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Akdeniz M, Yardımcı B, Kavukcu E. Ethical considerations at the end-of-life care. SAGE Open Med 2021; 9:20503121211000918. [PMID: 33786182 PMCID: PMC7958189 DOI: 10.1177/20503121211000918] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/12/2021] [Indexed: 11/16/2022] Open
Abstract
The goal of end-of-life care for dying patients is to prevent or relieve
suffering as much as possible while respecting the patients’ desires.
However, physicians face many ethical challenges in end-of-life care.
Since the decisions to be made may concern patients’ family members
and society as well as the patients, it is important to protect the
rights, dignity, and vigor of all parties involved in the clinical
ethical decision-making process. Understanding the principles
underlying biomedical ethics is important for physicians to solve the
problems they face in end-of-life care. The main situations that
create ethical difficulties for healthcare professionals are the
decisions regarding resuscitation, mechanical ventilation, artificial
nutrition and hydration, terminal sedation, withholding and
withdrawing treatments, euthanasia, and physician-assisted suicide.
Five ethical principles guide healthcare professionals in the
management of these situations.
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Affiliation(s)
- Melahat Akdeniz
- Department of Family Medicine, Faculty of Medicine, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey
| | | | - Ethem Kavukcu
- Department of Sports Medicine, Faculty of Medicine, Akdeniz University Hospital, Akdeniz University, Antalya, Turkey
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Cooper E, Hutchinson A, Sheikh Z, Taylor P, Townend W, Johnson MJ. Palliative care in the emergency department: A systematic literature qualitative review and thematic synthesis. Palliat Med 2018; 32:1443-1454. [PMID: 30028242 DOI: 10.1177/0269216318783920] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Despite a fast-paced environment, the emergency clinician has a duty to meet the palliative patient's needs. Despite suggested models and interventions, this remains challenging in practice. AIM To raise awareness of these challenges by exploring the experience of palliative care patients and their families and informal carers attending the emergency department, and of the clinicians caring for them. DESIGN Qualitative systematic literature review and thematic synthesis. Search terms related to the population (palliative care patients, family carers, clinicians), exposure (the emergency department) and outcome (experience). The search was international but restricted to English and used a qualitative filter. Title, abstracts and, where retrieved, full texts were reviewed independently by two reviewers against predefined inclusion criteria arbitrated by a third reviewer. Studies were appraised for quality but not excluded on that basis. DATA SOURCES MEDLINE [1946-], Embase[1947-], CINAHL [1981-] and PsycINFO [1987-] with a bibliography search. RESULTS 19 papers of 16 studies were included from Australia ( n = 5), the United Kingdom ( n = 5), and United States ( n = 9) representing 482 clinical staff involved in the emergency department (doctors, nurses, paramedics, social workers, technicians), 61 patients and 36 carers. Nine descriptive themes formed three analytic themes: 'Environment and Purpose', 'Systems of Care and Interdisciplinary Working' and 'Education and Training'. CONCLUSION In the included studies, provision of emergency palliative care is a necessary purpose of the emergency department. Failure to recognise this, gain the necessary skills or change to systems better suited to its delivery perpetuates poor implementation of palliative care in this environment.
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Affiliation(s)
- Esther Cooper
- 1 Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Mersey Deanery, Health Education England, UK.,2 Hull York Medical School, University of Hull, Hull, UK
| | - Ann Hutchinson
- 3 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Zain Sheikh
- 4 Head and Neck Specialities, York Hospital, York Teaching Hospitals NHS Foundation Trust, York, UK.,5 Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - Paul Taylor
- 6 School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK.,7 St Luke's Hospice, Sheffield, UK
| | - Will Townend
- 8 Department of Emergency Medicine, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Miriam J Johnson
- 3 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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3
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[Outpatient palliative medicine : Attitudes in the care of palliative emergencies. Prospective questionnaire-based investigation]. Anaesthesist 2018; 67:216-224. [PMID: 29480318 DOI: 10.1007/s00101-018-0417-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The right to adequate outpatient palliative care has existed for several years in Germany. In recent years outpatient palliative care has developed very positively. Nevertheless, in emergency situations paramedics and emergency physicians were often included in the care of palliative care of patients. The aim of our study was to investigate the cooperation between outpatient palliative care teams and the emergency medical services. Another aim was to identify structural realities and based on these to discuss the possibilities in the optimization of outpatient palliative medical emergency situations. METHODS A standardized self-designed questionnaire was distributed to specialized outpatient palliative care teams (SPCS) in Germany. For this purpose, closed and open questions (mixed methods) were used. The evaluation was carried out according to the questionnaire categories in quantitative and qualitative forms. The questionnaire was subdivided into general information and specific questions. RESULTS The survey response rate was 79% from a total of 81 SPCS in 2011. The following standards in palliative emergency care were recommended: (1) early integration of outpatient palliative care services and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, emergency drug boxes, do not attempt resuscitation orders and (4) emergency medical training (physicians and paramedics). CONCLUSION Outpatient palliative care in Germany has developed very positively during the last years; however, there are still deficits in terms of optimal patient care, one of which refers to the treatment of palliative care emergencies. In this context, optimization in the cooperation between outpatient palliative care services and emergency medical services should be discussed.
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Sueiras P, Romano-Betech V, Vergil-Salgado A, de Hoyos A, Quintana-Vargas S, Ruddick W, Castro-Santana A, Islas-Andrade S, Altamirano-Bustamante NF, Altamirano-Bustamante MM. Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care. PLoS One 2017; 12:e0181514. [PMID: 28759585 PMCID: PMC5536364 DOI: 10.1371/journal.pone.0181514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice. Methods and findings The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach. A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence. Conclusions By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.
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Affiliation(s)
- Perla Sueiras
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Victoria Romano-Betech
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Alejandro Vergil-Salgado
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Adalberto de Hoyos
- CIECAS, Instituto Politécnico Nacional, Lauro Aguirre 120, Agricultura, Miguel Hidalgo, Ciudad de México, México
| | - Silvia Quintana-Vargas
- Instituto de Salud Pública del Estado de Guanajuato, Tamazuca 4, Centro, Guanajuato, México
| | - William Ruddick
- Center for Bioethics, New York University, New York, NY, United States of America
| | - Anaclara Castro-Santana
- National Research Council for Science and Technology (CONACYT), Ciudad de México, México
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
| | - Sergio Islas-Andrade
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
| | - Nelly F. Altamirano-Bustamante
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
| | - Myriam M. Altamirano-Bustamante
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
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Chung RYN, Wong ELY, Kiang N, Chau PYK, Lau JYC, Wong SYS, Yeoh EK, Woo JW. Knowledge, Attitudes, and Preferences of Advance Decisions, End-of-Life Care, and Place of Care and Death in Hong Kong. A Population-Based Telephone Survey of 1067 Adults. J Am Med Dir Assoc 2017; 18:367.e19-367.e27. [PMID: 28214237 DOI: 10.1016/j.jamda.2016.12.066] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES According to the 2015 Quality of Death Index published by the Intelligence Unit of the Economist, Hong Kong is ranked 22nd in terms of quality of palliative care in the world, behind many other major developed countries in Asia, including Taiwan, Singapore, Japan, and South Korea. The objectives of the present study were to describe the knowledge, attitude, and preferences of the general Hong Kong adult population across different age groups regarding end-of-life (EOL) care decisions, place of care and death, as well as advance directive (AD). METHODS This was a population-based cross-sectional survey conducted by telephone. A total of 1067 adults over 30 years old were contacted through residential telephone lines using a random sampling method and were interviewed. Information on sociodemographic factors, general health status, chronic diseases, knowledge, attitude and preferences of advance decisions, EOL care, and place of death were collected. RESULTS A total of 85.7% had not heard of AD, but 60.9% would prefer to make their own AD if legislated after explanation; and for those who did not prefer to have an AD, the predominant concern was the possible change of mind afterward. Adjusted logistic regression suggested that female participants were less willing to make an AD, whereas those with prior knowledge of do-not-attempt-cardiopulmonary-resuscitation significantly increased the chance of making an AD. In terms of life-sustaining treatments, a predominant 87.6% preferred to receive appropriate palliative care that gives comfort rather than to prolong life if being diagnosed to be terminally ill; 43% disagreed that doctors should generally try to keep patients alive for as long as possible; and 86.2% agreed that the patient's own wishes should determine what treatment he/she should receive. Adjusted logistic regression showed that palliative care was more preferred by age groups 50 years or above but was less preferred by those who did not care for their family members with chronic diseases. Regarding place of death, 31.2% of the participants would choose to die at home, and among those, 19.5% would still prefer to die at home even if they did not have sufficient support. Adjusted logistic regression showed a decreased trend for all older age groups from 40-49 years to 80+ years, as well as having poor self-rated health, to prefer to die at home. Being a female participant and having education level of tertiary or above, however, had higher preference for death at home. CONCLUSIONS This is the first population-representative survey of the general Hong Kong adult population on the knowledge, attitude, and preferences of AD, EOL care, and place of care/death. The main implication of this study was that preferences to have autonomy over own EOL care, to receive palliative care, and to die at home were greater than the actual practice currently, highlighting the service gaps for better EOL care in the future.
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Affiliation(s)
- Roger Yat-Nork Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Eliza Lai-Yi Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Nicole Kiang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Patsy Yuen-Kwan Chau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janice Y C Lau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jean W Woo
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
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Søreide K. Service as joint editor-in-chief for 11 years comes to an end: adieu, godspeed and auf wiedersehn! Scand J Trauma Resusc Emerg Med 2015; 23:110. [PMID: 26718460 PMCID: PMC4696309 DOI: 10.1186/s13049-015-0192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Higginson IJ, Koffman J, Hopkins P, Prentice W, Burman R, Leonard S, Rumble C, Noble J, Dampier O, Bernal W, Hall S, Morgan M, Shipman C. Development and evaluation of the feasibility and effects on staff, patients, and families of a new tool, the Psychosocial Assessment and Communication Evaluation (PACE), to improve communication and palliative care in intensive care and during clinical uncertainty. BMC Med 2013; 11:213. [PMID: 24083470 PMCID: PMC3850793 DOI: 10.1186/1741-7015-11-213] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 08/30/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are widespread concerns about communication and support for patients and families, especially when they face clinical uncertainty, a situation most marked in intensive care units (ICUs). Therefore, we aimed to develop and evaluate an interventional tool to improve communication and palliative care, using the ICU as an example of where this is difficult. METHODS Our design was a phase I-II study following the Medical Research Council Guidance for the Development and Evaluation of Complex Interventions and the (Methods of Researching End-of-life Care (MORECare) statement. In two ICUs, with over 1900 admissions annually, phase I modeled a new intervention comprising implementation training and an assessment tool. We conducted a literature review, qualitative interviews, and focus groups with 40 staff and 13 family members. This resulted in the new tool, the Psychosocial Assessment and Communication Evaluation (PACE). Phase II evaluated the feasibility and effects of PACE, using observation, record audit, and surveys of staff and family members. Qualitative data were analyzed using the framework approach. The statistical tests used on quantitative data were t-tests (for normally distributed characteristics), the χ2 or Fisher's exact test (for non-normally distributed characteristics) and the Mann-Whitney U-test (for experience assessments) to compare the characteristics and experience for cases with and without PACE recorded. RESULTS PACE provides individualized assessments of all patients entering the ICU. It is completed within 24 to 48 hours of admission, and covers five aspects (key relationships, social details and needs, patient preferences, communication and information status, and other concerns), followed by recording of an ongoing communication evaluation. Implementation is supported by a training program with specialist palliative care. A post-implementation survey of 95 ICU staff found that 89% rated PACE assessment as very or generally useful. Of 213 family members, 165 (78%) responded to their survey, and two-thirds had PACE completed. Those for whom PACE was completed reported significantly higher satisfaction with symptom control, and the honesty and consistency of information from staff (Mann-Whitney U-test ranged from 616 to 1247, P-values ranged from 0.041 to 0.010) compared with those who did not. CONCLUSIONS PACE is a feasible interventional tool that has the potential to improve communication, information consistency, and family perceptions of symptom control.
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Affiliation(s)
- Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, School of Medicine, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
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Turriziani A, Attanasio G, Cogliandolo S, Scarcella F, Sangalli L, De Gennaro E, Scopa A, Genualdo A, Nazzicone G, Ricciotti MA, Cassano A. Improving the quality of life of terminally ill oncological patients: the example of palliative care at Hospice Villa Speranza. Future Oncol 2013; 9:771-6. [DOI: 10.2217/fon.13.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | - Luisa Sangalli
- Hospice Villa Speranza, Università Cattolica S. Cuore, Roma, Italy
| | | | - Anna Scopa
- Hospice Villa Speranza, Università Cattolica S. Cuore, Roma, Italy
| | | | - Giulia Nazzicone
- Hospice Villa Speranza, Università Cattolica S. Cuore, Roma, Italy
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Wiese CH, Lassen CL, Bartels UE, Taghavi M, Elhabash S, Graf BM, Hanekop GG. International recommendations for outpatient palliative care and prehospital palliative emergencies - a prospective questionnaire-based investigation. BMC Palliat Care 2013; 12:10. [PMID: 23432905 PMCID: PMC3602669 DOI: 10.1186/1472-684x-12-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background To determine the international recommendations and current practices for the treatment and prevention of palliative emergencies. The primary goal of the study was to gather information from experts on their nationally practised concepts. Methods One hundred and fifty self-report surveys were distributed by email to selected leading experts (palliative and emergency medical care) in Europe, North and South America, Africa, Asia, and Australia. An expert in this context was defined as an author of an article that was ranked by three reviewers as relevant to outpatient palliative and emergency medical . Results The total response rate was 61% (n = 92 experts). Survey responses were obtained from 35 different countries. The following standards in the treatment of palliative emergencies were recommended: (1) early integration of “Palliative Care Teams” (PCTs) and basic outpatient palliative care systems, (2) end-of-life discussions, (3) defined emergency medical documents, drug boxes, and “Do not attempt resuscitation” orders and (4) emergency medical training (physicians and paramedics). Conclusions This study detected structurally and nationally differences in outpatient palliative care regarding the treatment of palliative emergencies. Accordingly, these differences should be discussed and adapted to the respective specifications of individual single countries. A single established outpatient palliative emergency medical care concept may be the basis for an overall out-of-hospital palliative care system.
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Affiliation(s)
- Christoph Hr Wiese
- Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg 93053, Germany.
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Limehouse WE, Ramana Feeser V, Bookman KJ, Derse A. A model for emergency department end-of-life communications after acute devastating events--part II: moving from resuscitative to end-of-life or palliative treatment. Acad Emerg Med 2012; 19:1300-8. [PMID: 23167864 DOI: 10.1111/acem.12018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/31/2012] [Accepted: 06/14/2012] [Indexed: 12/20/2022]
Abstract
The model for emergency department (ED) end-of-life communications after acute devastating events addresses decision-making capacity, surrogates, and advance directives, including legal definitions and application of these steps. Part II concerns communications moving from resuscitative to palliative and end-of-life treatments. After completing the steps involved in determining decision-making, emergency physicians (EPs) should consider starting palliative measures versus continuing resuscitative treatment. As communications related to these end-of-life decisions increasingly fall within the scope of emergency medicine (EM) practice, we need to become educated about and comfortable with them.
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Affiliation(s)
- Walter E. Limehouse
- Department of Medicine; Division of Emergency Medicine; Medical University of South Carolina; Charleston SC
| | - V. Ramana Feeser
- Department of Emergency Medicine; Virginia Commonwealth University Medical Center; Richmond VA
| | - Kelly J. Bookman
- Department of Emergency Medicine; University of Colorado; Aurora CO
| | - Arthur Derse
- Department of Emergency Medicine and Center for Bioethics and Medical Humanities Medical College of Wisconsin; Milwaukee WI
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Papadimos TJ, Maldonado Y, Tripathi RS, Kothari DS, Rosenberg AL. An overview of end-of-life issues in the intensive care unit. Int J Crit Illn Inj Sci 2012; 1:138-46. [PMID: 22229139 PMCID: PMC3249847 DOI: 10.4103/2229-5151.84801] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The population of the earth is aging, and as medical techniques, pharmaceuticals, and devices push the boundaries of human physiological capabilities, more humans will go on to live longer. However, this prolonged existence may involve incapacities, particularly at the end-of-life, and especially in the intensive care unit. This arena involves not only patients and families, but also care givers. It involves topics from economics to existentialism, and surgery to spiritualism. It requires education, communication, acceptance of diversity, and an ultimate acquiescence to the inevitable. Here, we present a comprehensive overview of issues in the care of patients at the end-of-life stage that may cause physicians and other healthcare providers, medical, ethical, social, and philosophical concerns in the intensive care unit.
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Affiliation(s)
- Thomas J Papadimos
- Department of Anesthesiology, Division of Critical Care Medicine, The Ohio State University Medical Center, Columbus OH 43210, USA
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Wiese CHR, Vagts DA, Kampa U, Pfeiffer G, Grom IU, Gerth MA, Graf BM, Zausig YA. [Palliative care and end-of-life patients in emergency situations. Recommendations on optimization of out-patient care]. Anaesthesist 2011; 60:161-71. [PMID: 21184035 DOI: 10.1007/s00101-010-1831-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted. The goals of this study were to discuss cooperation between emergency medical and palliative care structures to optimize the quality of care in emergencies involving palliative care patients. METHODS For data collection an open discussion of the main topics by experts in palliative and emergency medical care was employed. Main outcome measures and recommendations included responses regarding current practices related to expert opinions and international literature sources. RESULTS As the essential points of consensus the following recommendations for optimization of care were named: (1) integration of palliative care in the emergency medicine curricula for pre-hospital emergency physicians and paramedics, (2) development of outpatient palliative care, (3) integration of palliative care teams into emergency medical structures, (4) cooperation between palliative and emergency medical care, (5) integration of crisis intervention into outpatient palliative emergency medical care, (6) provision of emergency plans and emergency medical boxes, (7) provision of palliative crisis cards and do not attempt resuscitation (DNAR) orders, (8) psychosocial aspects concerning palliative emergencies and (9) definition of palliative patients and their special situation by the physician responsible for prior treatment. CONCLUSIONS Prehospital emergency physicians are confronted with emergencies in palliative care patients every day. In the treatment of these emergencies there are potentially serious conflicts due to the different therapeutic concepts of palliative medical care and emergency medical services. This study demonstrates that there is a need for regulated criteria for the therapy of palliative patients and patients at the end of life in emergency situations. Overall, more clinical investigations concerning end-of-life care and unresponsive palliative care patients in emergency medical situations are necessary.
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Affiliation(s)
- C H R Wiese
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany.
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Norton CK, Hobson G, Kulm E. Palliative and End-of-Life Care in the Emergency Department: Guidelines for Nurses. J Emerg Nurs 2011; 37:240-5. [DOI: 10.1016/j.jen.2010.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 01/29/2010] [Accepted: 02/20/2010] [Indexed: 10/19/2022]
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Wiese C, Löffler E, Vormelker J, Meyer N, Taghavi M, Strumpf M, Kazmaier S, Roessler M, Zausig Y, Popov A, Lassen C, Graf B, Hanekop G. Kenntnisse angehender Notfallmediziner über die Tumorschmerztherapie bei Palliativpatienten. Schmerz 2010; 24:508-16. [DOI: 10.1007/s00482-010-0956-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ambulante und stationäre palliativmedizinische Patientenversorgung in Deutschland. Anaesthesist 2010; 59:162-70. [DOI: 10.1007/s00101-009-1651-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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