Abstract：
OBJECTIVES:Little is known about how clinicians perceive prognostic uncertainty. Our study objective was to identify factors that influence how prognostic uncertainty is viewed by physicians, as it relates to their communications with families. DESIGN:Thirty semi-structured interviews with qualitative content analysis (9 surgeons, 16 intensivists, 3 nurse practitioners, and 2 "other" clinicians). We analyzed interviews using qualitative description with constant comparative techniques. SETTING:Open medical, surgical, neurosurgical, and cardiovascular intensive care units (ICUs) in a 900-bed academic, tertiary Houston hospital. INTERVENTIONS:None. MAIN RESULTS:We identified 2 main factors that influence how clinicians perceive prognostic uncertainty and their perceptions about whether and why they communicate prognostic uncertainties to families: (1) Communicating Uncertainty to "Soften the Blow"; and (2) Communicating Uncertainty in Response to Clinicians' Interpretations of Surrogate Decision Makers' Perceptions of Prognostic Uncertainty. We also identified several subthemes. CONCLUSIONS:Clinician-family interactions influence how clinicians perceive prognostic uncertainty in their communications with patients or families. We discuss ethical and clinical implications of our findings.
journal_name
J Palliat Carejournal_title
Journal of palliative careauthors
Peoples HA,Boone B,Blumenthal-Barby JS,Bruce CRdoi
10.1177/0825859719845005subject
Has Abstractpub_date
2020-01-01 00:00:00pages
29-33issue
1eissn
0825-8597issn
2369-5293journal_volume
35pub_type
杂志文章abstract：:With recent changes in health care there is greater emphasis on providing care at home, including the support of families to enable more home deaths. Since a home death may not be practical or desirable in every family situation, there is a need for an objective way to assess the viability of a home death in each indi...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2000-04-01 00:00:00
abstract：:Palliative care is one of the newer health specialties and continues to mature. While there has been remarkable progression of clinical skills and education, there has been a lack of focus on palliative care interdisciplinary leadership or development of leadership skills. This article highlights the importance of int...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718791427
更新日期：2018-08-16 00:00:00
abstract：:The study assessed the components of high-quality HIV palliative care using the multidimensional model of quality assessment developed by Maxwell (4). Data collection consisted of interviews with individual subjects and focus groups. The interviews took place in three London health authorities. Seven service users and...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：1999-01-01 00:00:00
abstract：:This retrospective study compared 100 consecutive non-cancer (NC) patients referred to a palliative care consult team (PCT) in a Swiss university hospital to 506 cancer (C) patients referred during the same period. The frequencies of reported symptoms were similar in both groups. The main reasons for referral in the N...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2009-07-01 00:00:00
abstract：BACKGROUND:One challenge for those who manage amyotrophic lateral sclerosis (ALS) is to understand patients' needs. AIM:The aim of this study was to examine the needs of Singapore ALS patients from their perspective as well as that of their caregivers and healthcare professionals in order to develop a template for bet...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/082585971503100304
更新日期：2015-01-01 00:00:00
abstract：UNLABELLED:In Poland, medical curricula cover palliative care for adults, not for children. This paper evaluates feedback of students who participated in a pilot pediatric palliative care education program. METHOD:An anonymous questionnaire was designed for the students; they were asked to assess each aspect of the pr...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2012-01-01 00:00:00
abstract：OBJECTIVE:Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort-particularly those with a comorbid, chronic and persistent mental illness (CPMI)-are poorly documented. We sought to explore the exper...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859720951360
更新日期：2020-08-18 00:00:00
abstract：BACKGROUND:Socioeconomic disparities in home death have been noted in the literature. Home-based palliative care increases access to home death and has been suggested as a means to decrease these disparities. AIM:Our study examines the association between socioeconomic status and other demographic factors on place of ...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859719855020
更新日期：2020-07-01 00:00:00
abstract：:A survey was conducted to determine what pharmaceutical services are provided to palliative care sites in Australia and Canada, and the pharmacist's role on the interdisciplinary team. Questionnaires were sent to 100 selected sites in each country. Questions pertained to demographics and the level of duties performed....
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2002-01-01 00:00:00
abstract：:Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and disability worldwide. For many patients, maximal therapy for COPD produces only modest relief of disabling symptoms and these symptoms result in a significantly reduced quality of life. Despite the high morbidity and mortality, patients w...
journal_title：Journal of palliative care
pub_type： 杂志文章,评审
doi：
更新日期：2005-10-01 00:00:00
abstract：:The Regional Palliative Care Unit in Ottawa conducted a retrospective study to determine how satisfied patients and families were with the service the Unit offers. Forty-five primary care providers, bereaved from 6 to 12 months, completed the 64-item semistructured telephone interview in a mean time of 20 minutes. The...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：1992-01-01 00:00:00
abstract：:This study measures the proportion of cancer patients in Ontario, Canada, with intensive care unit (ICU) admissions, emergency room (ER) visits, or chemotherapy in the last two weeks of life. We used the Ontario Cancer Registry to identify a cohort of cancer patients who died in 2001. These cases were then linked to a...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2006-04-01 00:00:00
abstract：:Historically, health and social care professionals have described their lack of competence and confidence in many aspects of palliative care, and have recognized the need for increased educational opportunities, where new skills can be acquired and existing knowledge consolidated. Redressing these omissions has led to...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2001-07-01 00:00:00
abstract：:Caregivers are often overwhelmed by the strain of terminal caregiving. We wished to better understand the needs of terminal caregivers and to supply a basis for tailoring interventions to them during caregiving and early bereavement. This report provides a profile of 124 bereaved caregivers interviewed within three mo...
journal_title：Journal of palliative care
pub_type： 杂志文章,多中心研究
doi：
更新日期：1999-04-01 00:00:00
abstract：:This article describes two young, potentially curable patients who chose a course of treatment that ultimately resulted in death. Their choice was in part influenced by the prospect of the disfiguring surgery that would have been required for cure. In the first patient this would have meant massive head and neck surge...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：1998-01-01 00:00:00
abstract：:With increasing trends towards home care of children with even the most complex conditions and care requirements, respite becomes critical in improving the quality of life for terminally ill children and their families. This article reports on the respite component of an evaluation project that examined the effect of ...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2004-01-01 00:00:00
abstract：:Health care workers often perceive a conflict between autonomy and beneficence when dealing with clients living at risk in the community. Respect for personal freedom and the desire to help and protect vulnerable people frequently appear to demand opposite interventions. The assessment of decision-making capacity is a...
journal_title：Journal of palliative care
pub_type： 杂志文章,评审
doi：
更新日期：1998-04-01 00:00:00
abstract：PURPOSE::The primary objective of this study was to quantify cancer family caregiver (FCG) quality of life (QOL) in a Southern Albanian population and to determine whether differences exist between 4 domains of QOL (physical, psychological, social, and spiritual). This study also sought to compare QOL in our cohort to ...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718812432
更新日期：2019-04-01 00:00:00
abstract：:In traditional Chinese culture, death was sensitive and mentioning it was sacrilegious and to be avoided. Many Chinese families object to telling the patient a "bad" diagnosis or prognosis, which may hinder the chance in advance care planning (ACP) discussion. While death remains an inevitable consequence of being bor...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718763644
更新日期：2018-10-01 00:00:00
abstract：PURPOSE:The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. METHODS:The sample consisted of 120 patients with advanced cancer. The self-administered questionnair...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718759882
更新日期：2018-04-01 00:00:00
abstract：:Doctor-patient communication is a quintessential part of medical care. Yet, several factors challenge its effectiveness. The author, a third year Pediatrics resident, explores the ways medical education creates distance between doctors' and patients' ability to achieve mutual understanding in the clinical setting and ...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718795438
更新日期：2019-01-01 00:00:00
abstract：:Medical professional societies have traditionally opposed physician-assisted suicide and euthanasia (PAS-E), but this opposition may be shifting. We present 5 reasons why physicians shouldn't be involved in PAS-E. 1. Slippery slopes: There is evidence that safeguards in the Netherlands and Belgium are ineffective and ...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718777325
更新日期：2018-10-01 00:00:00
abstract：OBJECTIVE:Practice guidelines indicate that patients who have months to weeks left to live should not be offered chemotherapy. We examined factors associated with clinician-reported poor performance status as determined by the Palliative Performance Scale (PPS) and subsequent initiation of intravenous (IV) chemotherapy...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2014-10-01 00:00:00
abstract：BACKGROUND:The Patient Self-Determination Act (PSDA) requires hospitals, home health agencies, nursing homes, and hospice providers to offer new patients information about advance directives. There is little evidence regarding whether encounters with these health-care providers prompt advance directive completion by pa...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718769099
更新日期：2018-07-01 00:00:00
abstract：BACKGROUND:Health professionals are expected to support family caregivers of patients requiring palliative care. However, there is a dearth of empirical evidence to help clinicians identify caregivers who might be at risk of poor psychosocial functioning. PURPOSE:This secondary analysis of baseline data from a larger ...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2006-10-01 00:00:00
abstract：:Emergency department (ED) use is a quality-of-care indicator for community-based end-of-life (EOL) care. This study examined ED use by EOL home care clients. The sample included all EOL home care clients who received care from one community care access centre in Ontario, Canada. Information on health was gathered usin...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2011-10-01 00:00:00
abstract：:This article examines the intersection between masculinity, military culture, and hospice and palliative care (HPC). The authors conducted a narrative literature review, supplemented with clinical annotations, to identify the impact of masculinity and military culture on the following topics salient to end-of-life car...
journal_title：Journal of palliative care
pub_type： 杂志文章,评审
doi：10.1177/0825859719851483
更新日期：2020-04-01 00:00:00
abstract：OBJECTIVE:This study aimed to characterize the strategies and psychosocial conditions that influence how resilient people live in the face of advanced cancer. METHODS:Grounded theory interviews and a survey of 10 resilient people with advanced cancer were collected and analyzed. FINDINGS:Personal assets - including p...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2013-07-01 00:00:00
abstract：:Informal hospice caregivers play a key role in managing patients' pain at home, but lack of adherence to doctor-prescribed analgesic regimens and medication errors are significant barriers to truly effective pain management. A digital pain diary may improve caregiver management of pain at home; however, most digital p...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859717722466
更新日期：2017-04-01 00:00:00
abstract：:Comfort care for cancer patients in the terminal stage has been the goal of hospice programs since their inception. Among the many treatment modalities available to homebound patients, transfusions have been little studied for their effects on advanced disease symptoms, particularly for those in the terminal phase. Ou...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：1993-10-01 00:00:00
