Media Watch 547

Attached is the current issue of Media Watch (#547).

Of particular interest in this week's issue:

Physicians’ perceptions of hope and how hope informs interactions with patients: A qualitative, exploratory study

AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE | Online – 15 January 2018 – Today some studies of physicians’ perceptions of hope are available, but not studies of how hope informs patient care. Hope was defined [by participants] as an abstract, evolving concept characterized by future-oriented wishes; offering possibilities for reframing and shaping new meaning; an attitude of positivity or optimism; an attribute of the human condition with emotional and relational roots; and, as a response to the existential inevitability of suffering and death. Three themes describing hope emerged: “assessing hope,” “fostering and sustaining hope,” and “attributes and outcomes of hope.” The findings show how physicians conceptualize hope and how these conceptions differ in the empirical light of the study. Physicians’ perceptions of “hope” may evolve when entering into a therapeutic relationship exploring the needs and desires of patients. Physicians’ perspectives about “hope” may at times not be solely their own, but are those of their patients and thus resulting in an amalgamation, or a rebuilding/rekindling of hope amidst hopelessness, that suits a particular relationship. 

Forgoing life-sustaining treatments in the ICU. To withhold or to withdraw: Is that the question?

MINERVA ANESTESIOLOGICA | Online – 17 January 2018 – In the last decades, mortality from severe acute illnesses has considerably declined thanks to the advances in intensive care medicine. Meanwhile, critical care physicians realized that life-sustaining treatments (LST) may not be appropriate for every patient, and end-of-life care in the intensive care unit (ICU) started to receive growing attention. Most deaths occurring in the ICU now follow a decision to forgo life-sustaining treatments (DFLST), which can be implemented either by withdrawing (WDLST) or withholding (WHLST) life-sustaining treatments. Despite the broad consensus about the equivalence of the two practices from an ethical point of view, the issue of the best option between WDLST and WHLST constantly gives rise to controversies in clinical practice. This review is not intended to take a stand for or against WDLST or WHLST. Based on available evidence, the definitions of the two practices are first presented. Secondly, the preferences of ICU physicians towards WDLST and WHLST are examined. Finally, some arguments are offered outlining pros and cons of WDLST and WHLST, stressing that the clinician’s attention should focus on an early and thorough recognition of patients in need of a DFLST, rather than on the theoretical strength and weakness of the two practices. This approach will enable physicians to make informed decisions on how to implement the limitation of LSTs, considering the patients’ clinical conditions and preferences, the circumstances and needs of their families.