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International Journal of Environmental... Jun 2020Deactivation of an implantable cardioverter-defibrillator (ICD) is a critical issue in the advance care planning (ACP) of ICD recipients; however, related perspectives...
Exploring Advance Directive Perspectives and Associations with Preferences for End-of-Life Life-Sustaining Treatments among Patients with Implantable Cardioverter-Defibrillators.
Deactivation of an implantable cardioverter-defibrillator (ICD) is a critical issue in the advance care planning (ACP) of ICD recipients; however, related perspectives have rarely been explored. Thus, this study aimed to provide an initial investigation of ICD recipients' perceived susceptibility and barriers/benefits regarding ACP and/or advance directives (ADs), and associations of these modifiable factors with preferences for end-of-life life-sustaining treatments (LSTs) (cardiopulmonary resuscitation (CPR), ventilator support, hemodialysis, and hospice care). Using a descriptive correlational design, 48 ICD recipients (age, 50.1 years; male, 85.4%) completed survey questionnaires. "No burden on family" was the most highly valued (59.1%), followed by "comfortable death" (20.4%), and both (11.4%). LST preference was 43.8% for ventilator support, 45.8% for both hemodialysis and hospice care, and 54.2% for CPR. Perceived susceptibility to having unexpected end-of-life experiences increased the likelihood of preference for aggressive LSTs, with preferences increasing by 15% for CPR, 17% for ventilator support, and 23% for hemodialysis. A non-modifiable factor, older age, was the only predictor of increased preference for hospice care (odds ratio = 1.09, = 0.016). Among the modifiable factors, a higher perceived susceptibility increased the likelihood of aggressive LST preferences. The findings imply that to facilitate informed decisions for LSTs, early ACP discussion could be helpful and enhance these modifiable factors.
Topics: Advance Directives; Aged; Defibrillators, Implantable; Female; Humans; Male; Middle Aged; Patient Preference; Stroke Volume; Terminal Care; Ventricular Function, Left
PubMed: 32549238
DOI: 10.3390/ijerph17124257 -
Revista Brasileira de Enfermagem 2015characterizing the national and international scientific literature about the advanced directives of living will as applied to the terminally ill patient. (Review)
Review
OBJECTIVE
characterizing the national and international scientific literature about the advanced directives of living will as applied to the terminally ill patient.
METHOD
integrative review considering the articles published in Portal Capes, SciELO, LILACS, MEDLINE, Journal of Bioethics and Bioethikos, with the descriptors: Advanced directives, Wills regarding life and Advance Directives, Living Will and Terminally Ill, totaling 44 articles submitted to content analysis.
RESULTS
three categories emerged: Students and professionals facing the advance directives of living will: Perceptions, opinions and practices; Patient's receptivity to the Advance Directives of Living Will; The family facing the advance directives of living will.
CONCLUSION
the relevance of the topic became evident as a guarantee of respect for the dignity and autonomy of the patient, as well as to reduce ethical conflicts faced by families and health professionals facing care at the end of life.
Topics: Advance Directives; Humans; Living Wills; Terminally Ill
PubMed: 26312526
DOI: 10.1590/0034-7167.2015680321i -
Indian Journal of Medical Ethics 2018On Friday, March 9, 2018 the five-judge Constitution Bench (CB) of the Supreme Court of India (SCI) chaired by Dipak Misra, the Chief Justice of India, pronounced its...
On Friday, March 9, 2018 the five-judge Constitution Bench (CB) of the Supreme Court of India (SCI) chaired by Dipak Misra, the Chief Justice of India, pronounced its judgment (1) (henceforth CC judgment) granting, for the first time in India, legal recognition to "advanced medical directives" or "living wills", ie, a person's decision communicated in advance on withdrawal of life-saving treatment under certain conditions, which should be respected by the treating doctor/s and the hospital. It also reiterates the legal recognition of the right to "passive euthanasia"; and draws upon Article 21 - the right to life - of the Constitution of India (henceforth Constitution) (2) interpreting robustly that the "right to life" includes the "right to die with dignity". Justices Misra and Khanwilkar disposed of the writ petition filed in 2005 by Common Cause (3) (henceforth CC petition) saying, "The directive and guidelines shall remain in force till the Parliament brings a legislation in the field" (1:p 192).
Topics: Advance Directives; Decision Making; Euthanasia, Passive; Humans; India; Living Wills; Personal Autonomy; Personhood; Right to Die; Value of Life; Withholding Treatment
PubMed: 29724694
DOI: 10.20529/IJME.2018.028 -
Journal of Pain and Symptom Management Aug 2020The importance of advance care planning (ACP) has been increasingly recognized by health systems. However, 46%-76% of patients report engaging in ACP with lawyers,...
The importance of advance care planning (ACP) has been increasingly recognized by health systems. However, 46%-76% of patients report engaging in ACP with lawyers, whereas only a minority report doing so with physicians. In the U.S., ACP with lawyers focuses on advance directive documents, naturally occurs outside of health care contexts, and is often uninformed by the clinical context, such as one's prognosis and clinical trajectory. These forms are regularly stored at home or at a lawyer's office and not available at the bedside when needed in a medical crisis. Yet, in contrast to clinicians, lawyers hold sophisticated knowledge about their states' advance directive law. Lawyers may also understand clients' socioeconomic context and plans more broadly, which are known to be critical for contextualizing and personalizing patient care but are often not well captured in health care. Aligning medical and legal approaches to ACP is important to ensuring the quality and value of those efforts. As an important first step toward this goal, we convened an interprofessional panel of medical and legal experts to elucidate the state of medical-legal ACP and begin to identify strategies to improve and align practices within and across professions. This article describes the historical disconnects between the medical and legal practice of ACP, recommendations and products of the interprofessional panel, and recommendations for future medical-legal collaboration.
Topics: Advance Care Planning; Advance Directives; Humans; Physicians
PubMed: 32240757
DOI: 10.1016/j.jpainsymman.2020.03.004 -
Australian Family Physician Apr 2015Although most people have clear preferences with regard to end-of-life care, there is a disconnect between these preferences and what happens in practice. Advance care... (Review)
Review
BACKGROUND
Although most people have clear preferences with regard to end-of-life care, there is a disconnect between these preferences and what happens in practice. Advance care directives (ACDs) are a way of allowing people to plan ahead for any future loss in decision-making capacity, by allowing a systematic approach to decision making that respects the person's previously ex-pressed wishes.
OBJECTIVE
This article reviews ACDs, considering, in particular, aspects of their use for patients in residential aged care.
DISCUSSION
All people should be offered the opportunity to make an ACD as part of their routine care prior to any need for residential care. Once there is a need for residential care, advance care directives become even more important. Systems to ensure routine re-view of advance care directives and appropriate transfer of information between healthcare providers should be implemented by clinicians and residential aged care facilities.
Topics: Advance Directives; Aged; Decision Making; Homes for the Aged; Humans; Terminal Care
PubMed: 25901401
DOI: No ID Found -
Patient Education and Counseling Nov 2021The primary purpose of this study was to analyze the completion of advance directives among African American and White adults and examine related factors, including...
OBJECTIVE
The primary purpose of this study was to analyze the completion of advance directives among African American and White adults and examine related factors, including demographics, socio-economic status, health conditions, and experiences with health care providers.
METHODS
This study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We compared correlates of completion of advance directives among a sample of 1635 African American and White adults. Multivariate analysis was conducted.
RESULTS
Whites were 50% more likely to complete an advance directive than African Americans. The major differences between African Americans and Whites were mainly explained by the level of mistrust and discrimination experienced by African Americans and partially explained by demographic characteristics. Our study showed that at both bivariate and multivariate levels, participation in religious activities was associated with higher odds of completion of an advance directive for both African Americans and Whites.
CONCLUSION
Interventional studies needed to address the impact of mistrust and perceived discrimination on advance directive completion.
PRACTICAL IMPLICATIONS
Culturally appropriate multifaceted, theoretical- and religious-based interventions are needed that include minority health care providers, church leaders, and legal counselors to educate, modify attitudes, provide skills and resources for communicating with health care providers and family members.
Topics: Adult; Advance Directives; Black or African American; Family; Humans; Perceived Discrimination; Surveys and Questionnaires
PubMed: 33840551
DOI: 10.1016/j.pec.2021.03.031 -
La Clinica Terapeutica 2018The paper's authors aim to elaborate on law 22 dicembre 2017, n. 219 , designed to regulate informed consent practices and advance health care directives", which has... (Review)
Review
The paper's authors aim to elaborate on law 22 dicembre 2017, n. 219 , designed to regulate informed consent practices and advance health care directives", which has sparked a passionate debate centered on the substantial innovation achieved over the past decades in bio-medical science and at the same time, the noteworthy accomplishments made in enforcing human and personal rights. Within the paper, article three is delved into, which covers the creation of the so-called DAT ("Disposizioni anticipate di trattamento", advance health care directives), by which patients, in light of possible future incapacity to choose, can express their convictions and decisions on how to be treated and their consent or dissent to undergo treatments and procedures, including artificial nutrition and hydration. The authors peruse the new law's provisions through a medical perspective, and observe how they are heavily tilted towards patient choice, thus making doctors little more than mere tools of such decisions.
Topics: Adult; Advance Directives; Aged; Aged, 80 and over; Attitude of Health Personnel; Female; Humans; Informed Consent; Italy; Male; Middle Aged; Physicians
PubMed: 29595870
DOI: 10.7417/T.2018.2058 -
BMC Medical Ethics Jun 2018Due to the rapid changes in the medical world and the aging population, the need for advanced care planning grows. Despite efforts to make this topic discussed, only a...
BACKGROUND
Due to the rapid changes in the medical world and the aging population, the need for advanced care planning grows. Despite efforts to make this topic discussed, only a minority of patients discusses the advance directive with their general practitioner (GP). This study aimed to map thresholds: What barriers are identified by GPs and patients in preparing and discussing an advance directive?
METHODS
A cross section survey in patients and GP's was performed. Citizens were recruited by multimedia and by street interviews. GP's were recruited by mailing.
RESULTS
Most of the 502 citizens already heard of an advance directive but only 17 had declared one while 21 never want one. Eighty percent wants to take the initiative themselves but half of the participants wants the GP to be actively involved. Thirty percent finds the document too difficult to understand. The need to draw an advance directive grew with increasing age. Of the 117 GP's involved, 65% drafted five or less advance directives the past year. A lack of time, experience and a poor access to the correct administrative requirements were only a few of the barriers.
CONCLUSIONS
Preparing and drafting an advance directive is a time-consuming and difficult procedure. Patients and GP's have the right to be informed and instructed on how to prepare an advance directive.
Topics: Advance Directives; Aged; Aged, 80 and over; Attitude of Health Personnel; Awareness; Communication; Comprehension; Cross-Sectional Studies; Female; General Practitioners; Health Knowledge, Attitudes, Practice; Health Services Needs and Demand; Humans; Information Dissemination; Male; Middle Aged; Primary Health Care; Surveys and Questionnaires
PubMed: 29890967
DOI: 10.1186/s12910-018-0305-2 -
BMC Cancer Jan 2021In Mainland China, advance directives (ADs) and end-of-life care for patients with tumours, especially patients with brain tumours who may have lost consciousness or the...
BACKGROUND
In Mainland China, advance directives (ADs) and end-of-life care for patients with tumours, especially patients with brain tumours who may have lost consciousness or the ability to speak at the early stage of their illness, have been poorly acknowledged. Thus, this study aimed to clarify the knowledge and preferences of ADs and end-of-life care in patients with brain tumours and to investigate predictors of patient preferences.
METHODS
This was a population-based cross-sectional survey that was conducted via face-to-face interviews. Information on sociodemographic factors, brain tumour illness, knowledge and preferences of the advanced decisions and end-of-life care of the patients was collected.
RESULTS
A total of 88.61% of participants had never heard of ADs, but 65.18% reported that they would like to make ADs. Knowledge of ADs, receiving surgical treatment or radiotherapy, being younger than 70 years old, being male, having educational qualifications of college or beyond, being childless, having medical insurance for nonworking or working urban residents and self-paying medical expenses were predictors of preference for making ADs. A total of 79.43% of participants wanted to discuss end-of-life arrangements with medical staff, and 63.29% of participants were willing to receive end-of-life care, even though it would not delay death. A total of 65.82% of patients with brain tumours wanted resuscitation, and as many as 45.45% of the patients thought that they did not need life support if they were in a persistent vegetative state. Brain primary tumours, being younger than 70 years old, male sex, educational qualification of junior middle school or below, having children, having new rural cooperative medical insurance and having medical expenses paid by children or spouses were predictors of choosing appropriate palliative care.
CONCLUSIONS
ADs and end-of-life care have been poorly acknowledged among patients with brain tumours in mainland China. Additional efforts should be encouraged amongst patients with primary brain tumours, those who are undergoing surgery and radiotherapy and those who have low socioeconomic status. A longitudinal and comprehensive study is encouraged to promote disease-specific ADs among Chinese patients with brain tumours.
Topics: Adult; Advance Directives; Aged; Aged, 80 and over; Brain Neoplasms; China; Cross-Sectional Studies; Female; Follow-Up Studies; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Patient Preference; Prognosis; Surveys and Questionnaires; Terminal Care
PubMed: 33402101
DOI: 10.1186/s12885-020-07775-4 -
Revista Brasileira de Enfermagem 2019to explain the approaches and discussions about the Advance Healthcare Directives spread among health professionals, lawyers and society. (Review)
Review
OBJECTIVE
to explain the approaches and discussions about the Advance Healthcare Directives spread among health professionals, lawyers and society.
METHOD
bibliographic search in the databases SciELO, LILACS, BDENF, in Portuguese, carried out from December 2017 to January 2018.
RESULTS
22 articles were considered for analysis with interviews and testimonies of physicians, intensivists and geriatricians, nurses, technicians and Nursing auxiliaries, Medical students, lawyers and Law students.
CONCLUSION
there is a small number of papers on the Advance Healthcare Directives in Brazil, and a wide range of approaches that have not yet been clarified. The theme is not widely spread and little clarified in its essence.
Topics: Advance Directives; Decision Making; Humans; Personal Autonomy; Right to Die
PubMed: 30916293
DOI: 10.1590/0034-7167-2018-0347