Paediatric palliative care.
Lancet, 28 Jun 2008, vol. 371, no. 9631,
p. 2169
Darlington-Anne-Sophie-E, van-den-Heuvel-Eibrink-Marry-M, Passchier- Jan.
Publication type
Comment, Letter.
Comment on: Lancet. 2008 Mar 8; 371(9615):852-64.
Paediatric palliative care.
Lancet 28 Jun 2008, vol. 371, no. 9631, p. 2169
Vissers-Kris-C-P, Engels-Yvonne, Verhagen-Constans.
Comment, Letter.
Comment on: Lancet. 2008 Mar 8; 371(9615):852-64.
Friday 22 August 2008
Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions.
Impact of specialty on attitudes of Australian medical practitioners to end-of-life decisions.
Full text available at ProQuest
The Medical journal of Australia 21 Apr 2008, vol. 188, no. 8
p. 450-6
Parker-Malcolm-H, Cartwright-Colleen-M, Williams-Gail-M.
Abstract
OBJECTIVE: To compare attitudes and practices of Australian medical practitioners, by specialty, to a range of medical decisions at the end of life. DESIGN, SETTING AND PARTICIPANTS: As part of an international study, in 2003, a structured questionnaire was mailed to 2964 medical practitioners drawn from membership registers of Australian and Australasian professional colleges. Data from 1478 questionnaires were statistically analysed using validated instruments. MAIN OUTCOME MEASURES: Practitioners' willingness to comply with requests from patients and/or their relatives for symptom relief which might also hasten death; provision of terminal sedation and euthanasia, or willingness to provide these on their own initiative. RESULTS: Respondents reported being much more willing to comply with a patient's request for increasing symptom relief, even at risk of hastening death, than for terminal sedation. Over a quarter of respondents would provide terminal sedation to competent patients on their own initiative. A small number of respondents would intentionally hasten death. There were significant differences by specialty for all three actions. Oncologists, palliative care physicians and geriatricians were least likely to actively hasten death, and more likely to act unilaterally to relieve symptoms as a medical necessity. CONCLUSIONS: Perceptions about the causation of death and aspects of medical culture appear to influence physicians' attitudes towards medical decisions at the end of life. Our findings have implications for medical education, interprofessional communication and discussion between the medical profession and the community.
Full text available at ProQuest
The Medical journal of Australia 21 Apr 2008, vol. 188, no. 8
p. 450-6
Parker-Malcolm-H, Cartwright-Colleen-M, Williams-Gail-M.
Abstract
OBJECTIVE: To compare attitudes and practices of Australian medical practitioners, by specialty, to a range of medical decisions at the end of life. DESIGN, SETTING AND PARTICIPANTS: As part of an international study, in 2003, a structured questionnaire was mailed to 2964 medical practitioners drawn from membership registers of Australian and Australasian professional colleges. Data from 1478 questionnaires were statistically analysed using validated instruments. MAIN OUTCOME MEASURES: Practitioners' willingness to comply with requests from patients and/or their relatives for symptom relief which might also hasten death; provision of terminal sedation and euthanasia, or willingness to provide these on their own initiative. RESULTS: Respondents reported being much more willing to comply with a patient's request for increasing symptom relief, even at risk of hastening death, than for terminal sedation. Over a quarter of respondents would provide terminal sedation to competent patients on their own initiative. A small number of respondents would intentionally hasten death. There were significant differences by specialty for all three actions. Oncologists, palliative care physicians and geriatricians were least likely to actively hasten death, and more likely to act unilaterally to relieve symptoms as a medical necessity. CONCLUSIONS: Perceptions about the causation of death and aspects of medical culture appear to influence physicians' attitudes towards medical decisions at the end of life. Our findings have implications for medical education, interprofessional communication and discussion between the medical profession and the community.
End-of-life care in the trauma intensive care unit
Changing the culture around end-of-life care in the trauma intensive care unit.
The Journal of trauma Jun 2008, vol. 64, no. 6
p. 1587-93
Abstract
BACKGROUND: Ten percent to 20% of trauma patients admitted to the intensive care unit (ICU) will die from their injuries. Providing appropriate end-of-life care in this setting is difficult and often late in the patients' course. Patients are young, prognosis uncertain, and conflict common around goals of care. We hypothesized that early, structured communication in the trauma ICU would improve end-of-life care practice. METHODS: Prospective, observational, prepost study on consecutive trauma patients admitted to the ICU before and after a structured palliative care intervention was integrated into standard ICU care. The program included part I, early (at admission) family bereavement support, assessment of prognosis, and patient preferences, and part II (within 72 hours) interdisciplinary family meeting. Data on goals of care discussions, do-not-resuscitate (DNR) orders and withdrawal of life support (W/D) were collected from physician rounds, family meetings, and medical records. RESULTS: Eighty-three percent of patients received part I and 69% part II intervention. Discussion of goals of care by physicians on rounds increased from 4% to 36% of patient-days. During intervention, rates of mortality (14%), DNR (43%), and W/D (24%) were unchanged, but DNR orders and W/D were instituted earlier in hospital course. ICU length of stay was decreased in patients who died. CONCLUSIONS: Structured communication between physician and families resulted in earlier consensus around goals of care for dying trauma patients. Integration of early palliative care alongside aggressive trauma care can be accomplished without change in mortality and has the ability to change the culture of care in the trauma ICU.
The Journal of trauma Jun 2008, vol. 64, no. 6
p. 1587-93
Abstract
BACKGROUND: Ten percent to 20% of trauma patients admitted to the intensive care unit (ICU) will die from their injuries. Providing appropriate end-of-life care in this setting is difficult and often late in the patients' course. Patients are young, prognosis uncertain, and conflict common around goals of care. We hypothesized that early, structured communication in the trauma ICU would improve end-of-life care practice. METHODS: Prospective, observational, prepost study on consecutive trauma patients admitted to the ICU before and after a structured palliative care intervention was integrated into standard ICU care. The program included part I, early (at admission) family bereavement support, assessment of prognosis, and patient preferences, and part II (within 72 hours) interdisciplinary family meeting. Data on goals of care discussions, do-not-resuscitate (DNR) orders and withdrawal of life support (W/D) were collected from physician rounds, family meetings, and medical records. RESULTS: Eighty-three percent of patients received part I and 69% part II intervention. Discussion of goals of care by physicians on rounds increased from 4% to 36% of patient-days. During intervention, rates of mortality (14%), DNR (43%), and W/D (24%) were unchanged, but DNR orders and W/D were instituted earlier in hospital course. ICU length of stay was decreased in patients who died. CONCLUSIONS: Structured communication between physician and families resulted in earlier consensus around goals of care for dying trauma patients. Integration of early palliative care alongside aggressive trauma care can be accomplished without change in mortality and has the ability to change the culture of care in the trauma ICU.
Palliative care - Annals of Oncology
Palliative care
Annals of Oncology July 2008 ; VOL 19 ; PART suppl_5
Page: v160 - v160
Annals of Oncology July 2008 ; VOL 19 ; PART suppl_5
Page: v160 - v160
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