Journal of pain and symptom management
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J Pain Symptom Manage · Dec 2020
Case ReportsCan Orthodox Jewish Patients Undergo Palliative Extubation? A Challenging Ethics Case Study.
According to Jewish law/ethics, continuous life-sustaining therapy may not be withdrawn after its introduction, unless the patient has improved and no longer has a medical indication for the treatment. We report the case of an 88-year-old Orthodox Jewish patient, on invasive mechanical ventilation, with severe anoxic brain injury after multiple cardiac arrests. Although the patient's son informed the palliative care team that his father did not want to be in pain or to linger in a vegetative state when terminally ill, the mechanical ventilation was keeping him alive with a poor neurological prognosis. ⋯ Following intermediation by the hospital Rabbi, the definition of what would be a "reasonable expectation" and "reasonable amount of time" was established by the family Rabbi as "over 50%" and "on the order of hours," respectively. Following pulmonary consultation, the patient underwent palliative extubation and, 12 hours after the procedure, died comfortably surrounded by the family. In conclusion, the collaborative and interdisciplinary work among the family Rabbi, hospital Rabbi, and the various medical teams allowed the development of a plan that met all of the patient's personal and religious wishes and beliefs.
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J Pain Symptom Manage · Dec 2020
Observational StudyHow COVID-19 Changed Advance Care Planning: Insights from the West Virginia Center for End-of-Life Care.
Coronavirus disease 2019 (COVID-19) led to increased attention nationally on advance care planning. ⋯ COVID-19 resulted in a new sense of urgency regarding advance care planning by West Virginians with increased attention to document their wishes and ensure that they were in the registry.
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J Pain Symptom Manage · Dec 2020
Randomized Controlled TrialSurrogate Decision Maker Stress in Advance Care Planning Conversations: A Mixed-Methods Analysis from a Randomized Controlled Trial.
Spokespersons serving as surrogate decision makers for their loved ones report high levels of stress. Despite known benefits, advance care planning (ACP) conversations often do not occur. More information is needed to understand spokesperson stress during ACP. ⋯ Identifying what factors impact spokesperson stress in ACP conversations can be used to help design ACP interventions to more appropriately address the needs and concerns of spokespersons.
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J Pain Symptom Manage · Dec 2020
ReviewExploring the Uptake of Advance Care Planning in Older Adults: An Integrative Review.
Advance care planning (ACP) is essential to elicit goals, values, and preferences of care in older adults with serious illness and on trajectories of frailty. An exploration of ACP uptake in older adults may identify barriers and facilitators. ⋯ Enhanced communication and ACP facilitators improve uptake of ACP. Clinicians should be cognizant of these factors. This review provides a guide for clinicians who are considering implementation strategies to facilitate ACP in real-world settings.