bluuebunny/crossref_metadata_2025_split huggingface dataset:
ASSOCIATION OF TREATMENT PREFERENCES, SPIRITUAL BELIEFS AND RELIGION AMONG ADOLESCENTS INFECTED WITH HIV/AIDS PARTICIPATING IN FAMILY CENTERED (FACE) ADVANCE CARE PLANNING (ACP)
Authors: Lyon M E , Briggs L A , Gaines J , Cheng Y I , Wang J 
Published: April 2013

BackgroundAmong adults religious beliefs are associated with treatment preferences at the end-of-life (EOL). This is unknown for adolescents with HIV/AIDS.AimTo determine if spiritual beliefs, religious practices or religion are correlated with treatment preferences for end-of-life (EOL) care among adolescents with HIV/AIDS.MethodsAdolescents (N=53) aged 14 to 21 were enrolled in a 3-site, controlled, randomised clinical trial. Data were collected between 7/2011–10/2012. FACE-ACP consists of weekly, 60-min sessions: (1) Lyon Advance Care Planning Survey©; (2) Respecting Choices Interview; (3) Five Wishes©. Measures were Brief Multidimensional Measurement of Religiousness/Spirituality and Statement of Treatment Preferences. Six subjects had missing data.ResultsMean age was 18 years; 57% male; 94% African-American; 74% perinatally infected. In Situation 1 (long hospitalisation, low chance survival) 53% of adolescents reporting religion and 100% of non-religion group chose to continue treatment (p=0.0317). In Situation 2 (physical impairment) 74% of adolescents who ‘felt God's presence most days’ chose to continue treatments; 45% who did not ‘feel God's presence’ chose to continue (p=0.0426). In Situation 3 (mental impairment), there was no significant associations. Combining the three situations, 28% of religion group choose to continue treatment; 71% of non-religion group chose to continue (p=0.0364). Belief in miracles, HIV is a punishment from God, feeling abandoned by God, religious practices were not associated with treatment preferences.Conclusion/DiscussionReligious beliefs were associated with decisions to continue treatment, depending on the situation. These data begin to fill the gap in understanding the complexities of the influence of spirituality/religion on treatment preferences.
AUDIT OF RESUSCITATION PLANNING AND DOCUMENTATION AT A TERTIARY CHILDREN'S HOSPITAL OVER A 12 MONTH PERIOD
Authors: Kelly J , Herbert A , Ritchie J 
Published: April 2013

BackgroundResuscitation planning is a very important aspect of care for children with life limiting conditions.AimThis research aims to evaluate the practice of resuscitation planning at a major tertiary children's hospital.MethodsA list of patients who had died in 2011 was obtained from medical records. We collected information regarding parental demographics, patient diagnosis, the scope and timing of discussions and treatments/limitations to treatment, which were felt to be appropriate. The location of the documentation was also recorded.ResultsOf the 45 patients identified, 35 charts were available. 28 individuals had a condition carrying a poor prognosis or life limiting condition. In seven cases, death was unexpected. In 24 of 28(85.6%) charts a discussion was documented regarding end of life cares. However, only two (8.3%) of these were readily identifiable. In two cases, discussions were held more than 12 months before the child's death. When adjusted to exclude these variables, documentation was dated on average 35.6 days before death.DiscussionPatients of the Royal Children's Hospital with a life limiting condition had a documented resuscitation plan 85.6% of the time. However, this was not easily identified in 91.7% of cases. The timing of discussion varied considerably in relation to the time from resuscitation planning to death and the scope of discussion.ConclusionsThe sensitive and timely discussion of end of life cares should be undertaken and documented clearly and with a consistent manner in order to facilitate communication between all health care professionals providing care for the child. This study has identified considerable room for improvement at our institution.
PILOTING AN INTEGRATED APPROACH OF ADVANCE CARE PLANNING FOR AN ELDERLY POPULATION WITHIN A PROVINCIAL CITY
Authors: Fowler J 
Published: April 2013

BackgroundAdvance Care Planning (ACP) has been introduced into New Zealand in recent years. New Zealand National ACP Cooperative has developed ACP tools and resources. Wanganui is a provincial region (population 62 000 and above average elderly age group), and took the opportunity to take an integrated approach for piloting and implementing the Cooperatives tools.AimTo implement ACP within Wanganui region and gain sector-wide engagement and coordination (integration).MethodsThe 6 month pilot trialled the National ACP tools in primary and secondary areas; General Practitioner practice; Maori patients in a medical ward; Assessment Treatment and Rehabilitation Service; Aged Residential Care Facility. Clinical staff in the pilot areas had ACP conversations with elderly participants. Clinical staff raised ACP awareness with the general public.ResultsOf the 82 participants, 75% were interested in continuing ACP conversations (verbal and/or documented) with appropriate people for example, family/whanau; health professionals; lawyers. The pilot evaluation and recommendations identified several key areas, including outcomes and challenges that are being addressed collaboratively across the sectors. These are forming the basis for a Wanganui district wide application of ACP, that are in align with national and regional directions.DiscussionAn integrated approach has been a successful way to introduce ACP to Wanganui region stakeholders, and has enabled significant progress in a short period of time.ConclusionFindings to-date, indicate the Wanganui pilot supports an integrated approach for ACP across the specialist; primary and community services, with a common vision, shared processes and systems to improve end of life health care for the elderly.
DIGNITY OF LIFE AND PERSON-CENTRED PROCESSES FOR ADVANCE CARE PLANNING IN THE COMMUNITY
Authors: Smith C , Jaffray L , Ellis I 
Published: April 2013

BackgroundAs life expectancy increases, so do the number of elderly people living with advanced life-limiting chronic illness, including prolonging life through artificial or mechanical means. The aim of Advance Care Plans is to ensure that individual's treatment wishes and preferences are known and respected.AimWhilst research continues in regard to the development of electronic Advance Care Plans in the palliative care setting and residential aged care setting, there is a need to understand the relevance and practicality of developing Advance Care Plans for use by elderly people living with life-limiting chronic illnesses in the community.MethodsSystematic review—models of Advance Care Planning for elderly people living in the communityMeta- analysis and meta-synthesisInterviews—sample of ACP programme stakeholders and community dwelling elderly (early 2013)ResultsSeventy-one papers resulted from the search strategy with 17 papers selected for review. A meta-analysis and meta-synthesis has informed our proposed model for electronic Advance Care planning in the community—the Dignity of Life Model (a person-centred and dignity of life focussed approach). Interview data will inform the relevance and practicality of this proposed model.DiscussionThis research will assist to understand the relevance and practicality of developing an electronic Advance Care Plan (eAPC) for use by elderly people living with life-limiting chronic illnesses in the community.ConclusionProvide guidance on a model for electronic Advance Care Plan (eAPC) for use by elderly people living with life-limiting chronic illnesses in the community.
AUSTRALIAN PSYCHIATRISTS' KNOWLEDGE, ATTITUDES, AND PRACTICE IN RELATION TO ADVANCE CARE PLANNING FOR MENTAL HEALTH TREATMENT
Authors: Mountjoy R , Silvester W , Newton R , Fullam R , Mawren D 
Published: April 2013

BackgroundProposed revisions to the Victorian Mental Health Act intend to consider Advance Care Planning (ACP) in mental health treatment. No research has explored the feasibility and benefits of Psychiatric Advanced Directives (PADs) in Australia. International studies suggest that implementation of PADs can be limited by mental health clinicians' attitudes and knowledge.AimTo establish Australian psychiatrists' knowledge, attitudes and practice regarding PADs.MethodsA national online survey of Australian psychiatrists.ResultsOf 165 respondents, 56% reported low to very low knowledge of PADs and only 27% reported experience with PADs or a similar instrument. 76% of psychiatrists expressed support for the introduction of PAD legislation and 83% would be more inclined to use PADs if the law acknowledged their role as important. 79% expected that PADs will have a positive impact on mental health care, with the benefits considered to outweigh specific clinical issues such as medication refusal (54%) and limitations on patient care (64%).DiscussionAustralian psychiatrists have low levels of knowledge and experience regarding PADs. A high level of general support for PAD use and legislation was expressed.ConclusionAustralian psychiatrist expressed encouraging attitudes towards the implementation and use of PADs, and further research is required to develop an effective and sustainable model of ACP for mental health care in Australia.
TALKING WITH FAMILIES ABOUT ORGAN DONATION IN THE ICU
Authors: Truog R D 
Published: April 2013

BackgroundThere is a shortage of organs for life-saving transplants, and organ donation is an altruistic act that should be supported and encouraged. Patients may indicate their desire to be an organ donor through donor registries, but in most countries transplant coordinators still seek the assent of the family before proceeding with donation. These conversations with families are ethically challenging.AimTo explore the ethically challenging features of these conversations, in the context of talking with families about organ donation after circulatory death, or DCD.MethodsReview of the literature and of training videos that explore these ethical features.ResultsFour ethical tensions are identified:The decision to withdraw life sustaining treatment versus the decision to donate organs.Optimising the quality of the dying process versus optimising the quality and quantity of the donated organs.Obligations to provide balanced informed consent versus the belief that we should promote organ donation.Belief that we need to follow the ‘dead donor rule’ versus increasingly contrived protocols for dying and definitions of death.DiscussionAfter exploring these four ethical features, we will view segments from a video training tape that illustrate different approaches for resolving these tensions.ConclusionThe important goal of promoting organ donation needs to be pursued with awareness and sensitivity for the ethical tensions inherent in this process.
PROGNOSIS-BASED GUIDELINES FOR TREATMENT LIMITATION DECISIONS IN NEWBORN INFANTS
Authors: Wilkinson D 
Published: April 2013

Decisions to withdraw or withhold life-sustaining treatment from newborn infants are common in neonatal intensive care units (NICUs). The majority of deaths in NICU follow such treatment limitation decisions. There are professional guidelines for end of life decision-making in NICUs, however, these guidelines have been criticised. Many existing guidelines provide only vague guidance. For example, they indicate that treatment may be withheld when it is not in the best interests of an infant, but provide little assistance for clinicians in determining when this is the case. Other guidelines provide very specific criteria, for example specifying gestational age thresholds for resuscitation. However, guidelines of this nature potentially ignore other important prognostic factors.In this talk I will examine the use of explicit prognosis-based guidelines for decision-making in intensive care. Is it possible and is it desirable to derive such guidelines? I outline and defend one potential practice framework based on the concept of ‘gestational-age equivalence’.
ADVANCE CARE PLANNING AS A DYNAMIC PROCESS: A DESCRIPTIVE 1 YEAR REVIEW OF CHANGES IN ACP PLANS IN TAN TOCK SENG HOSPITAL
Authors: Ng R , Chong R , Chau H , Poi C H , Eng Ramdat J , May Y Z , Loke A , Wu H Y 
Published: April 2013

BackgroundAdvance care planning (ACP) is a process and people can change their minds about treatment preferences when goals of care change. The ACP project team in Tan Tock Seng Hospital continually audits ACP outcomes including any change in ACP plans.AimTo examine rate of change in ACP plans and factors that may have contributed to changes in ACP plans.MethodsACP outcomes for readmissions and death were analysed from retrospective audit of paper and electronic medical records.ResultsBetween October 2011 to December 2012, a total of 154 Preferred Plan of Care (PPC), a POLST-type ACP were completed with patients and/or their next-of-kin (NOK). Out of these 154 PPCs, 5 ACP plans were revised. Time lapse between creation of first and second ACP plan ranged from 3 to 91 days. One patient had decision making capacity at first and second ACP documentation, while 4 other patients had no decision making capacity at both ACP documentation. four revisions were initiated by doctors whilst one was initiated by the substitute decision maker. Two ACP plans were changed after further clarifications with NOK whilst three revisions took place when there were changes in the patients' medical condition or after trial of medical intervention. Three of the patients have since passed away.DiscussionThe number of changed ACP plans is a small fraction of the total completed. Doctors were active in continual exploration of ACP plans.ConclusionIn our cohort, ACP plans remain relatively stable. ACP is a dynamic process that need a culture of review and re-exploration of care preferences in order to be responsive to changes in medical condition and care preferences.
STARTING PILOTS IN ADVANCE CARE PLANNING IN A TERTIARY HOSPITAL IN SINGAPORE: 1 YEAR REVIEW
Authors: Ng R , Chong R , Chau H , Poi C H , Eng Ramdat J , May Y Z , Loke A , Wu H Y 
Published: April 2013

BackgroundEngagement with Respecting Choices since 2009 resulted in pilot initiatives in advance care planning (ACP) starting in hospitals and the community in Singapore since 2009. Since December 2011, a dedicated ACP project team was formed in Tan Tock Seng Hospital to support ACP pilot initiatives. These initiatives namely Preferred Plans of Care (POLST-type ACP) sprouted in the disciplines of Cardiology, Neurology, Neuro-surgery, General Medicine, Palliative Medicine, Post Acute Care at Home, Respiratory Medicine and Home Ventilation and Respiratory Support Services.AimTo audit awareness of ACP plans and congruence of patients' ACP plans with care delivery during readmission episodes and upon death.MethodsACP outcomes for readmissions and death were analysed from retrospective audit of paper and electronic medical records.ResultsFrom October 2011 to December 2012, a total of 154 preferred plans of care were completed with patients and/or next-of-kin. Five ACP plans were revised. Medical team was aware of patients' ACP plans in 75% of 67 readmissions. Medical interventions and initial place of care in event of deterioration were congruent with patients' stated preferences in 98% and 94% of readmissions respectively. Preferred place of death was honoured 74% upon death of patients.DiscussionThere was high awareness of advance care plan during readmission, and high congruence between patients' preferences and care delivery.ConclusionAdvance care planning is an effective process in honouring patients' care preferences. More can be done to examine resource allocation, sustainability and reach of the programme and to address barriers to ACP.
SURVEY OF THE ATTITUDES OF GENERAL PRACTITIONERS AND PATIENTS ABOUT DISCUSSING RESUSCITATION
Authors: Lim I , Silvester W 
Published: April 2013

BackgroundWhen confronted with acutely unwell, elderly patients, doctors often have limited knowledge about the patient's wishes for resuscitation. Providing inappropriate resuscitation causes patients to suffer, places unnecessary strain on their families and is a poor use of healthcare resources. Is the general practitioner (GP) well placed to discuss these issues with patients?GP Survey answer N=90Frequently or almost always (%)Occasionally or neverI discuss resuscitation with my patient24 (27%)66 (73%)I don't because: “lack of time”24 (36%)I don't because: “patients don't wish to talk about it”21 (32%)I don't because: “it should only be discussed near death”18 (27%)I don't because: “lack of knowledge/confidence”2 (3%)AimTo survey the practice and attitudes of GPs and patients to discussing resuscitation and identify strategies to encourage such discussion.MethodsFrom 18 April 2011 to 26 June 2011 Victorian GPs were surveyed anonymously through GP Divisions of Victoria and patients attending Ararat Medical Clinic aged over 65 were surveyed anonymously.Results90 GPs responded.Identified incentives to discuss resuscitation included: ‘knowledge that my patient wanted discussion’ 79%, ‘incorporation into management plan’ 71%, ‘discussion guidelines available’ 42%, ‘medicare item number’ 34%. Very few felt uncomfortable about the discussion or ‘not my duty’.Of 97 patients, 63% did not know what a resuscitation order was but 70% would like their GP to discuss it with them and 84% would be comfortable talking about it with family.DiscussionAlthough the majority of GPs do not discuss resuscitation frequently with their patients, for various reasons, there are opportunities, through perceived ‘incentives’, to improve the discussion rate. The majority of their patients are keen and comfortable to have this discussion.Conclusion:The majority of GPs believe that it is their responsibility, and the majority of patients that it is their wish, to discuss resuscitation. There are realistic opportunities to increase the discussion rate.
AN AUDIT OF CURRENT PRACTICE OF DOCUMENTATION AND IDENTIFICATION OF SUBSTITUTE DECISION-MAKERS/PERSONS RESPONSIBLE IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES
Authors: Welz M , Gee W , Workman B , Morton J 
Published: April 2013

BackgroundThere is little data on the correct identification and documentation of substitute decision-makers (SDM) or ‘persons responsible’ (PR) in residential aged care facilities (RACF). Current practice may not be consistent with the Victorian Guardianship and Administration Act (GAA) 1986.AimTo determine the extent of correct identification and documentation of SDMs or PRs as per GAA in two RACFs in Victoria, Australia.MethodsRetrospective audit of paper and scanned electronic medical records (n=88).Admission forms, which include the resident personal details form and the medical admission were examined for identification of next-of-kin (NOK), Power of Attorney-Medical Treatment (POA-MT) or guardian. The complete medical file was then examined to confirm correct identification on the admission forms. VCAT was also contacted where confirmatory documents were not found in medical records.ResultsFirst NOK was more consistently documented than second NOK (75% vs 33%).POA-MT or guardianship with healthcare powers (GHCP) was noted in ∼15% of admission forms with only 15.4% having valid documents available.In 26.1%, admission forms were unclear; of these, 34.8% were confirmed to have a POA-MT or GHCP. In 59.1%, no POA-MT or GHCP was noted; of these, 1.9% were found to have a POA-MT.For residents with no confirmed POA-MT or GHCP, the first NOK was a potential PR (as per GAA) in 71.8%. Of these, 49% were confirmed as the PR.Discussion/ConclusionDocumentation of POA-MT or GHCP is often incomplete or incorrect. A listed NOK is not necessarily the PR. Procedures and forms that use clear, unambiguous terminology must be developed to aid correct identification and documentation of SDMs.
DOCUMENTATION OF ADVANCE END OF LIFE CARE WISHES IN TWO AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES
Authors: Welz M , Gee W , Workman B , Morton J 
Published: April 2013

BackgroundHealthcare professionals often lack awareness of patients' wishes regarding end-of-life care (EOLC). Existing data suggest low utilisation and poor application rates of advance care directives in Australian residential aged care facilities (RACF).Southern Health RACFs use separate forms to document advance EOLC wishes, namely advance care wishes (ACW), terminal care wishes (TCW) and resuscitation status, however extent and quality of the documented information is unknown.Aim1. To audit the documentation rates of EOLC wishes in two low-level RACF in Victoria, Australia.2. To assess whether documented EOLC wishes are likely to affect medical care in an emergency department (ED) presentation.MethodsRetrospective audit of medical records (n=88). Assessment of documented EOLC wishes by a consultant physician with expertise in advance care planning.ResultsACW including ‘particular wishes’, ‘representatives’ wishes' and ‘cultural/religious EOL needs’ were documented in 78.4, 53.4 and 69.3% respectively.Completion of TCW (form comprising 11 questions regarding EOLC preferences) ranged between 50–65%.Resuscitation management plans available in less than 30%. The majority were for those who did not want resuscitation (93%).Quality of documented EOLC preferences: 66% assessed as likely to influence decisions in the ED. This includes clear wishes for all active care.Discussion/ConclusionThis audit demonstrates poor documentation of End of Life care wishes in a RACF setting. Healthcare services should prioritise staff and consumer education in this area and improve procedures and forms that provide clear guidelines for the useful documentation of EOL care wishes.
IMPROVING HOME DEATH DOWN UNDER
Authors: Molenaar R 
Published: April 2013

BackgroundThe rate of home death of palliative care patients in a Melbourne community based palliative care service has decreased over the last few years. As a result, the service has initiated a 6 month Structured Support Programme (SSP) intervention, completed in November 2012, encompassing a three visit platform of support which will be provided by a Nurse Practitioner Candidate (NPC). Preliminary results will be discussed in this presentation.AimOverall, this study aimed to determine whether a SSP provided by an advanced practice nurse can improve outcomes for patient and caregivers at home compared to regular support from the nursing team. Specific aims are to: improve symptom relief for patients, enhance psychosocial support for patient and carers, facilitate place of death according to patient and carer wishes and articulate a Nurse Practitioner (NP) model supporting complex End of Life (EOL) care.MethodsThe SSP provided by the NPC established both patient and carer needs, from which an anticipatory care plan was developed to provide a platform of future support for the patient and the carer.Results47% of patients who had the SSP died at home compared to 33% who did not. 60% of patients who had the SSP died where they wished compared to 33% who did not.DiscussionThis intervention was provided by a NPC, it was possible to identify where an endorsed NP would enhance access to medicationsConclusionA SSP provided by an advanced practice nurse can improve outcomes for patient and caregivers at home.