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Obliged to fight? Patient moral processes in the face of poor prognosis cancer.
Health Psychol
December 2024
Department of Health Behavior, Society and Policy, Rutgers School of Public Health.
Objective: Theoretical work suggests that moral psychological processes-those pertaining to the interests or welfare of others-are a key driver of overtreatment at the end of life. We examined patient moral processes and their associations with distress and treatment decision-making.
Method: During structured interviews with 116 patients with advanced cancer and a poor prognosis, Likert scale items were used to operationalize (a) moral emotions: feeling shame and guilt about cancer getting worse, (b) moral motives for cancer treatment: perceiving an obligation to family for continuing potentially nonbeneficial treatments, and (c) moral performance: putting up the appearance of feeling better than how one is really feeling (5-point response scale, ).
Using Human-Centered Design to Improve Serious Illness Care for Older Adults With Advanced Dementia.
J Pain Symptom Manage
November 2024
Division of Hospital Medicine (S.W.G., J.A., E.D.), Department of Medicine, University of California, San Francisco, California, USA; Philip R. Lee Institute for Health Policy Studies (S.W.G., D.D., E.D.), University of California, San Francisco, California, USA; Cicely Saunders Institute (E.D.), King's College London, London, UK. Electronic address:
Context: Older adults with advanced dementia increasingly receive potentially non-beneficial, high-intensity life-sustaining treatments and goal-discordant care in the United States. Interventions to address this issue have shown limited success.
Objectives: To use human-centered design (HCD) with clinicians caring for older adults with advanced dementia to develop intervention ideas to reduce high-intensity, goal-discordant treatments near the end of life.
Patients' psychosocial attributes and aggressiveness of cancer treatments near the end of life.
Oncologist
November 2024
Department of Supportive and Palliative Care, Institut Paoli-Camettes, Aix-Marseille Univ, CNRS, INSERM, Marseille, France.
Background: While the use of chemotherapy near the end of life (EOL) has been identified as a relevant criterion for assessing quality of cancer care and has been estimated as non-beneficial, a trend of aggressiveness in cancer care during the last period of life remains. Both patients' sociodemographic characteristics and physicians' practice setting are associated with this use. The role of patients' psychosocial characteristics has however been understudied.
View Article and Find Full Text PDFAbstractThis analysis of professional organizational policies regarding potentially inappropriate life-sustaining medical treatment (LSMT) focuses on the specific threshold criteria that policies apply for limiting LSMT, as well as when (if ever) override of patient/surrogate preferences may be reasonable. Our article offers a critical analysis of one influential approach, proffered by the Society of Critical Care Medicine, that applies a prognosis-based definition of nonbeneficial/inappropriate treatment to determine that ethical threshold. We observe that this prognosis-based threshold resembles rationing in important ways, though it pertains to settings where resources may not be limited.
View Article and Find Full Text PDFWe Have All the Time in the World: The Law and Ethics of Time-Limited Interventions in Clinical Care.
J Law Med Ethics
October 2024
GRADY HEALTH SYSTEM, ATLANTA, GEORGIA, USA.
The authors consider the legal and ethical considerations of offering a time-limited trial of a potentially non-beneficial intervention in the setting of patient or surrogate requests to pursue aggressive treatment. The likelihood of an intervention's success is rarely a zero-sum game, and an intervention's risk-to-benefit ratio may be indiscernible without further information (often, a matter of time).
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