Abstract：
BACKGROUND::Following the Supreme Court of Canada's Carter Decision, medical assistance in dying (MAID) became possible with individual court orders in February 2016. Subsequently, on June 17, 2016, legislation was passed that eliminated the need for court orders, essentially making physicians the arbiters of these requests. Canadian health-care facilities now face the challenge of addressing this unprecedented patient health-care need. AIM::To describe the manner in which London Health Sciences Center has approached local and regional requests for MAID, including the administration, ethics, privacy, and clinical process. DESIGN::A health-care systems descriptive study. SETTING/PARTICIPANTS::Between June 6, 2016, and May 30, 2018, London Health Sciences Center's MAID Internal Resource Committee triaged and referred 260 cases. Ninety-six received the requisite assessments were deemed eligible for and received MAID. RESULTS::The procedure was completed in hospital 59 (61%) times, and 37 (39%) times in the community (either private residence or long-Term Care facility). Nineteen patients did not meet MAID criteria and 63 patients died while awaiting the procedure. The median wait time between first request and referral was 1 day. The median time between referral and the procedure was 12.0 days. The ratio of referrals to completed cases is 96 of 260 (or 37% conversion rate). CONCLUSION::Our MAID processes, including our committee structure, referral triage process, and physical site have all undergone extensive review and improvement cycles throughout these first 2 years with the aim of ensuring that this procedure is managed in a respectful, confidential, safe, efficient, and patient-centered manner.
journal_name
J Palliat Carejournal_title
Journal of palliative careauthors
Ball IM,Hodge B,Jansen S,Nickle S,Sibbald RWdoi
10.1177/0825859718812446subject
Has Abstractpub_date
2019-04-01 00:00:00pages
78-84issue
2eissn
0825-8597issn
2369-5293journal_volume
34pub_type
杂志文章abstract：BACKGROUND:Patients with advanced chronic obstructive pulmonary disease (COPD) have a significant symptom burden despite maximal medical therapy, yet few are referred for concomitant palliative care. OBJECTIVE:To evaluate the utilization and impact of palliative care on the location of death and to identify clinical v...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859719851486
更新日期：2019-07-02 00:00:00
abstract：:There may be quantitatively more cancer in the developing world, Africa included, than in the developed world. Unlike in the developed world, cancer patients in Africa present for treatment at a late stage and therefore most of them have pain. Yet, the most commonly used modality for treatment of the cancer pain is dr...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：1989-06-01 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：:This study used a randomized controlled trial design to investigate the impact of hospice at home (HAH) on caregiver bereavement outcome. Secondary analyses considered the association between bereavement, place of death, and carers' assessment of support. Ninety-six informal carers of patients referred to HAH were sur...
journal_title：Journal of palliative care
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：2004-07-01 00:00:00
abstract：AIM:Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in US hospitals. We examined temporal trends and the impact of palliative care on the use of life-sustaining procedures in this population. MATERIALS...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718777375
更新日期：2018-07-01 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：:This paper addresses the music therapy process specific to one subgroup of the general population identified as having terminal illness. This subgroup includes individuals who are impoverished, homeless, and do not have someone to provide them with care at the end of life. Based upon her clinical work at Malachi House...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2001-10-01 00:00:00
abstract：:Professional caregivers for cancer patients are at high risk for work-related stress, but it is not clear how this relates to exposure to death and dying, and to professional satisfaction. This study compares work-related stress and staff satisfaction on an academic acute palliative care unit (PCU) with that on a medi...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2007-04-01 00:00:00
abstract：BACKGROUND:Little is known about current practice in using the anticonvulsant gabapentin in the management of cancer-related neuropathic pain. OBJECTIVES:The main objective of this study was to describe the pattern of gabapentin use as an adjuvant analgesic for cancer-related neuropathic pain in patients admitted to a...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2003-10-01 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：:Inpatient palliative care consultation has been demonstrated to improve quality of life as well as decrease hospital readmissions, intensive care unit transfers, and hospital costs for people with a life limiting illness. The clinical teaching units (CTUs) at London Health Sciences Centre (LHSC) routinely admit patien...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859718781363
更新日期：2018-10-01 00:00:00
abstract：INTRODUCTION:Health system restructuring combined with the preferences of many terminally ill care recipients and their caregivers has led to an increase in home-based palliative care, yet many care recipients die within institutional settings such as hospitals. This study sought to determine the place of death and its...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2010-01-01 00:00:00
abstract：BACKGROUND:Bleeding occurs with some regularity at the end of life. Patients often endure fatigue, weakness, pain, dyspnea and anxiety. These symptoms are magnified in visually apparent bleeds. Management can be particularly challenging as we attempt to balance therapies with goals of care. Children are at risk for suc...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859719883844
更新日期：2020-04-01 00:00:00
abstract：PURPOSE:To evaluate the perception of attending physicians, medical residents, and undergraduate medical students about death and dying, the end of life (EoL), and palliative care (PC) during training and clinical practice, highlighting knowledge gaps, and the changes needed in medical school curricula. METHOD:Cross-s...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859720923435
更新日期：2020-05-10 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：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：: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：AIM:The aim of this study was to evaluate the utility of the Edmonton Symptom Assessment System (ESAS-r) Scale on a tertiary palliative care unit. METHOD:There were 92 admitted patients who participated in the study; the scale was administered to those able to participate on day 1 (n = 35, 38 percent), on day 4 (n = 2...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/082585971503100107
更新日期：2015-01-01 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
abstract：:Morphine was administered to 56 advanced cancer patients; of that number spinal metastases had induced bone pain in 28 and malignant tumors had induced sciatica in 28. The sciatica was caused in 16 patients by direct invasion of the sacral plexus, in four by lumbar bone metastases, and in eight by pelvic bone metastas...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：1994-04-01 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：:There has been little research into pressure ulcer prevention and treatment in hospices. In this study, interviews with hospice directors of clinical services and direct-care nurses were analyzed using qualitative methods. Several general themes were found. Both pressure ulcer prevention and treatment can be painful t...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：
更新日期：2003-04-01 00:00:00
abstract：:This multi-centre study of adjuvant "burst" ketamine in palliative care in-patients documents its effectiveness, duration of pain relief, and adverse effects (AE) profile. Patients received a three-to-five day continuous subcutaneous infusion (CSCI) of ketamine escalated from 100 to 300 to 500 mg/24 hours if required....
journal_title：Journal of palliative care
pub_type： 临床试验,杂志文章,多中心研究
doi：
更新日期：2010-10-01 00:00:00
abstract：:In 1992, 82.2% of deaths in Alberta occurred in acute care hospitals or continuing care facilities. This paper outlines the end-of-life care of adult inpatients who died that year in four such facilities (n = 137). CPR was an infrequent end-of-life treatment modality (2.9%), in stark contrast to the extensive use of o...
journal_title：Journal of palliative care
pub_type： 杂志文章,多中心研究
doi：
更新日期：1997-01-01 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：BACKGROUND:There is a growing movement to increase palliative care consults from the emergency department (ED) to reduce healthcare costs and improve quality of life. The surprise question is a screening tool that emergency medicine physicians may be able to use towards achieving this goal. OBJECTIVE:The objectives of...
journal_title：Journal of palliative care
pub_type： 杂志文章
doi：10.1177/0825859719866698
更新日期：2020-10-01 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：: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：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：: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
