I carry around the quote “We cannot do everything, and there is a sense of liberation in realizing that,” by Archbishop Oscar Romero, in my bag, and resort to these words when I feel like I have to do more for the patient but can’t. These words carry much meaning in the life of an oncology fellow.
A time-sovereignty framework offers health and support professionals a means of understanding carers’ varying needs and tailoring support services.
oining the Medical Order for Life Sustaining Treatment (MOLST) initiative, Maryland has implemented this new form that a physician or nurse practitioner completes that indicates a person’s wishes in respect to life-sustaining treatments, according to a Baltimore Sun interview with Dr. Barbara Carroll, MD, the medical director at Broadmead, a senior living community. Other states that provide MOLST guidelines are New York, Massachusetts and Delaware.
Talking about death — even thinking about death — is uncomfortable for patients and families. Nearly 80 percent of us would prefer to spend our last days at home, but the majority of us will die in the hospital, and only 20 percent of us have expressed our wishes in writing.
In theory, or in a more perfect universe, our family members wouldn’t have a hard time deciding what to do when we were near death. However painful the task, the decisions would be clear: We would have prepared a written document, an advance directive, stating what we wanted doctors to do or not do, and our about-to-be survivors would follow our instructions. Simple.
In the elderly, an enhanced support including specific geriatric assessment and management optimizes the treatment course, including preoperative optimization, prevents treatment-related complications and loss of autonomy using or not geriatrics clinic or rehabilitation units, and limits the length of hospital stay and costs.
On October 29, 2013, the Vermont Ethics Network is holding a day-long discussion about end-of-life care in Vermont with the passage of Act 39 (Vermont’s new law on patient choice and control at the end-of-life). The day’s presentations will focus on:
Determine appropriateness of oncologic intervention in the geriatric oncology patient through assessment of their overall physical health, cognition, function and social situation.
Women are more likely to receive early DNR orders after ICH than men. Further prospective studies are needed to determine factors contributing to the sex variation in the use of early DNR order after ICH.