The Impact of Country and Culture on End-of-Life Care for Injured Patients: Results From an International Survey

Ball, Chad G.; Navsaria, Pradeep; Kirkpatrick, Andrew W.; Vercler, Christian J.; Dixon, Elijah; Zink, John U.; Laupland, Kevin B.; Lowe, Michael C.; Salomone, Jeffrey P.; Dente, Christopher J.; Wyrzykowski, Amy D.; Hameed, S. Morad; Widder, Sandy; Inaba, Kenji; Ball, Jill E.; Rozycki, Grace S.; Montgomery, Sean P.; Hayward, Thomas Z.; Feliciano, David V.

doi:10.1097/ta.0b013e3181f66878

Cited by 41 publications

(43 citation statements)

References 48 publications

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“…This latter concept raises the ethical principal of distributive justice and in some parts of the world (including in Europe), where the number of ICU beds is quite limited, this can be a major practical issue [25,26]. Yet, a considerable proportion of ICU patients are considered by physicians and other healthcare workers to be receiving "futile" care.…”

Section: The Extent and Impact Of "Futility" In Intensive Carementioning

confidence: 99%

When ICU Treatment Becomes Futile

Vincent¹

2014

J Clinic Res Bioeth

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Many patients admitted to the intensive care unit (ICU) have no hope of meaningful survival and receive "futile" therapy. When a patient is no longer capable of deciding (so that autonomy is no longer applicable), giving futile treatment is against the three other key ethical principles: beneficence, non-maleficence, and distributive justice. Continuing futile treatments impacts on the patient and his/her family, but also on other patients and society as a whole. In such situations, the goal of intensive care should no longer be to maximize a patient's chances of a good quality of life on discharge but rather to provide them with a dignified and comfortable death. Once a decision has been made that intervention is futile, all on-going treatment should thus be withdrawn except for comfort measures. Good and continuing communication with the family and all members of the healthcare team is an essential aspect of insuring the best possible dying process. In this article, we will explore this complex area and try to provide answers to some of the difficult issues involved, including how futility can be recognized, who should determine that further treatment is futile, and what should be done once it has been decided that further treatment is futile in a particular patient.

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Section: The Extent and Impact Of "Futility" In Intensive Carementioning

confidence: 99%

When ICU Treatment Becomes Futile

Vincent¹

2014

J Clinic Res Bioeth

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“…This finding differs significantly from a similar author-based study in the trauma/critical care field. 38 More specifically, very few of the observed differences were based on the country of practice. For example, the typical care algorithm of a patient with head PDAC would include interaction with an experienced, HPB-trained surgeon in an academic practice with plans for a curative resection.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike trauma or emergency surgery, 38 this is likely less of an issue in patients with PDAC given the outpatient opportunities to discuss goals of care and patient advance directives. It also provides an opportunity for detailed discussions of expectations and potential morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

“…8,[11][12][13][19][20][21]29,[31][32][33][34][35][38][39][40] Unfortunately, to our knowledge, this concept has not been explored in patients with head PDAC.…”

Section: Discussionmentioning

confidence: 99%

“…It should be noted that this survey is an extension of similar work by authors within the trauma/ critical care community. 38 Questions were created with the intent of characterizing the impact of medical, ethical, religious, social, training and system elements on end-of-life care for patients with PDAC in various geographic regions/countries. The study also included specific scenarios for patients with nonresectable disease at the time of operative exploration.…”

Section: Methodsmentioning

confidence: 99%

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Does regional variation impact decision-making in the management and palliation of pancreatic head adenocarcinoma? Results from an international survey

et al. 2014

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Background: Management and palliation of pancreatic head adenocarcinoma is challenging. End-of-life decision-making is a variable process involving multiple factors. Methods:We conducted a qualitative, physician-based, 40-question international survey characterizing the impact of medical, religious, social, training and system factors on care.Results: A total of 258 international clinicians completed the survey. Respondents were typically fellowship-trained (78%), with a mean of 16 years' experience in a universityaffiliated (93%) hepato-pancreato-biliary group (96%) practice. Most (91%) believed resection is potentially curative. Most patients were discussed preoperatively by multidisciplinary teams (94%) and medical assessment clinics (68%), but rarely critical care (21%). Intraoperative surgical palliation included double bypass or no intervention for locally advanced nonresectable tumours (41% and 49% v. 14% and 85%, respectively, for patients with hepatic metastases). Postoperative admission to the intensive care unit was frequent (58%). Severe postoperative complications were often treated with aggressive cardiopulmonary resuscitation, intubation and critical care (96%), with no defined time points for futility (74%). Admitting surgeons guided most end-of-life decisions (97%). Formal medical futility laws were rarely available (26%). Insurance status did not alter treatment (97%) or palliation (95%) in non-universal care regions. Clinician experi ence, regional culture and training background impacted treatment (all p < 0.05). Conclusion:Despite remarkable overall agreement, geographic and training differences are evident in the treatment and palliation of pancreatic head adenocarcinoma. Contexte :Le traitement et les soins palliatifs pour l'adénocarcinome de la tête du pancréas sont complexes. Les décisions de fin de vie reposent sur un processus hautement variable qui dépend de multiples facteurs.Méthodes : Nous avons administré à des médecins un sondage international qualitatif à 40 questions afin de caractériser l'impact sur les soins exercé par différents facteurs, notamment médicaux, religieux, sociaux, relatifs à la formation et systémiques. Résultats :En tout, 258 cliniciens ont participé à ce sondage international. Les participants étaient en général des spécialistes (78 %), cumulaient en moyenne 16 ans d'expéri-ence dans le domaine hépatopancréatobiliaire (96 %) au sein d'un groupe affilié à une université (93 %). La plupart (91 %) ont dit croire que la résection est potentiellement curative. La majorité des cas faisaient l'objet de discussions préopératoires par des équipes multidisciplinaires (94 %) et en clinique d'évaluation médicale (68 %), mais rarement par une équipe de soins intensifs (21 %). Les soins palliatifs chirurgicaux peropératoires incluaient la double dérivation ou la non intervention en présence de tumeurs non résé-cables localement avancées (41 % et 49 % c. 14 % et 85 %, respectivement, chez les patients porteurs de métastases hépatiques). L'admission postopératoire aux soins ...

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