Abstract
Alfakhri AS, Alsudukhi AWE, Alqahtani AA, et al. Depression among caregivers of patients with dementia. Inquiry 2018;1:1–6.
The authors of this study attempted to assess depressive symptoms in caregivers of patients with dementia, taking into account variables such as severity of dementia, sex, age, and financial state of the patient. They recruited 222 caregivers of patients with dementia from King Abdulaziz Medical City, Saudi Alzheimer's Disease Association, and online, from February to June 2017, and employed the Patient Health Questionnaire to assess depression and the Blessed Dementia Scale to assess severity of dementia. Results demonstrated that the prevalence of clinical depression among the caregivers was 14.9%. Minimal symptoms of depression were experienced by 96 caregivers (43.2%), moderate by 45 (20.3%), moderate-severe by 15 (6.8%), and severe by 8 (3.6%). Forty-six patients had mild dementia (22%), 73 had moderate (34.9%), and 90 had severe (43.1%). The authors conclude that caregivers of patients with dementia experience considerable burden and lower level of health-related quality of life and may be predisposed to developing clinical depression.
Laurent A, Bonnet M, Capellier G, et al. Emotional impact of end-of-life decisions on professional relationships in the ICU: An obstacle to collegiality? Crit Care Med 2017;45:2023–2030.
End-of-life decisions are not only common in the intensive care unit (ICU) but also frequently elicit strong feelings among healthcare professionals. Even though clinicians seek to develop more collegial interprofessional approaches to care and health decision making, there are many barriers to successfully managing complex decisions. The aim of this qualitative study was to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU. The setting for the study was two independent ICUs at the “Centre Hospitalier de l'Université de Montréal.” Interviews with ten physicians and ten nurses were completed. Results suggested that during the end-of-life decision-making process, nurses' feelings toward their patients and physicians' feelings toward their patients' families influence the decisions they make. Although these emotional dimensions allow nurses and physicians to act in a manner that is consistent with their professional ethics, the professionals themselves seem to have a poor understanding of these dimensions and often overlook them, thus hindering collegial decisions.
Hoyland-Scafe CA, Kramer BJ. Preparedness for death: How caregivers of elders with dementia define and perceive its value. Gerontologist 2017;57:1093–1102.
The purpose of this study was to ascertain how bereaved caregivers of a family member who died from a dementia-related diagnosis (1) define preparedness and (2) perceive its value. Purposive criterion sampling was used to identify 30 bereaved caregivers of family members aged 65 years and older who died with a dementia-related diagnosis. In-depth qualitative interviews were conducted over a 12-month period, and qualitative content analysis was used to analyze the data. Results demonstrated that one-third (n = 10) of caregivers interviewed were prepared for the death, and the majority who were prepared were enrolled in hospice. Five primary themes revealed ways that caregivers define various domains of preparedness: (1) accepting reality, (2) knowing death is near, (3) getting your “house in order”, (4) saying “what you need to say”, and (5) giving “permission” to die. The majority (87%) believed that it is important for caregivers to be prepared, and the value of preparedness was exemplified in five domains reflecting the benefits of being prepared. The authors conclude that the results of their study support further attention to the development and testing of interventions to address the unmet needs of caregivers of family members with dementia to help prepare them for the death in a variety of contexts.
Gaston NR, Randall JM, Kiesel LR. Physician-assisted suicide and Midwest social workers: Where do they stand? J Soc Work End Life Palliat Care 2018;14:73–92.
Physician-assisted suicide (PAS) is explicitly legal in five states and by court decision in 1. Legislative bills have been introduced in other states, including Minnesota, Iowa, and Wisconsin. This quantitative study was designed to understand Midwest, hospice, and palliative care at end-of-life social workers' attitudes toward PAS, preferred terminology, perception of preparedness for the implementation, and awareness of PAS legislation in their state. Sixty-two social workers from Minnesota, Iowa, and Wisconsin completed an anonymous online survey. The results indicated that over one-half of the participants supported PAS legislation and is consistent with previous research on social workers across the country. While there was a range of perceived preparedness for implementation, a majority felt moderately to very prepared. Professional and personal values, as well as professional experience, influenced their perceived preparedness. Few social workers had accurate awareness of PAS legislation in their state or had attended workshops/events for further education or as a policy advocate. To practice competently and advocate at all levels of practice, hospice and palliative care at end-of-life social workers need to understand their own attitudes and values toward PAS and pursue additional education around this ethical issue.
Russell JA, Epstein LG, Bonnie RJ, et al. Lawful physician-hastened death: AAN position statement. Neurology 2018;90:420–422.
In 1998, the American Academy of Neurology (AAN) published its prior position on physician-hastened death, titled “Assisted suicide, euthanasia, and the neurologist.” In that statement, the AAN expressed its vigorous opposition to its members' participation in either PAS (prescription without clinician administration) or euthanasia (prescription with clinician administration). At that time, physician participation in either of these hastened-death practices was illegal in all U.S. jurisdictions except Oregon. However, in consideration of the Ethics, Law, and Humanities Committee recommendations, the AAN Board of Directors carefully deliberated this important issue, taking into account the evolving legal environment, all aspects of the ethical debate, the reported values of AAN members, and expectations of their adult patients dying of neurologic illness. Accordingly, the AAN has decided to retire its 1998 position on “Assisted suicide, euthanasia, and the neurologist” and to leave the decision of whether to practice or not to practice lawful physician-hastened death (LPHD) to the conscientious judgment of its members acting on behalf of their patients. The Ethics, Law, and Humanities Committee and the AAN make no attempt to influence an individual member's conscience in consideration of participation or nonparticipation in LPHD. Although the AAN endorses the belief that LPHD decision making is ideally made within a well-established patient/doctor relationship, it places no obligation on its members to identify another physician willing to participate should their conscience preclude them from participation. The AAN remains opposed to member participation in euthanasia, which remains illegal in all U.S. jurisdictions, regardless of its legal status in the jurisdiction in which an AAN member may practice.
Lapierre S, Dransart DAC, St-Amant K, et al. Religiosity and the wish of older adults for physician-assisted suicide. Religions 2018;9:66.
In industrialized countries, population aging is associated with intense discussions on the issue of dying with dignity. Some countries have legalized assisted suicide and authorized physicians to provide the knowledge and/or means for suffering patients to end their life. The goal of this study was to ascertain if religiosity could be a predicting factor of older adults' wish for PAS. A sample of 216 men and women over 60 years (M = 72.5) answered the following question: “Would you disagree or agree with assisted suicide for yourself if you were very sick and would die in the near future?” They also completed questionnaires on religiosity, ageism, and death anxiety. A regression analysis showed that religiosity explained a significant (p < 0.001) proportion of the variance in the wish for PAS. The authors conclude that religiosity seems to reduce the likelihood that older adults would ask for PAS if they had a terminal illness, while ageism and death anxiety seemed to have the opposite effect. They also suggest that health professionals and legislators must be aware that psychosocial and spiritual variables have an important influence on the wish for PAS.