Approaching Death: Improving Care at the End of Life

Nadelson, Theodore

doi:10.1176/ajp.156.4.655

Cited by 8 publications

(8 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Seriously ill patients are often hospitalized and receive life-sustaining therapies by default, ie, unless patients or their caregivers have specifically requested otherwise. 1,2 Advance directives (ADs) were created to enable the many patients who wish to forgo such aggressive care near the end of life 3,4 to set limits on their future therapies. 5 However, despite national policies and practices that increasingly encourage AD completion, [6][7][8][9][10] evidence regarding the benefits of AD completion, or of making certain choices within ADs, is limited.…”

Section: Introductionmentioning

confidence: 99%

Effect of Default Options in Advance Directives on Hospital-Free Days and Care Choices Among Seriously Ill Patients

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE There is limited evidence regarding how patients make choices in advance directives (ADs) or whether these choices influence subsequent care. OBJECTIVE To examine whether default options in ADs influence care choices and clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included 515 patients who met criteria for having serious illness and agreed to participate. Patients were enrolled at 20

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of Default Options in Advance Directives on Hospital-Free Days and Care Choices Among Seriously Ill Patients

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In the overall Medicare population, even very short hospice stays appear to be associated with lower rates of hospital admission, intensive care unit (ICU) admission, and in-hospital death, 12 which may reflect higher-quality end-of-life care because evidence suggests that most Americans would prefer not to die in the hospital. 13,14 Patients with ESRD may stand to gain much from hospice care: many have limited life expectancy [15][16][17][18][19][20] and a high symptom burden [21][22][23][24][25][26][27][28][29] and receive extremely intensive care at the end of life, 11,[30][31][32] which may be inconsistent with their preferences. 33 Whether the association between the timing of hospice referral and health care utilization and costs for these patients is similar to that for the overall Medicare population-for whom even very short stays in hospice are associated with lower utilization and costs compared with those not referred to hospiceis not known.…”

mentioning

confidence: 99%

Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis

et al. 2018

View full text Add to dashboard Cite

IMPORTANCE Patients with end-stage renal disease are less likely to use hospice services than other patients with advanced chronic illness. Little is known about the timing of hospice referral in this population and its association with health care utilization and costs.OBJECTIVE To examine the association between hospice length of stay and health care utilization and costs at the end of life among Medicare beneficiaries who had received maintenance hemodialysis.

show abstract

“…12 Previous studies had shown that patients' priorities for quality care during advanced illness and at the end-of-life included expert pain and symptom management, avoiding inappropriate prolongation of the dying process, relieving burdens on loved ones, and being prepared for death. [15][16][17] Therefore, addressing cardiopulmonary resuscitation preferences with patients is a very important aspect to ensure patients' wishes are respected.…”

Section: Resultsmentioning

confidence: 99%

Untitled

2022

imjm

View full text Add to dashboard Cite

INTRODUCTION:End-of-life (EOL) care has become an important topic of discussion in those with chronic illness, especially in End Stage Renal Disease (ESRD) patients on dialysis. This study explored attitudes towards the EOL care among haemodialysis patients and compared them with the patients' family members. MATERIALS AND METHODS:The study was a cross-sectional descriptive study conducted in two tertiary hospitals in Malaysia. The data was collected by using a survey questionnaire from 164 participants which consisted of 82 pairs of patients and their relatives. RESULTS: 'Patient' and 'family' groups demonstrated differences in their preferences regarding EOL care options. Family members group favoured cardiopulmonary resuscitation (81.7% vs 41.4%) (p <0.001), endotracheal intubation (80.5% vs 43.9%) (p = 0.989) and nasogastric tube feeding (87.8% vs 67%) (p = 0.001) more than patients themselves. The physician was the most nominated surrogate decision -maker by the patient (91.5%). Majority of the patients (57.3%) felt uncomfortable discussing EOL care options. There was significant correlation between duration of dialysis and patients' EOL preferences where patients less than 5 years on haemodialysis favoured CPR (55.9% vs 31.3%; p = 0.026), intubation (55.9% vs 35.4%) and nasogastric tube feeding (82.3% vs 56.3%; p = 0.013) compared to patients who had been on haemodialysis for 5 years or longer. CONCLUSION: This study demonstrated significant differences between the attitudes of the patients and their relatives regarding EOL care preferences.

show abstract

Approaching Death: Improving Care at the End of Life

Cited by 8 publications

References 0 publications

Effect of Default Options in Advance Directives on Hospital-Free Days and Care Choices Among Seriously Ill Patients

Effect of Default Options in Advance Directives on Hospital-Free Days and Care Choices Among Seriously Ill Patients

Association Between Hospice Length of Stay, Health Care Utilization, and Medicare Costs at the End of Life Among Patients Who Received Maintenance Hemodialysis

Untitled

Contact Info

Product

Resources

About