It is known that the majority of palliative care patients would rather avoid dying in hospital. This preference is a concern that is acknowledged by healthcare providers.
The study aimed to identify the reasons for admission and death in hospital, enabling the development of plans to be put into place, to avoid this occurring in …
Cardiopulmonary resuscitation (CPR) has received frequent attention by professionals and the public in recent times. Concerns regarding the potential harms for little chance of success have caused palliative care units (PCUs) doubts about initiating CPR. However, there appears to be a moral responsibility to offer CPR to some, carefully selected, patients. Automatic external defibrillators (AEDs) have been shown to significantly increase chances of survival following CPR and are simple to use, even for nonprofessionals. It is argued that AEDs may increase the moral imperative on PCUs to offer CPR to certain patients and provide the basis for a necessary debate on where the border between appropriate active treatment and a disturbance to the aim of a peaceful death rests.
Euphemisms are frequently used to replace the words 'death' and 'dying' in the general population as well as within healthcare settings. Their use risks unclear communication leading to complaints in healthcare sectors ( Magnus, Fox, Elster, et al., 2015). The General Medical Council states: 'you must do your best to explain clinical issues in a way the person can understand'(General Medical Council. Treatment and care towards the end of life: working with the principles and decision-making models). Encouraging people to openly talk about death and dying enables them to make informed decisions about their future health care and treatment (Lakasing, 2014). Research has shown that patients and caregivers prefer communication using direct language, avoiding euphemisms (Collins, McLachlan, & Philip, 2018).
Aim
To observe the use of the 'd-words' (death/dying/died) compared to euphemisms in a hospice multi-disciplinary team.
Methods
A prospective, observational survey of language used in multi-disciplinary meetings over a two-week period across three hospices. Participants were blinded to data collection which was performed anonymously by one staff member on each site. The proportion of euphemisms were compared to 'd-words'.
Results
Multidisciplinary teams were more likely to use the 'd words' (76%; n: 241) than euphemisms (24%; n: 75). There was variation between the hospices: 39% (n:50) compared with 17% (n:20) and 7% (n:5). This could be due to differences in staff or interpretation during data collection.
Conclusion
Considering specialists in palliative care are heavily involved in discussions around death, it is unclear why 24% would opt to use euphemisms. Does this suggest fear within some professionals of talking about death openly? Are staff who use euphemisms amongst themselves more likely to use them with patients? Or by their use are staff exhibiting a sensitive approach to difficult issues? Further investigation is required to evaluate the use of euphemisms with patients and relatives and to compare across other healthcare settings.
To improve clinical and ethical understanding of patient preferences for information and involvement in decision making.To develop and evaluate a clinical tool to elicit these preferences and to consider the ethical issues raised.A before and after study.Three UK hospices.Patients with advanced life-threatening illnesses and their doctors.Questionnaire on information and decision-making preferences.Patient-based outcome measures were satisfaction with the amount of information given, with the way information was given, with family or carer information, and confidence about future decision making. Doctor-based outcome measures were confidence in matching information to patient preference, matching family or carer communication to patient preference, knowing patient preferences and matching future decision making with patient preference.Of 336 admissions, 101 patients (mean age 67.3 years, 47.5% men) completed the study (control, n = 40; intervention, n = 61). Patient satisfaction with the way information was given (chi2 = 6.38, df = 2, p = 0.041) and family communication (chi2 = 14.65, df = 2, p < 0.001) improved after introduction of the tool. Doctor confidence improved across all outcome measures (all p values < 0.001).Patient satisfaction and doctor confidence were improved by administering the questionnaire, but complex ethical issues were raised by implementing and applying this research. The balance of ethical considerations were changed by advanced life-threatening illness, because there is increased risk of harm through delivery of information discordant with the patient's own preferences. The importance of truly understanding patient preferences towards the end of life is highlighted by this study.
It was my first house job. Surgery. I was fresh out of medical school and enthusiastic, a keen but naive young doctor. Fred—we were not allowed to call her anything else—was in her 70s and came from the north east. Admitted under us with abdominal pain, she was soon found to have a large and advanced lung primary.
The prognosis was gloomy. She was awaiting a hospice bed and stayed with us on the ward for a couple …
Oliver is right that primary and secondary care should work together better.1 The joy of palliative medicine is that I work across both sectors; my experience means I have greater sympathy with my primary care colleagues than do many of those in secondary care.
With apologies to …
Cardiopulmonary resuscitation (CPR) is widely accepted as being an unsuccessful and unnecessary intervention for patients known to be dying from advanced disease. If patients with advanced terminal disease are being cared for at home, there are implications for ambulance service personnel attending emergency calls. If documentation of advance …
Mitchell and colleagues describe the importance of primary and specialist palliative care working together.1 That specialist services are “neither needed nor …
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
