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Nancy L Keating - One of the best experts on this subject based on the ideXlab platform.
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influence of peer physicians on intensity of end of life Care for cancer decedents
Medical Care, 2019Co-Authors: Nancy L Keating, Alistair J Omalley, Jukkapekka Onnela, Stacy W Gray, Bruce E LandonAbstract:Background:The intensity of End-Of-Life Care varies substantially both within and between areas. Differing practice patterns of individual physicians are likely influenced by their peers.Objective:To assess whether intensity of End-Of-Life Care previously provided by a physician’s peers influences p
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quality of end of life Care provided to patients with different serious illnesses
JAMA Internal Medicine, 2016Co-Authors: Melissa W Wachterman, Corey Pilver, Dawn Smith, Mary Ersek, Stuart R Lipsitz, Nancy L KeatingAbstract:Importance Efforts to improve End-Of-Life Care have focused primarily on patients with cancer. High-quality End-Of-Life Care is also critical for patients with other illnesses. Objective To compare patterns of End-Of-Life Care and family-rated quality of Care for patients dying with different serious illnesses. Design, Setting, and Participants A retrospective cross-sectional study was conducted in all 146 inpatient facilities within the Veteran Affairs health system among patients who died in inpatient facilities between October 1, 2009, and September 30, 2012, with clinical diagnoses categorized as end-stage renal disease (ESRD), cancer, cardiopulmonary failure (congestive heart failure or chronic obstructive pulmonary disease), dementia, frailty, or other conditions. Data analysis was conducted from April 1, 2014, to February 10, 2016. Main Outcomes and Measures Palliative Care consultations, do-not-resuscitate orders, death in inpatient hospices, death in the intensive Care unit, and family-reported quality of End-Of-Life Care. Results Among 57 753 decedents, approximately half of the patients with ESRD, cardiopulmonary failure, or frailty received palliative Care consultations (adjusted proportions, 50.4%, 46.7%, and 43.7%, respectively) vs 73.5% of patients with cancer and 61.4% of patients with dementia ( P P P = .61), but lower for patients with ESRD, cardiopulmonary failure, or frailty (54.8%, 54.8%, and 53.7%, respectively; all P ≤ .02 vs patients with cancer). This quality advantage was mediated by palliative Care consultation, setting of death, and a code status of do-not-resuscitate; adjustment for these variables rendered the association between diagnosis and overall End-Of-Life Care quality nonsignificant. Conclusions and Relevance Family-reported quality of End-Of-Life Care was significantly better for patients with cancer and those with dementia than for patients with ESRD, cardiopulmonary failure, or frailty, largely owing to higher rates of palliative Care consultation and do-not-resuscitate orders and fewer deaths in the intensive Care unit among patients with cancer and those with dementia. Increasing access to palliative Care and goals of Care discussions that address code status and preferred setting of death, particularly for patients with end-organ failure and frailty, may improve the overall quality of End-Of-Life Care for Americans dying of these illnesses.
Randall J Curtis - One of the best experts on this subject based on the ideXlab platform.
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hospital variation and temporal trends in palliative and end of life Care in the icu
Critical Care Medicine, 2013Co-Authors: Thomas W Decato, Sarah E Shannon, Ruth A Engelberg, Lois Downey, Elizabeth L Nielsen, Patsy D Treece, Anthony L Back, Erin K Kross, Randall J CurtisAbstract:A growing body of evidence demonstrates the importance of End-Of-Life Care in the ICU. The ICU is a common place of death, as approximately one fifth of all deaths in the United States occur during or soon after a stay in the ICU (1). Many studies have documented regional and interhospital variability in the intensity of treatment at the end of life, but variability in family assessments, nurse assessments, and specific quality markers for palliative and End-Of-Life Care in the ICU has not been as thoroughly examined (2–4). The Study to Understand Prognosis, Preferences, and Risks of Treatment (SUPPORT) showed that the quality of End-Of-Life Care for seriously ill hospitalized patients was poor between 1989 and 1994 with a high burden of pain and other symptoms, and many patients receiving treatments they would not choose (5). SUPPORT also found that, for 50% of the patients, physicians were unaware of preferences for intensity of Care at the end of life (5–7). Two recent trends raise the possibility that palliative and End-Of-Life Care in the ICU may have improved over time: 1) the increasing emphasis on providing palliative Care to patients in critical Care settings (8–11) and 2) findings from recent studies reporting relatively high levels of family satisfaction with Care in the ICU (12–14). Despite these important trends (15), there are few studies examining improvement in the delivery of palliative and End-Of-Life Care in the ICU over time. We were interested in examining interhospital variability and temporal trends in the quality of palliative and End-Of-Life Care in the ICU. We used data from a recent cluster-randomized trial of a quality-improvement intervention designed to improve palliative and End-Of-Life Care in the ICU (16) to ask two questions: 1) Is there significant variability across individual hospitals in the quality of End-Of-Life Care in the ICU, as defined by family and nurse ratings and by chart-based indicators of palliative Care? and 2) Is there evidence that this quality of Care has improved over time within institutions? Based on the prior literature, we hypothesized significant differences between individual hospitals and improved quality of End-Of-Life Care in the ICU over time.
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ethics and end of life Care for adults in the intensive Care unit
The Lancet, 2010Co-Authors: Randall J Curtis, Jean Louis VincentAbstract:The intensive Care unit (ICU) is where patients are given some of the most technologically advanced life-sustaining treatments, and where difficult decisions are made about the usefulness of such treatments. The substantial regional variability in these ethical decisions is a result of many factors, including religious and cultural beliefs. Because most critically ill patients lack the capacity to make decisions, family and other individuals often act as the surrogate decision makers, and in many regions communication between the clinician and family is central to decision making in the ICU. Elsewhere, involvement of the family is reduced and that of the physicians is increased. End-Of-Life Care is associated with increased burnout and distress among clinicians working in the ICU. Since many deaths in the ICU are preceded by a decision to withhold or withdraw life support, high-quality decision making and End-Of-Life Care are essential in all regions, and can improve patient and family outcomes, and also retention of clinicians working in the ICU. To make such a decision requires adequate training, good communication between the clinician and family, and the collaboration of a well functioning interdisciplinary team.
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nurses identification of important yet under utilized end of life Care skills for patients with life limiting or terminal illnesses
Journal of Palliative Medicine, 2010Co-Authors: Lynn F Reinke, Sarah E Shannon, Ruth A Engelberg, Danae Dotolo, Gerard A Silvestri, Randall J CurtisAbstract:Abstract Rationale: This study was designed to identify nurses' perspectives on nursing skills that are important yet under-utilized in End-Of-Life Care. Methods: A 45-item survey was administered to nurses (n = 717) in four U.S. states with a response rate of 79%. We identified skills that were endorsed by more than 60% of nurses as extremely important and also endorsed as not currently practiced by more than 25% of nurses. We used Chi square statistics to examine professional characteristics associated with ratings of End-Of-Life Care skills including practice settings, years of experience, and End-Of-Life Care education. Content analysis was used to examine nurses' responses to open-ended questions. Results: Nineteen items were endorsed as extremely important and also ranked as under-utilized. These End-Of-Life Care skills included communication skills, symptom management competencies especially those concerning anxiety and depression, and issues related to patient-centered Care systems. Four complemen...
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quality indicators for end of life Care in the intensive Care unit
Critical Care Medicine, 2003Co-Authors: Ellen B Clarke, Randall J Curtis, John M Luce, Mitchell M Levy, Marion Danis, Judith E Nelson, Mildred Z SolomonAbstract:ObjectiveThe primary goal of this study was to address the documented deficiencies in End-Of-Life Care (EOLC) in intensive Care unit settings by identifying key EOLC domains and related quality indicators for use in the intensive Care unit through a consensus process. A second goal was to propose sp
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understanding physicians skills at providing end of life Care perspectives of patients families and health Care workers
Journal of General Internal Medicine, 2001Co-Authors: Randall J Curtis, Sarah E Shannon, Marjorie D Wenrich, Jan D Carline, Donna M Ambrozy, Paul G RamseyAbstract:BACKGROUND A framework for understanding and evaluating physicians' skills at providing end of life Care from the perspectives of patients, families, and health Care workers will promote better quality of Care at the end of life.
Fiona Coyer - One of the best experts on this subject based on the ideXlab platform.
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modelling end of life Care practices factors associated with critical Care nurse engagement in Care provision
Intensive and Critical Care Nursing, 2016Co-Authors: Kristen Ranse, Patsy Yates, Fiona CoyerAbstract:Summary Objective To identify factors associated with critical Care nurses' engagement in End-Of-Life Care practices. Methods Multivariable regression modelling was undertaken on 392 responses to an online self-report survey of End-Of-Life Care practices and factors influencing practice by Australian critical Care nurses'. Univariate general linear models were built for six End-Of-Life Care practice areas. Results Six statistically significant ( p F (3, 377)=40.53, adjusted R 2 23.8%; Environmental modification F (5, 380)=19.55, adjusted R 2 19.4%; Emotional support F (10, 366)=12.10, adjusted R 2 22.8%; Patient and family centred decision making F (8, 362)=17.61 adjusted R 2 26.4%; Symptom management F (8, 376)=7.10, adjusted R 2 11.3%; and Spiritual support F (9, 367)=14.66, adjusted R 2 24.6%. Stronger agreement with values consistent with a palliative approach, and greater support for patient and family preferences were associated with higher levels of engagement in End-Of-Life Care practices. Higher levels of preparedness and access to opportunities for knowledge acquisition were associated with engagement in the interpersonal practices of patient and family centred decision making and emotional support. Conclusion This study provides evidence for interventions to address factors associated with nurse engagement to increase participation in all End-Of-Life Care practice areas.
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modelling end of life Care practices factors associated with critical Care nurse engagement in Care provision
Faculty of Health; Institute of Health and Biomedical Innovation, 2016Co-Authors: Kristen Ranse, Patsy Yates, Fiona CoyerAbstract:Objective - To identify factors associated with critical Care nurses’ engagement in End-Of-Life Care practices. Methods - Multivariable regression modelling was undertaken on 392 responses to an online self-report survey of End-Of-Life Care practices and factors influencing practice by Australian critical Care nurses’. Univariate general linear models were built for six End-Of-Life Care practice areas. Results - Six statistically significant (p < 0.001) models were developed: Information sharing F(3, 377) = 40.53, adjusted R2 23.8%; Environmental modification F(5, 380) = 19.55, adjusted R2 19.4%; Emotional support F(10, 366) = 12.10, adjusted R2 22.8%; Patient and family centred decision making F(8, 362) = 17.61 adjusted R2 26.4%; Symptom management F(8, 376) = 7.10, adjusted R2 11.3%; and Spiritual support F(9, 367) = 14.66, adjusted R2 24.6%. Stronger agreement with values consistent with a palliative approach, and greater support for patient and family preferences were associated with higher levels of engagement in End-Of-Life Care practices. Higher levels of preparedness and access to opportunities for knowledge acquisition were associated with engagement in the interpersonal practices of patient and family centred decision making and emotional support. Conclusion - This study provides evidence for interventions to address factors associated with nurse engagement to increase participation in all End-Of-Life Care practice areas.
Melissa W Wachterman - One of the best experts on this subject based on the ideXlab platform.
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quality of end of life Care provided to patients with different serious illnesses
JAMA Internal Medicine, 2016Co-Authors: Melissa W Wachterman, Corey Pilver, Dawn Smith, Mary Ersek, Stuart R Lipsitz, Nancy L KeatingAbstract:Importance Efforts to improve End-Of-Life Care have focused primarily on patients with cancer. High-quality End-Of-Life Care is also critical for patients with other illnesses. Objective To compare patterns of End-Of-Life Care and family-rated quality of Care for patients dying with different serious illnesses. Design, Setting, and Participants A retrospective cross-sectional study was conducted in all 146 inpatient facilities within the Veteran Affairs health system among patients who died in inpatient facilities between October 1, 2009, and September 30, 2012, with clinical diagnoses categorized as end-stage renal disease (ESRD), cancer, cardiopulmonary failure (congestive heart failure or chronic obstructive pulmonary disease), dementia, frailty, or other conditions. Data analysis was conducted from April 1, 2014, to February 10, 2016. Main Outcomes and Measures Palliative Care consultations, do-not-resuscitate orders, death in inpatient hospices, death in the intensive Care unit, and family-reported quality of End-Of-Life Care. Results Among 57 753 decedents, approximately half of the patients with ESRD, cardiopulmonary failure, or frailty received palliative Care consultations (adjusted proportions, 50.4%, 46.7%, and 43.7%, respectively) vs 73.5% of patients with cancer and 61.4% of patients with dementia ( P P P = .61), but lower for patients with ESRD, cardiopulmonary failure, or frailty (54.8%, 54.8%, and 53.7%, respectively; all P ≤ .02 vs patients with cancer). This quality advantage was mediated by palliative Care consultation, setting of death, and a code status of do-not-resuscitate; adjustment for these variables rendered the association between diagnosis and overall End-Of-Life Care quality nonsignificant. Conclusions and Relevance Family-reported quality of End-Of-Life Care was significantly better for patients with cancer and those with dementia than for patients with ESRD, cardiopulmonary failure, or frailty, largely owing to higher rates of palliative Care consultation and do-not-resuscitate orders and fewer deaths in the intensive Care unit among patients with cancer and those with dementia. Increasing access to palliative Care and goals of Care discussions that address code status and preferred setting of death, particularly for patients with end-organ failure and frailty, may improve the overall quality of End-Of-Life Care for Americans dying of these illnesses.
Robert D Truog - One of the best experts on this subject based on the ideXlab platform.
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improving the quality of end of life Care in the pediatric intensive Care unit parents priorities and recommendations
Pediatrics, 2006Co-Authors: Elaine C Meyer, Jeffrey P Burns, Marilyn D Ritholz, Robert D TruogAbstract:OBJECTIVE. Despite recognition that dying children and their families have unique palliative Care needs, there has been little empirical inquiry of parent perspectives to improve the quality of End-Of-Life Care and communication. The purpose of this study was to identify and describe the priorities and recommendations for endof-life Care and communication from the parents’ perspective. METHODS. This was a qualitative study based on parental responses to open-ended questions on anonymous, self-administered questionnaires, conducted at 3 pediatric ICUs in Boston, Massachusetts. Fifty-six parents whose children had died in PICUs after withdrawal of life support participated in this study. We measured parent-identified priorities for End-Of-Life Care and communication. RESULTS. Parents identified 6 priorities for pediatric End-Of-Life Care including honest and complete information, ready access to staff, communication and Care coordination, emotional expression and support by staff, preservation of the integrity of the parent-child relationship, and faith.
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parental perspectives on end of life Care in the pediatric intensive Care unit
Critical Care Medicine, 2002Co-Authors: Elaine C Meyer, Jeffrey P Burns, John L Griffith, Robert D TruogAbstract:ObjectiveTo identify priorities for quality End-Of-Life Care from the parents’ perspective.DesignAnonymous, self-administered questionnaire.SettingThree pediatric intensive Care units in Boston.ParticipantsParents of children who had died after withdrawal of life support.Measurement and Main Results
