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Palliative care, ethics

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https://read.qxmd.com/read/30757945/the-use-of-palliative-sedation-to-treat-existential-suffering-a-scoping-review-on-practices-ethical-considerations-and-guidelines
#1
Allysa L Ciancio, Raza M Mirza, Amy A Ciancio, Christopher A Klinger
CONTEXT: Though palliative sedation has been recognized as an acceptable practice in Canada for many years now, there is a lack of clinical research and guidelines pertaining to its use as a treatment of existential refractory symptoms in the terminally ill. OBJECTIVES: This scoping review aimed to survey the literature surrounding palliative sedation and existential suffering and to inform research, policy, and practice. METHODS: To address the main research question: Is palliative sedation an acceptable intervention to treat existential refractory symptoms in adults aged 65 and older? a scoping review following Arksey and O'Malley's framework was performed, spanning electronic databases of the peer reviewed and grey literature...
February 13, 2019: Journal of Palliative Care
https://read.qxmd.com/read/30755396/primary-palliative-care-research-opportunities-and-challenges
#2
Stephen Barclay, Emily Moran, Sue Boase, Margaret Johnson, Roberta Lovick, Jonathan Graffy, Patrick L White, Brenda Deboys, Katy Harrison, Brooke Swash
INTRODUCTION: Primary care has a central role in palliative and end of life care: 45.6% of deaths in England and Wales occur under the care of primary care teams at home or in care homes. The Community Care Pathways at the End of Life (CAPE) study investigated primary care provided for patients in the final 6 months of life. This paper highlights the opportunities and challenges associated with primary palliative care research in the UK, describing the methodological, ethical, logistical and gatekeeping challenges encountered in the CAPE study and how these were addressed...
February 12, 2019: BMJ Supportive & Palliative Care
https://read.qxmd.com/read/30744921/cardiac-surgery-in-hiv-patients-state-of-the-art
#3
REVIEW
Bobby Yanagawa, Subodh Verma, Girish Dwivedi, Marc Ruel
The clinical status of HIV infection has changed dramatically with the introduction of combined antiretroviral therapy. Patients with HIV are now living long enough to be susceptible to chronic illnesses, such as coronary disease and nonischemic cardiomyopathy, which can be consequences of the combined antiretroviral therapy treatment itself. Cardiovascular diseases are a major source of morbidity and mortality in HIV-positive patients. Increasingly, such patients might be candidates for the full range of cardiac surgical interventions, including coronary bypass, valve surgery, and heart transplantation...
November 20, 2018: Canadian Journal of Cardiology
https://read.qxmd.com/read/30742452/-care-for-the-patient-and-his-family-at-the-end-of-life-compassionate-advance-care-planning
#4
Encarnación Pérez Bret, Rogelio Altisent Trota, Javier Rocafort Gil, Paula Jaman Mewes
End of life is frequently accompanied by suffering and hardships that can be alleviated in the Palliative Care (PC) units by applying compassionate advance care. It is the aim of this paper to describe the concept of "compassionate advance care" as a way of caring for the patient and his family at the end of life from the perspective of both professionals, teachers and students of the health sciences, and persons with advanced disease and their families. A qualitative methodology was used. Data were collected through in-depth interviews and focus groups, and analysed and coded using the theory of Grounded Theory...
January 2019: Cuadernos de Bioética: Revista Oficial de la Asociación Española de Bioética y Ética Médica
https://read.qxmd.com/read/30738286/selecting-and-evaluating-decision-making-strategies-in-the-intensive-care-unit-a-systematic-review
#5
REVIEW
Monika C Kerckhoffs, Matthijs Kant, Johannes J M van Delden, Lotty Hooft, Jozef Kesecioglu, Diederik van Dijk
PURPOSE: Many patients in the Intensive Care Unit (ICU) die after a decision to withhold or withdraw treatment. To ensure that for each patient the appropriate decision is taken, a careful decision-making process is required. This review identifies strategies that can be used to optimize the decision-making process for continuing versus limiting life sustaining treatment of ICU patients. METHODS: We conducted a systematic review of the literature by searching PUBMED and EMBASE...
January 30, 2019: Journal of Critical Care
https://read.qxmd.com/read/30696686/multicomponent-non-pharmacological-intervention-to-prevent-delirium-for-hospitalised-people-with-advanced-cancer-study-protocol-for-a-phase-ii-cluster-randomised-controlled-trial
#6
Annmarie Hosie, Jane Phillips, Lawrence Lam, Slavica Kochovska, Beverly Noble, Meg Brassil, Susan E Kurrle, Anne Cumming, Gideon A Caplan, Richard Chye, Brian Le, E Wesley Ely, Peter G Lawlor, Shirley H Bush, Jan Maree Davis, Melanie Lovell, Linda Brown, Belinda Fazekas, Seong Leang Cheah, Layla Edwards, Meera Agar
INTRODUCTION: Delirium is a significant medical complication for hospitalised patients. Up to one-third of delirium episodes are preventable in older inpatients through non-pharmacological strategies that support essential human needs, such as physical and cognitive activity, sleep, hydration, vision and hearing. We hypothesised that a multicomponent intervention similarly may decrease delirium incidence, and/or its duration and severity, in inpatients with advanced cancer. Prior to a phase III trial, we aimed to determine if a multicomponent non-pharmacological delirium prevention intervention is feasible and acceptable for this specific inpatient group...
January 28, 2019: BMJ Open
https://read.qxmd.com/read/30689225/the-ethical-conundrum-conflicting-advocacy-positions-in-advanced-heart-failure-therapy
#7
Denise M Dudzinski, Claudius Mahr, Jason Bjelkengren, Nahush A Mokadam
It is estimated that nearly 6.5 million Americans over the age of 20 suffer from heart failure. Heart failure is the leading cause of hospitalization in patients over 65 years of age, and carries with it a 5-year mortality of nearly 50%. [1] Despite advances in medical therapy, treatment for medically refractory end-stage, advanced heart failure is limited to heart transplant, mechanical circulatory support (MCS), or palliative care only. Patient selection in advanced heart failure (AHF) therapy is complex...
January 28, 2019: Clinical Transplantation
https://read.qxmd.com/read/30688390/attitudes-of-clinicians-toward-cardiac-surgery-and-trisomy-18
#8
Meagan E Kaulfus, Helena Gardiner, S Shahrukh Hashmi, Hector Mendez-Figueroa, Victoria J Miller, Blair Stevens, Rebecca Carter
Trisomy 18 is an autosomal trisomy condition characterized by minor to major birth defects, severe disabilities, and high rates of pre- and postnatal mortality. Interventions for these infants have traditionally been withheld with focus instead on palliative support. The issues and attitudes surrounding corrective surgery of congenital heart defects, which is a birth defect that occurs in approximately 90% of infants with trisomy 18, is of our study's interest as recent literature has indicated that cardiac surgery is being performed and may lead to improved survival compared to palliative care...
January 28, 2019: Journal of Genetic Counseling
https://read.qxmd.com/read/30688153/research-ethics-in-palliative-care-a-hallmark-in-palliative-medicine
#9
Sandra Martins Pereira, Pablo Hernández-Marrero
No abstract text is available yet for this article.
January 28, 2019: Palliative Medicine
https://read.qxmd.com/read/30679290/advance-care-planning-for-patients-with-advanced-illnesses-attending-hospital-outpatient-clinics-study-a-study-protocol-for-a-randomised-controlled-trial
#10
Joel Rhee, Anne Meller, Karolina Krysinska, Peter Gonski, Vasi Naganathan, Nicholas Zwar, Andrew Hayen, John Cullen, Julie-Ann O'Keefe, Julie McDonald, Ben Harris-Roxas, Gideon A Caplan
INTRODUCTION: It is unclear whether advance care planning (ACP) undertaken with patients living in the community can improve patient care and avoid unwanted interventions and hospital admissions. We have designed a randomised controlled trial (RCT) to examine if ACP undertaken with patients with advanced illnesses attending hospital outpatient clinics can reduce unplanned hospital admissions and improve patient and caregiver well-being. METHODS AND ANALYSIS: Pragmatic RCT involving patients from subspecialty outpatient clinics at five clinical sites in Sydney, Australia...
January 24, 2019: BMJ Open
https://read.qxmd.com/read/30677752/long-term-ventilation-in-neuromuscular-patients-review-of-concerns-beliefs-and-ethical-dilemmas
#11
REVIEW
Claudia Crimi, Paola Pierucci, Annalisa Carlucci, Andrea Cortegiani, Cesare Gregoretti
BACKGROUND: Noninvasive mechanical ventilation (NIV) is an effective treatment in patients with neuromuscular diseases (NMD) to improve symptoms, quality of life, and survival. SUMMARY: NIV should be used early in the course of respiratory muscle involvement in NMD patients and its requirements may increase over time. Therefore, training on technical equipment at home and advice on problem solving are warranted. Remote monitoring of ventilator parameters using built-in ventilator software is recommended...
January 24, 2019: Respiration; International Review of Thoracic Diseases
https://read.qxmd.com/read/30638215/-palliative-care-in-the-cardiac-setting-a-consensus-document-of-the-italian-society-of-cardiology-italian-society-of-palliative-care-sic-sicp
#12
Raffaella Antonione, Gianfranco Sinagra, Matteo Moroni, Michele Correale, Dario Redaelli, Domenico Scrutinio, Eugenia Malinverni, Savina Nodari, Raffaele Calabrò, Italo Penco, Giuseppe Mercuro
Palliative care is recognized as an approach that improves quality of life of patients and families facing life-threatening illnesses. This is achieved through prevention, early identification, assessment and treatment of symptoms and other psycho-social, spiritual and economic issues. Palliative care is not dependent on prognosis and can be delivered as "simultaneous care", together with disease-modifying treatments and adequate symptom relief. Palliative care relies on coordination across settings of care and offers open communication to patients and caregivers...
January 2019: Giornale Italiano di Cardiologia
https://read.qxmd.com/read/30636204/healthcare-professionals-moral-distress-in-adult-palliative-care-a-systematic-review
#13
Marina Maffoni, Piergiorgio Argentero, Ines Giorgi, Julia Hynes, Anna Giardini
OBJECTIVES: Palliative care providers may be exposed to numerous detrimental psychological and existential challenges. Ethical issues in the healthcare arena are subject to continual debate, being fuelled with ongoing medical, technological and legal advancements. This work aims to systematically review studies addressing the moral distress experienced by healthcare professionals who provide adult palliative care. METHODS: A literature search was performed on PubMed, Scopus, Web of Science and PsycINFO databases, searching for the terms 'moral distress' AND 'palliative care'...
January 12, 2019: BMJ Supportive & Palliative Care
https://read.qxmd.com/read/30632479/-that-just-breaks-my-heart-moral-concerns-of-direct-care-workers-providing-palliative-care-in-ltc-homes
#14
Elaine Wiersma, Jill Marcella, Jessica McAnulty, Mary Lou Kelley
ABSTRACTThe literature on ethics in health care that explores the moral concerns of care providers typically focuses on registered health professionals and ethical dilemmas in acute and primary care. Far less attention has been paid to the long-term care (LTC) environment and non-registered, direct care workers. To address this gap, this research examined the moral concerns of personal support workers (PSWs) who provide direct care to residents. Data were collected during a 5-year participatory action research project to formalize palliative care programs in LTC homes...
January 11, 2019: Canadian Journal on Aging, la Revue Canadienne du Vieillissement
https://read.qxmd.com/read/30589144/nursing-s-professional-dignity-in-palliative-care-exploration-of-an-italian-context
#15
Alessandro Stievano, Laura Sabatino, Dyanne Affonso, Douglas Olsen, Isabelle Skinner, Gennaro Rocco
AIMS AND OBJECTIVES: To determine the relevance of nursing's professional dignity in palliative care. BACKGROUND: Dignity is a valued concept in the ethical discourse of health disciplines. Nursing's professional dignity, a concept related to professional identity, is not clearly defined nor have its characteristics been delineated for its clinical relevance in palliative care. DESIGN: A qualitative methodological approach. METHODS: Focus groups elicited dialogues of nursing's professional dignity among 69 nurses working in hospices and home-care in Italy...
December 27, 2018: Journal of Clinical Nursing
https://read.qxmd.com/read/30579650/the-practice-of-mutual-protection-in-the-care-of-children-with-palliative-care-needs-a-multiple-qualitative-case-study-approach-from-jordan
#16
Maha Atout, Pippa Hemingway, Jane Seymour
PURPOSE: This study explores the experience of disclosing critical information in the care of children with palliative care needs, from the perspective of physicians, nurses, and mothers in Jordan. DESIGN AND METHODS: This study employed a qualitative case study approach. It was conducted in three paediatric units in a Jordanian hospital. Each case comprised a child aged 1-12 years with a condition eligible for palliative care who received health care in one of these units, and their most involved carers (e...
December 19, 2018: Journal of Pediatric Nursing
https://read.qxmd.com/read/30578180/voluntary-stopping-of-eating-and-drinking-in-switzerland-from-different-points-of-view-protocol-for-a-mixed-methods-study
#17
Sabrina Stängle, Wilfried Schnepp, Mirjam Mezger, Daniel Büche, André Fringer
BACKGROUND: "To die with dignity" has reached the significance of a core value in democratic societies. Based on this unconditional value, people require autonomy and care. "Voluntary stopping of eating and drinking" (VSED) represents an alternative to assisted suicide because no one else is involved in the action of death fastening, even though from outside, it might be considered as an extreme form of passive euthanasia. However, there are no data available about the prevalence and frequency of either explicit VSED or the implicit reduction of food and liquid in Switzerland...
December 21, 2018: JMIR Research Protocols
https://read.qxmd.com/read/30563824/ethical-issues-in-nursing-home-palliative-care-a-cross-national-survey
#18
Deborah H L Muldrew, Sharon Kaasalainen, Dorry McLaughlin, Kevin Brazil
OBJECTIVES: With an increased dependency on nursing homes to provide care to the ageing population, it is likely that ethical issues will also increase. This study aimed to identify the type of ethical issues and level of associated distress experienced by nurses providing palliative care in nursing homes in the UK and Canada, and pilot the Ethical issues in Palliative Care for Nursing Homes (EPiCNH) instrument in Canada. METHODS: A cross-sectional survey design was used...
December 18, 2018: BMJ Supportive & Palliative Care
https://read.qxmd.com/read/30527870/palliative-and-end-of-life-care-content-within-common-pharmacy-textbooks
#19
Christopher Herndon, Joseph Lider
INTRODUCTION: This study compared the end-of-life care (EOLC) content in pharmacy-related textbooks to textbooks evaluated in a comparable 2003 study. METHODS: Six common pharmacy-related textbooks were reviewed for content relating to EOLC. Five of the textbooks were the newest editions of the same texts reviewed in a similar 2003 study, and one focused primarily on clinical ethics, a topic that was underrepresented in the previous study. The six texts were searched for a list of 33 keywords or phrases pertaining to EOLC...
January 2019: Currents in Pharmacy Teaching & Learning
https://read.qxmd.com/read/30525773/perinatal-bereavement-and-palliative-care-offered-throughout-the-healthcare-system
#20
Charlotte Wool, Anita Catlin
The aims of this article are twofold: (I) provide a general overview of perinatal bereavement services throughout the healthcare system and (II) identify future opportunities to improve bereavement services, including providing resources for the creation of standardized care guidelines, policies and educational opportunities across the healthcare system. Commentary is provided related to maternal child services, the neonatal intensive care unit (NICU), prenatal clinics, operating room (OR) and perioperative services, emergency department (ED), ethics, chaplaincy and palliative care services...
November 22, 2018: Annals of Palliative Medicine
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