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There is a growing body of literature describing the characteristics of patients who plan for the end of life, but little research has examined how caregivers influence patients' advance care planning (ACP). The purpose of this study was to examine how patient and caregiver characteristics are associated with advance directive (AD) completion among patients diagnosed with a terminal illness. We defined AD completion as having completed a living will and/or identified a healthcare power of attorney.
A convenience sample of 206 caregiver–patient dyads was included in the study. All patients were diagnosed with an advanced life-limiting illness. Trained research nurses administered surveys to collect information on patient and caregiver demographics (i.e., age, sex, race, education, marital status, and individual annual income) and patients' diagnoses and completion of AD. Multivariate logistic regression was employed to model predictors for patients' AD completion.
Over half of our patient sample (59%) completed an AD. Patients who were older, diagnosed with amyotrophic lateral sclerosis, and with a caregiver who was Caucasian or declined to report an income level were more likely to have an AD in place.
Significance of results:
Our results suggest that both patient and caregiver characteristics may influence patients' decisions to complete an AD at the end of life. When possible, caregivers should be included in advance care planning for patients who are terminally ill.
Explain the concept and moral foundations of surrogate decision-making.
Describe the ethical and legal criteria for choosing a surrogate and for surrogate
Identify classic ethical dilemmas of surrogate decision-making, for example:
family stake in treatment decisions, reliability of surrogate decision-makers,
potential conlicts between possible surrogates, and between surrogates and care
Mr. D was a 57-year-old man with a history of schizoaffective disorder and drug abuse who
presented to the emergency department with a diffuse painful maculopapular rash, blistering
of his mouth, sloughing of skin at the tip of his nose and a temperature of 104 degrees.
He required urgent intubation due to extensive oropharyngeal involvement and an increasing
oxygen requirement in the emergency department. He was admitted to the burn intensive care
unit and diagnosed with drug-induced toxic epidermal necrolysis caused by a new psychiatric
medication that was begun severalweeks prior to his presentation. His rash involved 95 percent
of his body including his mucous membranes and his eyes.
His hospital course was complicated bywound infection, sepsis requiring pressors, hypotension,
acute renal failure, and severe pain, particularly with dressing changes. He had a prolonged
stay in the intensive care unit and remained ventilator dependent. His prognosis based
on his presentation, including the extent of skin involvement and subsequent complications,
was poor. His mortality was estimated at greater than 75 percent and, even if he survived a several
month intensive care unit stay, he would require a lengthy, painful rehabilitation course
and likely lifelong assistance with care either at a facility or with care providers in his home.
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