The Experts below are selected from a list of 7011 Experts worldwide ranked by ideXlab platform
Lev Inger - One of the best experts on this subject based on the ideXlab platform.
-
Factors Associated with Physician Moral Distress Caring for Hospitalized Elderly Patients Needing a Surrogate Decision-Maker: a Prospective Study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev Inger, Emily S. BurkeAbstract:Background When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. Objective To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Design Prospective survey. Participants Physicians ( n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers ( n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Main Measures Moral distress thermometer. Key Results Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Conclusions Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
-
factors associated with physician moral distress caring for hospitalized elderly patients needing a Surrogate decision maker a prospective study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev IngerAbstract:When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Prospective survey. Physicians (n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers (n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Moral distress thermometer. Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
-
Nontraditional Surrogate Decision Makers for Hospitalized Older Adults.
Medical care, 2018Co-Authors: Amber R. Comer, James E. Slaven, Lev Inger, Emily S. Burke, Annie Montz, Alexia M. TorkeAbstract:Background Without advanced preparation of legal documents, state law determines who may serve as a Surrogate decision maker for patients in hospitals. Objectives To examine the relationship characteristics associated with traditional versus nontraditional health care Surrogates who are making medical decisions for patients in hospitals. Research design Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study. Subjects In total, 364 patient/Surrogate dyads consisting of patients aged 65 years and older admitted to the medical or medical intensive care unit services who lacked decision-making capacity based on a physician assessment and also had a Surrogate available. Results This study of Surrogate decision makers for hospitalized older adults found that the relationships of nontraditional Surrogates such as, nieces, nephews, and friends serving in the Surrogate role is nearly identical to those of traditional, first degree relatives serving as a Surrogate. Over two-thirds (71.2%) of nontraditional Surrogates saw the patient in-person at least weekly compared with 80.8% of legal Surrogates (P-value, 0.9023). Almost all traditional and nontraditional Surrogates discussed the patient's medical preferences with the patient (96.9% of legal Surrogates and 89.2% of nontraditional Surrogates; P=0.0510). Conclusions This study shows that both traditional and nontraditional Surrogates, who are a patient's primary care giver have similar relationships with patients. The findings of this study suggest that requiring family members such as grandchildren to take the extra step of formal appointment through a legal channel may not be necessary to protect patients. Therefore, broader state laws expanding the list of Surrogates authorized by state statute to include more nontraditional Surrogates may be necessary.
Emily S. Burke - One of the best experts on this subject based on the ideXlab platform.
-
Factors Associated with Physician Moral Distress Caring for Hospitalized Elderly Patients Needing a Surrogate Decision-Maker: a Prospective Study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev Inger, Emily S. BurkeAbstract:Background When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. Objective To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Design Prospective survey. Participants Physicians ( n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers ( n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Main Measures Moral distress thermometer. Key Results Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Conclusions Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
-
Nontraditional Surrogate Decision Makers for Hospitalized Older Adults.
Medical care, 2018Co-Authors: Amber R. Comer, James E. Slaven, Lev Inger, Emily S. Burke, Annie Montz, Alexia M. TorkeAbstract:Background Without advanced preparation of legal documents, state law determines who may serve as a Surrogate decision maker for patients in hospitals. Objectives To examine the relationship characteristics associated with traditional versus nontraditional health care Surrogates who are making medical decisions for patients in hospitals. Research design Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study. Subjects In total, 364 patient/Surrogate dyads consisting of patients aged 65 years and older admitted to the medical or medical intensive care unit services who lacked decision-making capacity based on a physician assessment and also had a Surrogate available. Results This study of Surrogate decision makers for hospitalized older adults found that the relationships of nontraditional Surrogates such as, nieces, nephews, and friends serving in the Surrogate role is nearly identical to those of traditional, first degree relatives serving as a Surrogate. Over two-thirds (71.2%) of nontraditional Surrogates saw the patient in-person at least weekly compared with 80.8% of legal Surrogates (P-value, 0.9023). Almost all traditional and nontraditional Surrogates discussed the patient's medical preferences with the patient (96.9% of legal Surrogates and 89.2% of nontraditional Surrogates; P=0.0510). Conclusions This study shows that both traditional and nontraditional Surrogates, who are a patient's primary care giver have similar relationships with patients. The findings of this study suggest that requiring family members such as grandchildren to take the extra step of formal appointment through a legal channel may not be necessary to protect patients. Therefore, broader state laws expanding the list of Surrogates authorized by state statute to include more nontraditional Surrogates may be necessary.
Susan E. Hickman - One of the best experts on this subject based on the ideXlab platform.
-
Factors Associated with Physician Moral Distress Caring for Hospitalized Elderly Patients Needing a Surrogate Decision-Maker: a Prospective Study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev Inger, Emily S. BurkeAbstract:Background When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. Objective To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Design Prospective survey. Participants Physicians ( n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers ( n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Main Measures Moral distress thermometer. Key Results Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Conclusions Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
-
factors associated with physician moral distress caring for hospitalized elderly patients needing a Surrogate decision maker a prospective study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev IngerAbstract:When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Prospective survey. Physicians (n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers (n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Moral distress thermometer. Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
James E. Slaven - One of the best experts on this subject based on the ideXlab platform.
-
Factors Associated with Physician Moral Distress Caring for Hospitalized Elderly Patients Needing a Surrogate Decision-Maker: a Prospective Study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev Inger, Emily S. BurkeAbstract:Background When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. Objective To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Design Prospective survey. Participants Physicians ( n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers ( n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Main Measures Moral distress thermometer. Key Results Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Conclusions Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
-
factors associated with physician moral distress caring for hospitalized elderly patients needing a Surrogate decision maker a prospective study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev IngerAbstract:When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Prospective survey. Physicians (n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers (n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Moral distress thermometer. Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
-
Nontraditional Surrogate Decision Makers for Hospitalized Older Adults.
Medical care, 2018Co-Authors: Amber R. Comer, James E. Slaven, Lev Inger, Emily S. Burke, Annie Montz, Alexia M. TorkeAbstract:Background Without advanced preparation of legal documents, state law determines who may serve as a Surrogate decision maker for patients in hospitals. Objectives To examine the relationship characteristics associated with traditional versus nontraditional health care Surrogates who are making medical decisions for patients in hospitals. Research design Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study. Subjects In total, 364 patient/Surrogate dyads consisting of patients aged 65 years and older admitted to the medical or medical intensive care unit services who lacked decision-making capacity based on a physician assessment and also had a Surrogate available. Results This study of Surrogate decision makers for hospitalized older adults found that the relationships of nontraditional Surrogates such as, nieces, nephews, and friends serving in the Surrogate role is nearly identical to those of traditional, first degree relatives serving as a Surrogate. Over two-thirds (71.2%) of nontraditional Surrogates saw the patient in-person at least weekly compared with 80.8% of legal Surrogates (P-value, 0.9023). Almost all traditional and nontraditional Surrogates discussed the patient's medical preferences with the patient (96.9% of legal Surrogates and 89.2% of nontraditional Surrogates; P=0.0510). Conclusions This study shows that both traditional and nontraditional Surrogates, who are a patient's primary care giver have similar relationships with patients. The findings of this study suggest that requiring family members such as grandchildren to take the extra step of formal appointment through a legal channel may not be necessary to protect patients. Therefore, broader state laws expanding the list of Surrogates authorized by state statute to include more nontraditional Surrogates may be necessary.
Lucia D. Wocial - One of the best experts on this subject based on the ideXlab platform.
-
Factors Associated with Physician Moral Distress Caring for Hospitalized Elderly Patients Needing a Surrogate Decision-Maker: a Prospective Study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev Inger, Emily S. BurkeAbstract:Background When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. Objective To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Design Prospective survey. Participants Physicians ( n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers ( n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Main Measures Moral distress thermometer. Key Results Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Conclusions Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.
-
factors associated with physician moral distress caring for hospitalized elderly patients needing a Surrogate decision maker a prospective study
Journal of General Internal Medicine, 2020Co-Authors: Lucia D. Wocial, Paul R. Helft, James E. Slaven, Kianna Montz, Patrick O. Monahan, Susan E. Hickman, Christopher M. Callahan, Greg A. Sachs, Lev IngerAbstract:When working with Surrogate Decision-Makers, physicians often encounter ethical challenges that may cause moral distress which can have negative consequences for physicians. To determine frequency of and factors associated with physicians’ moral distress caring for patients requiring a Surrogate. Prospective survey. Physicians (n = 154) caring for patients aged 65 years and older and their Surrogate Decision-Makers (n = 362 patient/Surrogate dyads). Patients were admitted to medicine or medical intensive care services, lacked decisional capacity and had an identified Surrogate. Moral distress thermometer. Physicians experienced moral distress in the care of 152 of 362 patients (42.0%). In analyses adjusted for physician, patient, and Surrogate characteristics, physician/Surrogate discordance in preferences for the plan of care was not significantly associated with moral distress. Physicians were more likely to experience moral distress when caring for older patients (1.06, 1.02–1.10), and facing a decision about life-sustaining treatment (3.58, 1.54–8.32). Physicians were less likely to experience moral distress when caring for patients residing in a nursing home (0.40, 0.23–0.69), patients who previously discussed care preferences (0.56, 0.35–0.90), and higher Surrogate ratings of emotional support from clinicians (0.94, 0.89–0.99). Physicians’ internal discordance when they prefer a more comfort-focused plan than the patient is receiving was associated with significantly higher moral distress (2.22, 1.33–3.70) after adjusting for patient, Surrogate, and physician characteristics. Physician moral distress occurs more frequently when the physician is male, the patient is older or requires decisions about life-sustaining treatments. These findings may help target interventions to support physicians. Prior discussions about patient wishes is associated with lower distress and may be a target for patient-centered interventions.