(25 March, 2021) Preparing for End of Life: The Value of Having Hard Conversations about Death
Have you ever wondered what it would be like to have control over how you die and where? If you had the opportunity to plan those details to help you prevent suffering in your last days, would you like to get involved?
We can’t know for certain when we will die, but for older people with chronic irreversible illness there is an unspoken – or speculative – understanding that their years are numbered. Some of us would challenge that prognosis by trying different treatments and lifestyles hoping for a miracle; some of us would ignore the shadow over our heads and live life to the fullest so we have no regrets when we look back; and some of us would just grab the news like a bull by the horns and face the fact that we should be prepared for when the time comes.
(1st October, 2019) Doing everything near the end of life may be inappropriate
No-one wants to be a patient in an intensive care unit (ICU). But if you ever do require intensive care, would you or your family like to be better informed about the harms and benefits of intensive treatment?
And would having better information about what may happen during the ICU stay and after help you make informed decisions, especially if you are no longer in a position to make decisions?
(15 September, 2017) “Please don’t let this happen to me” – too much medicine at the end of life
A clinical prediction tool is being trialed in a Sydney hospital to give doctors and families the confidence to stop “heroic” interventions like cardiopulmonary resuscitation (CPR) on frail elderly people approaching the natural end of their lives.
The aim is to try to halt the “conveyer belt” that is pouring frail, elderly people with multiple problems into intensive care units in the last few weeks of their lives, and to remind health professionals and families that death is both natural and inevitable.
(February 2020) Strategies for improving end-of-life discussions
There’s a need to better balance clinicians’ evidence-based bias and older patients’ value-based preferences in shared decision-making, write a collaborative of researchers and advocates from Queensland and New South Wales.
Older people today may be more willing to discuss end-of-life treatment preferences than in the past two decades. However, solely focusing on decision-making may burden uninformed patients and distressed caregivers and families.
(6 May, 2021) Impact of COVID-19 distancing on the quality of dying
During the COVID-19 pandemic the media and the regulators have given limited attention to the impact of social distancing rules on the quality of living and dying, not only for COVID-19 patients, but for anyone who has reached the end of life from natural causes in hospitals and residential aged care facilities (RACFs). Fear for the safety of other patients, visitors, and healthcare clinicians during the pandemic (Gordon et al., 2020), triggered unprecedented isolation practices including limiting staff numbers attending to patients, transitioning to virtual rounds (Arora, Chivu, Schram, & Meltzer, 2020), restricting hours and duration of visiting, isolating patients in ICU at end of life, and enacting policies on numbers of bedside family/caregivers who can accompany terminal patients (Wakam, Montgomery, Biesterveld, & Brown, 2020). In some institutions, nursing staff, and social workers on shift are taking the place of families, providing a compassionate presence to dying patients: others are dying unaccompanied. Unfortunately, these extraordinary circumstances place an immediate and ongoing emotional burden on clinicians and families alike. While it is true that people will eventually adapt and that those of us who lived through the pandemic will recover from the shock and unexpected changes to our lifestyle and clinical practice, many who lost loved ones without a proper farewell due to draconian health service rules will experience prolonged, complicated grief responses, post-traumatic stress (Selman et al., 2020) and separation distress (Gesi et al., 2020). Meanwhile the strict rules have caused clinicians job dissatisfaction, and moral distress (Canadian Medical Association, 2020). The quality of dying has been negatively impacted. The ethical dilemma for clinicians is reconciling the need for compliance with internal policies and the competing need for holistic management of the individual.
(22 January, 2020) Tackling overtreatment near the end of life
We hear increasingly about the importance of tackling overtreatment, but less often about how overtreatment plays out in the lives of patients and their families.
In the article below, Associate Professor Magnolia Cardona introduces us to “Walter”, a fictitious character whose story is typical of many older patients, and explains how tackling overtreatment could improve his care.
This article is published as part of the TOO MUCH of a Good Thing series, which is investigating how to reduce overdiagnosis and overtreatment in Australia and globally, and is published as a collaboration between Wiser Healthcare and Croakey.
Magnolia Cardona 