Wishes Of Patient Research Articles

The Secret of Quality Is Love: A Qualitative Study Exploring Physician and Nurse Perspectives on What It Means to Love Their Patients.

Little research systematically explores healthcare professionals' understanding of what it means to love their patients. The authors hypothesized that nurses and physicians would describe a language of love relevant to health care. Researchers conducted structured interviews with 29 physicians and 32 nurses at an academic medical center through a combination of purposive, convenience, and snowball sampling. Interviews were transcribed verbatim and analyzed using grounded theory, identifying major themes from qualitative data. Most nurses and physicians declared they should love their patients. Characteristics of loving physicians and nurses included caring, clinical excellence, advocating, meeting needs, compassion, sacrifice, and tough love. Moral imperatives included the duty to act on behalf of the patient's best interest, respect the patient's wishes, treat patients as you would want your family treated, and recognize limits of life. Many physicians and nurses commented that loving patients could transform health care. Physicians and nurses described characteristics and imperatives of love that may serve as an ethical standard for healthcare professionals.

Can Clinical Ethics Survive Climate Change?

The Ethics of Environmentally Responsible Health Care (2004) argued that the obligation to protect nature must be a core principle of bioethics and that the environmental harm of health-care practices should be taken seriously. In the two decades since, the accelerating pace of climate change and environmental decline has strengthened the moral case for reducing the environmental costs of health care. Nevertheless, mainstream bioethics has until recently neglected these vital issues. In response, a field of clinical environmental bioethics is emerging that applies concepts and measures of sustainability to such key clinical ethical issues as humanizing technology, setting limits, caring for the dying, respecting patient wishes, and allocating resources justly. Bioethical analysis of these and other issues can support just and humane health-care adaptation to climate change. Health-care adaptation in turn plays an important role in helping communities and nations adapt to the inevitable forward march of climate change. This essay offers two recommendations: (1) establish a climate transition commission for health-care adaptation to climate change with bioethics participation, and (2) strengthen advocacy for health-care reform by uniting it with climate activism.

End-of-life Decisions for Patients with Prolonged Disorders of Consciousness in England and Wales: Time for Neuroscience-informed Improvements.

This article explores how the law of England and Wales1 has responded thus far to medical and clinical advances that have enabled patients with prolonged disorders of consciousness to survive. The authors argue that, although the courts have taken account of much of the science, they are now lagging behind, with the result that some patients are being denied their legal rights under the Mental Capacity Act 2005. The article further argues that English law does not comply with the United Kingdom's commitments under the United Nations Convention on the Rights of Persons with Disabilities. Stressing the need for the law to keep in step with advances in science, the article concludes with robust recommendations for improvements, based on the latest research in neuroscience, to the way in which life-sustaining treatment decisions are made. This would mean that the wishes of patients, including those with covert awareness, can be better reflected in best interests assessments.

Effect of Advance Care Planning on Surrogate Decision Makers' Preparedness for Decision Making: Results of a Mixed-Methods Randomized Controlled Trial.

Background: Advance care planning (ACP) is intended to help patients and their spokespersons prepare for end-of-life decision making, yet little is known about what factors influence the extent to which spokespersons feel prepared for that role. Objective: To examine spokespersons' perceived preparedness for surrogate decision making after engaging in ACP. Design: Mixed methods experimental design with qualitative thematic analysis and data transformation (creating categorical data from rich qualitative data) of interviews collected during a randomized controlled trial (2012-2017). Setting/Participants: Two tertiary care medical centers (Hershey, PA and Boston, MA). Of 285 dyads (patients with advanced illness and their spokespersons) enrolled in the trial, 200 spokesperson interviews were purposively sampled and 198 included in the analyses. Main Outcomes and Measures: Interviews with spokespersons (four weeks post-intervention) explored spokespersons' perceived preparedness for surrogate decision making, occurrence of ACP conversations, and spokespersons' intentions regarding future surrogate decisions. Data transformation was used to categorize participants' responses into three categories: Very Prepared, Very Unprepared, or In Between Prepared and Unprepared. Themes and categories were compared across arms. Results: About 72.72% of spokespersons (144/198) reported being Very Prepared and 27.28% (54/198) reported being Very Unprepared or In Between with no differences in preparedness across study arms. Occurrence of post-intervention ACP conversations did not influence perceived preparedness; however, spokespersons who used an ACP decision aid reported more conversations. Four themes emerged to explain spokespersons' perceived preparedness: (1) perceptions about ACP; (2) level of comfort with uncertainty; (3) relational issues; and (4) personal characteristics. Regarding future intentions, it emerged that spokespersons believed their knowledge of patient wishes, as well as other personal, relational, situational, and emotional factors would influence their surrogate decisions. Conclusions: Factors extrinsic to specific ACP interventions influence how prepared spokespersons feel to act as spokespersons. Understanding these factors is important for understanding how to improve concordance between patients' stated end-of-life wishes and surrogate decisions. Trial Registration: NCT02429479.

Adaptations to the Serious Illness Conversation Guide to Be More Culturally Safe


 
 
 The Serious Illness Conversation Guide (SICG) has been shown to be an effective communication tool used by health care professionals when interacting with patients facing a life-limiting illness. However, Ariadne Labs, the originators of the tool, have not tested it with First Nations and Indigenous Peoples. In this project, the British Columbia Centre for Palliative Care and the First Nations Health Authority in British Columbia (BC), Canada collaborated to adapt the SICG to be more culturally safe for First Nations and Indigenous Peoples. Multiple feedback strategies were employed. Feedback was received from 35 older adults, Elders, and community members from two First Nations communities plus approximately 80 nurses serving in First Nations communities across BC. Key areas of focus for feedback on the clinical tool included setting up the conversation, involving family, closing the conversation, and using principles of health literacy to reduce power differences. Three questions were added in response to feedback received. By creating a safe space for dialogue, it is hoped that health care providers and family members will develop a deeper understanding of what is important to the person with a life-limiting illness. These conversations promote patient-centred health care that aligns with patient values and wishes. Findings from this project directly informed modification of the tool to support a more culturally safe conversation. Further research will inform whether this tool is culturally safe for all seriously ill people.
 
 

Integrated palliative care and health care delivery among older adults

Background: Improving end-of-life care (EOL) is increasingly recognized as a health priority, and inadequate integration of palliative care (PC) services globally represents a serious gap in healthcare while serving an aged population. Objective: This review aims to understand how an integrated approach to PC may be influential in the delivery of health care amongst an aged population. Methods: A scoping review was conducted in which 15 randomized controlled trials (RCT) discussing integrated and traditional PC, published between 2000 and July 2020 were included. RCTs were identified and thematically analysed using the framework described by Arksey and O’Malley. Results: The themes identified discuss the effect of early integration of PC on improving patient’s quality of life (QoL), cost-effectiveness, the importance of coordinated care between healthcare professionals, and stigma attached to PC. The early integration of PC has been shown to significantly improve the QoL of elderly patients with advanced cancer and/or chronic medical conditions. A reduction in unnecessary hospitalizations, shortened overall hospital stay, decreased stay in an intensive care unit (ICU), along with decreased caregiver burden has also been shown in studies. Conclusion: Effective coordination of care is crucial in the prevention of fragmented care and in ensuring the expressed wishes of patients are honoured. Furthermore, the stigma attached to the provision of PC is largely due to inadequate knowledge about PC and hence, education is key.

Experiences of Bereaved Family Members Receiving Commemorative Paintings

Although family members of patients who die in the intensive care unit commonly experience long-term psychological distress, end-of-life bereavement support programs for such relatives are uncommon. Whether art influences the grief experience of families is largely unexplored. To explore the influence of personalized paintings created to honor deceased critically ill patients on family members' bereavement experience. A qualitative descriptive analysis was conducted of semistructured interviews of grieving relatives who received a painting after the death of their loved one. The deceased patients were from a 21-bed medical-surgical intensive care unit. Eleven families were invited to receive a painting, of whom 1 family declined. A total of 22 family members of 10 patients who died in the intensive care unit were interviewed in the study between July 11, 2017, and May 19, 2019. Patients were enrolled in an end-of-life care program that elicits and implements wishes of patients and their families to bring peace during the dying process. Selected families of 10 decedents were invited to receive a painting to honor their loved one 1 to 10 months after the patient's death. Using details about the patient's life story, the artist created individualized paintings to commemorate each patient. The experiences of family members receiving a personalized painting and its reported influence on their grieving experience. The family members of 10 decedents (mean [SD] age, 60 [14] years; 5 women [50%]; 8 White patients [80%]) were interviewed. The central theme of art to facilitate healing was illustrated through the following domains: the cocreation process, painting narratives, postmortem connections, and legacy. The process of cocreating the paintings with the artist and family members involved reminiscing, storytelling, and creativity. Family members emphasized the role of art to facilitate healing, exemplified through connections with images portrayed that deeply resonated with memories of their loved one. Participants indicated that the paintings validated that the patient was remembered, helped families feel less alone during a time of grief, honored the loved one's life, and enhanced connections between family members and clinicians. This qualitative study's findings suggest that the creation of personalized paintings commemorating the lives of patients may help foster legacy and postmortem connections with clinicians and may help family members in their healing process.

Assisted suicide: Perception of nursing students about professional performance on this topic

Introduction: Assisted suicide is considered an action in which a patient, wishes to terminate his/her life due to the pain and suffering caused by a disease and requests the necessary help from the healthcare professionals. The right to decide about ending one’s own life and the impact attributed to the experienced suffering are the main questions regarding assisted suicide.
 Objective: Characterize the perceptions of nursing students about professional performance in the face of assisted suicide.
 Methods: The research comprised a descriptive analysis with a qualitative approach, based on the application of semi-structured interviews on nursing students enrolled in the curricular 9th period, during 2014, in the city of Recife-PE, Brazil. The sample consisted of 19 students. The data, were analyzed and categorized using the Collective Subject Discourse (CSD) method.
 Results and Discussion: The obtained data suggest that students consider assisted suicide as a way of preserving dignity in the face of procedures that will make the death an inevitably painful process. Indicate that euthanasia and assisted suicide should remain illegal, and they would not get involved professionally. But others assured their willingness to participate because they would be satisfying the patient's wishes, however, for its legalization it is necessary to create principles that would guide the execution of these procedures.
 Conclusion: The students consider, that the professional can eliminate real possibilities of treatment and recovery of the patient by accepting his request for suicide. However, some students are in favor of this procedure, arguing that the patient is free to conduct his own life.

Patient-centred care delivered by general practitioners: a qualitative investigation of the experiences and perceptions of patients and providers

BackgroundPatient-centred care (PCC) is care that is respectful and responsive to the wishes of patients. The body of literature on PCC delivered by general practitioners (GPs) has increased steadily over...

The Last Gift: Advanced Healthcare Directives and the Family Members of Incapacitated Patients

Abstract This article will provide an overview of the law related to the withdrawal of treatment from incapacitated adult patients in Ireland and the role of family members in such decisions. This overview will touch on the best interests test, how the wishes of an incapacitated patient may be assessed, and the tension that may arise between medical assessments and the views of the family of the patient. Cases arising in the UK and the USA will be discussed where relevant. It will be argued that family members should be provided with more information, particularly with respect to Do Not Attempt Resuscitation orders. The article calls for greater discussion about death and dying, and greater use of advance healthcare directives.

Comfort Status and Its Influencing Factors in Patients With Gastrointestinal Cancer After PICC Catheterization

Gastrointestinal cancer is one of the higher-incidence malignant tumors worldwide. A majority of patients with gastrointestinal cancer receive chemotherapy, with peripherally inserted central catheter (PICC) serving as the main infusion instrument. Little research has addressed the issue of post-catheterization comfort in patients. The purpose of the study was to investigate the comfort status of patients with gastrointestinal cancer at a tertiary hospital in China after PICC catheterization and to analyze the influencing factors. Ninety-one patients with gastrointestinal cancer who were currently receiving initial chemotherapy were recruited from a third-class hospital in Changsha City from June 2018 to August 2019. Patients received ultrasound-guided PICC catheterization and were then investigated one-month later using a general demographics questionnaire, comfort evaluation scale, Cancer Patients PICC Self-management Scale, and complications evaluation scale. Ninety-one effective questionnaires were received (recovery rate: 100%). The total comfort score was 34.99 ± 4.07, with 10 patients (11.0%) reporting 'general comfort' and 81 patients (89.0%) reported 'comfort'. The average score for self-management ability was 151.55 ± 18.33. Nineteen patients (20.9%) had blood leakage and 7 (7.7%) had catheter prolapse. Multiple stepwise linear regression analysis showed that the limb used for catheterization, self-management ability, and occupation were the factors that significantly influenced degree of comfort in the participants (p < .05), predicting 21.9% of the total comfort score. The overall comfort level of patients with gastrointestinal cancer after PICC catheterization was comfort. In clinical work, nurses should choose the left limb based on patient wishes, pay attention to improving the self-management ability of patients, and provide appropriate nursing suggestions for patients who are wage earners to improve post-catheterization comfort.

ES-1 Clinical results of tumor treating fields in patients with glioblastoma in Japan, compared with global surveillance

INTRODUCTION: The tumor treatment field induces apoptosis of tumor cells by providing a low intensity, intermediate frequency, alternating current electric field via a transducer array. TTFields is based on Phase 3 EF-11 and EF-14 trials for glioblastoma in the US FDA and Japan PMDA. Therefore, I will report the statistics of TTFields use in Japan along with recent papers. METHODS: 410 patients were treated with TTFields in Japan (December 2017-), of which 17 were at Tokyo Women’s Medical University. We also referred to papers about global post-marketing surveillance and recent studies. RESULTS: Of the 410 patients, 409 (99.8%) were diagnosed with ndGBM(male: female, 66.8%: 33.2%). As of June 2020, 222 patients (54.1%) were on treatment and 188 (45.9%) were discontinued. In 17 cases at TWMU, the average age was 46.3 years. The average treatment period was 218 days, with 6 patients (35%) continuing treatment, 6 patients (35%) discontinuing due to patient wishes, and 5 patients (30%) discontinuing treatment due to recurrence. Side effects were contact dermatitis under the array in 9 patients (57%) and mild malaise in 7 patients (43%). We experienced long-term progression-free cases with TTF use of 25 months (survival 30 months after surgery) with a glioma partially resected and 21 months (survival 27 months after surgery) with a biopsied glioma. In the biopsy case, bevacizumab was used in combination during the treatment. Conclusion: In global surveillance, use for rGBM accounts for 39%, but Japan is limited to use for ndGBM due to insurance coverage. In terms of side effects, it showed a good safety profile comparable to previous trials. Long-term progression-free cases have been observed, and it is necessary to examine the characteristics of patients who respond to treatment and the effect of concomitant use with bevacizumab by prospective studies

Generalised external apical root resorption: aetiology in 3 radio-graphically comparable cases

There are various types of dental root resorption. Local external apical root resorption is often recognised after orthodontic therapy. However, a generalised form is rare. 3 patients with the rare dental condition 'idiopathic generalised apical external root resorption' were referred and treated within an 8-year period. The prognosis of preserving the dentition is for the most part unfavourable and only a very speculative prediction about (the pace of) progression can be given. No standard treatment protocol is available for this condition. A dental treatment plan should be flexible and individually adjusted to patient's wishes.

Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses

BackgroundEnd-of-life (EOL) conversations are highly important for patients living with life-threatening diseases and for their relatives. Talking about the EOL is associated with reduced costs and better quality of care in the final weeks of life. However, there is therefore a need for further clarification of the actual wishes of patients and their relatives concerning EOL conversations in an acute hospital setting.AimThe purpose of this study was to explore the wishes of patients and their relatives with regard to talking about the EOL in an acute hospital setting when living with a life-threatening disease.MethodsThis study is a qualitative study using semi-structured in-depth interviews. A total of 17 respondents (11 patients and six spouses) participated. The patients were identified by the medical staff in a medical and surgical ward using SPICT™. The interview questions were focused on the respondents’ thoughts on and wishes about their future lives, as well as on their wishes regarding talking about the EOL in a hospital setting.ResultsThis study revealed that the wish to talk about the EOL differed widely between respondents. Impairment to the patients’ everyday lives received the main focus, whereas talking about EOL was secondary. Conversations on EOL were an individual matter and ranged from not wanting to think about the EOL, to being ready to plan the funeral and expecting the healthcare professionals to be very open about the EOL. The conversations thus varied between superficial communication and crossing boundaries.ConclusionThe wish to talk about the EOL in an acute hospital setting is an individual matter and great diversity exists. This individualistic stance requires the development of conversational tools that can assist both the patients and the relatives who wish to have an EOL conversation and those who do not. At the same time, staff should be trained in initiating and facilitating EOL discussions.

The Japan Geriatrics Society consensus statement "recommendations for older persons to receive the best medical and long-term care during the COVID-19 outbreak-considering the timing of advance care planning implementation".

Since the end of 2019, a life-threatening infectious disease (coronavirus disease 2019: COVID-19) has spread globally, and numerous victims have been reported. In particular, older persons tend to suffer more severely when infected with a novel coronavirus (SARS-CoV-2) and have higher case mortality rates; additionally, outbreaks frequently occur in hospitals and long-term care facilities where most of the residents are older persons. Unfortunately, it has been stated that the COVID-19 pandemic has caused a medical collapse in some countries, resulting in the depletion of medical resources, such as ventilators, and triage based on chronological age. Furthermore, as some COVID-19 cases show a rapid deterioration of clinical symptoms and accordingly, the medical and long-term care staff cannot always confirm the patient's values and wishes in time, we are very concerned as to whether older patients are receiving the medical and long-term care services that they wish for. It was once again recognized that it is vital to implement advance care planning as early as possible before suffering from COVID-19. To this end, in August 2020, the Japan Geriatrics Society announced ethical recommendations for medical and long-term care for older persons and emphasized the importance of conducting advance care planning at earlier stages. Geriatr Gerontol Int 2020; 20: 1112-1119.

Модификация илеумкондуита по Bricker – техника Li-Kotb

Introduction. The choice of method of urine derivation is main question after removal of the urinary bladder. Materials and methods. The choice of the method of urine derivation is based on the indications and contraindications to a particular method, the patient's wishes, his somatic status and individual anatomical features, as well as kidney function. Bricker procedure is the most used form of incontinent urine derivation. 10% of patients after the formation of Bricker ileumconduitis have complications from anastomoses, most often-left ileo-ureteral anastomosis. Li Y. et al. modified the standard procedure for the formation of ileal conduit in order to minimize complications associated with left ileo-ureteral anastomosis. Description of a clinical case. The article presents a clinical case of using Li-Kotb modification technique of ileal conduit. Discussion. Due to the presence of a single functioning left kidney in the patient, we sought to provide reliable urine derivation. Therefore, we leaned towards a modified method of forming of ileal conduit using Li-Kotb method, rather than the classical technique. Conclusion. According to the authors of the method, the modified Bricker ileal conduit formation technique is safe, reproducible and reduces the risk of failure and stricture of the left ileo-ureteral anastomosis.

Consequences of ineffective information and knowledge management (IKM) in hospitals: junior doctors’ perspectives

ABSTRACT Information and knowledge represent important organisational assets. In healthcare environments, patient wellbeing depends on effective management of these assets. This paper describes junior doctors’ perspectives of adverse consequences of ineffective information and knowledge management (IKM) practices. The research for this phenomenological study consisted of semi-structured interviews with ten junior doctors in public hospitals in Adelaide, South Australia. The reasons for ineffective IKM include limited access to information, inadequate clinical handover, inappropriate use of information systems, and incomplete documentation. Adverse medical events resulting from ineffective IKM practices include medication errors, delays in patient care or discharge, poor post-discharge care, confidentiality breaches, acting against patient wishes, disability or even death. Junior doctors regard health information systems and access to electronic patient medical records as important for improving IKM. Behaviour of staff often results in ineffective IKM and the paper suggests that an IKM-focused culture should be driven by hospital management.

Immediate Implant Placement In Anterior Maxilla – A Retrospective Study

Tooth failure in the region more generally results in a lack of bone volume in the vertical and horizontal direction. On attempts to reduce this alveolar bone resorption to preserve periodontal construction, implant placement was advised immediately after tooth extraction. A retrospective analysis was performed for patients attending a private hospital in Chennai, India. The aim of the study is to study the prevalence of immediate implant placement in the anterior maxilla. Patients who have undergone immediate implant placement in anterior maxilla from June 2019 to March 2020 were included in the study. The data were entered into Microsoft Excel and tabulated. Following which data was imported into the SPSS software by IBM. Data analysis was performed in the statistical software SPSS and data were analyzed by descriptive analysis and Pearson correlation. Within the limits of the study, a total of 77 implants in the anterior maxilla were placed, out of which, 21 implants were immediate implants. From the 21 immediate implants placed, 6 [7.8%] were placed in the anterior maxilla region alone. Immediate Implant in the anterior maxillary region was placed most commonly among the age group 19 to 35 years (14.28%), followed by 9.52% among the age group 55 to 75 years. Immediate Implant in the anterior maxillary region was placed most commonly among the male population (23.81%). Analyzing the etiology of extraction for Immediate Implant Placement, decay (14.29%) was the most common cause of extraction, followed by trauma (9.5%). Replacement assessments can be and guided by the patient's wishes.

Exploring the components of the quality of death in Japanese emergency departments: A qualitative study

BackgroundThe need to care for patients who die in the emergency department is increasing in Japan, and emergency nurses are required to provide end-of-life care to ensure that patients experience a good death. However, the components of the quality of death and what constitutes a good death for patients dying in the emergency department are unclear. AimThis study aimed to explore the components of the quality of death for patients who die in emergency departments of Japanese hospitals. MethodsThis study employed a qualitative design. An inductive content analysis was conducted based on semi-structured interviews with 26 participants, which included 15 emergency nurses, five emergency physicians, and six bereaved families. ResultsSeven components of quality of death were identified: (1) transition to the end-of-life phase after receiving the best treatment, (2) dying without suffering, (3) having the patient's wishes respected, (4) having a loved one nearby, (5) maintaining human dignity, (6) having no change in appearance, and (7) not making the family feel guilty. ConclusionThese components suggested that emergency nurses should: support patients' receipt of the best treatment and foster their smooth transition to the end-of-life phase at the appropriate time, ensure that the patients in the end-of-life phase spend time with their loved ones immediately before their death, enable the maintenance of human dignity and patient identity of end-of-life patients, and make sure that the families of end-of-life patients do not feel guilt.

Designing a Mission statement Mobile app for palliative care: an innovation project utilizing design-thinking methodology

BackgroundEliciting individual values and preferences of patients is essential to delivering high quality palliative care and ensuring patient-centered advance care planning. Despite advance care planning conserving healthcare costs by up to 36%, reducing psychological distress of patients and caregivers, and ensuring palliative care delivery in line with patient wishes, less than 33% of adults engage in it. We aimed to develop a mobile application intervention to address the challenges related to advance care planning and improve the delivery of palliative care.MethodsDesign-thinking methodology was used to develop a mobile application, in response to issues prominently identified in current palliative care literature.ResultsIssues surrounding communication of patient values from both the patient and provider side is identified as a main issue in palliative care. We designed a mobile application intervention prototype to address this.ConclusionsOur “Mission Statement” mobile application will allow patients to create a mission statement identifying what they want their care team to know about them, as well as space to identify important values and preferences. Patients will be able to evolve their mission statement and values and preferences over the course of their palliative care journey through the application. Design-thinking methodology is an effective tool to drive healthcare innovation and bridge the gap between research findings and implementation.