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Vendetta L, Vig E, Kross E, Merel SE. The Role of the Palliative Medicine Clinician in the Family Conference. Am J Hosp Palliat Care 2023; 40:5-9. [PMID: 35465731 DOI: 10.1177/10499091221093560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Facilitating a family conference is a core skill for a palliative medicine clinician, yet the role of the palliative medicine consultant in a family conference has not been clearly defined in the literature. Most educational articles describe a structured approach to a family conference that focuses on the role of the person leading the conference, who may be a palliative medicine specialist or a member of the primary team caring for the patient. For the palliative medicine clinician, balancing the roles of communication facilitator and palliative consultant is nuanced and requires a specific framework and set of skills. In this article, we review the literature on family conferences focusing on facilitation and communication by the palliative care consultant during the conferences, and outline specific ways the palliative medicine clinician can contribute to family conferences. Our hope is that this framework helps guide palliative medicine clinicians and others seeking more specialized training in palliative medicine to be more intentional with their contributions to family conferences in the future. We also hope that this framework will help palliative medicine educators training future specialists.
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Affiliation(s)
- Lindsay Vendetta
- 601956VA Puget Sound Geriatric Research Education and Clinical Center, Seattle, WA, USA.,205280University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, WA, USA
| | - Elizabeth Vig
- 205280University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, WA, USA.,UW Geriatrics and Extended Care, VA Puget Sound Healthcare System, Seattle, WA
| | - Erin Kross
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Seattle, WA, USA.,Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA
| | - Susan E Merel
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle, WA.,205280University of Washington Department of Medicine, Division of General Internal Medicine, Seattle, WA, USA
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2
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Wang A, Thomas K, Weil J, Hudson P. Characteristics of family meetings for patients with advanced disease in an Australian metropolitan tertiary hospital. BMJ Support Palliat Care 2020:bmjspcare-2020-002250. [PMID: 32718937 DOI: 10.1136/bmjspcare-2020-002250] [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: 02/07/2020] [Revised: 06/08/2020] [Accepted: 06/14/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Family meetings (FMs) between clinicians, patients and family are recommended as a valuable communication and care planning method in the delivery of palliative care. However, there is a dearth of knowledge regarding FM characteristics, with few studies describing the prevalence, circumstances and content of FMs. The aims of this study were to: (1) measure the prevalence of FMs, (2) examine circumstance and timing of FMs, and (3) explore the content of FMs. METHODS A retrospective medical record audit was conducted of 200 patients who died in an Australian hospital of an expected death from advanced disease. Details of FMs were collected using an audit tool, along with patient demographics and admission data. RESULTS 33 patients (16.5%) had at least one FM during their inpatient stay. The majority of FMs occurred for patients admitted to an inpatient palliative care unit (59.5%) and were most commonly facilitated by doctors (81.0%). Patient attendance was frequent (40.5%). FM content fell into six categories: medical information, supportive communication behaviours of clinicians, psychosocial support for patients and families, end-of-life discussions, discharge planning and administrative arrangements. CONCLUSIONS Despite the benefits FMs confer, FMs appear to be infrequently used at the end of life. When FMs are used, there is a strong medical focus on both facilitation and content. Available FM documentation tools also appear to be underused. Clinicians are encouraged to have a greater understanding of FMs to optimise their use and adopt a proactive and structured approach to the conduct and documentation of FMs.
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Affiliation(s)
- Amy Wang
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Kristina Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jennifer Weil
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
- Vrije University Brussels, Brussels, Belgium
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3
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Gibbon LM, GrayBuck KE, Mehta A, Perry SE, Peterson S, Schreiber KM, Merel SE. Equitable Care for Critically Ill Patients from Culturally Diverse Communities in the COVID-19 Pandemic. J Palliat Med 2020; 23:1559-1561. [PMID: 32543958 DOI: 10.1089/jpm.2020.0347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lindsay M Gibbon
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine E GrayBuck
- Department of Spiritual Care, University of Washington, Seattle, Washington, USA
| | - Amisha Mehta
- Supportive and Palliative Care Service, UW Valley Medical Center, Renton, Washington, USA
| | - S Elizabeth Perry
- Supportive and Palliative Care Service, UW Valley Medical Center, Renton, Washington, USA
| | - Sarah Peterson
- Supportive and Palliative Care Service, UW Valley Medical Center, Renton, Washington, USA
| | - Kira M Schreiber
- Department of Social Work, University of Washington, Seattle, Washington, USA
| | - Susan E Merel
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
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Broden EG, Deatrick J, Ulrich C, Curley MAQ. Defining a "Good Death" in the Pediatric Intensive Care Unit. Am J Crit Care 2020; 29:111-121. [PMID: 32114610 DOI: 10.4037/ajcc2020466] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Societal attitudes about end-of-life events are at odds with how, where, and when children die. In addition, parents' ideas about what constitutes a "good death" in a pediatric intensive care unit vary widely. OBJECTIVE To synthesize parents' perspectives on end-of-life care in the pediatric intensive care unit in order to define the characteristics of a good death in this setting from the perspectives of parents. METHODS A concept analysis was conducted of parents' views of a good death in the pediatric intensive care unit. Empirical studies of parents who had experienced their child's death in the inpatient setting were identified through database searches. RESULTS The concept analysis allowed the definition of antecedents, attributes, and consequences of a good death. Empirical referents and exemplar cases of care of a dying child in the pediatric intensive care unit serve to further operationalize the concept. CONCLUSIONS Conceptual knowledge of what constitutes a good death from a parent's perspective may allow pediatric nurses to care for dying children in a way that promotes parents' coping with bereavement and continued bonds and memories of the deceased child. The proposed conceptual model synthesizes characteristics of a good death into actionable attributes to guide bedside nursing care of the dying child.
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Affiliation(s)
- Elizabeth G Broden
- Elizabeth G. Broden is a doctoral student, University of Pennsylvania School of Nursing, and a registered nurse, Pediatric Intensive Care Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Janet Deatrick
- Janet Deatrick is a professor emerita, Department of Family and Community Health, University of Pennsylvania School of Nursing
| | - Connie Ulrich
- Connie Ulrich is a professor, Department of Biobehavioral Health, School of Nursing, and a professor of bioethics, School of Medicine, University of Pennsylvania
| | - Martha A Q Curley
- Martha A.Q. Curley is the Ruth M. Colket Endowed Chair in Pediatric Nursing, Children's Hospital of Philadelphia, and a professor, Department of Family and Community Health, School of Nursing and Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania
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Abstract
PURPOSE OF REVIEW Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. RECENT FINDINGS Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices. SUMMARY Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide.
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Glajchen M, Goehring A. The Family Meeting in Palliative Care: Role of the Oncology Nurse. Semin Oncol Nurs 2017; 33:489-497. [PMID: 29107531 DOI: 10.1016/j.soncn.2017.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the family meeting in palliative and end-of-life care, highlighting the role of the oncology nurse. Specific strategies will be provided for pre-meeting preparation, communication, and follow-up activities. DATA SOURCES A conceptual framework drawn from family and communication theory, and best practices from the clinical, research, nursing, and palliative care literature. CONCLUSION Working with patients and families is complex, but the family meeting is a promising tool and a potential quality indicator in palliative care. IMPLICATIONS FOR NURSING PRACTICE The nurse is well positioned to participate fully in every aspect of the family meeting.
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Fang ML, Sixsmith J, Sinclair S, Horst G. A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review. BMC Geriatr 2016; 16:107. [PMID: 27193395 PMCID: PMC4872365 DOI: 10.1186/s12877-016-0282-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/11/2016] [Indexed: 11/23/2022] Open
Abstract
Background Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. Methods To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014. Results The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making. Conclusions This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0282-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mei Lan Fang
- Gerontology Research Centre, Simon Fraser University, 2800-515 West Hastings Street, Vancouver, BC, V6B 5 K3, Canada.
| | - Judith Sixsmith
- Institute of Health and Wellbeing, University of Northampton, Northampton, UK.,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Hospice Clinical Team, Canadian Virtual Hospice, Winnipeg, MB, Canada
| | - Glen Horst
- Hospice Clinical Team, Canadian Virtual Hospice, Winnipeg, MB, Canada
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Singer AE, Ash T, Ochotorena C, Lorenz KA, Chong K, Shreve ST, Ahluwalia SC. A Systematic Review of Family Meeting Tools in Palliative and Intensive Care Settings. Am J Hosp Palliat Care 2015. [PMID: 26213225 DOI: 10.1177/1049909115594353] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Family meetings can be challenging, requiring a range of skills and participation. We sought to identify tools available to aid the conduct of family meetings in palliative, hospice, and intensive care unit settings. METHODS We systematically reviewed PubMed for articles describing family meeting tools and abstracted information on tool type, usage, and content. RESULTS We identified 16 articles containing 23 tools in 7 categories: meeting guide (n = 8), meeting planner (n = 5), documentation template (n = 4), meeting strategies (n = 2), decision aid/screener (n = 2), family checklist (n = 1), and training module (n = 1). We found considerable variation across tools in usage and content and a lack of tools supporting family engagement. CONCLUSION There is need to standardize family meeting tools and develop tools to help family members effectively engage in the process.
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Affiliation(s)
- Adam E Singer
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA RAND Corporation, Santa Monica, CA, USA
| | - Tayla Ash
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Claudia Ochotorena
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - Karl A Lorenz
- RAND Corporation, Santa Monica, CA, USA Quality Improvement Resource Center, Greater Los Angeles VA Health Care System, Los Angeles, CA, USA Stanford University School of Medicine, Stanford, CA, USA VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Kelly Chong
- Quality Improvement Resource Center, Greater Los Angeles VA Health Care System, Los Angeles, CA, USA
| | - Scott T Shreve
- Quality Improvement Resource Center, Greater Los Angeles VA Health Care System, Los Angeles, CA, USA Pennsylvania State College of Medicine, Lebanon, PA, USA
| | - Sangeeta C Ahluwalia
- RAND Corporation, Santa Monica, CA, USA Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
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Dojeiji S, Byszewski A, Wood T. Development and pilot testing the Family Conference Rating Scale: A tool aimed to assess interprofessional patient-centred communication and collaboration competencies. J Interprof Care 2015; 29:415-20. [PMID: 26171866 DOI: 10.3109/13561820.2015.1039116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is a paucity of evidence-based literature on the essential communication and collaboration skills to guide health care teams in conducting and assessing their performance in the Family Conference (FC). The authors developed and collected validity evidence for a rating scale of team FC performance, the Family Conference Rating Scale (FCRS). In phase 1, essential FC communication and collaboration skills were identified through a review of existing communication tools and literature on team functioning; a draft 34-item scale was developed. In phase 2, the scale was narrowed to a 6-category, 9-point scale with descriptors of expected behaviours through an iterative process: testing of the scale on 10 FC transcripts by two experts, soliciting feedback from a focus group of seven health care providers, and testing by non-experts on 49 live FCs. In phase 3, scores on the revised scale were validated by 10 health care providers from different disciplines by rating three videos of FCs of variable quality. Raters were able to detect inter-video variation in FC quality. The reliability of the FCRS was 0.95 and the inter-rater reliability, 0.68. The FCRS may enhance the ability of health professions educators to teach and assess interprofessional patient-centred communication and collaboration competencies.
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Affiliation(s)
- Sue Dojeiji
- a Department of Medicine, Division of Physical Medicine and Rehabilitation , University of Ottawa , Ottawa , Ontario , Canada
| | - Anna Byszewski
- b Department of Medicine, Division of Geriatric Medicine , University of Ottawa , Ottawa , Ontario , Canada , and
| | - Tim Wood
- c Department of Innovation in Medical Education , University of Ottawa , Ottawa , Ontario , Canada
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Broom A, Good P, Kirby E, Lwin Z. Negotiating palliative care in the context of culturally and linguistically diverse patients. Intern Med J 2013; 43:1043-6. [DOI: 10.1111/imj.12244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A. Broom
- School of Social Science; University of Queensland; Brisbane Queensland Australia
| | - P. Good
- Department of Palliative Care; Mater Health Service; Brisbane Queensland Australia
- St Vincent's Private Hospital Brisbane; Brisbane Queensland Australia
- Mater Research Institute; University of Queensland; Brisbane Queensland Australia
| | - E. Kirby
- School of Social Science; University of Queensland; Brisbane Queensland Australia
| | - Z. Lwin
- Department of Medical Oncology; Mater Health Services; Brisbane Queensland Australia
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11
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:402-16. [DOI: 10.1097/spc.0b013e3283573126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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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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Sharma RK, Hughes MT, Nolan MT, Tudor C, Kub J, Terry PB, Sulmasy DP. Family understanding of seriously-ill patient preferences for family involvement in healthcare decision making. J Gen Intern Med 2011; 26:881-6. [PMID: 21499822 PMCID: PMC3138973 DOI: 10.1007/s11606-011-1717-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Surrogate accuracy in predicting patient treatment preferences (i.e., what patients want) has been studied extensively, but it is not known whether surrogates can predict how patients want loved ones to make end-of-life decisions on their behalf. OBJECTIVE To evaluate the ability of family members to correctly identify the preferences of seriously-ill patients regarding family involvement in decision making. DESIGN Cross-sectional survey. PARTICIPANTS Twenty-five pancreatic cancer and 27 amyotrophic lateral sclerosis (ALS) patients and their family members (52 dyads total). MAIN MEASURES Patients and family members completed the Decision Control Preferences (DCP) scale regarding patient preferences for family involvement in health care decisions using conscious and unconscious scenarios. KEY RESULTS Patient and family member agreement was 56% (29/52 dyads) for the conscious scenario (kappa 0.29) and 46% (24/52 dyads) for the unconscious scenario (kappa 0.15). Twenty-four family members identified the patient's preference as independent in the unconscious scenario, but six of these patients actually preferred shared decision making and six preferred reliant decision making. In the conscious scenario, preference for independent decision making was associated with higher odds of patient-family agreement (AOR 5.28, 1.07-26.06). In the unconscious scenario, cancer patients had a higher odds of agreement than ALS patients (AOR 3.86; 95% CI 1.02-14.54). CONCLUSION Family members were often unable to correctly identify patient preferences for family involvement in end-of-life decision making, especially when patients desired that decisions be made using the best-interest standard. Clinicians and family members should consider explicitly eliciting patient preferences for family involvement in decision making. Additional research is still needed to identify interventions to improve family member understanding of patient preferences regarding the decision-making process itself.
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Affiliation(s)
- Rashmi K Sharma
- Division of Hospital Medicine, Northwestern University, Chicago, IL 60611, USA.
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