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Journal articles on the topic 'End-of-life choice'

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Author: Grafiati
Published: 9 March 2023
Last updated: 10 March 2023

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1

Kirby, Roger. "Choice at the end of life?" Trends in Urology & Men's Health 9, no. 1 (January 2018): 4. http://dx.doi.org/10.1002/tre.612.

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2

Nasser, Norman, Nadia J. Pruett, Jason Sawyer, and Amy E. Nolen. "Supporting patient choice at end of life." Canadian Medical Association Journal 194, no. 28 (July 24, 2022): E990—E992. http://dx.doi.org/10.1503/cmaj.220338.

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3

Drought, Theresa S., and Barbara A. Koenig. ""Choice" in End-of-Life Decision Making." Gerontologist 42, suppl_3 (October 1, 2002): 114–28. http://dx.doi.org/10.1093/geront/42.suppl_3.114.

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4

Colenda, C. C. "Patient Choice and End-of-Life Decisions." American Journal of Geriatric Psychiatry 11, no. 1 (February 1, 2003): 113–14. http://dx.doi.org/10.1176/appi.ajgp.11.1.113.

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5

Wilkinson, Dominic. "Safeguarding choice at the end of life." Journal of Medical Ethics 41, no. 8 (July 24, 2015): 575–76. http://dx.doi.org/10.1136/medethics-2015-102990.

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6

Betteley, Adrienne. "Giving people choice at the end of life." International Journal of Palliative Nursing 18, no. 10 (October 2012): 472–73. http://dx.doi.org/10.12968/ijpn.2012.18.10.472.

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7

Froggatt, Katherine. "‘Choice over care at the end of life’." Journal of Research in Nursing 10, no. 2 (March 2005): 189–202. http://dx.doi.org/10.1177/174498710501000205.

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8

Chumbley, Karen. "O-18 Delivering choice in end of life care." BMJ Supportive & Palliative Care 5, Suppl 3 (November 2015): A79.2—A79. http://dx.doi.org/10.1136/bmjspcare-2015-001026.220.

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9

MacCallum, Annie. "The Ultimate Choice: An end-of-life care conference." British Journal of Cardiac Nursing 3, no. 7 (July 2008): 330–31. http://dx.doi.org/10.12968/bjca.2008.3.7.30505.

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10

Williams, J. "Ensuring Quality and Choice in End of Life Care." BMJ Supportive & Palliative Care 1, no. 1 (June 1, 2011): 66. http://dx.doi.org/10.1136/bmjspcare-2011-000053.2.

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11

MEEKER, MARY ANN, and MARY ANN JEZEWSKI. "Family decision making at end of life." Palliative and Supportive Care 3, no. 2 (June 2005): 131–42. http://dx.doi.org/10.1017/s1478951505050212.

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Objective: To enhance understanding of the phenomenon of family surrogate decision-making at the end of life (EOL) by means of a systematic review and synthesis of published research reports that address this phenomenon.Methods: Garrard's (1999) methods for conducting a systematic review of the literature were followed. Fifty-one studies focusing on family decision-making experiences, needs, and processes when assisting a dying family member were selected following electronic database searches and ancestry searches.Results: In studies using hypothetical scenarios to compare patients' choices and surrogates' predictions of those choices, surrogates demonstrated low to moderate predictive accuracy. Increased accuracy occurred in more extreme scenarios, under conditions of forced choice, and when the surrogate was specifically directed to use substituted judgment. In qualitative explorations of their perspectives, family members voiced their desire to be involved and to accept the moral responsibility attendant to being a surrogate. Quality of communication available with providers significantly influenced family satisfaction with decision-making and EOL care. Group or consensual decision-making involving multiple family members was preferred over individual surrogate decision-making. Surrogates experienced long-term physical and psychological outcomes from being decision-makers.Significance of results: Functioning as a surrogate decision-maker typically places great moral, emotional, and cognitive demands on the family surrogate. Clinicians can provide improved care to both patients and families with better understanding of surrogates' needs and experiences.
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12

Nazarko, Linda. "Bowel care at end of life." British Journal of Community Nursing 28, no. 3 (March 2, 2023): 138–42. http://dx.doi.org/10.12968/bjcn.2023.28.3.138.

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Most people, given a choice prefer to die at home. As death approaches the dying person may say “please let me die at home, in my own bed”. Many relatives promise their loved ones that they can remain at home until the end. One issue that can cause great distress and at times lead to unnecessary hospital admission is poorly managed bowel care. This article will examine how ageing, illness and medication can affect bowel function and quality of life.
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13

D’Errico, Ellen M. "Teaching Facilitation of Patient Choice at the End of Life." Journal of Nursing Education 52, no. 2 (March 1, 2013): 120. http://dx.doi.org/10.3928/01484834-20130123-11.

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14

Sullivan, Mark D. "The Illusion of Patient Choice in End-of-Life Decisions." American Journal of Geriatric Psychiatry 10, no. 4 (July 2002): 365–72. http://dx.doi.org/10.1097/00019442-200207000-00003.

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15

Orentlicher, D. "The illusion of patient choice in end-of-life decisions." JAMA: The Journal of the American Medical Association 267, no. 15 (April 15, 1992): 2101–4. http://dx.doi.org/10.1001/jama.267.15.2101.

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16

Orentlicher, David. "The Illusion of Patient Choice in End-of-Life Decisions." JAMA: The Journal of the American Medical Association 267, no. 15 (April 15, 1992): 2101. http://dx.doi.org/10.1001/jama.1992.03480150107047.

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17

Singleton, Carol. "Choice and fairness are key to end of life care." Nursing Standard 25, no. 28 (March 16, 2011): 32. http://dx.doi.org/10.7748/ns.25.28.32.s45.

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18

Fischhoff, Baruch, and Amber E. Barnato. "Value Awareness: A New Goal for End-of-life Decision Making." MDM Policy & Practice 4, no. 1 (January 2019): 238146831881752. http://dx.doi.org/10.1177/2381468318817523.

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The principal policy tool for respecting the preferences of patients facing serious illnesses that can prompt decisions regarding end-of-life care is the advance directive (AD) for health care. AD policies, decision aids for facilitating ADs, and clinical processes for interpreting ADs all treat patients as rational actors who will make appropriate choices, if provided relevant information. We review barriers to following this model, leading us to propose replacing the goal of rational choice with that of value awareness, enabling patients (and, where appropriate, their surrogates) to be as rational as they can and want to be when making these fateful choices. We propose approaches, and supporting research, suited to individuals’ cognitive, affective, and social circumstances, resources, and desires.
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19

Natsume, Maika, Kiyotaka Watanabe, Satoko Matsumoto, Daisuke Naruge, Kazuhiko Hayashi, Junji Furuse, Masafumi Kawamura, et al. "Factors Influencing Cancer Patients' Choice of End-of-Life Care Place." Journal of Palliative Medicine 21, no. 6 (June 2018): 751–65. http://dx.doi.org/10.1089/jpm.2017.0481.

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20

Callahan, Daniel. "End-of-Life Care: A Philosophical or Management Problem?" Journal of Law, Medicine & Ethics 39, no. 2 (2011): 114–20. http://dx.doi.org/10.1111/j.1748-720x.2011.00581.x.

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Early in 1970, just as we were organizing The Hastings Center, we had to decide which issues on a long menu of possibilities should receive our early attention. At the top of our list was end-of-life care. Complaints about care for the dying had mounted during the 1960s, fueled by technological progress in sustaining life, by too many patients abandoned by physicians as they lay dying, by a lack of patient choice on how their lives should end, and by woefully inadequate pain management. After a few years of study, the care of the dying seemed to admit of a solution: giving patients more choice by the use of living wills or appointment of a surrogate, improving the training of physicians to better deal with death and discussion with patients, and creating a hospice movement and greatly enhanced palliative care.
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21

Cassidy, Helen, Adam Sims, and Susanna Every-Palmer. "Psychiatrists’ views on the New Zealand End of Life Choice Act." Australasian Psychiatry 30, no. 2 (March 4, 2022): 254–61. http://dx.doi.org/10.1177/10398562221077889.

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Objective This cross-sectional survey aimed to establish the views and intentions of New Zealand (NZ) psychiatrists regarding their role as competence assessors in the NZ End of Life Choice Act (‘Act’). Some questions were replicated from a pre-existing Ministry of Health workforce survey regarding the Act, for comparative analysis between psychiatrists and other health professionals. Methods The survey was disseminated via email to all NZ psychiatrists registered with the Royal Australia and NZ College of Psychiatry and promoted by snowballing methods to reach non-members. Results There were similar (moderate) levels of understanding of the Act, compared to other health professionals. Psychiatrists show similar levels of support for assisted dying as other health professionals (55% and 47%, respectively), however psychiatrists are significantly less likely to be willing to provide assisted dying services than other health professionals. Concerns were raised regarding the challenges faced by psychiatrists and need for more clarity around the psychiatrist’s role. Conclusions Few NZ psychiatrists were willing to be involved with the Act. There was a perceived lack of information around a psychiatrist’s role, responsibilities and legal protections. Further guidance is needed regarding the concept of capacity in assisted dying and the factors that challenge these assessments.
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22

Geddis, Andrew. "New Zealand votes on end of life choice and cannabis legalisation." Australian Health Review 44, no. 6 (2020): 819. http://dx.doi.org/10.1071/ahv44n6_ed4.

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23

ROSENBERGER, NANCY. "Final Days: Japanese Culture and Choice at the End of Life." American Anthropologist 108, no. 4 (December 2006): 906–8. http://dx.doi.org/10.1525/aa.2006.108.4.906.

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24

Glasper, Alan. "The Government's progress in promoting choice in end-of-life care." British Journal of Nursing 26, no. 22 (December 14, 2017): 1256–57. http://dx.doi.org/10.12968/bjon.2017.26.22.1256.

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25

Tucker, Kathryn L., and Fred B. Steele. "Patient Choice at the End of Life: Getting the Language Right." Journal of Legal Medicine 28, no. 3 (September 18, 2007): 305–25. http://dx.doi.org/10.1080/01947640701554427.

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26

Marquis, Don. "Abortion and the Beginning and End of Human Life." Journal of Law, Medicine & Ethics 34, no. 1 (2006): 16–25. http://dx.doi.org/10.1111/j.1748-720x.2006.00004.x.

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How can the abortion issue be resolved? Many believe that the issue can be resolved if, and only if, we can determine when human life begins. Those opposed to abortion choice typically say that human life begins at conception. Many who favor abortion choice say that we will never know when human life begins. The importance of the when-does-human-life-begin issue is not so much argued for as it is taken to be self-evident. Furthermore, belief that this issue is fundamental is taken for granted – at least outside of philosophy – by many of the people who seem to disagree about almost everything else concerning abortion. It has been my experience that – with rare exceptions – even those who insist that the issue of abortion should focus on the interests of pregnant women believe that this focus is warranted because fetuses are either not yet fully alive or not yet fully human.
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27

Wilson, F., M. Gott, and C. Ingleton. "Perceived risks around choice and decision making at end-of-life: A literature review." Palliative Medicine 27, no. 1 (October 12, 2011): 38–53. http://dx.doi.org/10.1177/0269216311424632.

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Background: the World Health Organization identifies meeting patient choice for care as central to effective palliative care delivery. Little is known about how choice, which implies an objective balancing of options and risks, is understood and enacted through decision making at end-of-life. Aim: to explore how perceptions of ‘risk’ may inform decision-making processes at end-of-life. Design: an integrative literature review was conducted between January and February 2010. Papers were reviewed using Hawker et al.’s criteria and evaluated according to clarity of methods, analysis and evidence of ethical consideration. All literature was retained as background data, but given the significant international heterogeneity the final analysis specifically focused on the UK context. Data source: the databases Medline, PsycINFO, Assia, British Nursing Index, High Wire Press and CINAHL were explored using the search terms decision*, risk, anxiety, hospice and palliative care, end-of-life care and publication date of 1998–2010. Results: thematic analysis of 25 papers suggests that decision making at end-of-life is multifactorial, involving a balancing of risks related to caregiver support; service provider resources; health inequalities and access; challenges to information giving; and perceptions of self-identity. Overall there is a dissonance in understandings of choice and decision making between service providers and service users. Conclusion: the concept of risk acknowledges the factors that shape and constrain end-of-life choices. Recognition of perceived risks as a central factor in decision making would be of value in acknowledging and supporting meaningful decision making processes for patients with palliative care needs and their families.
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28

Lamas, Daniela, and Lisa Rosenbaum. "Freedom from the Tyranny of Choice — Teaching the End-of-Life Conversation." New England Journal of Medicine 366, no. 18 (May 3, 2012): 1655–57. http://dx.doi.org/10.1056/nejmp1201202.

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29

Wilson, Fiona, Christine Ingleton, Merryn Gott, and Clare Gardiner. "HOW DO PERCEPTIONS OF RISK SHAPE 'CHOICE' IN END-OF-LIFE CARE?" BMJ Supportive & Palliative Care 4, Suppl 1 (March 2014): A28.2—A28. http://dx.doi.org/10.1136/bmjspcare-2014-000654.77.

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30

Robinson, Louise, Julian Hughes, Sarah Daley, John Keady, Clive Ballard, and Ladislav Volicer. "End-of-life care and dementia." Reviews in Clinical Gerontology 15, no. 2 (May 2005): 135–48. http://dx.doi.org/10.1017/s0959259806001833.

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In the UK, research continues to confirm that people with certain chronic illnesses, such as chronic lung disease and cardiac failure, represent the ‘disadvantaged dying’ compared to those with terminal cancer. But what is the situation for people dying with advanced dementia and what is the experience of their carers? Practical guidance for clinicians is scarce. In Standard 7 of the National Service Framework for Older People, which covers mental health, there is mention neither of how care should be provided nor of how patient choice should be ensured for people with dementia at the end of life. In the UK, 5% of the population aged 65 and over and 20% of those aged 80 and over have dementia similar prevalence figures are found in the USA. Current predictions suggest that the number of people with dementia will increase by 40% by 2026 and will double by 2050. The increased demand for end-of-life care for people with dementia will be associated with major social and economic costs, but what is the current standard of such care? How can the quality be improved? And how should future services be configured to cope with this increasing need? In this paper, we review current knowledge around end-of-life care in dementia, discuss the clinical challenges and ethical dilemmas presented to carers, consider the difficulties in delivering such care and suggest practical approaches to improve the quality of such care.
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31

Yang, Liu (Cathy), Olivier Toubia, and Martijn G. de Jong. "Attention, Information Processing, and Choice in Incentive-Aligned Choice Experiments." Journal of Marketing Research 55, no. 6 (December 2018): 783–800. http://dx.doi.org/10.1177/0022243718817004.

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In incentive-aligned choice experiments, each decision is realized with some probability, Prob. In three eye-tracking experiments, we study the impact of varying Prob from 0 (as in purely hypothetical choices) to 1 (as in real-life choices) on attention, information processing, and choice. Consistent with the bounded rationality literature, we find that as Prob increases from 0 to 1, consumers process the choice-relevant information more carefully and more comprehensively. Consistent with the psychological distance literature, we find that as Prob increases from 0 to 1, consumers become less novelty seeking and more price sensitive. These findings underscore that even with incentive alignment, preference measurement choice experiments such as choice-based conjoint analyses only represent an approximation of real-life choices. Although it is not feasible to systematically use questions with high Prob in the field, we predict and find that placing a higher probability question (such as an external validity task) at the beginning rather than the end of a questionnaire has a carryover effect on attention and information processing throughout the questionnaire, and it influences preference estimates as well.
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32

Fenton, Wendy. "Inpatient care at end of life is a positive choice for some." Nursing Standard 25, no. 24 (February 16, 2011): 32. http://dx.doi.org/10.7748/ns.25.24.32.s44.

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33

Nakano, Lynne Y. "Final Days: Japanese Culture and Choice at the End of Life (review)." Journal of Japanese Studies 33, no. 1 (2007): 239–43. http://dx.doi.org/10.1353/jjs.2007.0029.

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34

Krakauer, Randall. "Invictus: Increasing Patient Choice in Advanced Illness and End-of-Life Care." Frontiers of Health Services Management 27, no. 3 (2011): 43–48. http://dx.doi.org/10.1097/01974520-201101000-00006.

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35

Thomas, Keri. "Matters of life and death: the new Government report on choice in end-of-life care." British Journal of Community Nursing 21, no. 10 (October 2, 2016): 528–30. http://dx.doi.org/10.12968/bjcn.2016.21.10.528.

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36

Reed, Frances M., Les Fitzgerald, and Melanie R. Bish. "Rural District Nursing Experiences of Successful Advocacy for Person-Centered End-of-Life Choice." Journal of Holistic Nursing 35, no. 2 (May 5, 2016): 151–64. http://dx.doi.org/10.1177/0898010116646643.

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Choices in care during the end stages of life are limited by the lack of resources and access for rural people. Nursing advocacy based on the holistic understanding of people and their rural communities may increase the opportunity for choice and improve the quality of care for people living and dying at home. Pragmatism and nurse agency theory were used for a practical exploration of how district nurses successfully advocate for rural Australian end-of-life goals to begin the development of a practice model. In two stages of data collection, rural district nurse informants ( N = 7) were given the opportunity to reflect on successful advocacy and to write about their experiences before undertaking further in-depth exploration in interviews. They defined successful advocacy as “caring” that empowers people in the “big and small” personal goals important for quality of life. The concepts described that enable successful advocacy were organized into a network with three main themes of “willing” investment in holistic person-centered care, “knowing” people and resources, and feeling “supported.” The thematic network description provides deep insight into the emotional skill and moral agency involved in successful end-of-life nurse advocacy and can be used as a sound basis for modeling and testing in future research.
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37

Stajduhar, Kelli I. "Burdens of Family Caregiving at the End of Life." Clinical & Investigative Medicine 36, no. 3 (June 1, 2013): 121. http://dx.doi.org/10.25011/cim.v36i3.19722.

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A patient’s ability to be cared for and to die at home is heavily dependent upon the efforts of family caregivers. Considerable stresses are associated with such caregiving, including physical, psychosocial and financial burdens. Research has shown that unmet needs and dissatisfaction with care can lead to negative outcomes for caregivers. While many family caregivers also report caregiving as life-enriching, some report that they would prefer alternatives to care at home, primarily because of these associated burdens. Little is known about which interventions are most effective to support family caregivers ministering palliative care at home. Well-designed studies to test promising interventions are needed, followed by studies of the best ways to implement the most effective interventions. Clinically effective practice support tools in palliative home care are warranted to identify family caregiver needs and to ensure that patients and their family caregivers have a choice about where care is provided.
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38

Waller, Amy, Rob Sanson-Fisher, Scott D. Brown, Laura Wall, and Justin Walsh. "Quality versus quantity in end-of-life choices of cancer patients and support persons: a discrete choice experiment." Supportive Care in Cancer 26, no. 10 (May 3, 2018): 3593–99. http://dx.doi.org/10.1007/s00520-018-4226-x.

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39

Whitty-Rogers, Joanne, Marion Alex, Cathy MacDonald, Donna Pierrynowski Gallant, and Wendy Austin. "Working with Children in End-of-Life Decision Making." Nursing Ethics 16, no. 6 (November 2009): 743–58. http://dx.doi.org/10.1177/0969733009341910.

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Traditionally, physicians and parents made decisions about children’s health care based on western practices. More recently, with legal and ethical development of informed consent and recognition for decision making, children are becoming active participants in their care. The extent to which this is happening is however blurred by lack of clarity about what children — of diverse levels of cognitive development — are capable of understanding. Moreover, when there are multiple surrogate decision makers, parental and professional conflict can arise concerning children’s ‘best interest’. Giving children a voice and offering choice promotes their dignity and quality of life. Nevertheless, it also presents with many challenges. Case studies using pseudonyms and changed situational identities are used in this article to illuminate the complexity of ethical challenges facing nurses in end-of-life care with children and families.
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40

Borgstrom, Erica. "Planning for an (un)certain future: Choice within English end-of-life care." Current Sociology 63, no. 5 (July 13, 2015): 700–713. http://dx.doi.org/10.1177/0011392115590084.

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41

Shah, Koonal K., Aki Tsuchiya, and Allan J. Wailoo. "Valuing health at the end of life: A stated preference discrete choice experiment." Social Science & Medicine 124 (January 2015): 48–56. http://dx.doi.org/10.1016/j.socscimed.2014.11.022.

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42

Burt, Robert A. "The Medical Futility Debate: Patient Choice, Physician Obligation, and End-of-Life Care." Journal of Palliative Medicine 5, no. 2 (April 2002): 249–54. http://dx.doi.org/10.1089/109662102753641223.

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43

Fischer, Barbara, Harry Telser, and Peter Zweifel. "End-of-life healthcare expenditure: Testing economic explanations using a discrete choice experiment." Journal of Health Economics 60 (July 2018): 30–38. http://dx.doi.org/10.1016/j.jhealeco.2018.06.001.

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44

Karasz, Alison, Galit Sacajiu, Misha Kogan, and Liza Watkins. "The Rational Choice Model in Family Decision Making at the End of Life." Journal of Clinical Ethics 21, no. 3 (September 1, 2010): 189–200. http://dx.doi.org/10.1086/jce201021302.

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45

Turley, Alan, Emma B. Larson, Jenny Silver, and Catherine Klingler. "Religious Preference and Hospice Choice." OMEGA - Journal of Death and Dying 81, no. 2 (May 2, 2018): 319–29. http://dx.doi.org/10.1177/0030222818774205.

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This article will employ a database from a large hospice provider with offices in 16 states to examine the impact of religious preference on hospice choice. Little work has been done on this issue, even though religion is the only social institution that specifically addresses the end of life. Hospice work, in particular, has drawn little attention despite it effecting millions of patients and their families. Of all the medical subspecialties, hospice is one of the most effected by society’s views on death and religious views of dying. It is also the only government-funded medical service that requires religious support be made available to patients. Our hypothesis is that certain religious groups have a predisposition against end-of-life interventions and will be less likely to utilize hospice. This impacts a multibillion dollar a year industry that supplies hospice service to millions of patients, and our research points to one major religious group not accessing their hospice benefit at the same rate as other denominations.
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46

Salt, Susan, and Laura Edwards. "P-92 A snapshot of choice around end of life care from one community." BMJ Supportive & Palliative Care 5, Suppl 3 (November 2015): A33.2—A33. http://dx.doi.org/10.1136/bmjspcare-2015-001026.92.

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47

Djulbegovic, Benjamin, Athanasios Tsalatsanis, Rahul Mhaskar, Iztok Hozo, Branko Miladinovic, and Howard Tuch. "Improving Hospice Referral: Application of Regret-Based Decision Modeling at End-of-Life Care." Blood 128, no. 22 (December 2, 2016): 535. http://dx.doi.org/10.1182/blood.v128.22.535.535.

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Abstract Introduction: Terminally ill patients are often faced with the decision to forgo potentially life-prolonging treatment or to accept hospice care leading to a peaceful death. The decision process in such situations is heavily affected by emotions, chief among them is regret. Modern cognitive science increasingly accepts a dual processing approach to human cognition which takes into account both emotion-based (type 1) and analytical-based (type 2) cognitive processing. Because regret is a human emotion (type 1), which involves counterfactual deliberations (type 2), we have previously proposed that it can activate both cognitive domains by serving as a link between type 1 and type 2 processes and therefore help with end of life decisions more precisely than other decision making methodologies. Here, we report the application of a regret-based model built to facilitate referral to hospice while helping patients clarify their preferences related to how they wish to spend the remaining days of their lives. Methods: Between March 2013 to December 2015, we conducted a prospective cohort study at the Tampa General Hospital and the Moffitt Cancer Center that enrolled 178 consecutive adult patients aware of the terminal nature of their disease. Eligible patients were those who were at the point in their care where they had to decide between continuing potentially "curative/life-prolonging" treatment (Rx) or accepting hospice care. The study was broken down into 4 steps. First, we computed the patient's probability of survival at 6 months using a validated Palliative Performance Score (PPS-based) predictive model. This probability was communicated to patients as i. percentage, ii. pictorial, and iii. life expectancy in days. Then, we used the Dual Visual Analog Scale technique (DVAS) to elicit patient preferences towards continuing current treatment vs. accepting hospice care. The first scale in DVAS measured the levels of regret of omission (RGO) (e.g. failure to reap hospice benefits and incurring treatment harms) while the second scale measured regret of commission (RGC) (e.g. incurring harms from hospice and failing to provide potential benefits of treatment). The ratio RGO/RGC was used to compute the threshold probability at which a patient is indifferent between accepting hospice care or continuing current treatment. Each patient's threshold was contrasted against the previously estimated survival probability to suggest a patient specific management plan, which was later compared with the patient's actual choice. The final step of the study involved asking each patient a series of qualitative questions to evaluate the usefulness of the regret model in the hospice referral process. Results: 96% (171/178) of the patients found the information provided by the model helpful; 90% (160/178) stated that it will influence their care decision. 85% (151/178) of the patients agreed with the model's recommendations to either accept hospice care or continue with current treatment [p<0.000001]. The regret model predicted the actual choices for 72% (128/178) of patients [p <0.00001]. Logistic regression analysis showed that people who were initially inclined to be referred to hospice and were predicted to choose hospice over disease-directed treatment by the regret model had close to 98% probability of choosing hospice care at the end of their lives. No other factors (age, gender, race, educational status and pain level) affected the patient actual choice. Conclusions: To our knowledge, this is the first formal study in which helping patient clarify their preferences enabled them to make actual choices with high level of satisfaction. The regret model was well received by patients and its recommendations were largely accepted. We found that people suffering from a terminal disease who are initially inclined to choose hospice and do not regret such a choice will select hospice care with high level of certainty. We conclude that using the regret model to elicit patient choices is both descriptively and prescriptively valid and can be easily implemented in the actual practice. Disclosures No relevant conflicts of interest to declare.
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48

Jindal, SK. "End of Life Care: A Curricular and Practice Need." Journal of Postgraduate Medicine, Education and Research 46, no. 3 (2012): 117–21. http://dx.doi.org/10.5005/jp-journals-10028-1027.

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ABSTRACT End of life (EOL) care is a subset of palliative care during the terminal phase of an illness. It primarily aims to provide psychosocial supports and symptomatic relief employing a step-ladder approach to management of physical pain, breathlessness and other distressing symptoms. Futile aggressive and invasive treatments are either withheld or withdrawn. The EOL care accepts the principles of stopping disease-modifying therapy after all possible reversible factors of the illness are excluded. It does not imply the non-use of curative treatment whenever it is considered useful. In case of the ‘double-effect’ of a drug, it gives preference to symptomrelieving over the harmful effects, which are accepted as of secondary importance. EOL care is governed by well established moral principles and individual's freedom of choice. It allows the normal and natural process of death to happen for an incurable and end-stage disease. How to cite this article Jindal SK. End of Life Care: A Curricular and Practice Need. J Postgrad Med Edu Res 2012;46(3): 117-121.
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Storey, Les, Pauline Callagher, Douglas Mitchell, Robert Addison-Jones, and Wendy Bennett. "Extending choice over where patients with motor neurone disease receive end-of-life care." British Journal of Neuroscience Nursing 2, no. 10 (December 2006): 493–98. http://dx.doi.org/10.12968/bjnn.2006.2.10.22532.

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50

Ebunoluwa, Oduwole. "Ethical case deliberation involving the end of life decision." Bangladesh Journal of Bioethics 3, no. 1 (June 11, 2012): 23–29. http://dx.doi.org/10.3329/bioethics.v3i1.10869.

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End of life decisions involving the patients who are in unbearable, intense suffering are often not easy to make especially when there are moral dilemmas or conflicts. The patient, physician and care givers may have to come together to decide on a reasonable course of action. However, in arriving at a moral course of action a moral conflict may arise between all concerned parties. In resolving such a conflict there is a need to adopt a method. Here, a brief set of questions has been used as a method that can help to structure a case deliberation following a set of carefully separated steps. This paper adopts the Nijmegen method of case deliberation to analyse a case that involves a moral conflict. In addition to the method adopted the paper gives a careful consideration to the cultural underpinnings of the case. The choice of this method does not indicate that it is the best of all existing method but that the whole exercise is an attempt to point out how a moral conflict may arise in a case and how such conflict can be resolved by using a structured method. DOI: http://dx.doi.org/10.3329/bioethics.v3i1.10869 Bangladesh Journal of Bioethics 2012; 3(1):23-29
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