December 19th, 2011 by RyanDuBosar in Research
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Struggling with the meaning of life is one thing. Struggling with the meaning of end-of-life directives shouldn’t be.
Physicians misidentify living wills as do-not-resuscitate (DNR) designations and DNR orders as end-of-life care directives, concluded a study. Adding code status designations to a standard advanced directive can ensure that patients receive or do not receive the care they want.
The study, “TRIAD III: Nationwide Assessment of Living Wills and Do Not Resuscitate Orders,” appeared in the Dec. 5 issue of The Journal of Emergency Medicine.
Researchers Read more »
*This blog post was originally published at ACP Hospitalist*
December 13th, 2011 by AndrewSchorr in True Stories
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Film adaptation of "Tuesdays with Morrie"
Many of you know about, or have read, the highly recommended book, Tuesdays With Morrie. I am reading it now with my 14-year-old son, Eitan, as part of an assignment for his ninth grade English class. Morrie, a college professor in Boston, was dying, withering away with ALS. Each Tuesday he would have a visit from one of his favorite former students, Mitch, a journalist from Detroit. Morrie, a man in his 70’s, mused about many things including the meaning of life and the inevitability of death. He was prepared for his end.
The other day I spoke about that book with a former high school English teacher – not Eitan’s. The circumstance was not good. The woman, 37, had been diagnosed with stomach cancer just six weeks ago. She’d been having heartburn and it wouldn’t go away. Endoscopy showed the cancer and other tests revealed its spread to her liver and lung – stage 4. The woman and her husband, her high school sweetheart, sat across from me at lunch. They have three young children, age Read more »
*This blog post was originally published at Andrew's Blog*
December 13th, 2011 by Shadowfax in Opinion
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A must-read piece from Ken Murray:
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
Worth the full read.
And so true. I’ve joked about getting the above tattoo when my times comes. (I would quibble that the modern CPR success rate is better than infinitesimal, especially with hypothermia, but it still ain’t great.)
It may have to do with Read more »
*This blog post was originally published at Movin' Meat*
December 7th, 2011 by RyanDuBosar in News, Research
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Don’t assume elderly heart failure patients are assumed to prefer improved quality of life over longevity, study authors noted. The majority of them prefer longevity over quality of life, half expressed a desire for resuscitation if needed, and it was difficult to predict individual preferences.
Researchers looked at patients’ willingness to trade survival time for quality-of-life and the preferences for among 622 heart failure patients aged 60 or older participating in the Trial of Intensified vs. Standard Medical Therapy in Elderly Patients with Congestive Heart Failure.
End-of-life preferences were assessed by using a time trade-off tool and one question concerning CPR preference. To assess time trade-off, patients were asked whether they preferred living 2 years in their current state of health or living 1 year in excellent health. If 1 year in excellent health was chosen, the patients were asked whether they would prefer 2 years in their current state of health or 6 months in perfect health. If 2 years in the current state were chosen, then they were asked whether they would prefer 2 years in their current state of health or 18 months in perfect health. The series continued until the choices were the same. This time point subtracted from 24 months derived the number of months of survival time that the patient would be willing to trade.
End-of-life preferences were assessed at baseline, and at 12 and 18 months. Read more »
*This blog post was originally published at ACP Hospitalist*
November 25th, 2011 by Bryan Vartabedian, M.D. in Opinion
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This is my 3rd year participating in The Engage with Grace Blog Rally. Engage With Grace is a movement designed to help advance the conversation about the end-of-life experience. It began with a simple idea: Create a tool to get people talking. Their tool is a slide with five questions designed to initiate dialog about our end-of-life preferences. I originally heard about Engage with Grace from Paul Levy and he’s at it again this year.
This campaign has forced me to Read more »
*This blog post was originally published at 33 Charts*
