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Agentic Dying
Published in Vincent La Placa, Julia Morgan, Social Science Perspectives on Global Public Health, 2023
Carlos J. Moreno-Leguizamon, Marcela Tovar-Restrepo, Ana María Medina Chavez
In most advanced economies, palliative care, as a medical discipline, has progressed immensely in the last 50 years, to the extent that there is now a marked differentiation between ‘palliative’ and ‘end-of-life’ care in the UK. Palliative care is the care needed when facing a long-term chronic or severe disease, and end-of-life care occurs, when a person is facing the ‘last year’ of life (Moreno-Leguizamon et al., 2017). In contrast to advanced economies, in low- and middle-income countries, there is still a need to recognise palliative care, end-of-life care, hospices, or alternative places to die, besides hospitals. In Colombia, death is an event that occurs in hospitals (Colombian Palliative Care Observatory, 2020).
Management of communication and swallowing at the end of life
Published in Rebecca Allwood, Working with Communication and Swallowing Difficulties in Older Adults, 2022
An end of life care plan is a useful tool to communicate the communication and swallowing needs of a dying client to family members and medical or caring staff involved in the care. The document needs to be individualised to the needs of the client and flexible enough to be changed regularly to accommodate changing symptoms during this time. A copy can be placed near the person’s bed with their consent or their families’ consent, if the client is unable, and a copy for the notes. At the end of the chapter, there is a proforma for an end of life care plan.
Community Care and Dignity
Published in Milika Ruth Matiti, Lesley Baillie, Paula McGee, Dignity in Healthcare, 2020
The DN service is committed to facilitating patient choice during end-of-life care provision, to allow all patients to die at their preferred place of care with privacy and dignity and with their symptoms controlled. Care includes daily monitoring of a patient’s condition, administration of prescribed drugs and assessment of additional support, for example, referral to the Marie Curie service (a UK-based charity delivering home care for people with cancer), and using evidence-based practice in line with national and local policies, guidelines, pathways and protocols. Bereavement visits are also offered to families.
In-hospital end-of-life care in the old: a retrospective study of intensive care unit use and do-not-resuscitate forms in patients deceased in a Belgian university hospital
Published in Acta Clinica Belgica, 2023
Felicia Bentin, Nele Van Den Noortgate, Ruth Piers
A study at the University Hospital in Ghent (Belgium) 10 years ago (in 2007–2008) showed that more than half of the patients who died in-hospital received a treatment in the ICU before dying although many of them had important underlying comorbidities [5,6]. It has been shown that aggressive care at the end of life is associated with poorer patient quality of life and worse bereavement adjustment in caregivers. Intensive care unit (ICU) use at the end of life is a measure of treatment intensity and can be used as an indicator of the quality of end-of-life care [7–9]. Advance care planning conversations ensure less aggressive care during the final stages of a patient’s life. In-hospital these advance care planning conversations result in treatment limitation decisions. Having a DNR form at the moment of death is another quality indicator for end-of-life care [8].
The prevalence and types of advance care planning use in patients with advanced cancer: A retrospective single-centre perspective, Australia
Published in Progress in Palliative Care, 2023
Arron Veltre, Andrew Broadbent, Jasotha Sanmugarajah, Amy Marshall, Mohammad Hamiduzzaman
Advance care planning (ACP) is widely reported to be of value in maintaining the patients’ autonomy, reducing patient and family anxiety, improving end-of-life care, and reducing futile or unwarranted intervention.1 The ACP is a process of discussion and documentation involving but not limited to: knowledge of disease and diagnosis, personal concern about health and care, values and goals of care, treatment and care place preferences, and proxy decision maker(s).2 Terminology and its application vary across and within countries, but ACP generally involves Advance Care Plans, Advance Care Directives, Statement of Choices, Advance Health Directives, Enduring Powers of Guardianship and/or Attorney, and Acute Resuscitation Plan.2,3 It is advocated that older adults begin ACP early, even when they are healthy, but individuals should particularly be encouraged to participate in the process when diagnosed with a life-limiting or chronic illness.4 Evidence shows both invitations to ACP and completion of documentation are effective, for example, Houben et al. (2014) reported a correlation of increased documentation and discussions about care preference with the patients’ wishes being met.5 Therefore, the ACP becomes integral to the care, communication and treatment plans for patients and their families and carers in high-income countries including Australia.
Bereaved caregivers’ satisfaction with end-of-life care
Published in Progress in Palliative Care, 2022
Abbey Frame, Janie Busby Grant, Elizabeth Layard, Brett Scholz, Eleanor Law, Kristen Ranse, Imogen Mitchell, Michael Chapman
Advances in health care have increased life expectancy and decreased the occurrence of sudden unexpected deaths.1 Simultaneously, dying has become institutionalised, with more deaths occurring in hospitals, residential aged care and other facilities, and only a small proportion dying at home.2–4 End-of-life care involves psychosocial, physical and spiritual prevention, assessment, treatment, and support for terminally ill individuals and their caregivers.5 The evolution of end-of-life care practices in Australia has resulted in care that focuses primarily on alleviating and managing physical pain and symptoms irrespective of illness, while overlooking other important elements such as preparation and acceptance of death, the existential meaning surrounding death, and the psychological and social aspects of death.6