Journal of palliative medicine
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Many patients who are in the last phase of life use multiple medications that are continued until shortly before they ultimately die. Little is known about physicians' opinions and experiences regarding medication discontinuation at the end of patients' lives. ⋯ Although physicians agree that patients use too many medications at the end of life, they quite regularly seem to give patients medications for chronic diseases, for which the benefit at the end of life may be debatable. More scientific evidence on whether or not these types of medication might be discontinued in the last phase of life is needed.
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Many older patients with a limited life expectancy experience fragility fracture of the hip, and this event is associated with increased risk of premature mortality, functional decline, and institutionalization. The treating team, in collaboration with patients and their families, must determine whether a surgical or conservative approach is in the patient's best interest when a patient has limited life expectancy. ⋯ We propose that physicians caring for patients with limited life expectancy and fragility fracture of the hip should initiate a goals of care discussion to help determine whether operative repair will be the most patient-centered approach. Training on conducting goals of care discussions should be a standard part of surgical training programs. Goals of care discussions should include prognosis, patient values and preferences, pain, likelihood for functional recovery, and burdens and benefits of surgical versus nonsurgical management. Multidisciplinary input is required, and many patients will benefit from geriatric and/or palliative care team involvement.
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While following patients' advance directives (ADs) is legally binding, French physicians in Intensive Care Unit (ICU) perceive them as complicating their decision. Decision making and ICU residents benefit from personalizing the dying process. In France, ADs can include personal information. ⋯ Personalizing ADs of an unknown patient leads ICU residents to be less prone to follow them, but does not affect whether or not they decide to consult the patient's family. Hence, promoting shared decision making by including the incapacitated patients' families in treatment decisions is a major challenge, especially in countries such as France, where ADs are legally binding.