End-of-life decision-making capacity in an elderly patient with schizophrenia and terminal cancer

Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned

Background

The importance of advance care planning (ACP) has been highlighted by the advent of life-threatening COVID-19. Anecdotal evidence suggests changes in implementation of policies and procedures is needed to support uptake of ACPs. We investigated the barriers and enablers of ACP in the COVID-19 context and identify recommendations to facilitate ACP, to inform future policy and practice.

Methods

We adopted the WHO recommendation of using rapid reviews for the production of actionable evidence for this study. We searched PUBMED from January 2020 to April 2021. All study designs including commentaries were included that focused on ACPs during COVID-19. Preprints/unpublished papers and Non-English language articles were excluded. Titles and abstracts were screened, full-texts were reviewed, and discrepancies resolved by discussion until consensus.

Results

From amongst 343 papers screened, 123 underwent full-text review. In total, 74 papers were included, comprising commentaries (39) and primary research studies covering cohorts, reviews, case studies, and cross-sectional designs (35). The various study types and settings such as hospitals, outpatient services, aged care and community indicated widespread interest in accelerating ACP documentation to facilitate management decisions and care which is unwanted/not aligned with goals. Enablers of ACP included targeted public awareness, availability of telehealth, easy access to online tools and adopting person-centered approach, respectful of patient autonomy and values. The emerging barriers were uncertainty regarding clinical outcomes, cultural and communication difficulties, barriers associated with legal and ethical considerations, infection control restrictions, lack of time, and limited resources and support systems.

Conclusion

The pandemic has provided opportunities for rapid implementation of ACP in creative ways to circumvent social distancing restrictions and high demand for health services. This review suggests the pandemic has provided some impetus to drive adaptable ACP conversations at individual, local, and international levels, affording an opportunity for longer term improvements in ACP practice and patient care. The enablers of ACP and the accelerated adoption evident here will hopefully continue to be part of everyday practice, with or without the pandemic.

Experiences of Everyday Life among Individuals with Co-Existence of Serious Mental Illness and Cancer-A Qualitative Systematic Literature Review

Daily life with severe mental health (SMI) and cancer comorbidity entails multiple challenges. The study aims to explore everyday life experiences among individuals with SMI and cancer comorbidity from the perspectives of patients, significant others, and involved healthcare professionals. The study is registered in PROSPERO (CRD42021259604). A qualitative systematic review was conducted through searches in the databases MEDLINE, CINAHL, PsychInfo, and Web of Sciences (last search 14 February 2023). Inclusion criteria were empirical qualitative research studies investigating experiences of healthcare and everyday life among persons living with SMI and who were subsequently diagnosed with cancer from the perspective of the individuals themselves, their significant others, and healthcare professionals involved in their care. Exclusion criteria: Literature reviews, quantitative studies, intervention studies, quantitative parts of mix-methods studies, non-English languages, persons <18 years, dementia/learning disabilities, diagnosed with anxiety/depression as a consequence of cancer. Seven articles, published between January 2011 and February 2023, were included and analysed through a thematic analysis. The PRISMA 2020 checklist guided the study. The results were presented in four themes: 'Navigating between different worlds and logics', 'Decision-making capacity depending on the assessor', 'Cancer must give way to severe mental illness or vice versa', and 'Significant others as a safety net'. Research about the everyday lives of persons with SMI and cancer comorbidities from patients' and relatives' perspectives is lacking and thus called for.

Assisted dying requests from people in detention: Psychiatric, ethical, and legal considerations-A literature review

The principle of equivalence of care states that prisoners must have access to the same standard of health care as the general population. If, as recent court decisions suggest, assisted dying is not limited to people with a terminal physical illness or irremediable suffering, it might also be requested by people with severe mental illness in detention. Some of the countries with legal regulations on assisted dying also have recommendations on how to handle requests from prisoners. However, detention itself can lead to psychological distress and suicidality, so we must consider whether and how people in such settings can make autonomous decisions. Ethical conflicts arise with regard to an individual's free will, right to life, and physical and personal integrity and to the right of a state to inflict punishment. Furthermore, people in prison often receive insufficient mental health care. In this review, we compare different practices for dealing with requests for assisted dying from people in prison and forensic psychiatric facilities and discuss the current ethical and psychiatric issues concerning assisted dying in such settings.

Knowledge, attitude and practice of advance care planning among nursing interns: A mixed-methods approach

AIM

To investigate the knowledge, attitudes and practice of advance care planning and confirm their influencing factors among nursing interns in China.

BACKGROUND

Due to a lack of standardized courses on advance care planning (ACP) in China, nursing interns do not possess the knowledge of ACP and cannot apply it to clinical practice.

DESIGN

A convergent parallel mixed-methods design.

METHODS

382 nursing interns aged > 18 years were recruited using convenience sampling. Quantitative data were collected using the General Demographic Characteristics Questionnaire and the Advance Care Planning Knowledge, Attitude and Practice Questionnaire. Thirteen nursing interns were drawn from the quantitative phase and their interviews were thematically analyzed.

RESULTS

The ACP attitudes and practice scores of nursing students were 48.85 ± 6.39 and 32.23 ± 4.58, respectively, with a high level, while their ACP knowledge score was 6.89 ± 2.70, with a medium level. The significant promotive factors included positive attitude toward death and the nursing major and experience in clinical rescues and palliative care training; The key hindrance factors included the lack of ACP education and the limitations of the working environment.

CONCLUSIONS

The study highlighted the importance of delivering systematic palliative care training and integrating the practice of ACP into routine nursing practice. Doing this can help expand advance care planning knowledge, establish positive attitudes and meet the practical needs of nursing interns for their ACP clinical practice.