Objective: Despite the clinical, ethical, and legal magnitude of end-of-life decision-making, the capacity of terminally ill patients to make the medical decisions they often face is largely unknown. In practice, clinicians are responsible for determining when their patients are no longer competent to make treatment decisions, yet the accuracy of these assessments is unclear. The purpose of this study was to explore decision-making capacity and its assessment in terminally ill cancer patients.
Methods: Fifty-five patients with advanced cancer receiving inpatient palliative care and 50 healthy adults were administered the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to evaluate decision-making capacity with regard to the four most commonly used legal standards: Choice, Understanding, Appreciation, and Reasoning. Participants made a hypothetical treatment decision about whether to accept artificial nutrition and hydration for treatment of cachexia. Participants' physicians independently rated their decision-making capacity.
Results: Terminally ill participants were significantly more impaired than healthy adults on all MacCAT-T subscales. Most terminally ill participants were able to express a treatment choice (85.7%), but impairment was common on the Understanding (44.2%), Appreciation (49.0%), and Reasoning (85.4%) subscales. Agreement between physician-rated capacity and performance on the MacCAT-T subscales was poor.
Conclusions: The use of the MacCAT-T revealed high rates of decisional impairment in terminally ill participants. Participants' physicians infrequently detected impairment identified by the MacCAT-T. The findings from the present study reinforce the need for engagement in advance care planning for patients with advanced cancer.
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http://dx.doi.org/10.1016/j.jagp.2017.11.012 | DOI Listing |
Front Psychol
December 2024
Psicología, Facultad de Ciencias de la Salud, Universidad a Distancia de Madrid (UDIMA), Madrid, Spain.
Background: Animal-assisted therapy (AAT) is increasingly recognized as beneficial in palliative care, aiming to enhance the well-being of terminally ill patients. Palliative care focuses on holistic support for physical, emotional, social, and spiritual needs. AAT uses animal interactions to alleviate symptoms such as pain, anxiety, and depression, promoting social engagement and emotional comfort.
View Article and Find Full Text PDFNihon Koshu Eisei Zasshi
December 2024
Previous Division of Environmental Medicine and Population Sciences /Department of Social and Environmental Medicine, Osaka University.
Objectives In Japan, efforts to provide "end-of-life care" in nursing homes are increasing and its introduction through long-term care insurance in 2006 is a major step forward. However, previous studies have shown that relocating older adults to their end-of-life care affects their burden. This study examined individuals' end-of-life care use under long-term care insurance in older care facilities and investigated the relocation frequency among terminally ill older residents of nursing facilities using receipt data.
View Article and Find Full Text PDFJ Hosp Palliat Care
December 2024
College of Nursing, Kyungdong University, Wonju, Korea.
Purpose: This study explored nurses' experience of "good nursing care" in the context of caring for terminally ill and end-of-life patients, providing a foundation for improving patient care.
Methods: We employed a qualitative research approach, integrating both inductive and deductive analysis methods. Data collection occurred from May 1 to August 1, 2023, involving nine nurses from intensive care units, hospice and palliative care wards, and nursing homes.
J Hosp Palliat Care
December 2024
HCA Hospice Limited, Singapore, Singapore.
The objective of this case presentation is to identify factors that hinder home deaths after patients have been compassionately discharged from the hospital. It aims to shed light on modifiable factors that could facilitate a home death. Compassionate discharges differ from routine discharges as they are done to support the wishes of terminally ill patients to pass on at home.
View Article and Find Full Text PDFOncol Rev
November 2024
Department of Cardiology, School of Medicine, Shahed University, Tehran, Iran.
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