To explore people's intentions to opt for a good death when planning for their end-of-life care, this study examined the type of end-of-life care preferred by patients receiving advance care planning (ACP) consulting services for five specified clinical and disability conditions and possible factors affecting their decision-making. This cross-sectional study analyzed 1303 hospital patients and 1032 nonhospital patients who attended a clinic providing ACP consulting services. This study revealed the following two results. First, patients who were older, were female, did not have an appointed surrogate decision-maker, and were nonhospital patients had a higher intention of not receiving life-sustaining treatments (LST) or artificial nutrition and hydration (ANH) under the five specified clinical and disability conditions. Second, people who were the least willing to receive LST or ANH under the following conditions (in descending order): permanent vegetative state, severe dementia, irreversible coma, other disease conditions recognized by the central competent authority, and end-of-life stage.
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http://dx.doi.org/10.1177/00302228221143687 | DOI Listing |
JAMA
January 2025
Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis.
Importance: Care management benefits community-dwelling patients with dementia, but studies include few patients with moderate to severe dementia or from racial and ethnic minority populations, lack palliative care, and seldom reduce health care utilization.
Objective: To determine whether integrated dementia palliative care reduces dementia symptoms, caregiver depression and distress, and emergency department (ED) visits and hospitalizations compared with usual care in moderate to severe dementia.
Design, Setting, And Participants: A randomized clinical trial of community-dwelling patients with moderate to severe dementia and their caregivers enrolled from March 2019 to December 2020 from 2 sites in central Indiana (2-year follow-up completed on January 7, 2023).
Alzheimer Dis Assoc Disord
January 2025
Department of Psychiatry, University of Michigan, Ann Arbor, MI.
Objectives: Many individuals with dementia with Lewy bodies (DLB) die of disease-related complications, but predicting the end of life can be challenging. We identified a phenotype associated with approaching end of life.
Methods: We present 4 exemplar cases where individuals with DLB experienced refractory psychosis before death.
West J Nurs Res
January 2025
UT Health San Antonio, San Antonio, TX, USA.
Background: Provision of palliative care in acute care settings is significantly lacking despite evidence that early integration leads to better patient/family-related outcomes and improved healthcare cost and efficiency.
Objective: This study investigated influencing factors that affect the nature and frequency of palliative care practices of acute care nurses.
Methods: A descriptive, cross-sectional design was used to examine the effects of personal and environmental factors on nurses' palliative care practices in the acute care setting.
Cureus
December 2024
Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, IND.
Background Currently, there is no data on the prevalence of urethral stricture illness in India. For short-segment bulbar urethral stricture, end-to-end anastomosis is the gold standard of care. The purpose of this study was to find where the direct vision internal urethrotomy (DVIU) exists in today's era.
View Article and Find Full Text PDFBackground: Despite guideline recommendations, few institutions have implemented clinical pathways that incorporate frailty into routine decision-making for patients undergoing radical cystectomy (RC). This paper presents an integrated clinical pathway designed to address the needs of frail patients undergoing RC. The purpose of the study is to determine whether a multifaceted prevention programme that tailors interventions to the syndromic components of frailty can improve postoperative morbidity and recovery time for patients.
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