I have come to the conclusion that a successful systematic approach to earlier transitions from disease-directed cancer therapy to end-of-life and palliative care can only come from better communication in the context of more trusting relationships.
Of all the sad pronouncements that oncologists deliver, this may be the one that stings the most. If you were expecting hope from your doctor, how would you react to these words? Would you sit with quiet disbelief, or storm out of the office?
Survival for cancer patients in the United States ranks among the highest in the world. Despite the demonstrated success of the US cancer delivery system, government and private payers are forcing changes to the delivery of and payment model for oncology care.
It will likely not come as a surprise to anyone that the cost of cancer care is on the rise, from $104 billion in 2006 to over $173 billion in 2020. The rise in cost is driven by both the increasing cost in therapy (witness the newly approved metastatic melanoma treatment that is $120,000 for a 12-week course of therapy) and the extent of care.
One in four Americans facing end-of-life is a veteran. Because of their traumatic experiences during combat, including experiences with death, veterans with cancer and other serious illnesses can have complex healthcare needs.
This Registered Nurses' Association of Ontario (RNAO) clinical best practice guideline provide evidence-based recommendations for registered nurses and registered practical nurses on best nursing practices for end-of-life care during the last day
Advance directives (ADs) are one of the few means for patients to indicate their end-of-life (EOL) treatment option preference. An effective and consistent solution for increasing the AD completion rate remains elusive. A literature search revealed three studies completed in the United States that employed an identical methodology and focused on registered nurses (RNs). These studies examined a variety of concepts, including nurses' knowledge, attitudes, experience, and confidence with regard to ADs.|This review completed a systematic synthesis of reported results from three survey studies that focused, respectively, on oncology, critical care, and emergency RNs who were members of various professional nursing organizations.|Our investigation addressed the following research questions: What are the knowledge, attitudes, experience, and confidence of RNs with regard to ADs, and what is the relationship among these study variables? Each study used the Knowledge, Attitudes, and
Medical end-of-life decisions, defined as end-of-life practices with a potential or certain life-shortening effect, precede almost 50% of deaths in Western countries, and receive ample medical-ethical attention. This systematic review aims to detect whether there are differences in the prevalence of medical end-of-life decisions in 'vulnerable' patient groups. In 2009, five major databases were scrutinized for publications containing original data on the prevalence of euthanasia/physician-assisted suicide, life-ending without explicit patient request, intensified symptom alleviation, non-treatment decisions and palliative sedation by social factors (eg age, gender and SES). Heterogeneous findings were pooled using a random effects model. We identified 6377 papers of which 51 papers were selected, involving over 1.09 million patients. Most publications reported the prevalence of non-treatment decisions. The most studied social factors were age and gender. Among patients older than
William S. Breitbard, MD, acting chair at the department of psychiatry and behavioral sciences and chief of psychiatry service at Memorial Sloan-Kettering Cancer Center, discusses how to have an effective end-of-life conversation with a patient.