End Of Life

From Anvita Health Wiki

Contents 1 Notes 2 More General Terms 3 Additional Terms 4 References

Notes

• end-of-life medical expenditures exceed costs of prior care & are likely to be unsustainable [6]
• US hospitals vary widely on their use of resources for end of life care.
• prevalence of pain increases rapidly in the last few months of life, regardless of the cause of death [3]
• advanced dementia is consistently associated with severe disability in the last year of life [5]
• end-of-life care discussions with patients with advanced cancer often come late in the course of the disease [7]
  

• No support for belief that cancer patients can delay their death for an important event. [2]
  
• Spiritual & existential concerns of patients at end-of-life

• past

• value & meaning of person's life
• worth of relationships
• value of previous achievements
• painful memories or shame
• guilt about failures, unfulfilled aspirations

• present

• diruption of personal integrity
• physical, psychologic, & social changes
• increased dependency
• meaning of person's life
• meaning of suffering

• future

• impending separation
• hopelessness
• meaninglessness
• death

• religion

• strength of faith
• a life lived without disgrace to the faith
• existence of afterlife

More General Terms

• geriatrics

Additional Terms

• death
• hospice
• impending death
• palliative care

References

1. Journal Watch 24(9):75, 2004 Wennberg JE, Fisher ES, Stukel TA, Skinner JS, Sharp SM, Bronner KK. Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States. BMJ. 2004 Mar 13;328(7440):607. <PubMed> PMID: [1] <Internet> [2]
2. Journal Watch 25(2):15, 2005 Young DC, Hade EM. Holidays, birthdays, and postponement of cancer death. JAMA. 2004 Dec 22;292(24):3012-6. PMID: [3]
3. Physician's First Watch, Nov 2, 2010 Massachessetts Medical Society [4] Smith AK et al The Epidemiology of Pain During the Last 2 Years of Life Annals of Internal Medicine 2010, 153:563-569 <PubMed> PMID: [5] <Internet> [6]
4. Curtis JR and Vincent J-L. Ethics and end-of-life care for adults in the intensive care unit. Lancet 2010 Oct 16; 376:1347. PMID: [7]
5. Gill TM, Gahbauer EA, Han L, Allore HG. Trajectories of disability in the last year of life. N Engl J Med 2010 Apr 1; 362(13):1173-1180. PMID: [8]
6. Kelley AS et al. Determinants of medical expenditures in the last 6 months of life. Ann Intern Med 2011 Feb 15; 154:235 PMID: &dopt=Abstract
7. Mack JW et al. End-of-life care discussions among patients with advanced cancer: A cohort study. Ann Intern Med 2012 Feb 7; 156:204. PMID: [9]
8. National Guideline Clearinghouse
   - NIH State-of-the-Science Conference Statement on improving end-of-life care. ngc-guideline: [10]
   - Evidence-based practice guideline. Family preparedness and end of life support before the death of a nursing home resident. University of Iowa Gerontological Nursing Interventions Research Center, Research Translation and Dissemination Core ngc-guideline: [11]
   - End of life care during the last days and hours. Registered Nurses' Association of Ontario (RNAO) ngc-guideline: [12]

end of life