Browsing by Subject "end of life"

Now showing 1 - 6 of 6
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    Acceptability and Feasibility of a Meaning-Based Intervention for Patients With Advanced Cancer and Their Spouses A Pilot Study
    (Sage, 2016) Wagner, Christina D.; Johns, Shelley; Brown, Linda F.; Hanna, Nasser; Bigatti, Silvia M.; Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public Health
    Background: Constructing meaning in cancer leads to improved psychosocial outcomes for patients and survivors. Aim: We tested the feasibility and preliminary efficacy of a meaning-based intervention for couples. Design: The single-arm pilot study tested a 4-session, tailored, activities-based couple’s intervention. Setting/Participants: Twelve adults with incurable cancer and their partners participated either in a university office or at the couple’s home. Results: The study showed good feasibility. One of the two patients depressed at baseline was no longer depressed at postintervention. Patients’ threat appraisals decreased and transcendence increased. In partners, depression, anxiety, and challenge appraisal decreased; threat and secondary appraisals and peace with illness increased. Conclusions: Our findings suggest feasibility and efficacy, and further research and continued evaluation of this intervention are warranted.
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    Family Members End of Life Decision Making Experiences
    (Office of the Vice Chancellor for Research, 2013-04-05) Garcia, Aiza; Carpenter, Janet S.
    Significance: The purpose of this study was to explore the experiences of individuals who accept the role of decision maker for a family member at the end of life, particularly focusing on their perspectives on their interactions with clinicians and the impact these interactions made on their decision-making process. With the completion of this study, the hopes are to develop a better understanding of the needs and of individuals making decisions for their family members at their end of life to ultimately improve the way clinicians interact with them. Objective: To understand family members’ experiences with end of life decision making including how clinicians interacted with them. Method: Individual interviews were conducted with 10 family members who contributed to making an end-of-life decision for a family member. All individuals who were 18 or older, English speaking, and willing to discuss their experiences were eligible for the study. The participants were privately interviewed over the phone. For analysis of the data, a coding scheme was constructed by selecting significant components of the family members’ experiences. The texts of the interviews were transcribed and coded allowing for the review of commonalities across the experiences. Measurements: Qualitative interviews were used to describe experiences using a semi-structured interview guide. The interview guide was developed using the Ottawa Decision Support Framework, a guide for clients to use in decision-making regarding the health or social aspects of their life. This framework allows the interview and data to focus on evaluating the needs of the individual. Main Results: Pending – data analysis is underway Conclusions: Results will be used to understand needs and improve interactions with families making end of life decisions.
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    Life and Treatment Goals of Patients with Advanced Cancer
    (Office of the Vice Chancellor for Research, 2013-04-05) Banno, Daniella; Rand, Kevin L.
    To improve the care of patients with advanced cancer who may be near the end of life, there is a pressing need to better understand their life and treatment goals, and how these relate to psychological adjustment. Patients (N=63) with incurable advanced lung or gastrointestinal cancers completed self-report measures of hope, optimism, and symptoms of anxiety and depression. Patients also participated in a semi-structured interview and were asked to list their current life and treatment goals. Then, they selected five “priority goals” from among both lists and ranked them in order of importance. Subsequently, priority goals were coded into categories such as: Life-Fulfillment (“To go to the beach”), and Life Prolongation, (“To live another 20 years”). The three most common categories were: 1) Life Fulfillment (49% of patients); 2) Social Connection (43%); and 3) Life-Prolongation (29%). Interestingly, a sizable portion of patients (22%) listed cure as a priority goal, with several (13%) indicating it was their most important goal. Counterintuitively, patients who had cure as a priority goal were neither more hopeful nor optimistic than those who did not have cure as a priority goal. Patients who listed cure as their most important goal reported significantly greater depressive symptoms, t(62) = 2.79, p = .007. In order to examine the robustness of this association a regression analysis was conducted predicting depressive symptoms. After controlling for patient age, gender, ECOG performance status, physician-rated prognosis, and patient-rated prognosis, having cure as the most important goal remained a significant predictor of greater depressive symptoms (β = .367, p = .017). These results suggest that patient life and treatment goals may have important implications for patients’ psychological adjustment. Specifically, holding on to cure as an important goal in the face of advanced disease may place patients at risk for greater psychological distress.
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    Supportive Intervention for Advanced Lung Cancer Patients and Their Partners
    (Office of the Vice Chancellor for Research, 2013-04-05) Davis, Breanna; Bigatti, Silvia M.
    In recent years, cancer has ruthlessly taken many lives. Many forms of cancer have proven to be incurable, so a good sense of well-being and significant meaning of life is important before death. Although there have been a few programs that have focused on death-related concerns of dying patients, none have included the partner. Relationship issues have surfaced as one of the crucial concerns for patients, especially at the end of life. The stress of a patient also affects the partner’s well-being in the long run. The intention of this intervention is to lessen death-related stress for cancer patients and their partners. Cancer patients and their partners will be selected through a screening process through the Indiana University Cancer Center for a four-week intervention. The patients and partners then will take a pre-intervention assessment (Quantitative) followed by the intervention (Qualitative) itself. After the intervention, the patients and partners will take a post-intervention assessment (Quantitative). When analyzing, we will look for themes in the data and determine if the numbers have improved from the preassessment to the post-assessment. The findings from the qualitative and quantitative data will be used to assist in the improvement of cancer interventions and the updating of current practices, which will enhance its efficacy.
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    Timing of Do‐Not‐Resuscitate Orders for Hospitalized Older Adults Who Require a Surrogate Decision‐Maker
    (2011-07) Torke, Alexia M.; Sachs, Greg A.; Helft, Paul R.; Petronio, Sandra; Purnell, Christianna E.; Hui, Siu; Callahan, Christopher M.
    OBJECTIVES: To examine the frequency of surrogate decisions for in-hospital do-not-resuscitate (DNR) orders and the timing of DNR order entry for surrogate decisions. DESIGN: Retrospective cohort study. SETTING: Large, urban, public hospital. PARTICIPANTS: Hospitalized adults aged 65 and older over a 3-year period (1/1/2004–12/31/2006) with a DNR order during their hospital stay. MEASUREMENTS: Electronic chart review provided data on frequency of surrogate decisions, patient demographic and clinical characteristics, and timing of DNR orders.
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    What Should We Learn From Early Hemodialysis Allocation About How We Should Be Using ECMO?
    (AMA, 2019-05) Gutteridge, Daniel; bosslet, Gabriel T.; Medicine, School of Medicine
    Early hemodialysis allocation deliberations should inform our current considerations of what constitutes reasonable uses of extracorporeal membrane oxygenation. Deliberative democracy can be used as a strategy to gather a plurality of views, consider criteria, and guide policy making.