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Hewitt J, Alsaba N, May K, Noon HS, Rennie C, Marshall AP. Emergency department and intensive care unit health professionals' knowledge and application of the law that applies to end-of-life decision-making for adults: A scoping review of the literature. Aust Crit Care 2022:S1036-7314(22)00099-6. [PMID: 36096921 DOI: 10.1016/j.aucc.2022.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/01/2022] [Accepted: 08/07/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Laws that regulate healthcare practice at the end of life reflect the values of the society where they apply. Traditionally, healthcare professionals rely on their clinical knowledge to inform treatment decisions, but the extent to which the law also informs health professionals' decision-making at the end of life is uncertain. OBJECTIVE The objective of this study was to describe what healthcare professionals working in emergency departments and intensive care units know about the law that relates to end-of-life decision-making for hospitalised adults and what affects its application. REVIEW METHOD This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. DATA SOURCES Data were sourced by searching the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL [via EBSCOhost]), Nursing and Allied Health and Health and Medical Collection (via ProQuest Central), Excerpta Medica dataBASE (Embase), PubMed, PsycINFO, and HeinOnline. RESULTS Systematic screening of the search results and application of inclusion criteria resulted in the identification of 18 quantitative and three qualitative articles that were reviewed, summarised, and reported. Ten of the quantitative studies assessed knowledge and attitudes to law or end-of-life decision-making using hypothetical scenarios or vignettes. Qualitative studies focussed on how the law was applied when end-of-life decisions were made. End-of-life decision-making is mostly based on the clinical needs of the patient, with the law having a secondary role. CONCLUSION Around the world, there are significant gaps in healthcare professionals' legal knowledge. Clinical factors are considered more important to end-of-life decision-making than legal factors. End-of-life decision-making is perceived to carry legal risk, and this results in the provision of nonbeneficial end-of-life care. Further qualitative research is needed to ascertain the clinician-related factors that affect the integration of law with end-of-life decision-making.
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Affiliation(s)
- Jayne Hewitt
- Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; Griffith University, Griffith Law School, Law Futures Centre, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia.
| | - Nemat Alsaba
- Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia; Bond University, Faculty of Health Science and Medicine, 14 University Drive, Robina, Queensland, 4226, Australia.
| | - Katya May
- Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia.
| | - Halima Sadia Noon
- Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; James Cook University, College of Medicine and Dentistry, 1 James Cook Drive, Douglas, Townsville, Queensland, 4810, Australia.
| | - Cooper Rennie
- Griffith University, School of Medical Science, Nathan Campus, 170 Kessels Rd, Nathan, Queensland 4111, Australia.
| | - Andrea P Marshall
- Griffith University, School of Nursing and Midwifery, Gold Coast Campus, Parklands Drive, Southport, Queensland, 4222, Australia; Gold Coast University Hospital, 1 Hospital Blvd, Southport, Queensland, 4215, Australia.
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Dabar G, Akl IB, Sader M. Physicians' approach to end of life care: comparison of two tertiary care university hospitals in Lebanon. BMC MEDICAL EDUCATION 2021; 21:592. [PMID: 34823513 PMCID: PMC8620620 DOI: 10.1186/s12909-021-03022-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 09/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The care of terminally ill patients is fraught with ethical and medical dilemmas carried by healthcare professionals. The present study aims to explore the approaches of Lebanese attending physicians towards palliative care, end of life (EOL) care, and patient management in two tertiary care university hospitals with distinct medical culture. METHODS Four hundred attending physicians from the American University of Beirut Medical Center (AUBMC) and Hotel Dieu de France (HDF) were recruited. Participants were Medical Doctors in direct contact with adult patients that could be subject to EOL situations providing relevant demographic, educational, religious as well as personal, medical or patient-centric data. RESULTS The majority of physicians in both establishments were previously exposed to life-limiting decisions but remains uncomfortable with the decision to stop or limit resuscitation. However, physicians with an American training (AUBMC) were significantly more likely to exhibit readiness to initiate and discuss DNR with patients (p<0.0001). While the paternalistic medicinal approach was prevalent in both groups, physicians with a European training (HDF) more often excluded patient involvement based on family preference (p<0.0001) or to spare them from a traumatic situation (p=0.003). The majority of respondents reported that previous directives from the patient were fundamental to life-limiting decisions. However, the influence of patient and medical factors (e.g. culture, religion, life expectancy, age, socioeconomic status) was evidenced in the HDF group. CONCLUSION Early physician-initiated EOL discussions remain challenged in Lebanon. Paternalistic attitudes limit shared decision making and are most evident in European-trained physicians. Establishing a sound and effective framework providing legal, ethical and religious guidance is thus needed in Lebanon.
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Affiliation(s)
- George Dabar
- Pulmonary and Critical Care Division, Hotel Dieu de France Hospital, Saint Joseph University, Boulevard Alfred Naccache Achrafieh, PO Box 166830, Beirut, Lebanon
| | - Imad Bou Akl
- Pulmonary and Critical Care Division, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mirella Sader
- Anesthesia and Critical Care Division, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Sprung CL, Jennerich AL, Joynt GM, Michalsen A, Curtis JR, Efferen LS, Leonard S, Metnitz B, Mikstacki A, Patil N, McDermid RC, Metnitz P, Mularski RA, Bulpa P, Avidan A. The Influence of Geography, Religion, Religiosity and Institutional Factors on Worldwide End-of-Life Care for the Critically Ill: The WELPICUS Study. J Palliat Care 2021:8258597211002308. [PMID: 33818159 DOI: 10.1177/08258597211002308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the association between provider religion and religiosity and consensus about end-of-life care and explore if geographical and institutional factors contribute to variability in practice. MATERIALS AND METHODS Using a modified Delphi method 22 end-of-life issues consisting of 35 definitions and 46 statements were evaluated in 32 countries in North America, South America, Eastern Europe, Western Europe, Asia, Australia and South Africa. A multidisciplinary, expert group from specialties treating patients at the end-of-life within each participating institution assessed the association between 7 key statements and geography, religion, religiosity and institutional factors likely influencing the development of consensus. RESULTS Of 3049 participants, 1366 (45%) responded. Mean age of respondents was 45 ± 9 years and 55% were females. Following 2 Delphi rounds, consensus was obtained for 77 (95%) of 81 definitions and statements. There was a significant difference in responses across geographical regions. South African and North American respondents were more likely to encourage patients to write advance directives. Fewer Eastern European and Asian respondents agreed with withdrawing life-sustaining treatments without consent of patients or surrogates. While respondent's religion, years in practice or institution did not affect their agreement, religiosity, physician specialty and responsibility for end-of-life decisions did. CONCLUSIONS Variability in agreement with key consensus statements about end-of-life care is related primarily to differences among providers, with provider-level variations related to differences in religiosity and specialty. Geography also plays a role in influencing some end-of-life practices. This information may help understanding ethical dilemmas and developing culturally sensitive end-of-life care strategies.
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Affiliation(s)
- Charles L Sprung
- Department of Anesthesiology, Critical Care Medicine, and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ann L Jennerich
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Gavin M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrej Michalsen
- Department of Anaesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang, Germany
| | - J Randall Curtis
- Division of Pulmonary, Critical Care and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Linda S Efferen
- Department of Medicine, Stony Brook Medicine, Stony Brook, NY, USA
| | - Sara Leonard
- Department of Anaesthesia and Critical Care, King's College Hospital, London, UK
| | - Barbara Metnitz
- Austrian Centre for Documentation and Quality Assurance in Intensive Care Medicine, Vienna, Austria
| | - Adam Mikstacki
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Namrata Patil
- Division of Thoracic Surgery and Division of Trauma, Burn and Critical Care, Department of Surgery, Brigham & Women's Hospital, Boston, MA, USA
| | - Robert C McDermid
- Division of Critical Care, University of Alberta, Edmonton, Alberta, Canada
| | - Philipp Metnitz
- Clinical Department of General Anaesthesiology, Emergency and Intensive Care Medicine, LKH-University Hospital of Graz, Medical University of Graz, Graz, Austria
| | - Richard A Mularski
- The Center for Health Research Kaiser Permanente Northwest, Portland, OR, USA
| | - Pierre Bulpa
- Intensive Care Unit of Mont-Godinne University Hospital, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Alexander Avidan
- Department of Anesthesiology, Critical Care Medicine, and Pain Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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