Journal of palliative medicine
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Randomized Controlled Trial
Advance Care Planning to Improve End-of-Life Decision-Making Consistency between Older People and Their Surrogates in Taiwan.
Background: Surrogates often do not accurately predict older people's preferences about end-of-life (EOL) care. Few studies have examined the impact of advance care planning (ACP) on EOL decision-making consistency between older people and their surrogates, and these studies have yielded conflicting results. Objectives: To evaluate the effectiveness of ACP in improving EOL decision-making consistency between older people and their surrogates. Design: The intervention in this pre-post quasi-experimental design included an informative video, a brochure about ACP, and a guided discussion about EOL wishes. Setting: Two geriatric wards in a medical center in northern Taiwan. Subjects: One hundred eight participants, as 54 pairs of older people and their surrogates, were randomly assigned to either the experimental or control group. The experimental group received an intervention, while the control group received usual care. Measurements: Life-Support Preferences Questionnaire. Results: The intervention did not improve decision-making consistency between older people and their surrogates. ⋯ This study also found that some older people had difficulty concentrating on the educational brochure or understanding the related terms. Conclusions: Preparation for ACP discussion is needed for older people and their surrogates. Longer-term effects of ACP should be monitored because ACP interventions may have enhanced empathy between older people and their surrogates. Additionally, a culturally sensitive illustrated questionnaire that explains life-support preferences and ACP topics may improve communication between older people and their surrogates.
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Background: Despite advances in medical technology, resources for pediatric palliative care (PPC) for children with serious illnesses are limited in South Korea. Physicians' awareness of and willingness to provide general palliative care and refer to specialized palliative care are key elements for providing PPC. Objective: The aim of this study was to explore physicians' perceptions of PPC and the differences therein between nononcologists and oncologists. ⋯ Furthermore, oncologists preferred earlier referrals than did nononcologists. Conclusions: To promote PPC provision and improve the quality of life of pediatric patients and their families, it is important to introduce PPC early into disease-modifying treatment at any level of health care. Developing education and training curricula regarding PPC for health care providers caring for children with severe illnesses is crucial.
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Background: End-of-life dreams and visions (ELDVs) can provide both meaning and comfort to individuals nearing death. While research has examined the prevalence and content of ELDVs, little is known on how dreaming at end of life may affect psychological processes. Objective: This study aimed to explore differences in posttraumatic growth (PTG) between hospice patients who experience ELDVs and hospice patients who do not experience this phenomenon. ⋯ Patients with ELDV experiences had higher scores on all subscales as well as overall PTG compared to nondreaming patients. Conclusions: Dreams and visions at the end of life affect PTG of dying individuals in hospice care. Further research should be conducted between groups to examine the effects ELDVs may have on other psychological processes.
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Background: Older adults frequently report a preference to "trial" intubation and mechanical ventilation (MV) if faced with life-threatening respiratory failure. Understanding the anticipated outcome of unplanned MV is key to structuring a time-limited trial of treatment. Objective: To characterize the time-to-death (TTD) among adults 65 years of age and older, who undergo emergency intubation and MV. Design: Retrospective cohort study. Setting/Subjects: All patients 65 years of age and older, who underwent emergency department (ED) intubation from 2008 to 2015, from 417 hospitals were included. Measurements: The primary outcome was TTD after emergency intubation. Results: We identified 41,463 ED encounters. The median TTD was three days (interquartile range, IQR, 1-8). ⋯ Bivariate analysis comparing TTD by Charleston Comorbidity Index (CCI) revealed a trend of increasing TTD with increasing CCI score among decedents. Patients with a CCI of 0 had a median TTD of one day (IQR 4), whereas the median TTD among those with a CCI >4 was four days (IQR 9). Conclusions: In a large, nationally representative cohort of older adults undergoing ED intubation, the median time from intubation to death was short; however, the length of time between intubation and death varied considerably by principal diagnosis. This information will help guide providers' prognostication after emergency intubation and enhance serious illness conversations by informing expectations. Tweet: Thirty-five percent of older adults die after ED intubation-most only survive two or three days after intubation.