Talking about end-of-life care

The purpose of the paper is to describe how residents express preferences for end-of-life (EOL) care | Geriatric Nursing

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For this qualitative study, we conducted semi-structured interviews and completed conventional content analysis to describe how residents’ expressed their preferences for care at the end of life. Sixteen residents from four nursing homes (NH) in southeastern Pennsylvania participated in this study. Residents were on average 88 years old, primarily non White, and widowed. Three key domains emerged from the analyses: Preferences for Today, Anticipating the End of My Life, and Preferences for Final Days. Residents linked their everyday living and EOL preferences by using ‘if and then’ logic to convey anticipation and readiness related to EOL. These findings suggest new strategies to start discussions of EOL care preferences with NH residents.

Full reference: Towsley, G.L. et al. (2017) Talking about end-of-life care: Perspectives of nursing home residents. Geriatric Nursing. Published online: 01 August 2017

My patient is 93 and has pneumonia. It’s time to talk about her death

Doctors don’t like to lose but she tells me she is ready to go. Now it’s important to maintain her comfort and dignity | The Guardian Healthcare Network

Mrs S is 93 years old and has severe pneumonia. She is sitting up in bed, with a big unwieldy mask strapped to her nose and mouth like a facehugger from Alien. This device is all that keeps her from lapsing into a coma. I sit at her bedside. We have just met. I am here to talk to her about her death.

As the medical registrar for a big hospital, I am often called in to help by other specialties when trouble arrives. Some days, by the time I’m summoned, trouble has already got its feet under the table. On rare days, I really am there to save lives. Other days, I feel like the grim reaper, stalking the halls like death in a pencil skirt.

As our knowledge continues to advance, and the menu of available treatments continues to expand, we can do more and more to keep people alive. But every day in hospitals up and down the country, the debate continues to rage as to what we should do. It’s a discussion that sounds like it should have a simple answer. Patients want to live; families want to do their best for their loved ones; doctors don’t like to lose and it’s easy to default to a “Do everything that you can” mindset.

Read the full news story here

How are non-numerical prognostic statements interpreted and are they subject to positive bias?

Frank, clear communication with family members of terminally ill or incapacitated patients has important implications for well-being, satisfaction with care and sound decision-making | BMJ Supportive & Palliative Care

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Objectives: Numerical prognostic statements, particularly more negative ones, have been found to be interpreted in a positively biased manner. Less precise non-numerical statements, preferred by physicians, and particularly statements using threatening terms (dying vs surviving) may be even more subject to such biases.

Methods: Participants (N=200) read non-numerical prognostic statements framed in terms of dying or surviving and indicated their interpretation of likelihood of survival.

Results: Even the most extreme statements were not interpreted to indicate 100% likelihood of surviving or dying, (eg, they will definitely survive, 92.77%). The poorness of prognoses was associated with more optimistically biased interpretations but this was not, however, affected by the wording of the prognoses in terms of dying versus surviving.

Conclusions: The findings illuminate the ways in which commonly used non-numeric language may be understood in numeric terms during prognostic discussions and provide further evidence of recipients’ propensity for positive bias.

Full reference: Moyer, A. et al. (2017) How are non-numerical prognostic statements interpreted and are they subject to positive bias? 

Passed away, kicked the bucket, pushing up daisies – the many ways we don’t talk about death

Fear of talking about dying ‘leading to thousands of traumatic hospital deaths’

Cancer charity says there is a ‘crisis of communication’ in UK over dying | The Independent

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Thousands of cancer patients would prefer to die at home but are forced to suffer “traumatic” deaths in hospital, according to Macmillan. Taboos around talking about death are fuelling a “crisis of communication” in the UK that prevents people from planning their final days, warned the organisation in a new report.

Research by the charity found that while 38 per cent of people who die from cancer die in hospital, just one per cent would choose to do so, with 64 per cent saying they wanted to die at home.

Read the news article here

Palliative Care Triggers in the Intensive Care Unit

Jones, B. & Bernstein, C. (2017) Dimensions of Critical Care Nursing. 36(2) pp. 106–109

There is growing recognition that electronic medical record triggers in the intensive care unit (ICU) have led to an increase in palliative care consultations. One suburban health care system adopted triggers unique to their culture and setting in a pilot study and saw an increase in palliative consultations in the ICU. Implementing triggers is often a complex and multifaceted process to adopt. This review shares the steps from concept to implementation of establishing palliative prompts in 1 ICU within an integrated health care system.

Read the abstract here

How nurses support families of intensive care patients towards the end of life

Families of people dying in intensive care need to receive personalised communication and ongoing support, and be involved in the dying process | NIHR

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Researchers gathered evidence on how nurses care for patients and their families in intensive care when life-sustaining treatment is withdrawn. The included studies explored the care of the family before, during and after the process. Most of the studies in this small, mixed methods review were qualitative.

Reviewers identified three main ways, or themes, in which families are supported. First, information and good communication, such as the focus on careful use of language, was seen commonly. Second, by careful management of treatment withdrawal itself, for example by clarifying the gradual change expected when medically focussed life-sustaining treatments are withdrawn and family centred end-of-life care begins. Lastly they described a common focus on making the nursing contribution more visible, such as using techniques to build lasting memories for families.

Read the full overview here