients.
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Affiliation(s)
- Muna S Alnamlah
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sarah A Itani
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Maram M Alqahtani
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Alaa A Al Abdrabalnabi
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aroub Muammar
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ritesh G Menezes
- College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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Master JF, Wu B, Ni P, Mao J. The Compliance of End-of-Life Care Preferences Among Older Adults and Its Facilitators and Barriers: A Scoping Review. J Am Med Dir Assoc 2021; 22:2273-2280.e2. [PMID: 34087224 DOI: 10.1016/j.jamda.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/11/2021] [Accepted: 05/03/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the compliance of end-of-life (EOL) care preferences, and the facilitators and barriers of promoting quality of EOL care among older adults. DESIGN A scoping review was used to identify key themes in the compliance of EOL care preferences among older adults. SETTING AND PARTICIPANTS Studies published between 2009 and 2020 were identified from the Medline and Cochrane libraries. Eligible articles containing components related to the compliance of EOL care preferences among older adults were selected. MEASURES The eligible articles were thematically synthesized. Factors that affected the compliance of EOL care preferences among older adults were identified from the key components. RESULTS In total, 35 articles were included to identify the key components in the compliance of EOL care preferences: (1) supportive policy, (2) supportive environment, (3) cultural characteristics, (4) advance care planning (ACP), (5) the concordance of EOL care preferences between patients and surrogate decision makers, (6) prognosis awareness, and (7) patient's health status and the type of disease. Facilitators for the compliance of EOL care preferences included enactment of relevant policy, sufficient care institutions, the utilization of ACP, and poor health status. Barriers included lack of supportive policy, different culture, and low utilization of ACP. CONCLUSIONS/IMPLICATIONS The compliance of EOL care preferences was low among older adults. The compliance of EOL care preferences can be improved through relevant policy development and the utilization of ACP.
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Affiliation(s)
- Jie Fu Master
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY, USA
| | - Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Madadin M, Al Sahwan HS, Altarouti KK, Altarouti SA, Al Eswaikt ZS, Menezes RG. The Islamic perspective on physician-assisted suicide and euthanasia. MEDICINE, SCIENCE, AND THE LAW 2020; 60:278-286. [PMID: 32623956 DOI: 10.1177/0025802420934241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Physician-assisted suicide (PAS) and euthanasia can be debated from ethical and legal perspectives, and there are a variety of views regarding their acceptability and usefulness. Religion is considered an important factor in determining attitudes towards such practices. This narrative review aims to provide an overview of the Islamic perspective on PAS and euthanasia and explore the Islamic approach in addressing the related issues. The PubMed database was searched to retrieve relevant articles, then the references listed in the selected articles were checked for additional relevant publications. Additionally, religious books (Quran and hadith) and legal codes of selected countries were also consulted from appropriate websites. The Islamic code of law discusses many issues regarding life and death, as it considers any act of taking one's life to be forbidden. Islam sanctifies life and depicts it as a gift from God (Allah). It consistently emphasises the importance of preserving life and well-being. Therefore Muslims, the followers of Islam, have no right to end their life. All Islamic doctrines consider PAS and euthanasia to be forbidden. However, if the patient has an imminently fatal illness, withholding or withdrawing a futile medical treatment is considered permissible. From a legal perspective, Islamic countries have not legalised PAS and euthanasia. Such practices are therefore considered suicides when patients consent to the procedure, and homicides when physicians execute the procedure.
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Affiliation(s)
- Mohammed Madadin
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Houria S Al Sahwan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Khadijah K Altarouti
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Sarraa A Altarouti
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zahra S Al Eswaikt
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ritesh G Menezes
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Almoallem AM, Almudayfir MA, Al-Jahdail YH, Ahmed AE, Al-Shaikh A, Baharoon S, AlHarbi A, Al-Jahdali H. Top Ethical Issues Concerning Healthcare Providers Working in Saudi Arabia. J Epidemiol Glob Health 2020; 10:143-152. [PMID: 32538030 PMCID: PMC7310778 DOI: 10.2991/jegh.k.191211.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/20/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Healthcare providers working in Saudi Arabia come from various nationalities, cultures, and training backgrounds. This study aimed to assess the perceptions of healthcare providers working in Riyadh hospitals about ethical dilemmas and solutions. Methods: This is a cross-sectional study among physicians working in Riyadh’s private and governmental hospitals between June and December 2017. The study collected information on demographics, knowledge about medical ethics, the sources of such knowledge, and common ethical issues in general and the top ethical issues and dilemmas encountered in their daily practice. Results: A total of 455 physicians from government and private hospitals were enrolled in the study. The mean age of the participants was 34.29 ± 10.5 years, females were 29.7% and mean years of practice was 13.0 ± 11.5. The top ethical issues identified by the participants were “disagreement with the patients’ relatives about treatment” (91%), patient disagreement with decisions made by professionals (84%), treating the incompetent patient (79%), conflict with administration policy and procedures (77%), scarcity of resources (72%), and making decision about do-not-resuscitate or life-sustaining treatment (68%). There were significant differences in dealing with ethical issues in relation to gender, confidence about ethical knowledge, nationality, seniority, training site, and private or government hospitals academic and nonacademic. Conclusion: Healthcare providers in Riyadh hospitals face multiple ethical challenges. In addition to improvement in ethics knowledge through educational program among healthcare professional, there is a valid need for healthcare professionals and other sectors within society to engage in serious and continuous dialogue to address these issues and propose recommendations.
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Affiliation(s)
| | | | - Yassar H Al-Jahdail
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh
| | - Anwar E Ahmed
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
| | - Adnan Al-Shaikh
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,Department of Pediatrics, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
| | - Salim Baharoon
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,Department of Medicine, King Abulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
| | - Abdullah AlHarbi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,Department of Medicine, King Abulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
| | - Hamdan Al-Jahdali
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,Department of Medicine, King Abulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh.,College of Medicine, King Abdullah International Medical Research Center (KAIMRC), Riyadh
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8
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Miller AC, Khan AM, Hebishi K, Castro Bigalli AA, Vahedian-Azimi A. Ethical Issues Confronting Muslim Patients in Perioperative and Critical Care Environments: A Survey of Islamic Jurisprudence. Anesthesiol Clin 2020; 38:379-401. [PMID: 32336391 DOI: 10.1016/j.anclin.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Ethical dilemmas may arise when medical management conflicts with a patient's values, culture, religion, or legal considerations. Many Muslims encounter ethical dilemmas as patients in perioperative and critical care settings. This article discusses the fundamentals of Islamic jurisprudence and how this may affect hospitalized patients in terms of cleanliness and prayer in the setting of stoma and urinary catheters, fasting, transfusion, transplants, xenografts and animal-based medications, do-not-resuscitate orders, and postmortem examinations. Provider familiarity with how such situations may affect Muslim patients is important to navigate potential conflict and to deliver competent care.
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Affiliation(s)
- Andrew C Miller
- Department of Emergency Medicine, Vidant Medical Center, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Mailstop 625, Greenville, NC 27834, USA; The MORZAK Collaborative, 600 Moye Boulevard, Mailstop 625, Greenville, NC 27834, USA.
| | - Abbas M Khan
- The MORZAK Collaborative, 600 Moye Boulevard, Mailstop 625, Greenville, NC 27834, USA
| | - Karim Hebishi
- Departments of Internal Medicine and Psychiatry, Vidant Medical Center, East Carolina University Brody School of Medicine, 600 Moye Boulevard, Mailstop 628, Greenville, NC 27834, USA
| | - Alberto A Castro Bigalli
- East Carolina University Brody School of Medicine, 600 Moye Boulevard, Room 2S-20, Greenville, NC 27834, USA
| | - Amir Vahedian-Azimi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, P.O. Box 19575-174, Sheykh bahayi Stress, Vanak Square, Tehran, Iran
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Miller AC. Opinions on the Legitimacy of Death Declaration by Neurological Criteria from the Perspective of 3 Abrahamic Faiths. Medeni Med J 2019; 34:305-313. [PMID: 32821453 PMCID: PMC7433742 DOI: 10.5222/mmj.2019.48379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/24/2019] [Indexed: 11/22/2022] Open
Abstract
Traditional criteria to identify death may not fit all circumstances. This manuscript explores religious jurisprudence to ascertain whether death declaration by neurological criteria (DDNC) is accepted as a valid method by 3 Abrahamic religious traditions ie. Islam, Judaism, and Catholicism. Among Islamic sources (order of primacy), neither the Qur'an, Sunnah as reported in Hadith, Ijma' (scholarly consensus), nor Qiyas (precedent-based analogy) clearly describe death determination criteria. Through Ijtihad (lowest level of Shari 'ah), 5 of 6 identified non-binding fatwa support DDNC. Faith-based medical organizations are divided. Eleven of 13 surveyed Muslim-majority countries have laws supporting DDNC. Concern exists that premature death declaration could violate the Shari'ah concept of Hifz-An-nafs (saving life). As such, DDNC remains debated in Islamic circles. Among the 3 main sources of Jewish law (Halacha), the Torah (oral and written) does not clearly define death declaration criteria. Although Talmudic interpretations of Misnah Oholot 1:6 and Gamara Hullin 21a suggest a possible justification for death determination using neurologic criteria in some conditions, the bulk of mitzvot d'rabbanan (Rabbinic Law) rejects DDNC and adheres to cardiorespiratory criteria. Lastly, Catholic Church Cannon Law and the Holy Scripture recorded in Bible does not define death determination criteria. Following the Council of Vienne, Saint Thomas's loss of integration view has predominated. In 2000, Pope John Paul II expressed tentative and qualifid support for DDNC, however the topic remains controversial. Despite dissenting opinions in each faith, DDNC is currently accepted as valid by many Muslims and Catholics, while rejected by Judaism.
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Affiliation(s)
- Andrew C Miller
- East Carolina University, Department of Emergency Medicine, Greenville, USA
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10
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Alshammaray S, Duraisamy B, Albalawi Y, Ratnapalan S. Development of Palliative and End of Life Care: The Current Situation in Saudi Arabia. Cureus 2019; 11:e4319. [PMID: 31186996 PMCID: PMC6541163 DOI: 10.7759/cureus.4319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
As part of the health care reforms and transformation project of the Vision 2030, a group of expert healthcare professionals was tasked with the development of a model of care for patients with life-shortening illnesses in Saudi Arabia. This Care Design Group (CDG 1-3) held a series of workshops and conducted surveys and online discussions to systematically document and develop a model of care. These interventions were aimed at achieving a national standard of care. This short article is a description of this very successful process of development.
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Affiliation(s)
| | | | - Yousef Albalawi
- Palliative Care, Vision Realization Office, Ministry of Health, Riyadh, SAU
| | - Savithiri Ratnapalan
- Pediatrics, University of Toronto's Continuing Professional Development Office, SickKids Hospital, Toronto, CAN
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Ahaddour C, Van den Branden S, Broeckaert B. Between quality of life and hope. Attitudes and beliefs of Muslim women toward withholding and withdrawing life-sustaining treatments. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:347-361. [PMID: 29043540 DOI: 10.1007/s11019-017-9808-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The technological advances in medicine, including prolongation of life, have constituted several dilemmas at the end of life. In the context of the Belgian debates on end-of-life care, the views of Muslim women remain understudied. The aim of this article is fourfold. First, we seek to describe the beliefs and attitudes of middle-aged and elderly Moroccan Muslim women toward withholding and withdrawing life-sustaining treatments. Second, we aim to identify whether differences are observable among middle-aged and elderly women's attitudes toward withholding and withdrawing life-sustaining treatments. Third, we aim to explore the role of religion in their attitudes. Fourth, we seek to document how our results are related to normative Islamic literature. Qualitative empirical research was conducted with a sample of middle-aged and elderly Moroccan Muslim women (n = 30) living in Antwerp (Belgium) and with experts in the field (n = 15). We found an unconditional belief in God's sovereign power over the domain of life and death (cf. determined lifespan by God) and in God's almightiness (cf. belief in a miracle). However, we also found a tolerant attitude, mainly among our middle-aged participants, toward withholding and withdrawing (treatment) based on theological, eschatological, financial and quality of life arguments. Our study reveals that religious beliefs and worldviews have a great impact on the ethical attitudes toward end-of-life issues. We found divergent positions toward withholding and withdrawing life-sustaining treatments, reflecting the lines of reasoning found in normative Islamic literature. In our interviews, theological and eschatological notions emerged as well as financial and quality of life arguments.
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Affiliation(s)
- Chaïma Ahaddour
- Faculty of Theology and Religious Studies (Research Unit of Theological and Comparative Ethics), KU Leuven, Sint-Michielsstraat 6, 3000, Leuven, Belgium.
| | - Stef Van den Branden
- Faculty of Theology and Religious Studies (Research Unit of Theological and Comparative Ethics), KU Leuven, Sint-Michielsstraat 6, 3000, Leuven, Belgium
| | - Bert Broeckaert
- Faculty of Theology and Religious Studies (Research Unit of Theological and Comparative Ethics), KU Leuven, Sint-Michielsstraat 6, 3000, Leuven, Belgium
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12
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Gouda A, Alrasheed N, Ali A, Allaf A, Almudaiheem N, Ali Y, Alghabban A, Alsalolami S. Knowledge and Attitude of ER and Intensive Care Unit Physicians toward Do-Not-Resuscitate in a Tertiary Care Center in Saudi Arabia: A Survey Study. Indian J Crit Care Med 2018; 22:214-222. [PMID: 29743759 PMCID: PMC5930524 DOI: 10.4103/ijccm.ijccm_523_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Only a few studies from Arab Muslim countries address do-not-resuscitate (DNR) practice. The knowledge of physicians about the existing policy and the attitude towards DNR were surveyed. Objective The objective of this study is to identify the knowledge of the participants of the local DNR policy and barriers of addressing DNR including religious background. Methods A questionnaire has been distributed to Emergency Room (ER) and Intensive Care Unit (ICU) physicians. Results A total of 112 physicians mostly Muslims (97.3%). About 108 (96.4%) were aware about the existence of DNR policy in our institute. 107 (95.5%) stated that DNR is not against Islamic. Only (13.4%) of the physicians have advance directives and (90.2%) answered they will request to be DNR if they have terminal illness. Lack of patients and families understanding (51.8%) and inadequate training (35.7%) were the two most important barriers for effective DNR discussion. Patients and families level of education (58.0%) and cultural factors (52.7%) were the main obstacles in initiating a DNR order. Conclusions There is a lack of knowledge about DNR policy which makes the optimization of DNR process difficult. Most physicians wish DNR for themselves and their patients at the end of life, but only a few of them have advance directives. The most important barriers for initializing and discussing DNR were lack of patient understanding, level of education, and the culture of patients. Most of the Muslim physicians believe that DNR is not against Islamic rules. We suggest that the DNR concept should be a part of any training program.
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Affiliation(s)
- Alaa Gouda
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, KSA
| | - Norah Alrasheed
- Department of Emergency Care, King Abdulaziz Medical City, Riyadh, KSA
| | - Alaa Ali
- Alfaisal University, College of Medicine, Riyadh, KSA
| | - Ahmad Allaf
- Alfaisal University, College of Medicine, Riyadh, KSA
| | - Najd Almudaiheem
- Princess Nourah Bint Abdulrahman University, College of Medicine, Riyadh, KSA
| | - Youssuf Ali
- Alfaisal University, College of Medicine, Riyadh, KSA
| | - Ahmad Alghabban
- Department of Emergency Care, King Abdulaziz Medical City, Riyadh, KSA
| | - Sami Alsalolami
- Department of Emergency Care, King Abdulaziz Medical City, Riyadh, KSA
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Boucher NA, Siddiqui EA, Koenig HG. Supporting Muslim Patients During Advanced Illness. Perm J 2017; 21:16-190. [PMID: 28609264 DOI: 10.7812/tpp/16-190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Religion is an important part of many patients' cultural perspectives and value systems that influence them during advanced illness and toward the end of life when they directly face mortality. Worldwide violence perpetrated by people identifying as Muslim has been a growing fear for people living in the US and elsewhere. This fear has further increased by the tense rhetoric heard from the recent US presidential campaign and the new presidential administration. For many, this includes fear of all Muslims, the second-largest religious group in the world with 1.6 billion adherents and approximately 3.5 million in the US alone. Patient-centered care requires health professionals to look past news headlines and unchecked social media so they can deliver high-quality care to all patients. This article explores areas of importance in the context of advanced illness for practitioners of Islam. These include the conditions needed for prayer, the roles of medical treatment and religious authority, the importance of modesty, the religious concordance of clinicians, the role of family in medical decision making, advance care planning, and pain and symptom management. Initial recommendations to optimize care for Muslim patients and their families, informed by the described tenets of Muslim faith, are provided for clinicians and health systems administrators. These include Islamic cultural awareness training for staff, assessment of patients and families to determine needs, health education and decision-making outreach, and community health partnerships with local Islamic institutions.
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Affiliation(s)
- Nathan A Boucher
- Postdoctoral Fellow at the Geriatric Research Education and Clinical Center at the Durham Veterans Administration Medical Center and a Senior Fellow at the Duke University Center for the Study of Aging in NC.
| | - Ejaz A Siddiqui
- Muslim Liaison at the Mount Sinai Medical Center in New York, NY.
| | - Harold G Koenig
- Professor of Psychiatry and Behavioral Sciences and an Associate Professor of Medicine at Duke University Medical Center in Durham, NC, and an Adjunct Professor in the Department of Medicine at King Abdulaziz University in Jeddah, Saudi Arabia.
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Chamsi-Pasha H, Albar MA. Ethical Dilemmas at the End of Life: Islamic Perspective. JOURNAL OF RELIGION AND HEALTH 2017; 56:400-410. [PMID: 26797682 DOI: 10.1007/s10943-016-0181-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Many Muslim patients and families are often reluctant to accept fatal diagnoses and prognoses. Not infrequently, aggressive therapy is sought by the patient or his/her family, to prolong the life of the patient at all costs. A series of searches were conducted of Medline databases published in English between January 2000 and January 2015 with the following Keywords: End-of-life, Ethics and Islam. Islamic law permits the withdrawal of futile treatment, including all kinds of life support, from terminally ill patients leaving death to take its natural course. However, such decision should only take place when the physicians are confident that death is inevitable. All interventions ensuring patient's comfort and dignity should be maintained. This topic is quite challenging for the health care providers of Muslim patients in the Western World.
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Affiliation(s)
- Hassan Chamsi-Pasha
- Department of Cardiology, King Fahd Armed Forces Hospital, P.O. Box: 9862, Jeddah, 21159, Saudi Arabia.
| | - Mohammed Ali Albar
- Department of Medical Ethics, International Medical Center, Jeddah, Saudi Arabia
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Hassanin FS, Schaalan MF, Kamal KM, Miller FD. An Initial Investigation of Do Not Resuscitate Acceptance in Egypt. Am J Hosp Palliat Care 2016; 33:823-828. [DOI: 10.1177/1049909115594613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The aim of this work was to obtain objective data on the extent of knowledge and attitudes of the do not resuscitate (DNR) concept in an Egyptian urban setting. Methods: This survey was conducted in Cairo, Egypt, using a structured questionnaire including 23 questions. Questions and questionnaire were developed from literature on DNR in the region and from pilot testing. Results: A total of 461 persons participated. In all, 48 participants (10.4%, 95% confidence interval [CI]: 7.8-13.7) agreed on the concept of DNR, 226 (49%, 95% CI: 36.1-45.2) stated that it depends on the patient condition, and 187 (40.5%, 95% CI: 44.4-53.7) rejected DNR. Combining the first 2 categories, agree and depends on patient condition, over 60% of the respondents in effect supported DNR. Family members (35.6%, 95% CI: 31.4-40.3) and attending physicians (43.3%, 95% CI: 30.1-39.0) were selected over religious leaders (21%, 95% CI: 17.5-25.2) and representatives from state institutions (4.6%, 95% CI: 2.9-7.0) as to who should have authority for making a DNR decisions. Discussion: These and additional results provide objective evidence that DNR will not be rejected outright in Egypt. More formal surveys are justified and will provide needed guidance for implementing DNR and related end-of-life medical care in Egypt.
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Affiliation(s)
| | - Mona F. Schaalan
- Faculty of Pharmacy, Misr International University, Cairo, Egypt
| | - Karim M. Kamal
- Faculty of Pharmacy, Misr International University, Cairo, Egypt
| | - F. DeWolfe Miller
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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Caring for terminally ill Muslim patients: Lived experiences of non-Muslim nurses. Palliat Support Care 2016; 14:599-611. [DOI: 10.1017/s1478951516000249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:The nursing profession demands knowledge, awareness, and experience regarding the ethnic, religious, cultural, and social constructs involved in patient care. Non-Muslim nurses must have theoretical and empirical insights into treatment methods and caring for terminally ill Muslim patients. In particular, non-Muslim nurses should acquire knowledge of Islamic rules and regulations. They should also be familiar with the unique religious and sociocultural practices that pertain to healthcare practices. Our study aimed to explore non-Muslim nurses' experiences in caring for terminally ill Muslim patients and their families regarding physical, social, cultural, spiritual, and religious practices. The study also sought to investigate the context or situations that influence these experiences as described by the nurses.Method:In this qualitative descriptive study, 10 nurses working in medical, oncology, and oncology/palliative care units in a tertiary care hospital in Saudi Arabia were interviewed. A modified Stevick–Colaizzi–Keen method was employed for data analysis.Results:Three main themes constituted the nurses' lived experiences: family matters, end-of-life practices, and nurse challenges. Cultural values, religious practices, and a family approach to the process of care influenced nurses' experiences. Issues related to an absence of palliative care integration and the unavailability of members in the interdisciplinary team also influenced their experiences. Nurses showed a lack of cultural knowledge of some practices due to a lack of awareness of cultural diversity and the unavailability of formal cultural education.Significance of Results:Provision of culturally competent care at the end of life for Muslim patients in Saudi Arabia requires a thoughtful understanding of religious and cultural practices as well as knowledge of the role of the family throughout the care process. The introduction of a cultural care nursing delivery model that incorporates a cultural education program with Islamic teachings and practices at its core is recommended.
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Miller AC. Opinions on the Legitimacy of Brain Death Among Sunni and Shi'a Scholars. JOURNAL OF RELIGION AND HEALTH 2016; 55:394-402. [PMID: 26581553 DOI: 10.1007/s10943-015-0157-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The concept of brain death poses a great challenge to clinicians who may be required to bridge the interface of culture, religion, law, and medicine. This review discusses and applies Islamic jurisprudence to the question of whether brain death is accepted as true death under Islamic law. Among the five sources of Islamic law, the Qur'an and Sunnah do not directly address brain death. Scholarly consensus (Ijmā') does not exist, and Qiya does not apply. When applying Ijtihad, the identified collection of non-binding fatwā offer conflicting results. Debate continues as to the validity of brain-death criteria within Islamic circles.
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Affiliation(s)
- Andrew C Miller
- Department of Emergency Medicine, West Virginia University School of Medicine, 1 Medical Center Drive, Morgantown, WV, 26506-9149, USA.
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
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Miller AC, Ziad-Miller A, Elamin EM. Brain death and Islam: the interface of religion, culture, history, law, and modern medicine. Chest 2014; 146:1092-1101. [PMID: 25287999 PMCID: PMC4188144 DOI: 10.1378/chest.14-0130] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 04/15/2014] [Indexed: 11/01/2022] Open
Abstract
How one defines death may vary. It is important for clinicians to recognize those aspects of a patient's religious beliefs that may directly influence medical care and how such practices may interface with local laws governing the determination of death. Debate continues about the validity and certainty of brain death criteria within Islamic traditions. A search of PubMed, Scopus, EMBASE, Web of Science, PsycNet, Sociological Abstracts, DIALOGUE ProQuest, Lexus Nexus, Google, and applicable religious texts was conducted to address the question of whether brain death is accepted as true death among Islamic scholars and clinicians and to discuss how divergent opinions may affect clinical care. The results of the literature review inform this discussion. Brain death has been acknowledged as representing true death by many Muslim scholars and medical organizations, including the Islamic Fiqh Academies of the Organization of the Islamic Conference and the Muslim World League, the Islamic Medical Association of North America, and other faith-based medical organizations as well as legal rulings by multiple Islamic nations. However, consensus in the Muslim world is not unanimous, and a sizable minority accepts death by cardiopulmonary criteria only.
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Affiliation(s)
- Andrew C Miller
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
| | | | - Elamin M Elamin
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, James A. Haley Veteran's Hospital and University of South Florida, Tampa, FL
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Abstract
Palliative and end-of-life care, once the purview of oncologists and intensivists, has also become the responsibility of the emergency physician. As our population ages and medical technology enables increased longevity, it is essential that all medical professionals know how to help patients negotiate the balance between quantity and quality of life. Emergency physicians have the opportunity to educate patients and their loved ones on how to best accomplish their goals of care while also enhancing quality of life through treatment of symptoms. The emergency physician must be aware of the ethical and medico-legal parameters that govern decision making.
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Al-Arifi MN. Community pharmacist perception and attitude toward ethical issues at community pharmacy setting in central Saudi Arabia. Saudi Pharm J 2014; 22:315-25. [PMID: 25161375 PMCID: PMC4142367 DOI: 10.1016/j.jsps.2013.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/31/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE The purpose of this study is to identify the community pharmacist perceptions and attitudes toward ethical issues at community pharmacy setting in Saudi Arabia. METHOD A cross-sectional, descriptive, and qualitative survey of community pharmacists was conducted and the survey questions were pre-tested by a pharmacist with extensive experience in ethical issues. Based on the result of a pilot study the questionnaire was used with some modifications and the final questionnaire was sent to the participants by handing over in person, mail or Email. RESULTS 45.7% Often discuss ethical issues with their patients, while only 2.1% never discuss it. 40.6% often record the ethical concern whereas only 1.9% of them never do so. 31.5% reported that patients initiate ethical issues. DISCUSSION 28.3% of the pharmacists initiate the discussion. The barriers that limit discussing ethical issues with their patients were lack of time due to other obligations assigned to the community pharmacist (69.2%), lack of reliable resources (10.7%), not interested in the subject (10.1%), lack of knowledge on ethical issues (4.8%), and other reasons (5.3%). Recourses are books (37.7%), internet web sites (31.1%), and brochures (26.8%). Only a minority of respondents had access to computer databases (15.8%) and other resources (1.3%). Most perceived ethical problems were: being asked for hormonal contraception, dispensing a drug for unreported indication (69.2%), dispensing dose of medicine for a child that is outside the SNF limits (68.9%), unwanted professional behavior about controlled drugs (66.6%), a colleague insisting on unethical behavior (65.0%), a colleague has done something unethical for the first time (64.7%), suspecting that a child is being abused (63.3%) prescribing on private scripts for suspected medications of possible abuse (60.7%) and terminally ill patient asks for a diagnosis or prognosis (52.9%). CONCLUSION The findings of this study assured the need of Saudi health authorities to implement a code of ethics for pharmacy practicing to cover all aspects of ethical issues.
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Affiliation(s)
- Mohamed N. Al-Arifi
- Clinical Pharmacy Department, Director of Drug and Poison Information Center, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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al-Awamer A, Downar J. Developing a palliative care service model for Muslim Middle Eastern countries. Support Care Cancer 2014; 22:3253-62. [DOI: 10.1007/s00520-014-2347-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 06/29/2014] [Indexed: 11/30/2022]
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Hui D, Nooruddin Z, Didwaniya N, Dev R, De La Cruz M, Kim SH, Kwon JH, Hutchins R, Liem C, Bruera E. Concepts and definitions for "actively dying," "end of life," "terminally ill," "terminal care," and "transition of care": a systematic review. J Pain Symptom Manage 2014; 47:77-89. [PMID: 23796586 PMCID: PMC3870193 DOI: 10.1016/j.jpainsymman.2013.02.021] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 11/23/2022]
Abstract
CONTEXT The terms "actively dying," "end of life," "terminally ill," "terminal care," and "transition of care" are commonly used but rarely and inconsistently defined. OBJECTIVES We conducted a systematic review to examine the concepts and definitions for these terms. METHODS We searched MEDLINE, PsycINFO, Embase, and CINAHL for published peer-reviewed articles from 1948 to 2012 that conceptualized, defined, or examined these terms. Two researchers independently reviewed each citation for inclusion and then extracted the concepts/definitions when available. We also searched 10 dictionaries, four palliative care textbooks, and 13 organization Web sites, including the U.S. Federal Code. RESULTS One of 16, three of 134, three of 44, two of 93, and four of 17 articles defined or conceptualized actively dying, end of life, terminally ill, terminal care, and transition of care, respectively. Actively dying was defined as "hours or days of survival." We identified two key defining features for end of life, terminally ill, and terminal care: life-limiting disease with irreversible decline and expected survival in terms of months or less. Transition of care was discussed in relation to changes in 1) place of care (e.g., hospital to home), 2) level of professions providing the care (e.g., acute care to hospice), and 3) goals of care (e.g., curative to palliative). Definitions for these five terms were rarely found in dictionaries, textbooks, and organizational Web sites. However, when available, the definitions were generally consistent with the concepts discussed previously. CONCLUSION We identified unifying concepts for five commonly used terms in palliative care and developed a preliminary conceptual framework toward building standardized definitions.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
| | - Zohra Nooruddin
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Neha Didwaniya
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Rony Dev
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Maxine De La Cruz
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Sun Hyun Kim
- Department of Family Medicine, Myong Ji Hospital, Kwandong University, College of Medicine, Gyeonggi, Republic of Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea
| | - Ronald Hutchins
- Research Medical Library, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Christiana Liem
- Research Medical Library, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Razban F, Iranmanesh S, Rafei H. Nurses' attitudes toward palliative care in south-east Iran. Int J Palliat Nurs 2013; 19:403-10. [DOI: 10.12968/ijpn.2013.19.8.403] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farideh Razban
- School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran, and Department of Nursing, Sirjan School of Medical Sciences, Sirjan, Iran
| | | | - Hossein Rafei
- School of Nursing and Midwifery, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Arabiat DH, Al Jabery M, Abdelkader RH, Mahadeen A. Jordanian mothers' beliefs about the causes of cancer in their children and their impact on the maternal role. J Transcult Nurs 2013; 24:246-53. [PMID: 23545695 DOI: 10.1177/1043659613481808] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Arab culture and Islamic beliefs contribute to values and practices regarding cancer. Mothers in Jordanian society are expected to be the primary caregivers to children. PURPOSE The purpose of this study was to explore Jordanian mothers' beliefs regarding the causes of cancer in their children and their impact on their role as mothers. DESIGN A descriptive, qualitative design was used. Individual interviews were conducted with Jordanian mothers (n = 51) of hospitalized children with cancer. RESULTS Causes of cancer were attributed to supernatural explanations and biomedical explanations. The impact of cancer on these mothers' lives varied. For some, their child's illness resulted in stronger family bonds, whereas for others, the families suffered a state of disequilibrium. CONCLUSIONS Cultural beliefs helped assign meaning to their children's illness. The maternal role of Jordanian women was partially fulfilled or inadequately performed, which in turn affected the functioning and coping abilities of the entire household.
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Alkabba AF, Hussein GMA, Albar AA, Bahnassy AA, Qadi M. The major medical ethical challenges facing the public and healthcare providers in Saudi Arabia. J Family Community Med 2012; 19:1-6. [PMID: 22518351 PMCID: PMC3326764 DOI: 10.4103/2230-8229.94003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Despite the relatively high expenditure on healthcare in Saudi Arabia, its health system remains highly centralized in the main cities with its primary focus on secondary and tertiary care rather than primary care. This has led to numerous ethical challenges for the healthcare providers. This article reports the results of a study conducted with a panel of practitioners, and non-clinicians, in Saudi Arabia, in order to identify the top ten ethical challenges for healthcare providers, patients, and their families. Materials and Methods: The study design was a cross-sectional, descriptive, and qualitative one. The participants were asked the question: “What top ten ethical challenges are Saudis likely to face in health care?” The participants were asked to rank the top ten ethical challenges throughout a modified Delphi process, using a ranking Scale. A consensus was reached after three rounds of questions and an experts’ meeting. Results: The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients’ Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) Beginning and end of life, and (10) Healthcare team ethics. Conclusion: Although many of the challenges listed by the participants have received significant public and specialized attention worldwide, scant attention has been paid to these top challenges in Saudi Arabia. We propose several possible steps to help address these key challenges.
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Affiliation(s)
- Abdulaziz F Alkabba
- Faculty of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSBAUHS), King Fahad Medical City (KFMC), Riyadh, Saudi Arabia.
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Abstract
For most clinicians and patients, the discussion of palliative care is a difficult topic. It is complicated by both the clinician's and patient's belief systems, which are frequently heavily influenced by cultural and religious upbringing. This article discusses the impact of some of those differences on attitudes toward end of life decisions. Several different religions and cultures have been evaluated for their impact on perceptions of palliative care and the authors will share some examples.
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Affiliation(s)
- Steven M Steinberg
- Department of Surgery, Division of Critical Care, Trauma and Burn, The Ohio State University, Columbus, Ohio, USA
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Khalid I, Hamad WJ, Khalid TJ, Kadri M, Qushmaq I. End-of-life care in Muslim brain-dead patients: a 10-year experience. Am J Hosp Palliat Care 2012; 30:413-8. [PMID: 22786839 DOI: 10.1177/1049909112452625] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Muslim countries, end-of-life practices in Muslim brain-dead patients are unknown. We conducted this study to evaluate this issue. RESULTS We identified 42 brain-dead patients between 2001 and 2011. The expectant terminal extubation occurred only in 5. Largely due to family opposition, 2 patients remained "full code," and rests were "do not attempt resuscitation" with varying usage of "life-sustaining" therapies. Only 2 out of 24 eligible patients donated organs. There was minimal involvement of social worker, palliative team, or Muslim chaplain in the end-of-life discussions. CONCLUSION In Muslim patients, the concept of terminal withdrawal and organ donation after brain death is still not well accepted. Future multicenter studies, involving palliative teams, should focus on improving these issues.
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Affiliation(s)
- Imran Khalid
- Department of Medicine, Critical Care Section, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia.
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Hui D, Mori M, Parsons HA, Kim SH, Li Z, Damani S, Bruera E. The lack of standard definitions in the supportive and palliative oncology literature. J Pain Symptom Manage 2012; 43:582-92. [PMID: 22104619 PMCID: PMC3818788 DOI: 10.1016/j.jpainsymman.2011.04.016] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 04/20/2011] [Accepted: 04/21/2011] [Indexed: 01/10/2023]
Abstract
CONTEXT Multiple organizations have raised concerns about the lack of standard definitions for terminology in the supportive and palliative oncology literature. OBJECTIVES We aimed to determine 1) the frequency of 10 commonly used terms in the supportive and palliative oncology literature, 2) the proportion of articles that provided definitions for each term, and 3) how each term was defined. METHODS We systematically searched MEDLINE, PubMed, PsycINFO, the Cochrane Library, Embase, ISI Web of Science, and Cumulative Index to Nursing and Allied Health Literature for original studies, review articles, and systematic reviews related to palliative care and cancer in the first six months of 2004 and 2009. We counted the number of occurrences for "palliative care," "supportive care," "best supportive care," "hospice care," "terminal care," "end-of-life," "terminally ill," "goals of care," "actively dying," and "transition of care" in each article, reviewed them for the presence of definitions, and documented the journal characteristics. RESULTS Among the 1213 articles found, 678 (56%) were from 2009. "Palliative care" and "end-of-life" were the most frequently used terms. "Palliative care," "end-of-life," and "terminally ill" appeared more frequently in palliative care journals, whereas "supportive care" and "best supportive care" were used more often in oncology journals (P<0.001). Among 35 of 601 (6%) articles with a definition for "palliative care," there were 16 different variations (21 of 35 articles used the World Health Organization definition). "Hospice care" had 13 definitions among 13 of 151 (9%) articles. "Supportive care" and other terms were rarely defined (less than 5% of articles that used the term). CONCLUSION Our findings highlight the lack of definitional clarity for many important terms in the supportive and palliative oncology literature. Standard definitions are needed to improve administrative, clinical, and research operations.
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Affiliation(s)
- David Hui
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Khater WA, Akhu-Zaheya LM, Abu Alhijaa EH, Abdulelah HA, EL-Otti SN. The practice of withholding and withdrawing life-support measures among patients with cancer in Jordan. Int J Palliat Nurs 2011; 17:440-5. [DOI: 10.12968/ijpn.2011.17.9.440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Compliance with DNR policy in a tertiary care center in Saudi Arabia. Intensive Care Med 2010; 36:2149-53. [PMID: 20838763 DOI: 10.1007/s00134-010-1985-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 05/10/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Do not resuscitate (DNR) is an important aspect of medical practice, although few studies from Arab Muslim countries address this issue. King Abdulaziz Medical City (KAMC), Saudi Arabia has a policy addressing all aspects of patient care at end of life. OBJECTIVE To assess compliance of physicians with the current DNR policy. METHODS A cohort study of data prospectively collected from 15/10/2008 through 15/01/2009 for patients where DNR was initiated. Patient charts were followed prospectively to observe DNR documentation completion. Data were analyzed in terms of frequencies and descriptive statistics, and the results expressed as percentages. RESULTS DNR was initiated in 65 patients referred to the intensive care unit (ICU): 46.2% females, 53.8% males; age range 19-93 years, mean ± standard deviation (SD) 66.1 ± 16.0 years. DNR was initiated by ICU physician in 80% of cases and by most responsible physician (MRP) in 20% of cases. There was a delay (of more than 48 h) in completing MRP signature in 8 patients (12.3%), and no signature at all by the MRP in 13 patients (20%). Documentation of discussion with the family was absent in 53.8% of cases. CONCLUSIONS ICU physicians have a role in initiating DNR. Mostly this issue is not addressed on admission. Documentation of DNR once initiated is still not up to the optimum level in 32.3% of cases, mainly due to MRP. Discussion with the patient's family was not well documented in the chart in more than half of cases.
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Bibliography. PROGRESS IN PALLIATIVE CARE 2009. [DOI: 10.1179/096992609x12455871937224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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