Browsing by Subject "Goals of care"

Now showing 1 - 4 of 4
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    COMPLETE (Communication Plan Early Through End of Life): Development of a Research Program to Diminish Suffering for Children at End of Life
    (Elsevier, 2021) Hendricks-Ferguson, Verna; Newman, Amy R.; Brock, Katharine E.; Haase, Joan E.; Raybin, Jennifer L.; Saini, Shermini; Moody, Karen M.; School of Nursing
    While overall survival has improved significantly for children with cancer over the past 75 years, cancer remains the leading cause of death from disease among children and adolescents. Further, despite the many advances in medical and nursing care, children with cancer still experience significant physical and emotional suffering over the course of their illness, especially at the end of life (EOL). Children endure significant rates of high-intensity medical interventions (e.g., intubation, intensive care unit admission) at the EOL despite many parents, adolescents, and young adult patients identifying home as their preferred location of death. Hospice care has the potential to ease suffering at the EOL and facilitate home deaths, and yet, most children still die in acute care settings without hospice care. Numerous barriers prevent timely enrollment in hospice among children with cancer who are in the EOL period. This report describes the development and testing of a palliative care/EOL communication intervention designed to overcome some of these barriers and subsequently improve EOL outcomes (i.e., earlier hospice enrollment, less use of high-intensity medical interventions, reduced pain and suffering) among children with cancer and their parents (i.e., less emotional distress and uncertainty, improved hope and healthcare satisfaction).
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    Identifying Goals of Care
    (Elsevier, 2020-09) Comer, Amber; Fettig, Lyle; Torke, Alexia M.; Medicine, School of Medicine
    Goals of care conversations are important but complex for clinicians caring for older adults. Although clinicians tend to focus on specific medical interventions, these conversations are more successful if they begin with gaining a shared understanding of the medical conditions and possible outcomes, followed by discussion of values and goals. Although training in the medical setting is incomplete, there are many published and online resources that can help clinicians gain these valuable skills.
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    No More Resuscitation a la Carte: Towards a Universal, Simple, Ethical, and Medically Sound Code Status Ordering
    (Wolters Kluwer, 2023-03-27) Al Faiyumi, Mohammed; Medicine, School of Medicine
    Cardiopulmonary resuscitation is a commonly performed intervention in clinical medicine and determining a patient’s code status is paramount. “Limited/partial code” has crept into medical practice throughout the years and has become an acceptable practice. We describe here a tiered, clinically sounds and ethical code status ordering that includes the main elements of resuscitation, helps with establishing goals of care, eliminates the use of “limited/partial code,” facilitates shared decision-making with patients and surrogates and is easy to communicate to healthcare team members.
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    Role of continuous renal replacement therapy in management of the preliver transplant patient
    (Wolters Kluwer, 2025) Yenebere, Priya; Kubal, Chandrashekhar A.; Jan, Muhammad Yahya; Medicine, School of Medicine
    Purpose of review: Highlight the importance of acute kidney injury (AKI) among liver transplant candidates, its importance of survival and the vital role of continuous renal replacement therapy (CRRT) as a supportive therapy. Recent findings: Kidney dysfunction is common in the preliver transplant patient. Early recognition, broad diagnostic work up, and therapeutic interventions are vital in minimizing morbidity and mortality in this critically ill group of patients. Liver dysfunction can impact kidney function in multiple ways, leading to worsening of clinical illness. High mortality and poor prognosis in those with AKI without CRRT and Liver Transplant are highlighted. Summary: Etiology of AKI may not be as important as is the potential for liver transplant (LT) listing in offering CRRT. Non eligibility for a LT does not by default imply non eligibility for CRRT. Multidisciplinary approach should be adopted among those with a need for CRRT in the setting of end-stage liver disease. Goals of care conversations are key, in evaluating the role of CRRT in this group of individuals as they have a very high risk of mortality.