Abstract:
BACKGROUND:Surrogates and clinicians often make treatment decisions for decisionally incapacitated patients with limited knowledge of their preferences. This study examined patients' life-sustaining treatment preferences to facilitate advance care planning discussions and surrogate decision making. METHODS:We interviewed 342 participants from 7 groups: younger and older well adults; persons with chronic illness, terminal cancer, and acquired immunodeficiency syndrome (AIDS); stroke survivors; and nursing home residents. Preferences for antibiotics, short- and long-term mechanical ventilation, hemodialysis, tube feeding, and cardiopulmonary resuscitation (CPR) were elicited for each participant's current health state and three hypothetical health states representing severe dementia, coma, and severe stroke. RESULTS:Participants chose to forego more invasive or long-term treatments at a higher rate than less invasive, short-term treatments in all health states. Participants were much more willing to forego treatments in coma than in their current health state, with stroke and dementia somewhere in between. Participants who were older, female, had worse functional status, had more depressive symptoms, or lived in a nursing home were more inclined to forego treatment in their current health state. In contrast, treatment preferences in hypothetical health states showed either no associations or much weaker associations with these factors. Participants who were willing to accept more invasive treatments were highly likely to accept less invasive treatments and participants who preferred to forego a less invasive treatment were highly likely to forego more invasive treatments. Participants who preferred to receive a treatment in a health state with severe impairments were highly likely to want the same treatment in a less impaired health state. Similarly, participants who preferred to forego a treatment in a less impaired health state were highly likely to forego the same treatment in a more impaired state. CONCLUSIONS:In advance care planning discussions, clinicians might explore with patients their preferences about short- and long-term treatments with variability in their invasiveness (including CPR) in both their current health state and hypothetical situations representing different levels of functional impairment. When surrogates have no knowledge about the wishes of formerly competent patients, clinicians may help them with medical decisions by discussing what other people commonly want in similar circumstances.
journal_name
J Palliat Medjournal_title
Journal of palliative medicineauthors
Pearlman RA,Cain KC,Starks H,Cole WG,Uhlmann RF,Patrick DLdoi
10.1089/jpm.2000.3.37subject
Has Abstractpub_date
2000-04-01 00:00:00pages
37-48issue
1eissn
1096-6218issn
1557-7740journal_volume
3pub_type
杂志文章abstract:BACKGROUND:Relief of distressful symptoms in terminally ill patients with cancer is of prime importance. Use of sedation to accomplish this has been the focus of recent medical studies in countries other than Japan. We investigated the influence on consciousness of sedative drugs in a Japanese hospice. DESIGN AND SUBJ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2005.8.20
更新日期:2005-02-01 00:00:00
abstract:: Background: Many older adults with serious illness who depend on others for care have symptoms that are difficult to manage. Supporting caregivers in symptom assessment (SA) may reduce suffering. Objective: Pilot an SA-Toolkit ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2020.0103
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:It is not known how often physicians use metaphors and analogies, or whether they improve patients' perceptions of their physicians' ability to communicate effectively. Therefore, the objective of this study was to determine whether the use of metaphors and analogies in difficult conversations is associated w...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2009.0221
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVE:To compare residents in hospice care at admission to the nursing facility to end stage residents not in hospice at admission. DESIGN AND METHODS:We analyzed 18,211 admission assessments recorded in the Minimum Data Set (MDS) during the year 2000 throughout the United States for residents classified as having...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/109662104773709341
更新日期:2004-04-01 00:00:00
abstract:OBJECTIVES:To determine the effects of thalidomide and placebo on anorexia-cachexia and its related symptoms, body composition, resting metabolic rate, and serum cytokines and their receptors in patients with advanced cancer. METHODS:Included in the study were patients with advanced cancer with weight loss greater tha...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1089/jpm.2012.0146
更新日期:2012-10-01 00:00:00
abstract:: Objectives: To discuss the outcomes of a formalized care transition process for palliative care patients from the hospital to the community. Background: Patients who received inpatient palliative care services from the speciali...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2020.0090
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:This study describes the process and population involved in pediatric advance care planning at one Midwest medical center. The outcomes and the parents' perceptions of this planning are also discussed. METHODS:Pediatric patients with advance directives were identified from ethics consultations records. Infor...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2005.8.766
更新日期:2005-08-01 00:00:00
abstract:BACKGROUND:Key to high-quality care of dying hospice patients at home is whether the hospice provides adequate training so the caregiver can safely care for the patient. OBJECTIVE:The study objective was to develop and validate a survey of hospice training for caregivers to ensure safe, high-quality care in the home s...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2015.0185
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:Critical care nurse communication training has largely been limited to didactic materials, interactive training for nurse supervisors, or brief participatory learning programs within the context of comprehensive end-of-life care educational seminars. Preliminary evidence suggests that an interactive approach...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2011.0225
更新日期:2011-12-01 00:00:00
abstract:BACKGROUND:Although the role of volunteers is at the heart of hospice care, little is known about hospice volunteer training and volunteer activity. METHOD:A survey was used to assess current training programs for hospice volunteers. Hospices were invited to participate in the study from a link on the website for the ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2009.0240
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:Cancer and its treatment can significantly affect appearance and body integrity. A number of studies have explored the impact of cancer and its treatment on body image, primarily in head and neck and breast cancer. The aim of this pilot study was to examine the construct of body image dissatisfaction and its...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0588
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Depression and pain often coexist in terminally ill patients, but few studies have examined their relationship among larger samples. Other psychosocial factors experienced by patients may become barriers to pain management and affect the relationship between depression and pain. OBJECTIVE:This study aims to...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0555
更新日期:2014-05-01 00:00:00
abstract:: Background: Involvement of the palliative care service has potential for patient and family benefit in critically ill patients, regardless of etiology. Anecdotally, there is a lack of involvement of the palliative care (PC) service in the neuro-intensive care unit (neuro-I...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0428
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Pain, not responsive to opioid analgesics, remains a problem for patients with chronic and cancer pain as well as their families, and clinicians. Opioid antagonists have various uses in pain and palliative care. Their use in the reversal of tolerance and hyperalgesia remains at the basic science level and ha...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2006.9.1250
更新日期:2006-12-01 00:00:00
abstract::Hospice Uganda was established in Kampala, September 27, 1993. Since then the hospice has served over 3,000 patients with cancer, and referrals of patients with HIV/AIDS are increasing steadily. The concepts of hospice and palliative care are well accepted in Uganda, but the delivery of services has been severely cons...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/10966210252785141
更新日期:2002-02-01 00:00:00
abstract:BACKGROUND:Given the volume and cost of inpatient care during the last year of life, there is a critical need to identify patterns of dying as a means of planning end-of-life care services, especially for the growing number of older persons who receive services from the Veterans Health Administration (VHA). METHODS:A ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2006.0256
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:The longer-term effects of opioids for breathlessness are not known in people with chronic heart failure (CHF). OBJECTIVE:Our aim was to assess the longer-term effect of oral opioids on breathlessness due to CHF. METHODS:We conducted a 3-month open-label extension to a crossover randomized controlled trial...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1089/jpm.2012.0270
更新日期:2013-03-01 00:00:00
abstract:: Background: Providers often use birth plans to document parents' wishes for their fetus with a life-limiting condition. Objective: The objective of the study was to (1) discover important components of a birth plan for parents ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2018.0596
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:Little is currently known about physicians': (1) level of involvement in and comfort delivering palliative care in the inpatient setting, (2) perceived barriers to referring patients to an inpatient Palliative Care Consult Service (PCCS), and (3) attitudes regarding palliative care. METHODS:Eligible partici...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2009.9656
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Outpatient palliative care (PC) has been shown to positively impact quality of life and decrease healthcare utilization, but there are limited data describing what activities render these benefits. OBJECTIVE:Describe the topics addressed by an outpatient PC team during scheduled visits. DESIGN:Longitudinal...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2017.0441
更新日期:2018-07-01 00:00:00
abstract:: Background: Patients with pulmonary hypertension (PH) experience distressing symptoms that can undermine quality of life (QoL) and treatment adherence. Complementary health approaches are known to help manage symptoms of chronic conditions and may have therapeutic benefits...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2019.0359
更新日期:2020-05-01 00:00:00
abstract::Physicians constantly confront to death and respond in a variety of ways to the many deaths that they witness and to their own sense of mortality. Student-doctors should be exposed, prior to and during their clinical training, to these different types of responses, so that they can prepare for their encounters with th...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/10966210260499023
更新日期:2002-12-01 00:00:00
abstract:UNLABELLED:Abstract Background: Despite parent and physician reports of inadequate skill development, there are few guidelines for training the pediatric care team in sharing life-altering information (SLAI), i.e., "breaking bad news." The necessary skills for SLAI differ between pediatric and adult medical environment...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0620
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:To determine whether it is possible to predict, at the time of hospice enrollment, which patients will die within 6 months. DESIGN:Electronic health record-based retrospective cohort study. SETTING:Patients admitted to 10 hospices in the CHOICE network (Coalition of Hospices Organized to Investigate Compara...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2013.0631
更新日期:2014-08-01 00:00:00
abstract:INTRODUCTION:Performing death pronouncement and communicating effectively with gathered family is an important skill relevant to end-of-life care. Often it is a responsibility of first-year residents who lack proper training or emotional preparation for the task. Residents' tension about this task presents an opportuni...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/109662104322737322
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVES:To examine the effect of patient-directed electronic messages on health care proxy (HCP) use. DESIGN:Randomized control trial using an electronic message intervention to encourage patients to complete an HCP document. SETTING:General medical practice at a large tertiary care teaching institution. PARTICIP...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,随机对照试验
doi:10.1089/jpm.2006.9.1320
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:To date, there are no known published studies that prospectively followed hospice patients receiving hydromorphone to evaluate the development of hydromorphone-induced neuroexcitation (HINE). The first objective of this study was to determine the incidence of HINE. The second objective was to i...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,多中心研究
doi:10.1089/jpm.2012.0467
更新日期:2013-10-01 00:00:00
abstract:BACKGROUND:Patients receiving hospice or palliative care often receive antimicrobial therapy; however the effectiveness of antimicrobial therapy for symptom management in these patients is unknown. OBJECTIVE:The study's objective was to systematically review and summarize existing data on the prevalence and effectiven...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/jpm.2013.0276
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Over the last 20 years, multiple interventions to better integrate palliative care and intensive care unit (ICU) care have been evaluated. This systematic review summarizes these studies and their outcomes. METHODS:We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL...
journal_title:Journal of palliative medicine
pub_type: 杂志文章,评审
doi:10.1089/jpm.2013.0409
更新日期:2014-02-01 00:00:00
abstract:PURPOSE:The majority of dying patients do not have access to necessary drugs to alleviate their most common symptoms, despite evidence of drug efficacy. Our aim was to explore the degree of consensus about appropriate pharmacological treatment for common symptoms in the last days of life for patients with cancer, among...
journal_title:Journal of palliative medicine
pub_type: 共识发展会议,杂志文章
doi:10.1089/jpm.2012.0205
更新日期:2013-01-01 00:00:00