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[PMID]:29210254
[Au] Autor:Donnelly M
[Ti] Título:Developing a Legal Framework for Advance Healthcare Planning: Comparing England & Wales and Ireland.
[So] Source:Eur J Health Law;24(1):67-84, 2017 Mar.
[Is] ISSN:0929-0273
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:This article examines the legislative frameworks for advance healthcare planning in England & Wales (the Mental Capacity Act 2005) and in Ireland (the Assisted Decision-Making (Capacity) Act 2015), undertaking a comparative analysis of each measure, with particular focus on the detail of the approaches taken. It is only through this kind of detailed focus that the normative choices made by legislation can fully be understood and evaluated. The article argues that, in several respects, possibly because the drafters were able to reflect lessons learned from other jurisdictions, the Assisted Decision-Making (Capacity) Act 2015 provides a more rounded and complete form of advance healthcare planning than that provided by the Mental Capacity Act. This is on the basis that it provides more protection for patient choice; better potential for delivery on the choices made; and a more appropriate balance between formalities and enforceability.
[Mh] Termos MeSH primário: Planejamento Antecipado de Cuidados/legislação & jurisprudência
[Mh] Termos MeSH secundário: Inglaterra
Seres Humanos
Irlanda
Competência Mental/legislação & jurisprudência
País de Gales
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171228
[Lr] Data última revisão:
171228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171207
[St] Status:MEDLINE


  2 / 1852 MEDLINE  
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[PMID]:29045355
[Au] Autor:Sullivan SS; Li J; Wu YB; Hewner S
[Ad] Endereço:Author Affiliations: PhD Student (Ms Sullivan), Associate Professor (Dr Wu), and Assistant Professor (Dr Hewner), School of Nursing, University at Buffalo, State University of New York; and Postoctoral Research Fellow (Dr Li), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
[Ti] Título:Complexity of Chronic Conditions' Impact on End-of-Life Expense Trajectories of Medicare Decedents.
[So] Source:J Nurs Adm;47(11):545-550, 2017 Nov.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The aim of this study is to determine if the pattern of monthly medical expense can be used to identify individuals at risk of dying, thus supporting providers in proactively engaging in advanced care planning discussions. BACKGROUND: Identifying the right time to discuss end of life can be difficult. Improved predictive capacity has made it possible for nurse leaders to use large data sets to guide clinical decision making. METHODS: We examined the patterns of monthly medical expense of Medicare beneficiaries with life-limiting illness during the last 24 months of life using analysis of variance, t tests, and stepwise hierarchical linear modeling. RESULTS: In the final year of life, monthly medical expense increases rapidly for all disease groupings and forms distinct patterns of change. CONCLUSION: Type of condition can be used to classify decedents into distinctly different cost trajectories. Conditions including chronic disease, system failure, or cancer may be used to identify patients who may benefit from supportive care.
[Mh] Termos MeSH primário: Planejamento Antecipado de Cuidados/normas
Centers for Medicare and Medicaid Services (U.S.)/economia
Doença Crônica/economia
Cuidados Paliativos na Terminalidade da Vida/economia
Doente Terminal/estatística & dados numéricos
[Mh] Termos MeSH secundário: Planejamento Antecipado de Cuidados/organização & administração
Idoso
Centers for Medicare and Medicaid Services (U.S.)/estatística & dados numéricos
Doença Crônica/classificação
Doença Crônica/mortalidade
Comunicação
Custos e Análise de Custo
Registros Eletrônicos de Saúde/normas
Registros Eletrônicos de Saúde/estatística & dados numéricos
Cuidados Paliativos na Terminalidade da Vida/utilização
Seres Humanos
Uso Significativo/normas
Uso Significativo/estatística & dados numéricos
Relações Médico-Paciente
Prognóstico
Estudos Retrospectivos
Medição de Risco/métodos
Estados Unidos/epidemiologia
Procedimentos Desnecessários/economia
Procedimentos Desnecessários/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:171019
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000541


  3 / 1852 MEDLINE  
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[PMID]:28992862
[Au] Autor:Dy SM; Isenberg SR; Al Hamayel NA
[Ad] Endereço:Primary Care for Cancer Survivors Program, Department of Medicine, Johns Hopkins University, Room 609, 624 North Broadway, Baltimore, MD 21209, USA. Electronic address: dy1@jhu.edu.
[Ti] Título:Palliative Care for Cancer Survivors.
[So] Source:Med Clin North Am;101(6):1181-1196, 2017 Nov.
[Is] ISSN:1557-9859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The palliative care approach for survivors begins with comprehensive assessment of communication and advance care planning needs and the physical, psychological and psychiatric, social, spiritual and religious, and cultural domains. Communication and decision-making about difficult issues should include responding to emotions, planning for future communication needs, and considering reasons for miscommunication. Key palliative approaches to symptom management include addressing physical and psychosocial concerns, and using nonpharmacologic approaches first or together with medications. Physicians should address advance care planning in older cancer survivors and those at significant risk of recurrence and mortality, ideally through ongoing conversations in a longitudinal care relationship.
[Mh] Termos MeSH primário: Neoplasias/psicologia
Cuidados Paliativos/organização & administração
Cuidados Paliativos/psicologia
Sobreviventes/psicologia
[Mh] Termos MeSH secundário: Planejamento Antecipado de Cuidados/organização & administração
Comunicação
Emoções
Relações Familiares
Seres Humanos
Equipe de Assistência ao Paciente/organização & administração
Assistência Centrada no Paciente/organização & administração
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE


  4 / 1852 MEDLINE  
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[PMID]:28884703
[Au] Autor:Rietjens JAC; Sudore RL; Connolly M; van Delden JJ; Drickamer MA; Droger M; van der Heide A; Heyland DK; Houttekier D; Janssen DJA; Orsi L; Payne S; Seymour J; Jox RJ; Korfage IJ; European Association for Palliative Care
[Ad] Endereço:Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands. Electronic address: j.rietjens@erasmusmc.nl.
[Ti] Título:Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care.
[So] Source:Lancet Oncol;18(9):e543-e551, 2017 Sep.
[Is] ISSN:1474-5488
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68-100%. ACP was defined as the ability to enable individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate. Recommendations included the adaptation of ACP based on the readiness of the individual; targeting ACP content as the individual's health condition worsens; and, using trained non-physician facilitators to support the ACP process. We present a list of outcome measures to enable the pooling and comparison of results of ACP studies. We believe that our recommendations can provide guidance for clinical practice, ACP policy, and research.
[Mh] Termos MeSH primário: Planejamento Antecipado de Cuidados
Cuidados Paliativos
[Mh] Termos MeSH secundário: Atitude do Pessoal de Saúde
Consenso
Técnica Delfos
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE


  5 / 1852 MEDLINE  
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[PMID]:28863219
[Au] Autor:de Caprariis PJ; Rucker B; Lyon C
[Ad] Endereço:From the Departments of Medicine and Family Medicine, and the Division of General Internal Medicine and Clinical Innovation, NYU Lutheran Medical Center, Brooklyn, and the Palliative Care Consulting Service, Brooklyn Hospital Center, Brooklyn, New York.
[Ti] Título:Discussing Advance Care Planning and Directives in the General Population.
[So] Source:South Med J;110(9):563-568, 2017 Sep.
[Is] ISSN:1541-8243
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The concept of end-of-life planning, along with medical and legal issues, has been discussed and has evolved over several years. The 1990 Patient Self-Determination Act and individual states' Department of Health Advance Directive forms helped overcome past problems. Patients with terminal and chronic illness are now able to have their wishes recognized for their future care. Any healthy individual's decision during an advance care planning (ACP) discussion can be adversely affected by various factors; however, multiple barriers-religion, culture, education, and family dynamics-can influence the process. Healthcare professionals' reluctance to initiate the conversation may result from limited training during medical school and residency programs. These limitations hinder both the initiation and productiveness of an ACP conversation. We explored ACP issues to provide guidance to healthcare professionals on how best to address this planning process with a healthy adult.
[Mh] Termos MeSH primário: Planejamento Antecipado de Cuidados
[Mh] Termos MeSH secundário: Planejamento Antecipado de Cuidados/normas
Diretivas Antecipadas/legislação & jurisprudência
Comunicação
Seres Humanos
Relações Médico-Paciente
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170902
[St] Status:MEDLINE
[do] DOI:10.14423/SMJ.0000000000000697


  6 / 1852 MEDLINE  
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[PMID]:28850960
[Au] Autor:Mehlis K; Becker C; Christ C; Laryionava K; Hiddemann W; Heußner P; Winkler EC
[Ad] Endereço:Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Medizinische Onkologie, Universitätsklinikum Heidelberg, Schwerpunkt "Ethik und Patientenorientierung in der Onkologie".
[Ti] Título:[Frequency and Timing of Decisions to Limit Intensive Medical Care and Tumor-Specific Therapy in University Hematology and Oncology].
[Ti] Título:Häufigkeit und Zeitpunkt von Entscheidungen gegen intensivmedizinische Maßnahmen und tumorspezifische Therapien in einer universitären Hämatologie und Onkologie..
[So] Source:Dtsch Med Wochenschr;142(17):e116-e123, 2017 Sep.
[Is] ISSN:1439-4413
[Cp] País de publicação:Germany
[La] Idioma:ger
[Ab] Resumo:Decisions to limit treatment (DLT) are important in order to prevent overtreatment at the end of life. However, they are not always discussed with the patient in advance or sufficiently documented. In a study to improve DLT in patients with an advanced hematological/ oncological disease we examined how often DLT precede deaths and how early they are determined. In a period of 6 months, 567 patients with advanced hematological/ oncological neoplasias had been recruited for the cross-sectional study at the University hospital in Munich. Using a standardized registration form an embedded researcher documented which DLT were determined for the patients and which of them were implemented until death. For 26 % (n = 147) of the 567 patients a DLT was determined. These DLT were mostly documented in writing from the beginning on (90 %; n = 132), 20 % (n = 30) were modified. The proportion of deceased patients with DLT was 82 % (n = 62 of 76 deceased). The median time between the initial determination of a DLT and the patient's death was 6 days at normal ward and 10.5 days at palliative ward. Compared to hematological patients, DLT were more frequently diagnosed in patients with an oncological disease (64 vs. 36 %) and the decisions were made slightly earlier (7 vs. 5 days before death). Our results show that DLT precede the death of many patients with a hematological/ oncological disease, but usually are made in the last week of life. This leads to the risk that the remaining few days to death are not sufficient for discussions with all parties involved and the planning of the end of life. These findings resulted in the development of an ethics policy for treatment limitation in cancer patients, which should support the concept of advance care planning. The project is funded by the German Cancer Aid.
[Mh] Termos MeSH primário: Neoplasias/epidemiologia
Neoplasias/terapia
Suspensão de Tratamento/estatística & dados numéricos
[Mh] Termos MeSH secundário: Planejamento Antecipado de Cuidados
Protocolos Antineoplásicos
Estudos Transversais
Alemanha/epidemiologia
Cuidados Paliativos na Terminalidade da Vida
Seres Humanos
Cuidados Paliativos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170830
[St] Status:MEDLINE
[do] DOI:10.1055/s-0043-103340


  7 / 1852 MEDLINE  
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[PMID]:28783768
[Au] Autor:Liantonio J; Liquori M; Lakhtman L; Parks S
[Ad] Endereço:Thomas Jefferson University Hospital, Philadelphia, PA, USA. Email: john.liantonio@jefferson.edu.
[Ti] Título:Advance care planning: Making it easier for patients (and you).
[So] Source:J Fam Pract;66(8):487-491, 2017 Aug.
[Is] ISSN:1533-7294
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Helpful resources, many of them online, are available to facilitate the process. And this time-intensive service is now billable under 2 CPT codes.
[Mh] Termos MeSH primário: Planejamento Antecipado de Cuidados/organização & administração
Documentação/métodos
Cuidados para Prolongar a Vida/organização & administração
Planejamento de Assistência ao Paciente/organização & administração
Assistência Terminal/organização & administração
[Mh] Termos MeSH secundário: Diretivas Antecipadas
Seres Humanos
Preferência do Paciente/estatística & dados numéricos
Qualidade da Assistência à Saúde/organização & administração
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170808
[St] Status:MEDLINE


  8 / 1852 MEDLINE  
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[PMID]:28760834
[Au] Autor:Heyland DK; Dodek P; You JJ; Sinuff T; Hiebert T; Tayler C; Jiang X; Simon J; Downar J; ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET)
[Ad] Endereço:Department of Critical Care Medicine (Heyland), Kingston General Hospital; Department of Public Health Sciences (Heyland), Queen's University; Clinical Evaluation Research Unit (Heyland, Jiang), Kingston General Hospital, Kingston, Ont.; Centre for Health Evaluation and Outcome Sciences and Division
[Ti] Título:Validation of quality indicators for end-of-life communication: results of a multicentre survey.
[So] Source:CMAJ;189(30):E980-E989, 2017 Jul 31.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The lack of validated quality indicators is a major barrier to improving end-of-life communication and decision-making. We sought to show the feasibility of and provide initial validation for a set of quality indicators related to end-of-life communication and decision-making. METHODS: We administered a questionnaire to patients and their family members in 12 hospitals and asked them about advance care planning and goals-of-care discussions. Responses were used to calculate a quality indicator score. To validate this score, we determined its correlation with the concordance between the patients' expressed wishes and the medical order for life-sustaining treatments recorded in the hospital chart. We compared the correlation with concordance for the advance care planning component score with that for the goal-of-care discussion scores. RESULTS: We enrolled 297 patients and 209 family members. At all sites, both overall quality indicators and individual domain scores were low and there was wide variability around the point estimates. The highest-ranking institution had an overall quality indicator score (95% confidence interval) of 40% (36%-44%) and the lowest had a score of 18% (11%-25%). There was a strong correlation between the overall quality indicator score and the concordance measure ( = 0.72, = 0.008); the estimated correlation between the advance care planning score and the concordance measure ( = 0.35) was weaker than that between the goal-of-care discussion scores and the concordance measure ( = 0.53). INTERPRETATION: Quality of end-of-life communication and decision-making appears low overall, with considerable variability across hospitals. The proposed quality indicator measure shows feasibility and partial validity. ClinicalTrials.gov, no. NCT01362855.
[Mh] Termos MeSH primário: Planejamento Antecipado de Cuidados
Comunicação
Tomada de Decisões
Família
Indicadores de Qualidade em Assistência à Saúde
Assistência Terminal/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Canadá
Feminino
Hospitais
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; OBSERVATIONAL STUDY; VALIDATION STUDIES
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170802
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.160515


  9 / 1852 MEDLINE  
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[PMID]:28723331
[Au] Autor:Drazen JM; Yialamas MA
[Ad] Endereço:From Brigham and Women's Hospital, Boston.
[Ti] Título:Certain about Dying with Uncertainty.
[So] Source:N Engl J Med;377(3):208-209, 2017 Jul 20.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Tomada de Decisões
Relações Médico-Paciente
Incerteza
[Mh] Termos MeSH secundário: Planejamento Antecipado de Cuidados
Idoso de 80 Anos ou mais
Morte
Feminino
Seres Humanos
Doença Cardiopulmonar
[Pt] Tipo de publicação:JOURNAL ARTICLE; PERSONAL NARRATIVES
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170801
[Lr] Data última revisão:
170801
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170721
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1706795


  10 / 1852 MEDLINE  
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[PMID]:28609264
[Au] Autor:Boucher NA; Siddiqui EA; Koenig HG
[Ad] Endereço:Postdoctoral Fellow at the Geriatric Research Education and Clinical Center at the Durham Veterans Administration Medical Center and a Senior Fellow at the Duke University Center for the Study of Aging in NC. nathan.boucher@duke.edu.
[Ti] Título:Supporting Muslim Patients During Advanced Illness.
[So] Source:Perm J;21, 2017.
[Is] ISSN:1552-5775
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Religion is an important part of many patients' cultural perspectives and value systems that influence them during advanced illness and toward the end of life when they directly face mortality. Worldwide violence perpetrated by people identifying as Muslim has been a growing fear for people living in the US and elsewhere. This fear has further increased by the tense rhetoric heard from the recent US presidential campaign and the new presidential administration. For many, this includes fear of all Muslims, the second-largest religious group in the world with 1.6 billion adherents and approximately 3.5 million in the US alone. Patient-centered care requires health professionals to look past news headlines and unchecked social media so they can deliver high-quality care to all patients. This article explores areas of importance in the context of advanced illness for practitioners of Islam. These include the conditions needed for prayer, the roles of medical treatment and religious authority, the importance of modesty, the religious concordance of clinicians, the role of family in medical decision making, advance care planning, and pain and symptom management. Initial recommendations to optimize care for Muslim patients and their families, informed by the described tenets of Muslim faith, are provided for clinicians and health systems administrators. These include Islamic cultural awareness training for staff, assessment of patients and families to determine needs, health education and decision-making outreach, and community health partnerships with local Islamic institutions.
[Mh] Termos MeSH primário: Cultura
Pessoal de Saúde
Islamismo
Cuidados Paliativos/normas
Assistência Centrada no Paciente
Preconceito
Assistência Terminal/normas
[Mh] Termos MeSH secundário: Planejamento Antecipado de Cuidados
Tomada de Decisões
Família
Seres Humanos
Manejo da Dor
Qualidade da Assistência à Saúde
Religião e Medicina
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.7812/TPP/16-190



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