Noninvasive ventilation and dyspnea in palliative medicine
PedPal Lit
2006
Nava S; Cuomo A; Maugeri FS; Selecky PA
Chest
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Patients' perspectives on physician skill in end-of-life care: differences between patients with COPD, cancer, and AIDS
Female; Male; Aged; Attitude to Death; Focus Groups; Medical; Non-U.S. Gov't; Pulmonary Disease; Human; Neoplasms/psychology; Truth Disclosure; Support; Middle Age; Ethics; Physician-Patient Relations; Terminal Care/psychology; Clinical Competence; Acquired Immunodeficiency Syndrome/psychology; Chronic Obstructive/psychology
OBJECTIVES: Patients' views of physician skill in providing end-of-life care may vary across different diseases, and understanding these differences will help physicians improve the quality of care they provide for patients at the end of life. The objective of this study was to examine the perspectives of patients with COPD, cancer, or AIDS regarding important aspects of physician skill in providing end-of-life care. DESIGN: Qualitative study using focus groups and content analysis based on grounded theory. SETTING: Outpatients from multiple medical settings in Seattle, WA. PATIENTS: Eleven focus groups of 79 patients with three diseases: COPD (n = 24), AIDS (n = 36), or cancer (n = 19). RESULTS: We identified, from the perspectives of patients, the important physician skills for high-quality end-of-life care. Remarkable similarities were found in the perspectives of patients with COPD, AIDS, and cancer, including the importance of emotional support, communication, and accessibility and continuity. However, each disease group identified a unique theme that was qualitatively more important to that group. For patients with COPD, the domain concerning physicians' ability to provide patient education stood out as qualitatively and quantitatively more important. Patients with COPD desired patient education in five content areas: diagnosis and disease process, treatment, prognosis, what dying might be like, and advance care planning. For patients with AIDS, the unique theme was pain control; for patients with cancer, the unique theme was maintaining hope despite a terminal diagnosis. CONCLUSIONS: Patients with COPD, AIDS, and cancer demonstrated many similarities in their perspectives on important areas of physician skill in providing end-of-life care, but patients with each disease identified a specific area of end-of-life care that was uniquely important to them. Physicians and educators should target patients with COPD for efforts to improve patient education about their disease and about end-of-life care, especially in the areas defined above. Physicians caring for patients with advanced AIDS should discuss pain control at the end of life, and physicians caring for patients with cancer should be aware of many patients' desires to maintain hope. Physician understanding of these differences will provide insights that allow improvement in the quality of care.
2002
Curtis JR; Wenrich MD; Carline JD; Shannon SE; Ambrozy DM; Ramsey PG
Chest
2002
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Patients with amyotrophic lateral sclerosis receiving long-term mechanical ventilation : Advance care planning and outcomes
DNAR Outcomes
Objective: To examine advance care planning and outcomes of patients with amyotrophic lateral sclerosis (ALS) receiving long-term mechanical ventilation (LTMV).Design: Case series.Setting: Population-based study in homes and chronic care facilities in four states, and Home Ventilator Program of California Kaiser Permanente.Patients: Seventy-five ALS patients receiving LTMV were identified; 11 died prior to interview, and 6 were totally locked in; 50 of 58 (86%) who were able to communicate consented to structured interviews, of whom 36 lived at home and 14 in an institution.Results: Thirty-eight patients (76%) had completed advance directives, and 96% wanted them. Thirty-eight patients wished to stop LTMV in certain circumstances, of whom 30 had completed advance directives. Those who had completed advance directives were more likely to have communicated their preference to stop LTMV to family and physician than those who had not (76 vs 29%; p=0.05). Patients living at home rated their quality of life on a 10-point scale better than those in an institution (7.2 vs 5.6; p=0.0052), and their yearly expenses were less ($136,560 vs $366,852; p=0.0018).Conclusions: Most ALS patients receiving LTMV would want to stop it under certain circumstances, and the process of advance care planning enhances communication of patient preferences to family and physicians. Home-based LTMV is less costly and associated with greater patient satisfaction.
1996-07
Moss AH; Oppenheimer EA; Casey P; Cazzolli PA; Roos RP; Stocking C; Siegler M
Chest
1996
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1378/chest.110.1.249" target="_blank" rel="noreferrer">10.1378/chest.110.1.249</a>