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Gillespie J, Trammell M, Ochoa C, Driver S, Callender L, Dubiel R, Swank C. Feasibility of overground exoskeleton gait training during inpatient rehabilitation after severe acquired brain injury. Brain Inj 2024; 38:459-466. [PMID: 38369861 DOI: 10.1080/02699052.2024.2317259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To describe the safety, feasibility, and tolerability of overground exoskeleton gait training (OEGT) integrated into clinical practice for patients after severe acquired brain injury (ABI). SETTING Inpatient rehabilitation hospital. PARTICIPANTS Eligible patients with severe ABI met the following criteria: age > 18, medically stable, met exoskeleton frame limitations, and a score of ≤ 3 on the motor function portion of the Coma Recovery Scale - Revised (CRS-R). Presence of consciousness disorder was not exclusionary. DESIGN Prospective observational study. MAIN MEASURES Outcomes examined safety (adverse events), feasibility (session count and barriers to session completion), and tolerability of OEGT (session metrics and heart rate). RESULTS Ten patients with ABI completed 10.4 ± 4.8 OEGT sessions with no adverse events. Barriers to session completion included clinical focus on prioritized interventions. Sessions [median up time = 17 minutes, (IQR: 7); walk time = 13 minutes, (IQR: 9); step count = 243, (IQR: 161); device assist = 74, (IQR: 28.0)] were primarily spent in Very Light to Light heart rate intensities [89%, (IQR: 42%) and 9%, (IQR: 33%), respectively]. CONCLUSION OEGT incorporated into the rehabilitation plan of care during inpatient rehabilitation after severe ABI was observed to be safe, feasible, and tolerable. However, intentional steps must be taken to facilitate patient safety.
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Affiliation(s)
- Jaime Gillespie
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Molly Trammell
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Christa Ochoa
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Simon Driver
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Librada Callender
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Rosemary Dubiel
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
| | - Chad Swank
- Physical Medicine and Rehabilitation, Baylor Scott and White Institute for Rehabilitation, Dallas, Texas, USA
- Physical Medicine and Rehabilitation, Baylor Scott and White Research Institute, Dallas, Texas, USA
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Choi WJ, Young MJ. Disambiguating Consciousness in Clinical Settings. Neurology 2023; 101:896-900. [PMID: 37748883 PMCID: PMC10662996 DOI: 10.1212/wnl.0000000000207765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- William J Choi
- From the Warren Alpert Medical School (W.J.C.), Brown University, Providence, RI; and Department of Neurology (M.J.Y.), Massachusetts General Hospital, Boston.
| | - Michael J Young
- From the Warren Alpert Medical School (W.J.C.), Brown University, Providence, RI; and Department of Neurology (M.J.Y.), Massachusetts General Hospital, Boston
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Latchem-Hastings J, Latchem-Hastings G, Kitzinger J. Caring for People with Severe Brain Injuries: Improving Health Care Professional Communication and Practice Through Online Learning. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:267-273. [PMID: 36715702 PMCID: PMC10664780 DOI: 10.1097/ceh.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/02/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Severe brain injuries can leave people in prolonged disorder of consciousness resulting in multifaceted medical, nursing, and rehabilitative needs that can be challenging for even the most experienced multidisciplinary team. The complexities of care, communication with families, and best interest decision-making about medical interventions means there is a need for ongoing training in clinical, social, ethical, and legal aspects. METHODS Using a combination of group discussions, interviews, and questionnaires with learners, this article reports an evaluation of designing and delivering an interprofessional, online work-based course to health care professionals caring for prolonged disorder of consciousness patients. RESULTS There were challenges for staff uptake because of COVID-19, but engaging with it increased knowledge in defining and diagnosing patients' conditions, understanding multidisciplinary team roles, communicating with families, and navigating legal and ethical issues. Course participation also enhanced critical and reflective thinking skills, provided a sense of connection to other professionals, and generated plans to improve service provision. DISCUSSION Online learning that enables health care professionals to engage at their own pace and also come together as an interprofessional community can provide invaluable continuing professional development and help to enhance joined up, holistic patient care. However, achieving this requires significant investment in creating research-led, multimedia, learning materials, and courses that include synchronous and asynchronous delivery to combine flexible study with the opportunity for peer networks to form. It also depends on a commitment from organizations to support staff online continuing professional development.
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Affiliation(s)
- Julie Latchem-Hastings
- Dr. J. Latchem-Hastings: Lecturer/HCRW Postdoctoral Fellow, School of Healthcare Sciences, College of Biomedical & Life Sciences, Cardiff University, Eastgate House, Cardiff, United Kingdom. Dr. G. Latchem-Hastings: Senior Lecturer, School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, University Hospital of Wales, Heath Park, Cardiff, United Kingdom. Prof. Kitzinger: Professor of Communications, Journalism, Media and Cultural Studies, Cardiff University, Two Central Square, Central Square, Cardiff, United Kingdom
| | - Geraldine Latchem-Hastings
- Dr. J. Latchem-Hastings: Lecturer/HCRW Postdoctoral Fellow, School of Healthcare Sciences, College of Biomedical & Life Sciences, Cardiff University, Eastgate House, Cardiff, United Kingdom. Dr. G. Latchem-Hastings: Senior Lecturer, School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, University Hospital of Wales, Heath Park, Cardiff, United Kingdom. Prof. Kitzinger: Professor of Communications, Journalism, Media and Cultural Studies, Cardiff University, Two Central Square, Central Square, Cardiff, United Kingdom
| | - Jenny Kitzinger
- Dr. J. Latchem-Hastings: Lecturer/HCRW Postdoctoral Fellow, School of Healthcare Sciences, College of Biomedical & Life Sciences, Cardiff University, Eastgate House, Cardiff, United Kingdom. Dr. G. Latchem-Hastings: Senior Lecturer, School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, University Hospital of Wales, Heath Park, Cardiff, United Kingdom. Prof. Kitzinger: Professor of Communications, Journalism, Media and Cultural Studies, Cardiff University, Two Central Square, Central Square, Cardiff, United Kingdom
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4
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Alimohammadi E, Arast A, Vlaisavljevic Z, Abdi A, Ramadhan H. The experiences of the caregivers caring for the patients in persistent vegetative state due to traumatic brain injury. SAGE Open Med 2023; 11:20503121231177550. [PMID: 37324120 PMCID: PMC10262620 DOI: 10.1177/20503121231177550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/07/2023] [Indexed: 06/17/2023] Open
Abstract
Objective Persistent vegetative state often occurs as a result of traumatic brain injuries; these patients are usually hospitalized for sustained periods, and the family caregivers are the main care providers in Iranian hospitals, especially for chronic and persistent vegetative state patients. The current study was conducted to investigate the family caregivers' experiences of caring for persistent vegetative state patients following traumatic brain injury. Methods This descriptive phenomenological study was carried out in 2019. Semi-structured interviews were done with 12 family caregivers caring for the patients in persistent vegetative state, hospitalized in a trauma center, after taking informed written consent and assuring about anonymity and confidentiality of their personal information. The interviews were analyzed using the Colaizzis҆ method. Results After analysis of 12 interviews, 5 themes, and 10 subthemes were extracted from 428 codes. Five themes include "uncountable struggles/challenges," "looking for peace," "therapeutic concerns," "preserving the connection," and "unheard sounds." Conclusion In this study, the family caregivers of the persistent vegetative state patients in the hospital experienced some challenges, and looked for peace by doing some work, for example, praying. They had some therapeutic concerns and unheard sounds and tried to fulfill them. We recommend, by using the results of this study and other related research, necessary care and facilities would be provided for the family caregivers of persistent vegetative state patients in hospitals.
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Affiliation(s)
- Ehsan Alimohammadi
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Atefeh Arast
- Student Research Committee, Kermanshah University of Medical Sciences, Imam Reza hospital, Kermanshah, Iran
| | - Zeljko Vlaisavljevic
- Department of Nursing, High School of Medical Professional Studies Medika, Clinical Center of Serbia, Belgrade, Serbia
| | - Alireza Abdi
- Nursing and Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Boubour A, Mboma S, Võ T, Birbeck GL, Seydel KB, Mallewa M, Chinguo D, Gladstone M, Mohamed S, Thakur KT. "We can't handle things we don't know about": perceived neurorehabilitation challenges for Malawian paediatric cerebral malaria survivors. BMC Pediatr 2020; 20:503. [PMID: 33138796 PMCID: PMC7607705 DOI: 10.1186/s12887-020-02405-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to identify perceptions of neurorehabilitation challenges for paediatric cerebral malaria (CM) survivors post-hospital discharge at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. METHODS An exploratory approach was used to qualitatively investigate the perceived neurorehabilitation challenges for paediatric CM survivors. Data were collected through semi-structured in-depth interviews (IDIs) and focus group discussions (FGDs). Eighteen data-gathering sessions were conducted with 38 total participants, including 3 FGDs with 23 primary caregivers, 11 IDIs with healthcare workers at QECH, and 4 IDIs with community-based rehabilitation workers (CRWs). RESULTS FGDs revealed that caregivers lack important knowledge about CM and fear recurrence of CM in their children. Post-CM children and families experience substantial stigma and sociocultural barriers to integrating into their community and accessing neurorehabilitative care. At a community-level, rehabilitation infrastructure, including trained staff, equipment, and programmes, is extremely limited. Rehabilitation services are inequitably accessible, and community-based rehabilitation remains largely unavailable. CONCLUSIONS There is an urgent need to establish further training of rehabilitation personnel at all levels and to build accessible rehabilitation infrastructure in Malawi for post-CM patients. Additional work is required to expand this study across multiple regions for a holistic understanding of neurorehabilitation needs.
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Affiliation(s)
- Alexandra Boubour
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
- Blantyre Malaria Project, University of Malawi College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Sebastian Mboma
- Blantyre Malaria Project, University of Malawi College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
- School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Tracy Võ
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Gretchen L Birbeck
- Epilepsy Division, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
| | - Karl B Seydel
- Blantyre Malaria Project, University of Malawi College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Macpherson Mallewa
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Paediatric Department, University of Malawi College of Medicine, Blantyre, Malawi
| | - Dorothy Chinguo
- Department of Physiotherapy and Occupational Therapy, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Suraya Mohamed
- School of Public Health, University of the Western Cape, Cape Town, Republic of South Africa
| | - Kiran T Thakur
- Division of Critical Care & Hospitalist Neurology, Columbia University Irving Medical Center, New York, NY, USA.
- Columbia University Irving Medical Center and New York Presbyterian Hospital, NY, USA.
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Kostick KM, Halm A, O'Brien K, Kothari S, Blumenthal-Barby JS. Conceptualizations of consciousness and continuation of care among family members and health professionals caring for patients in a minimally conscious state. Disabil Rehabil 2019; 43:2285-2294. [PMID: 34315308 DOI: 10.1080/09638288.2019.1697383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The American Academy of Neurology recently emphasized the importance of communicating with patients' families to better reflect patient values in clinical care. However, little is known about how decisions about continuing rehabilitative care made by family caregivers and healthcare providers working with minimally conscious patients are informed by conceptualizations of consciousness and moral status. METHODS We explored these issues in interviews with 18 family caregivers and 20 healthcare professionals caring for minimally conscious patients. Data were analyzed using thematic content analysis. RESULTS Results suggest that family members and healthcare professionals share similar views of what consciousness is ("being there") and what it is indicated by ("a look in the eyes," and/or an "ability to do"/agency). They also share a belief that the presence (or "level") of consciousness does not determine whether rehabilitative care should be discontinued. Rather, it should be determined by considerations of suffering and well-being. Providers were more likely to view suffering as rationale for discontinuation of care, while family members viewed suffering as an indicator of and motivator for potential recovery. CONCLUSION Findings can help optimize family-provider communications about minimally conscious patients by acknowledging shared assumptions and interpretations of consciousness, as well as key areas where perspectives diverge.Implications for rehabilitationFamily and professional caregivers' interpretations of consciousness and suffering are implicated in decisions about continuing rehabilitation for minimally conscious patients.Family members and healthcare providers both rely to some extent on non-observable evidence to evaluate consciousness, which may be an adaptive and philanthropic response to clinical uncertainty.Acknowledging shared assumptions and interpretations of consciousness, as well as diverging perspectives, can help to optimize family-provider communications.
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Affiliation(s)
- Kristin M Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Abby Halm
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Katherine O'Brien
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA.,TIRR Memorial Hermann Research Institute, Baylor College of Medicine, Houston, TX, USA
| | - Sunil Kothari
- TIRR Memorial Hermann Research Institute, Baylor College of Medicine, Houston, TX, USA
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Williams K, Christenbury J, Niemeier JP, Newman M, Pinto S. Is Robotic Gait Training Feasible in Adults With Disorders of Consciousness? J Head Trauma Rehabil 2019; 35:E266-E270. [PMID: 31479078 DOI: 10.1097/htr.0000000000000523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the feasibility and safety of robotic-assisted gait training (RAGT) in adults with disorders of consciousness (DoC). SETTING Inpatient rehabilitation hospital. PARTICIPANTS Four adult male patients with traumatic brain injury and DoC. DESIGN Subjects participated in RAGT with body weight support for 5 to 20 minutes, over 1- to 2-week periods. MAIN MEASURES Primary measures included vital signs, walking parameters, pain, arousal, and Agitation Behavior Scale scores. Additional data included Modified Ashworth Scale, Coma Recovery Scale-Revised, and Rancho Los Amigos Scale scores. RESULTS All participants safely completed at least one session of RAGT with body weight support with safe vital signs and low agitation levels. Two adverse events occurred (increased somnolence and pain due to harness placement), which were not considered severe. All subjects emerged out of DoC at which point research protocol was stopped. CONCLUSIONS Findings suggest inpatient-based RAGT may be safe and feasible to consider when developing a therapy plan of care in adults with DoC.
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Affiliation(s)
- Kathryn Williams
- Atrium Health's Carolinas Rehabilitation, Charlotte, North Carolina (Drs Williams, Newman, and Pinto and Ms Christenbury); and University of Alabama, Birmingham (Dr Niemeier)
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Logeswaran S, Papps B, Turner-Stokes L. Staff experiences of working with patients with prolonged disorders of consciousness: a focus group analysis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.11.602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: UK national clinical guidelines recommend assessment of patients in prolonged disorders of consciousness in specialist centres. Working in these centres can be challenging, but little is currently published about what staff experience or how best to support them. We explored the views of health care professionals working with prolonged disorders of consciousness patients in one specialist rehabilitation unit. Methods: Six focus groups were run with allied health professionals, medical and nursing staff in discipline-specific groups to explore the rewards and challenges of working with patients in prolonged disorders of consciousness, and what staff felt they needed to assist them. Transcribed data were analysed using thematic analysis. Findings: Five positive themes emerged: seeing change, supporting families, quality of the team and clinical input, work complexity and its personal impact. Three negative themes were identified: dealing with death and ‘living death’, dealing with family expectations and distress, and the negative professional and personal impact on staff. In terms of what would assist staff, three themes emerged: greater support with family communication, additional prolonged disorders of consciousness-specific training and further development of assessments of awareness. Conclusions: Staff recommendations on what would assist them could be used to inform the development of high-quality approaches to assessment and care in prolonged disorders of consciousness.
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Affiliation(s)
- Sophini Logeswaran
- Assistant clinical psychologist, Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
| | - Benjamin Papps
- Consultant clinical neuropsychologist, Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
| | - Lynne Turner-Stokes
- Northwick Park Professor of Rehabilitation Medicine, King's College London and Director, Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
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Span-Sluyter CAMFH, Lavrijsen JCM, van Leeuwen E, Koopmans RTCM. Moral dilemmas and conflicts concerning patients in a vegetative state/unresponsive wakefulness syndrome: shared or non-shared decision making? A qualitative study of the professional perspective in two moral case deliberations. BMC Med Ethics 2018; 19:10. [PMID: 29471814 PMCID: PMC5824545 DOI: 10.1186/s12910-018-0247-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term care of patients in VS/UWS. Methods A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Results Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Conclusions Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making.
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Affiliation(s)
- Conny A M F H Span-Sluyter
- Radboud University Medical Centre, department of primary care, Nijmegen, The Netherlands. .,Novicare, Professionals in Elderly Care, Best, the Netherlands.
| | - Jan C M Lavrijsen
- Radboud University Medical Centre, department of primary care, Nijmegen, The Netherlands
| | | | - Raymond T C M Koopmans
- Radboud University Medical Centre, department of primary care, Nijmegen, The Netherlands.,Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
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Kitzinger C, Kitzinger J. Court applications for withdrawal of artificial nutrition and hydration from patients in a permanent vegetative state: family experiences. JOURNAL OF MEDICAL ETHICS 2016; 42:11-7. [PMID: 26486571 PMCID: PMC4717453 DOI: 10.1136/medethics-2015-102777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 06/23/2015] [Accepted: 07/23/2015] [Indexed: 05/11/2023]
Abstract
Withdrawal of artificially delivered nutrition and hydration (ANH) from patients in a permanent vegetative state (PVS) requires judicial approval in England and Wales, even when families and healthcare professionals agree that withdrawal is in the patient's best interests. Part of the rationale underpinning the original recommendation for such court approval was the reassurance of patients' families, but there has been no research as to whether or not family members are reassured by the requirement for court proceedings or how they experience the process. The research reported here draws on in-depth narrative interviews with 10 family members (from five different families) of PVS patients who have been the subject of court proceedings for ANH-withdrawal. We analyse the empirical evidence to understand how family members perceive and experience the process of applying to the courts for ANH-withdrawal and consider the ethical and practice implications of our findings. Our analysis of family experience supports arguments grounded in economic and legal analysis that court approval should no longer be required. We conclude with some suggestions for how we might develop other more efficient, just and humane mechanisms for reviewing best interests decisions about ANH-withdrawal from these patients.
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Affiliation(s)
| | - Jenny Kitzinger
- School of Journalism, Culture & Media Studies, Cardiff University, Cardiff, UK
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