Media Watch 554

Attached is the current issue of Media Watch (#554).

 

Of particular interest in this week's issue:

Palliative care patients’ quality of dying and circumstances of death: Comparison of informal caregivers’ and healthcare professionals’ estimates

AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE | Online – 8 March 2018 – Patient-reported outcomes are usually considered to be the gold standard assessment. However, for the assessment of quality of dying and death, ratings of informal caregivers (ICGs) or health-care professionals (HCPs) must be considered for ethical and methodological reasons. The findings [of this study] appear to show a high satisfaction with quality of dying and death as rated by ICGs and HCPs, but the authors suspect this might be indicative of a methodological challenge, that is, a ceiling effect in both assessments. Single low scoring items may provide important clues for improvement in end-of-life care. Although descriptive data show comparable mean values and standard deviations, the actual congruence of ratings is low. Replacing one rating by another cannot be recommended. 

 

No one said he was dying: Families’ experiences of end-of-life care in an acute setting

AUSTRALIAN JOURNAL OF ADVANCED NURSING, 2018;35(3):21-31. This study identified key actions for nurses and doctors in providing a best practice approach to caring for the dying person. Firstly, allowing families time to prepare for their loved ones death by identifying that the person is dying and family as soon as possible. Families need to be involved in the conversations, and have information, including prognosis, explained to them. Clinicians should be sensitive, use plain language and avoid euphemisms, with follow up to ensure the family understands. Secondly, there is potential for ambiguity and uncertainty at the end of life. Clinicians should explain the prognosis and that the dying process varies between individuals. This must be honestly and openly acknowledged, and discussed with patients, substitute decisionmakers, families and carers. Finally, families of people who are dying also need care from the treating team, both during the dying process and following the death. There is a need to ensure there is support for the family with their grief responses and to identify those that are at risk of complicated grief. In order to address these priorities all members of the interdisciplinary team should receive education and training to prepare them for having conversations about end-of-life care. 

 

Barriers to advance care planning in end-stage renal disease: Who is to blame, and what can be done?

THE NEW BIOETHICS | Online – 7 March 2018 – Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in the authors’ hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? Through the authors’ own experience they affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without “clear and convincing evidence” of a patient’s previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting ACP early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail to recognize the need for ACP in a timely manner and lack the necessary training to provide it. The need for more training and new tools to recognize opportunities for ACP in daily practice remains unmet.