Forcible Amputation in Delusional Patients: A Narrative Analysis of Decisional Capacity.

This case study concerns the predicaments faced by two women who each had been advised by her physicians to have a gangrenous foot amputated to prevent the potentially fatal spread of infection. In both cases, the determination of the patients' decisional capacity was a critical component in judging whether or not to honor their medical treatment decisions. The communicative complexity of navigating a double bind, a situation in which a person confronts a choice between two undesirable courses of action, is also discussed.

Victim of Abuse, or Bully? The Case of the 800-Pound Man.

Obesity in the United States has been declared both a disease and an epidemic. Physicians have thus been identified as the "experts" in managing weight loss, but they have few effective solutions to recommend except bariatric surgery. Most physicians and medical facilities are unprepared to manage the complex medical needs of obese patients, and most families are unprepared to manage the dietary issues in helping a family member lose weight, much less the physical, psychological, and interpersonal issues that surface.

Dilemmas Adult Children Face in Discussing End-of-Life Care Preferences with Their Parents.

This study explored the perceived goals, barriers, and strategies that characterize family interactions about advance care planning (ACP), which is instrumental in guiding end-of-life care. Discussions within the family context can significantly improve end-of-life decision making but are complicated, partly because participants are attempting to achieve multiple, and often competing, goals. Participants ( = 75) responded to a hypothetical scenario about a conversation with a parent about ACP by completing an anonymous online survey.

Sometimes Those Hoofbeats Are Zebras: A Narrative Analysis.

The case of BB, an 11-year-old girl who was hospitalized because of sudden odd seizure-like symptoms and catatonic affect, highlights several ethical issues and communication problems. The correct diagnosis was initially missed, partly because physicians are trained to think of the most common explanation for a patient's symptoms; the medical education truism "when you hear hoofbeats, think horses, not zebras" was not helpful in BB's case. The common habit of medical professionals to not revisit a diagnosis once one is established also led to missed opportunities to provide appropriate care for this young patient.

The Role of Patients' Stories in Emergency Medicine Triage.

Emergency medicine is a communicative activity, and characteristics such as incomplete information, time pressure, and the potentially serious consequences of errors complicate effective communication and decision making. The present study examined the triage process as an interpretive activity driven in part by the patient's story. Of four identified communication processes in the emergency department (ED), the "handoff" of patients between shifts has been identified as especially problematic since missing contextual details from patients' stories increased the probability of errors.

African Americans and Hospice Care: A Narrative Analysis.

Recent studies suggest that terminally ill African Americans' care is generally more expensive and of lower quality than that of comparable non-Hispanic white patients. Scholars argue that increasing hospice enrollment among African Americans will help improve end-of-life care for this population, yet few studies have examined the experiences of African American patients and their loved ones after accessing hospice care. In this article, we explore how African American patients and lay caregivers evaluated their hospice experiences.

Beyond good intentions and patient perceptions: competing definitions of effective communication in head and neck cancer care at the end of life.

Effective communication between dying cancer patients and their health care providers about prognosis and treatment options ensures informed decision making at the end of life. This study analyzed data from interviews with end-stage head and neck cancer patients and their health care providers about communication competence and approaches to communicating about end-of-life issues. Patients rated their oncologists as competent and comfortable discussing end-of-life issues, although few reported discussing specific aspects of end-of-life care.

Healing the physician's story: a case study in narrative medicine and end-of-life care.

Telling stories after a loved one's death helps surviving family members to find meaning in the experience and share perceptions about whether the death was consistent with the deceased person's values and preferences. Opportunities for physicians to evaluate the experience of a patient's death and to expose the ethical concerns that care for the dying often raises are rare. Narrative medicine is a theoretical perspective that provides tools to extend the benefits of storytelling and narrative sense-making to physicians.

Well-being of family caregivers of persons with late-stage Huntington's disease: lessons in stress and coping.

The utility of a stress-process model in predicting health and quality-of-life outcomes for family caregivers of persons with Huntington's disease (HD) was tested. HD is an inherited neurodegenerative disease that poses particular challenges to patients and families. Seventeen family caregivers were interviewed and completed scales measuring stressors, appraisals, protective factors, and outcomes.

In search of a good death.

Spirituality and storytelling can be resources in aging successfully and in dying well given the constraints of modern day Western culture. This paper explores the relationship of aging to time and the dynamic process of the life course and discusses issues related to confronting mortality, including suffering, finitude, spirituality, and spiritual closure in regard to death. And, finally, the role of narrative in this process is taken up.

Quality of life at the end of life for nursing home residents: perceptions of hospice and nursing home staff members.

This study examined whether the perceptions of nursing staff members about the importance of quality-of-life domains and their perceived ability to influence those domains for residents at the end of life were affected by their institutional affiliation, level of training, or residents' cognitive status. Respondents were 146 Certified Nursing Assistants (CNAs) and Registered Nurses (RNs) from nursing homes and hospices. Magnitude estimation scales were used to rate the importance of and perceived ability to influence 11 quality-of-life domains for both cognitively intact and cognitively impaired residents.

Quality of life and symptom control in hospice patients with cancer receiving chemotherapy.

The value of palliative chemotherapy for hospice patients is difficult to quantify and little is known about outcomes from these treatments. This study examined quality of life and symptom control in hospice patients with cancer receiving chemotherapy and in a control group of hospice patients with cancer who had not received chemotherapy for at least 3 months. Using a case-control study design matching patients by age, gender, race, and cancer diagnosis, patients receiving chemotherapy reported a similar number of symptoms as patients off chemotherapy.

Implications of the Schiavo case for understanding family caregiving issues at the end of life.

The case of Mrs. Terri Schiavo illustrates common themes in family caregiving at the end of life but is distinctive from most family caregiving situations in other ways. As occurred in Mrs.

Advancing geriatrics education: evaluation of a new curricular initiative.

Background: This study describes the development of a required 1-week curricular program in geriatric medicine for 3rd-year medical students and presents 3 years of evaluation data.

Description: Successful aging, heterogeneity of the aging population, and comprehensive geriatric assessment were emphasized. In addition to didactic sessions, students participated in panel discussions and small group case conferences, and performed history and physical examinations on older patients.