Life‐Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?

Gallo, Joseph J.; Straton, Joseph B.; Klag, Michael J.; Meoni, Lucy A.; Sulmasy, Daniel P.; Wang, Nae Yuh; Ford, Daniel E.

doi:10.1046/j.1365-2389.2003.51309.x

Cited by 57 publications

(66 citation statements)

References 47 publications

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“…This fi nding is similar to the previous literature, which reported that doctors and nurses predominantly wished to forgo high-intensity treatment or resuscitation and opted for comfort care at end-of-life. (12)(13)(14)(15) This fi nding also explained the correlation in the present study between age and preference for CPR and symptom relief treatment, as the doctors and nurses in this study were generally younger than the patients and relatives. The discrepancy could be due to the fact that doctors and nurses may have realised, through exposure, that aggressive treatment does not always change the ultimate outcome for a functionimpaired patient and only results in more suffering instead of benefi ts.…”

Section: Discussionsupporting

confidence: 72%

Differences in attitudes to end-of-life care among patients, relatives and healthcare professionals

Ang

Zhang

Lim

2016

smedj

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INTRODUCTIONThis study explored and compared the differences in attitudes toward end-of-life care among patients, relatives and healthcare professionals, including doctors and nurses. METHODSWe performed a descriptive study on a cross-section of the population of a tertiary hospital in Singapore.Data was collected using a questionnaire survey involving 50 participants from each of the four groups of patients, relatives, doctors and nurses.RESULTS Family members were the most commonly nominated surrogate decision-makers by the patient group (76%) and the majority of the relative group (74%) felt comfortable deciding on end-of-life care for their loved ones. However, the patient and relative groups differed signifi cantly in their preferences on end-of-life care options, including cardiopulmonary resuscitation (CPR) (p = 0.001), intubation (p = 0.003), nasogastric tube feeding (p < 0.001) and the use of antibiotics (p = 0.023). Doctors, nurses and relatives demonstrated differences in preference between end-of-life care for themselves and for their loved ones, especially with regard to the use of nasogastric tube feeding. There was also a difference between patients and doctors in their decisions on CPR (p < 0.001) and intubation (p = 0.008).CONCLUSION This study demonstrated the importance of early planning for end-of-life care. This must be initiated proactively by healthcare professionals to engage patients in a culturally sensitive manner to discuss their preferences, in order to facilitate open communication between the patient and family.

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Section: Discussionsupporting

confidence: 72%

Differences in attitudes to end-of-life care among patients, relatives and healthcare professionals

Ang

Zhang

Lim

2016

smedj

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“…Some people want more care (even if the evidence suggests that it may not be beneficial), whereas others will want less care or interventions when the prospects for life become constrained or limited. There is a disparity in what physicians profess they want for their own end-of-life care and what is offered to their patients (7)(8)(9). Based on studies in older as well as younger physicians from different cultural backgrounds, between 80% and 88.3% prefer to receive pain medication but would refuse or forego life-sustaining treatments at the end of life.…”

Section: Framing the Issues And Scope Of Workmentioning

confidence: 99%

Thoughts about Dying in America : Enhancing the impact of one’s life journey and legacy by also planning for the end of life

Pizzo¹

2016

Proc. Natl. Acad. Sci. U.S.A.

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This Perspective offers a summary of the recommendations in the Institute of Medicine report Dying in America. How we die is a deeply personal issue that each of us will face. However, the approach to end-oflife (EOL) care in the United States needs improvement. Too frequently, healthcare delivery is uncoordinated and has many providers who are not adequately prepared to have meaningful conversations about EOL planning. This is amplified by payment systems and policies that create impediments, misunderstanding, and sometimes misinformation. Dying in America made five recommendations to improve quality and honor individual preferences near the EOL beginning with making conversations with providers and families something that occurs during various phases of the life cycle and not just when one is facing serious illness or possible EOL. It was recommended (i) that public and private payers and care delivery organizations cover the provision of comprehensive care that is accessible and available to individuals on a 24/7 schedule; (ii) that professional societies and other entities establish standards for clinician patient communication and advance care planning and that payers and care delivery organizations adopt them; (iii) that educational institutions, credentialing bodies, accrediting boards, state regulatory agencies, and care delivery organizations establish palliative care training, certification, and/or licensure requirements; (iv) that public and private payers and care delivery organizations integrate the financing of health and social services; and (v) that public and private organizations should engage their constituents and provide fact-based information to encourage advance care planning and informed choice. Whether you are probing the fundamental biological, chemical, or physical dimensions of life, seeking to understand the psychosocial factors impacting behavior or the forces that compose and define our planet or the cosmos, as a scientist you are likely thinking about how you might expand or deepen the scope of your research. You are probably not thinking about how the limits of your life will impact your discoveries. However, at some point and for each of us, our work (and life) will end, sometimes abruptly and without warning or more commonly slowly in a spiral of compromises and transitions. Ultimately, We All Will DieDying in America: Improving Quality and Honoring Individual Preferences Near the End of Life is the title of a report conducted by the Institute of Medicine (IOM) (now the National Academy of Medicine) that was published at the end of 2014 (1). I served as the cochair of the IOM Committee that produced this report and was invited to write this Perspective about it.Whether and how we plan for our own eventual death has important implications for us individually, and as members of families and communities. This awareness and the conversations that ensue can be as important to our legacy as the contributions we make personally and professionally. Indeed, a lack of planning and commun...

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“…In addition, more than 80% of these physicians indicated that the EOL care they would select was to receive pain medication, but refuse life-sustaining medical treatments. 15 In a 2011 essay titled "How Doctors Die," a retired family practice physician described why physicians administer so much care to patients at the end of their lives that they would not want for themselves. 16 His explanations for their aggressive EOL treatment included patients who have not made their wishes known, overwhelmed families who request that everything be done, expectations of outcomes that may be misguided or unrealistic, physicans attempting to address patient or family wishes or to minimize potential for litigation, as well as possible exploitation to earn higher fees.…”

Section: Attitude Toward and Disregard Of Advance Directives By Physimentioning

confidence: 99%

When It’s Your Time, Will It Be Your Way?

Alspach¹

2016

Critical Care Nurse

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Life‐Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?

Abstract: This survey of physicians calls attention to the gap between preferences for medical care at the end of life and expressing wishes to others through discussion and advance directives, even among physicians.

Cited by 57 publications

References 47 publications

Differences in attitudes to end-of-life care among patients, relatives and healthcare professionals

Differences in attitudes to end-of-life care among patients, relatives and healthcare professionals

Thoughts about Dying in America : Enhancing the impact of one’s life journey and legacy by also planning for the end of life

When It’s Your Time, Will It Be Your Way?

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