PROMISE Response Paper

Cultural consideration must be taken into account when discussing end-of-life issues with patients and family members. One cannot assume that cultural affiliation equals a deep connection to cultural beliefs and affiliation with one or more groups should not be used as an assumption about

11.4% of these patients families believed that they had been referred “too late” to hospice. This was associated with a general feeling of an ineffective level of care, unmet needs and lower satisfaction levels (Teno 2007).

For this study patient families were randomly assigned to the intervention or control group. In the control group the interactions between the family and ICU staff, including the end-of-life conference, occurred according to the usual practices and policies in the hospital; whereas in the intervention group, the research study was conducted according to specific guidelines. A bereavement information leaflet was given to each surrogate decision maker. In this research, the independent variable can be the type of family conference received by the surrogates and the dependent variables were the level of stress, anxiety, and depression levels indicated in the 90-day follow-up interview.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

.“As medical technology continues to advance and health care choices become more complicated, the preservation of end-of-life autonomy is an increasingly important issue faced by various client populations.” (Galambos, 1998).

A survey was conducted in 2000 on more than 9,000 patients discharged from more than 2,000 hospices on the services they received (Carlson, 2007). It revealed that 22% of them received five major palliative care services, which varied among the hospices. These palliative care services were nursing care, physician care, medication management, psychological care, and caregiver support. Approximately 14% of the hospices provided all five services and 33% provided only one or two services. Only 59% of these patients received medication management services. These included administering medication, dispensing correct dosages, and setting and following dosage schedule.

Key people could be family, doctors, carers, religious leaders etc. Each may own distinctive role to play in order for the choices and preferences of the individual to be respected and carried out. [ Every person’s end-of-life trajectory is different and needs differ in intensity and quality over time. End-of-life care must adapt to the varying and changing needs of the individual over time and that it cannot be limited to certain settings or services. The provision of good

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Great strides have been made to improve end-of-life care through palliative care and hospice programs, but sometimes that’s just not enough. In America, the care that is offered to the elderly and the chronically ill is less than ideal. Statistics show that an

The study also showed that for-profit, small and community hospitals had very limited accessibility to palliative care; and the higher request for physician assisted death came from outpatient facilities. It has been noted that palliative care practices are extremely low nationwide. Neither primary care physicians nor specialists who treat terminally ill patients routinely are provided with palliative care training. These are important facts since statistics show that although most individuals support the option for a physician-assisted suicide the low numbers of actual requests for assisted death reflected the preference of alternative treatment options. As patients regain the power of making decisions regarding their care, aggressive pain control measures are put in place; consideration of physician-assisted suicide becomes an avoidable option for a dignified death. Regardless of the views on physician-assisted death healthcare professional

Comparatively, Bailey et al. (2014) studied the effects of implementing interventions to improve end of life care for inpatient veterans. The problem statement was determined to be that end of life care in the inpatient setting was lacking, which drove the aim of the study to improve EOLC and to minimize suffering of the patients (Bailey et al., 2014). The researchers theorized that this could be accomplished if recognition of end of life was increased and if home-based palliative interventions were implemented. Therefore, the team sought to study the effectiveness of implementing staff education of three items: evaluating patients who are actively dying, communicating end of life interventions with patients and families, and implementing home-based best practices for end of life care (Bailey et al., 2014). The purpose here was to improve inpatient end of life care.

Families wanted truthful disclosure about the prognosis of a loved one and detailed explanations from healthcare providers (Dose et al., 2015). A Literature review concluded that communication at the end of life was poor, that patients were not informed about their prognosis, insufficient explanations were given to patients and their families and that busy staff were unavailable. (Robinson, Gott, Ingleton,2014). Doctors are sometimes over optimistic in diagnosing end of life which does not give patients and their families adequate time to prepare for death (Al-Qurainy, Collis, & Feuer, 2009).

The Institute of Medicine (IOM) September 2014 Report brief- Dying in America: Improving Quality and Honoring Individual Preferences near the End of Life addresses several necessities regarding end-of life (EOL) care. These necessities include; the needs and opportunities for improving EOL care, delivery of patient-centered and family-oriented care, clinician-patient communication and advance care planning, professional education and development, public education and engagement, as well as policies and payment systems to support high-quality EOL care. Taking care of the family and the patients near the end of life requires professional commitment and responsibility from all health care professionals including clinicians, clergy, caregivers, and support staff. The health system managers, payers, and policy makers also have obligation to make sure that EOL care is compassionate, affordable, sustainable, and high quality as possible. The IOM report point out that there has been a broad improvements towards the

Quality of Life and Functioning for End of Life Care. HAT2 Community Health Nursing. Western Governors University.

With an increasing aging population and growing numbers of individuals with chronic conditions, it is important for individuals to prepare for end-of-life care. An Advance Directive is a defined as a “legal document that provides data to critical care staff about patients’ wishes, especially when critical illness decreases decision-making ability” (McAdam, Stotts, Padilla, and Puntillo, 2005). An Advance Directive also allows for better communication between the patient and doctor, and preserves the autonomy of patients. It may also alleviate one’s family from any possible burden of uncertainty of one’s wishes. It provides guidance, which may avert arguments with family members concerning treatment choices (Cedars Sinai, 2015). The Patient