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*
December 4th, 2011 by DrWes in News, Opinion
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A sure-to-be controversial article appears in the Chicago Tribune earlier this asking the sensitive question of ‘Health care at any age, any cost?:’
“If you want to save all lives, you’re in trouble,” said Callahan, co-founder of The Hastings Center, a bioethics research institute in New York, and a faculty member at Harvard Medical School, in an interview. “And if you want to save all lives at any cost, you’re really in trouble.”
Callahan and co-author Nuland, a retired professor of surgery at Yale School of Medicine who wrote the best-selling “How We Die,” were both 80 when the article was published.
“We need to stop thinking of medicine as an all-out war against death, because death always wins,” said Callahan.
The article goes on the make some bold demands of doctors: Read more »
*This blog post was originally published at Dr. Wes*
November 24th, 2011 by RyanDuBosar in Research
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Sending dementia patients to the hospital could overwhelm the health care system and not offer them any better care at the end of life, researchers noted.
The researchers obtained data on all hospitalizations involving a dementia diagnosis for the 85 years and older group between years 2000 and 2008 from the nationally representative Nationwide Inpatient Sample database, a part of the Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project.
Annual hospitalization data came from the U.S. Census Bureau. They projected the future volume of hospitalizations involving a dementia diagnosis in the 85 years and older group two ways, Read more »
*This blog post was originally published at ACP Internist*
November 9th, 2011 by Lucy Hornstein, M.D. in Opinion
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Cancer is a dreadful disease. Just dreadful. Make no mistake: I have tremendous respect for the awesome doctors who treat patients afflicted with it day after day. Still, paradoxically, I can’t help but notice that some of them have just as hard a time as do other doctors with caring for patients at the end of their lives. I believe a large part of their difficulty stems from the ridiculously dysfunctional either/or approach to palliative care and hospice we’re stuck with in this benighted country.
The problem is that in order to qualify for hospice, patients must not only have a certified life expectancy of less than six months, but they must also not be undergoing any active treatment for their malignancy. When you stop to think about it, though, this is actually quite discriminatory. We don’t require people on hospice with other diagnoses to discontinue their life sustaining medications. Patients with COPD are allowed to continue their bronchodilators; CHF patients don’t have to stop their ACE inhibitors and digoxin. But if a cancer patient wants to qualify for hospice, they have to forgo curative treatments like chemotherapy.
So what if the oncologists call it “palliative” chemo instead? Read more »
*This blog post was originally published at Musings of a Dinosaur*
October 31st, 2011 by RyanDuBosar in Research
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Providing information of imminent death to cancer patients does not increase pain or anxiety, but is associated with improved care and to increase the likelihood of fulfilling the principles of a good death, a Swedish study found.
Informed patients significantly more often had parenteral drugs prescribed as needed, died in his or her preferred place, and had an informed family who were offered bereavement support. There was no difference between informed and uninformed patients in control of pain, anxiety, nausea, and respiratory tract secretions, although there was a difference in management of confusion. Results appeared in the Journal of Clinical Oncology.
Since 2000, there has been an increasing focus on palliative care in Sweden, the study authors wrote. In 2001, the Swedish Government identified breakpoints for Read more »
*This blog post was originally published at ACP Hospitalist*
