Abstract
Coppola KM, Strohmetz DB: Teaching end-of-life decision making “Newlywed style.” Death Stud 2016;40:147–153.
Teaching strategies utilized for topics related to death and dying are often journaling, reflection, and group discussions. This study describes an innovative demonstration in which pairs of students made hypothetical medical decisions using a technique similar to the one used on the American game show, “The Newlywed Game.” One hundred students at a private mid-Atlantic University participated in the study evaluating the impact of this demonstration on raising students' awareness of issues surrounding medical decision making and the need to clearly communicate one's desires to others. The authors conclude that this active demonstration helps students learn about difficult issues in a meaningful way.
Unger KM: Withdrawal of ventilatory support at home on hospice. J Pain Symptom Manage 2016 [Epub ahead of print]; DOI: 10.1016/j.jpainsymman.2016.03.004.
When ventilatory support is withdrawn in an intensive care unit (ICU), the place of death for most patients is the hospital. However, the majority of terminally ill patients prefer to die at home. Few articles have addressed taking adult mechanically ventilated patients home from the ICU for withdrawal of ventilatory support (WVS). The objective of this retrospective chart review of 14 patients who had WVS at home was to determine the outcomes of a protocol-driven program of WVS in the home under hospice care. All subjects were mechanically ventilated ICU patients referred to hospice with a request for WVS to be performed in the patient's home. A protocol/checklist guided care. Medical records were reviewed to obtain demographic and medical information, particularly with duration of mechanical ventilation, the use of premedication, level of consciousness at the time of WVS, symptoms following WVS, pharmacologic measures used for symptom control after WVS, and survival time after WVS. Results demonstrated that at the time of WVS, five patients were awake or arousable and nine were stuporous or comatose. Ten patients required no medication before WVS; only four required medications for symptom control after WVS. Median survival after WVS was 18.15 hours. In all cases, symptomatic control was judged to be excellent. The author concludes that successful WVS and a natural death at home are possible with logistic support from the hospice organization and the expertise of the hospice team guided by a comprehensive protocol/checklist.
Supiano KP, Andersen TC, Haynes LB: Sudden-on-chronic death and complicated grief in bereaved dementia caregivers: Two case studies of complicated grief group therapy. J Social Work End Life Palliat Care 2016;11:267–282.
Caring for a person with Alzheimer's disease is challenging and often has negative health and mental health effects that, for 7%–20% of caregivers, persist into bereavement in the form of complicated grief. Complicated grief is a state of prolonged and ineffective mourning. An under-recognized phenomenon in dementia care and bereavement is “sudden-on-chronic death.” In these situations, the caregiver is preparing for a gradual dying process from dementia, but the care recipient dies instead from a sudden death. In this study, an application of complicated grief group therapy for bereaved dementia caregivers with complicated grief is presented, and the effect of therapy with two bereaved caregivers who experienced the sudden death of their spouses who had a diagnosis of dementia is described. The authors note that the unique treatment elements of complicated grief group therapy facilitated resolution of the ‘trauma-like” features of bereavement and progression to a healthy grief process.
Best M, Butow P, Olver I: Doctors discussing religion and spirituality: A systematic literature review. Palliat Med 2016;30:327–337.
Discussion of religion and/or spirituality in the medical consultation is desired by patients and known to be beneficial. However, it is infrequent. The authors aimed to identify why this is so by answering the following research questions: (1) Do doctors report that they ask their patients about religion and/or spirituality and how do they do it? (2) According to doctors, how often do patients raise the issue of religion and/or spirituality in consultation and how do doctors respond when they do? (3) What are the known facilitators and barriers to doctors asking their patients about religion and/or spirituality? The authors searched nine databases from inception to January 2015 for original research articles reporting doctors' views on discussion of religion and/or spirituality in medical consultations. Articles were assessed for quality using QualSyst and results were reported using a measurement tool to assess systematic review guidelines. Results demonstrated that overall, 61 eligible articles were identified, comprising more than 20,044 physician reports. Religion and spirituality were discussed infrequently by physicians, although frequency increased with terminal illness. Many physicians preferred chaplain referral to discussing religion and/or spirituality with patients themselves. Such discussions were facilitated by prior training and increased physician religiosity and spirituality. Insufficient time and training were the most frequently reported barriers. The authors conclude that this review found that physician inquiry into the religion and/or spirituality of patients is inconsistent in frequency and nature, and that to meet patient needs, barriers to discussion need to be overcome.
Hupcey JE, Kitko L, Windy A: Patients' perceptions of illness severity in advanced heart failure. J Hosp Palliat Nurs 2016;18:110–114.
Heart failure impacts almost 6 million Americans. Complicating the high prevalence of heart failure is a five-year mortality rate approaching 50%. Moreover, patients with advanced heart failure face greater risk of death and rehospitalization. However, little progress has been made in the use of palliative or end-of-life services. To help determine why patients may not be receiving services, this study describes the perceptions of illness severity and terminality of advanced heart failure patients during the terminal course of the disease. One hundred individuals were interviewed and asked to describe their disease and where they see themselves in one year. For participants who died during the study, services utilized at end of life were documented. Results demonstrated that the majority of participants did not understand the severity or the terminality of heart failure. Of the 51 participants who died, only 14% perceived heart failure as terminal, and regardless of predicted survival, few patients were offered palliative care services. By virtue of their education, nurses are perfectly situated to provide basic palliative care. Envisioning palliative care as a philosophy of care, delivered by all healthcare providers, would lead to incorporating supportive interventions from diagnosis to end of life even without acceptance of disease terminality.
McLoughlin K, McGilloway S, Lloyd R, et al.: Walls, wisdom, worries, and wishes: Engaging communities in discussion about death, dying, loss, and care using Café Conversation. Prog Palliat Care 2016;24:9–14.
This article reflects on the adaptation of the World Café concept to engage with members of the public in Compassionate Communities Café Conversation, focusing on enabling people to understand the importance of thinking and talking about the end of life. The approach enables people to come together to share their experience and ideas, wisdom, worries, and wishes. The seven design principles of the World Café are central to the process, together with the sharing of resources developed to engage people in discussion as well as practical activity. This article outlines the preparation, presentation, and pilot evaluation of the Compassionate Communities Café Conversation experience in two towns in the Mid-West of Ireland. The experience and findings suggest that this approach offers a potentially very useful framework for use by others as part of a health-promoting approach to palliative care.