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Surrogate Decision Makers
Published in Eldo E. Frezza, Medical Ethics, 2018
A health care proxy (also referred to as a durable power of attorney for health care) is a document that appoints someone to make medical decisions for you if you are in a situation where you can’t make them yourself. You must choose your proxy thoughtfully since he/she will be acting on your behalf.
Palliative Care and End-of-Life Issues
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Rashmi Khadilkar, Hilary Yehling, Quill Timothy E.
Healthcare proxy—One of the most important decisions a patient can make when confronting a serious illness is the selection of a healthcare proxy—a person (or people) who the patient trusts to make treatment decisions in the event that the patient loses decision-making capacity in the future. Ideally, the proxy is someone close to the patient who is familiar with the patient’s values and goals; the proxy’s guiding principle should be to act as a surrogate for the patient and make the choices the patient would have made him- or herself if able to make and communicate a choice. In addition to choosing a proxy, the patient should be encouraged to create an advance directive, in which he or she outlines the measures (e.g., intubation, resuscitation, artificial nutrition, antibiotics, dialysis, etc.) he or she would want in the future if unable to make the decision for him- or herself. The patient should discuss his wishes directly with his family, healthcare proxy, and treating clinician once they are formulated.
Helping a Person with HIV/AIDS Prepare a Power of Attorney and a Living Will
Published in David M. Aronstein, Bruce J. Thompson, HIV and Social Work, 2014
The durable power of attorney for health care designates another person, typically a family member or friend, whom the patient wishes to make medical decisions if he or she becomes unable to do so. The designated person (known as a health care proxy) should be someone the patient knows well and trusts implicitly to make informed decisions based on what he or she would want. It is therefore crucial for the patient to discuss all of his or her preferences of various options concerning treatments, pain management, extraordinary medical procedures, etc., with the health care proxy.
Comparing advance care planning between older adults with and without HIV
Published in AIDS Care, 2023
Annie L. Nguyen, Bo Young Park, Erin Thayer, Jeff Bailey, Christopher Christensen, Jeff Taylor
Mortality rates among people living with HIV (PLWH) are decreasing and long-term survival rates are increasing (CDC, 2021). Conventionally defined among PLWH as people ages 50 and over, older PLWH accounted for about half of all PLWH in the US in 2017 (High et al., 2012). Many older PLWH encounter comorbid health conditions such as cardiovascular disease, diabetes, and cancer (Cahill & Valadez, 2013), alongside age-associated chronic conditions, like frailty, which elevated the conditions that threaten independent living (Wong et al., 2010). The health challenges that can accompany aging with HIV calls attention to the importance of advance care planning (ACP), a process of articulating preferences for end-of-life care. ACP helps providers make care decisions that are most aligned with the individual’s values and has been conceptualized as a health behavior (Fried et al., 2010). An advance directive (AD) is an ACP tool. It is comprised of a living will, a legal document that conveys healthcare wishes, and a durable power of attorney for healthcare or healthcare proxy, someone who is legally designated to make decisions for the individual. Using the Transtheoretical Model of behavior change, ACP can be characterized through the five temporal dimensions of change: (1) pre-contemplation, (2) contemplation, (3) preparation, (4) action/maintenance (Prochaska & Velicer, 1997). Health behavior programs and interventions typically aim to move individuals towards “action” and “maintenance”.
Shared decision making for patients with COVID-19 in a public training hospital in Mashhad, Iran
Published in International Journal of Healthcare Management, 2023
Saeed Mohammadpour, Mehdi Yousefi, Javad Javan-Noughabi, Tahereh Sharifi, Noureddin Niknam, Ali Khorsand Vakilzadeh, Atousa Ariafar, Nafiseh Arfa Shahidi
Determining a patient’s true wishes in the setting of COVID-19 can be challenging when potential life-preserving choices must be made emergently. Advanced directives may not be available, a health care proxy not clearly identified, or a surrogate not readily available at critical moments of decision-making [20, 26]. Given that in uncertain situations about the risks and benefits of treatment, the use of shared decision-making is recommended. During the COVID-19 pandemic, there is a compelling need to encourage participation in the SDM process, because this process will enhance patient satisfaction and reduce stress due to clinical ambiguities and thus increase the success of treatment. Despite the need to observe SDM in patients with COVID-19 due to the specific conditions of this disease, in Iran, there is no evidence to evaluate this variable and what affects it in this group of patients. As such, the present study aimed to assess the level of SDM from the perspective of COVID-19 patients and to identify the related factors to provide a corrective solution.
The COVID chronicles: An Employee Assistance Program’s observations and responses to the pandemic
Published in Journal of Workplace Behavioral Health, 2021
Daniel Hughes, Acanthus Fairley
The situation continued to escalate. By March 27th, there were over 69,000 confirmed COVID-19 cases in the USA and over 33,000 in NYS (COVID-19 Data, 2020). NYC was reporting over 20,000 cases. MSBI was caring for 80 confirmed cases, 14 in the ICU, with an additional 7 PUIs. The hospital stood up a COVID + dialysis unit while mobilizing an additional reserve of 18 ventilators. The pharmacy was reporting a shortage of Zithromax and concerns about PPE were increasing. The staff was reminded to collect health care proxy information on all incoming patients. On March 31st, the System’s Chief Medical Officer issued a broadcast notification to the staff. She stated that “every day brings new challenges in our fight against COVID-19.” She reported that on the previous afternoon, there were “1,360 COVID-19 positive patients in our hospitals” including “248 patients in our ICUs.” She went on to say that we were using 67% of our available ventilators and that an urgent request for more machines was delivered to Governor Cuomo. Our engineering staff had developed modifications so that one vent could be used for two patients. Access to and the distribution of PPE had become a critical issue. Hospitals, municipalities and states were competing against each other for supplies in a chaotic global market (Mahler & Montgomery, 2020). The outlook for April looked grim (Figure 1).