End of Life Committee - Bankstown Hospital - Grand Rounds - Further Reading - LibGuides at South Western Sydney Local Health District

THIS WEEK'S TOPIC

“EOL Audit Report with case studies”

Introduction

Welcome to the Grand Rounds Further Reading List.

This library guide is to help support you in your professional development.

If you have any questions, please contact the Clinical Library on 9722 8250 or email SWSLHD-BankstownLibrary@health.nsw.gov.

Articles

Cardona, M., et al. (2018). "Who Benefits from Aggressive Rapid Response System Treatments Near the End of Life? A Retrospective Cohort Study." The Joint Commission Journal on Quality and Patient Safety 44(9): 505-513. https://www.sciencedirect.com/science/article/pii/S1553725017304506

Background Many patients near the end of life are subject to rapid response system (RRS) calls. A study was conducted in a large Sydney, Australia, teaching hospital to identify a cutoff point that defines nonbeneficial treatment for older hospital patients receiving an RRS call, describe interventions administered, and measure the cost of hospitalization. Methods This was a retrospective cohort of 733 adult inpatients with data for the period three months before and after their last placed RRS call. Subgroup analysis of patients aged ≥ 80 years was conducted. Log-rank, chi-square, and t-tests were used to compare survival, and logistic regression was used to examine predictors of death. Results Overall, 65 (8.9%) patients had a preexisting not-for-resuscitation (NFR) or not-for-RRS order; none of those patients survived to three months. By contrast, patients without an NFR or not-for-RRS order had three-month survival probability of 71% (log-rank χ2 145.63; p < 0.001). Compared with survivors, RRS recipients who died were more likely to be older, to be admitted to a medical ward, and to have a larger mean number of admissions before the RRS. The average cost of hospitalization for the very old transferred to the ICU was higher than for those not requiring treatment in the ICU (US$33,990 vs. US$14,774; p = 0.045). Conclusion Identifiable risk factors clearly associated with poor clinical outcomes and death can be used as a guide to administer less aggressive treatments, including reconsideration of ICU transfers, adherence to NFR orders, and transition to end-of-life management instead of calls to the RRS team.

Dixon, J., et al. (2018). "The Effectiveness of Advance Care Planning in Improving End-of-Life Outcomes for People With Dementia and Their Carers: A Systematic Review and Critical Discussion." Journal of Pain and Symptom Management 55(1): 132-150.e131. https://www.sciencedirect.com/science/article/pii/S0885392417303330

Context End-of-life care for people with dementia can be poor, involving emergency hospital admissions, burdensome treatments of uncertain value, and undertreatment of pain and other symptoms. Advance care planning (ACP) is identified, in England and elsewhere, as a means of improving end-of-life outcomes for people with dementia and their carers. Objective To systematically and critically review empirical evidence concerning the effectiveness of ACP in improving end-of-life outcomes for people with dementia and their carers. Methods Systematic searches of academic databases (CINAHL Plus with full text, PsycINFO, SocINDEX with full text, and PubMed) were conducted to identify research studies, published between January 2000–January 2017 and involving statistical methods, in which ACP is an intervention or independent variable, and in which end-of-life outcomes for people with dementia and/or their carers are reported. Results A total of 18 relevant studies were identified. Most found ACP to be associated with some improved end-of-life outcomes. Studies were predominantly, but not exclusively, from the U.S. and care home-based. Type of ACP and outcome measures varied. Quality was assessed using National Institute of Health and Care Excellence quality appraisal checklists. Over half of the studies were of moderate to high quality. Three were randomized controlled trials, two of which were low quality. Conclusion There is a need for more high-quality outcome studies, particularly using randomized designs to control for confounding. These need to be underpinned by sufficient development work and process evaluation to clarify the appropriateness of outcome measures, explore implementation issues and identify “active elements.”

Gonella, S., et al. (2023). "Interventions to Promote End-of-Life Conversations: A Systematic Review and Meta-Analysis." Journal of Pain and Symptom Management 66(3): e365-e398.

https://www.sciencedirect.com/science/article/pii/S0885392423005055

Context Although several interventions aimed to promote end-of-life conversations are available, it is unclear whether and how these affect delivery of end-of-life conversations. Measuring the processes associated with high-quality end-of-life care may trigger improvement. Objectives To estimate the effect of interventions aimed to promote end-of-life conversations in clinical encounters with patients with advanced chronic or terminal illness or their family, on process indicators of end-of-life conversations. Methods Systematic review with meta-analysis (PROSPERO no. CRD42021289471). Four databases (PubMed, CINAHL, PsycINFO, and Scopus) were searched up to September 30, 2021. The primary outcomes were any process indicators of end-of-life conversations. Results of pairwise meta-analyses were presented as Risk Ratio (RR) for occurrence, standardized mean difference (SMD) for quality and ratio of means (ROM) for duration. Meta-analysis was not performed when fewer than four studies were available. Results A total of 4,663 articles were scanned. Eighteen studies were included in the systematic review and 16 entered at least one meta-analysis: documented occurrence (n = 8), patient-reported occurrence (n = 4), patient-reported-quality (n = 4), duration (n = 4). There was significant variability in settings, patients’ clinical conditions, and professionals. No significant effect of interventions on documented occurrence (RR 1.54, 95% CI 0.84–2.84; I2 91%), patient-reported occurrence (RR 1.52, 95% CI 0.80–2.91; I2 95%), patient-reported quality (SMD 0.83, 95% CI −1.06 to 2.71; I2 99%), or duration (ROM 1.20, 95% CI 0.95–1.51; I2 65%) of end-of-life conversations was found. Data on frequency were conflicting. Interventions targeting multiple stakeholders promoted earlier and more comprehensive conversations. Conclusion Heterogeneity was considerable, but findings suggest no significant effect of interventions on occurrence, patient-reported quality and duration of end-of-life conversations. Nevertheless, we found indications for interventions targeting multiple stakeholders to promote earlier and more comprehensive conversations.

Heufel, M., et al. (2022). "End of life care pathways in the Emergency Department and their effects on patient and health service outcomes: An integrative review." International Emergency Nursing 61: 101153.

https://www.sciencedirect.com/science/article/pii/S1755599X22000106

Introduction End of life (EOL) care in the Emergency Department (ED) requires focused, person-centred care to meet the needs of this vulnerable cohort of patients. Methods An integrative review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was conducted. Studies were included if they were primary research relating to patients in the ED at the EOL, and/or evaluated EOL care pathways in the ED. Databases OVID Emcare, OVID Medline, and Scopus were searched from 1966-September 2021; followed by screening and appraisal. Articles were compared and data grouped into categories. Results Eleven research articles were included generating three categories for EOL care in ED. 1) tools/criteria to identify patients who may require EOL care in ED; 2) processes for providing EOL care, and 3) implementation methods/frameworks to support the uptake of EOL care processes. Conclusion There were some commonalities in the criteria used to identify patients who may be at their EOL and the interventions implemented thereafter. There was no standardised process for screening for or treating EOL care needs in the ED. Further research is required to determine the impact that EOL care pathways have on patient and health service outcomes to inform strategies for future policy development.

Heufel, M., et al. (2023). "Development of an emergency department end of life care audit tool: A scoping review." International Journal of Nursing Studies Advances 5: 100143.

https://www.sciencedirect.com/science/article/pii/S2666142X23000279

Introduction Emergency departments frequently care for patients at the end of life and should have robust processes for reviewing delivery of care. The aim of this scoping review is to examine and collate the chart audit tools available to assess the quality of end of life care of patients who die in the emergency department, or, in the subsequent hospital admission. Methods A scoping review of the literature using the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines, and the methodological framework outlined by Arksey and O'Malley was conducted. Primary and secondary research, along with grey literature were searched. Both adult and paediatric populations were included. Databases Ovid Emcare, CINAHL and Medline were searched from 1961 to December 2022; followed by screening and appraisal. Articles were compared and data synthesised into categories. Results Fifty-eight articles were included generating three categories; contexts for end of life audit use, development and evaluation of audit tools, and audit characteristics / components. Four tools focused on the emergency department, however, did not comprehensively review both end of life and emergency department specific data. A draft audit tool for the emergency department was developed that consisted of the common elements to evaluate end of life care as identified in this review, emergency department-specific quality of care measures and the integration of the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL) tool. Conclusion No audit tool to comprehensively review end of life care provided for patients at the end of life in the emergency department was found. We developed an audit tool based on best available evidence that now needs testing for validity, feasibility, and usability to evaluate end of life in the emergency department setting is required.

Kim, J. S., et al. (2020). "Role of the Rapid Response System in End-of-Life Care Decisions." American Journal of Hospice and Palliative Medicine® 37(11): 943-949.

https://journals.sagepub.com/doi/abs/10.1177/1049909120927372

Purpose:An important role of the rapid response system (RRS) is to provide opportunities for end-of-life care (EOLC) decisions to be appropriately operationalized. We investigated whether EOLC decisions were made after the RRS-recommended EOLC decision to the primary physician.Materials and Methods:We studied whether patients made EOLC decisions consistent with the rapid response team’s (RRT) recommendations, between January 1, 2017, and February 28, 2019. The primary outcome was the EOLC decision after the RRT’s recommendation to the primary physician. The secondary outcome was the mechanism of EOLC decision-making: through institutional do-not-resuscitate forms or the Korean legal forms of Life-Sustaining Treatment Plan (LSTP).Results:Korean LSTPs were used in 26 of the 58 patients who selected EOLC, from among the 75 patients for whom the RRS made an EOLC recommendation. Approximately 7.2% of EOLC decisions for inpatients were related to the RRT’s interventions in EOLC decisions. Patients who made EOLC decisions did not receive cardiopulmonary resuscitation, mechanical ventilation, or dialysis.Conclusion:The timely intervention of the RRS in EOLC facilitates an objective assessment of the patient’s medical conditions, the limitation of treatments that may be minimally beneficial to the patient, and the choice of a higher quality of care. The EOLC decision using the legal process defined in the relevant Korean Act has advantages, wherein patients can clarify their preference, the family can prioritize the patient’s preference for EOLC decisions, and physicians can make transparent EOLC decisions based on medical evidence and informed patient consent.

Waller, A., et al. (2017). "Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness." BMC Palliative Care 16(1): 34.

https://doi.org/10.1186/s12904-017-0204-1

As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings.

Books

Advance Care Planning in End of Life Care by Keri Thomas (Editor); Ben Lobo (Editor); Karen Detering (Editor)
Call Number: BANKSTOWN Medical Library WB 310/ADV/3
ISBN: 9780198802136
Publication Date: 2018
Advance Care Planning (ACP) is an essential part of end of life care in the UK and most developed countries. It enables more people to live well and die as they would choose, and has significant implications for the individual person, their family and carers, and our wider society. In the context of an ageing population and increasing possibilities for medical interventions, ACP is a particularly important aspect of quality care.Expanded and fully updated throughout, this new edition gives a comprehensive overview of ACP and explores a wide range of issues and practicalities in providing end of life care. Written by experts from around the world, the book takes a comprehensive look at the subject by exploring the wide range of issues and practicalities in providing ACP; framing the purpose, process, and outcomes of these plans; and providing an important update on national and international research, policy and practice. Chapters also discuss values, goals and priorities, and include detailed case examples to aid best practice. This book is an invaluable resource for all clinicians involved in the caring for people in their final stages of life. It is of particular value to GPs, palliative care specialists, geriatricians, social care teams, researchers and policy leads interested in improving end of life care.
Being mortal : illness, medicine and what matters in the end by Gawande, Atul.
Call Number: BANKSTOWN Medical Library W 21/GAW/4
ISBN: 9781846685811
Publication Date: 2014
Gawande, a practicing surgeon, addresses his profession's ultimate limitation, arguing that quality of life is the desired goal for patients and families of the terminally ill.
Counseling Clients near the End of Life by James L. Werth (Editor)
Call Number: BANKSTOWN Medical Library WB 310/COU/1
ISBN: 9780826108494
Publication Date: 2012
I found this book to be a well-written, sensitively presented, and important resource for those engaged in this critical area of work. Thank you, Dr. Werth, for making such a substantial contribution to this field."--Journal of Palliative Care This book offers] over 20 contributors, all with impeccable credentials, covering many perspectives that we need to consider more frequently and in greater depth...There is much that awaits you in this book."--Illness, Crisis, and Loss Counseling Clients Near the End of Life is a marvelous resource for mental health providers who are searching for useful information in areas such as the following: resolving ethical dilemmas; assisting clients in planning for the end of life; counseling caregivers of clients who are near the end of life; and assisting people in dealing with grief. The editor of this work, Dr. James Werth, has done a splendid job of gathering various experts to share their perspectives on end of life care and choices at this time of life--and he has also written an excellent chapter on counseling clients who are dying."
End-of-Life Decisions in Medical Care by Stephen W. Smith
Call Number: BANKSTOWN Medical Library W 85.5/SMI/1
ISBN: 9781107005389
Publication Date: 2012
Those involved in end-of-life decision making must take into account both legal and ethical issues. This book starts with a critical reflection of ethical principles including ideas such as moral status, the value of life, acts and omissions, harm, autonomy, dignity and paternalism. It then explores the practical difficulties of regulating end-of-life decisions, focusing on patients, healthcare professionals, the wider community and issues surrounding 'slippery slope' arguments. By evaluating the available empirical evidence, the author identifies preferred ways to regulate decisions and minimise abuses at the end of life, and outlines an ethical theory which can provide practical guidance for those engaged in end-of-life decisions.
End-Of-Life Issues, Grief, and Bereavement by Sara Honn Qualls; Julia E. Kasl-Godley
Call Number: BANKSTOWN Medical Library WB 310/END/1
ISBN: 9780470406939
Publication Date: 2010
A practical overview of clinical issues related to end-of-life care, including grief and bereavement The needs of individuals with life-limiting or terminal illness and those caring for them are well documented. However, meeting these needs can be challenging, particularly in the absence of a well-established evidence base about how best to help. In this informative guide, editors Sara Qualls and Julia Kasl-Godley have brought together a notable team of international contributors to produce a clear structure offering mental health professionals a framework for developing the competencies needed to work with end-of-life care issues, challenges, concerns, and opportunities. Part of the Wiley Series in Clinical Geropsychology, this thorough and up-to-date guide answers complex questions often asked by patients, their families and caregivers, and helping professionals as well, including: How does dying occur, and how does it vary across illnesses? What are the spiritual issues that are visible in end-of-life care? How are families engaged in end-of-life care, and what services and support can mental health clinicians provide them? How should providers address mental disorders that appear at the end of life? What are the tools and strategies involved in advanced care planning, and how do they play out during end-of-life care? Sensitively addressing the issues that arise in the clinical care of the actively dying, this timely book is filled with clinical illustrations, guidance, tips for practice, and encouragement. Written to equip mental health professionals with the information they need to guide families and others caring for the needs of individuals with life-threatening and terminal illnesses, End-of-Life Issues, Grief, and Bereavement presents a rich resource for caregivers for the psychological, sociocultural, interpersonal, and spiritual aspects of care at the end of life.

e-books

End of Life by Jeff Menzise
Call Number: Proquest E-books (Athens login required)
ISBN: 9781943028009
Publication Date: 2016-09-23
What ought to be done at the end of life is both a personal and public decision. As our population ages, it is becoming a matter of great concern for the entire nation. Diseases that would have been death sentences a few decades ago are now often treatable.This guide explores end-of-life decisions and examines options and trade-offs inherent in this sensitive and universal issue. Medical advances make it more likely that we will care for relatives in their final days, facing decisions regarding their illnesses or death--as well as our own. Even those who never face such choices will pay for them through tax dollars and the cost of insurance premiums. And as more states consider passing "right-to-die" laws similar to the one that took effect in Oregon in 1997, this debate may become a local one.Under most circumstances, end-of-life decisions remain difficult and uncomfortable. A Consumer Reports survey found that 86 percent of those polled wanted to die at home. But fewer than half of the respondents over age 65 had living wills detailing their dying wishes, leaving them at the mercy of hospitals and stressed-out families forced to decide on their behalf. In 1990, the US Supreme Court affirmed an individual's "right to die." Later, in 1997, the court upheld New York and Washington state laws banning physician-assisted death, leaving it for individual states to decide their legality. These rulings established legal precedence for a national conversation.This issue guide asks: What should society allow, and support, at the end of life? It presents three different ways of looking at the problem and suggests possible actions appropriate to each.OPTION 1:Maintain Quality of Life. That means when continued efforts to keep terminally ill patients alive a few more days or weeks result in needless pain and suffering, life-support treatment should be discontinued. At that point, caregiving efforts should be devoted to keeping patients comfortable and pain free.OPTION 2:Preserve Life at All Costs. Do everything we can to prevent death. This means sparing no expense to extend the lives of those who are sick. It should be difficult for doctors to give up on patients, and the end must not be brought about by deliberate medical neglect or intervention. Right-to-die laws must be repealed.OPTION 3:My Right, My Choice. The freedoms we value so highly in choosing how we live should not be taken away from us at the end of our lives. People should have the right to end their own lives and to enlist their doctors in helping them to die when a terminal illness leaves nothing to look forward to but higher levels of pain and suffering. About National Issues Forum The National Issues Forums (NIF) is a network of organizations that brings together citizens around the nation to talk about pressing social and political issues of the day. Thousands of community organizations, including schools, libraries, churches, civic groups, and others, have sponsored forums designed to give people a public voice in the affairs of their communities and their nation. For more information about NIF and for additional publications, see NIF's website at www.nifi.org.
A Good Death from the Perspective of Patients with Severe Illness and Advance Care Planning (ACP) in Patients near End-Of-life by Lisa Kastbom
Call Number: Proquest E-books (Athens login required)
ISBN: 9789179297190
Publication Date: 2021
Improving Care for the End of Life by Joanne Lynn; Janice Lynch Schuster; Anne Wilkinson; Lin Noyes Simon
Call Number: Proquest E-books (Athens login required)
ISBN: 9780195310429
Publication Date: 2007
Health care professionals seeking to improve the quality of life for those living with serious illness and nearing the end of life will find exactly what their organization needs in the second edition of this acclaimed book by Dr. Joanne Lynn and her colleagues. Improving Care for the End of Life provides expert guidance on how to make significant improvements now, at all levels of the health care system from the bedside and the hospital to the health care policy and legislative arenas by using the rapid-cycle breakthrough approach to change. The ideas are proven, and the stories of teams that have put them to use will inspire and enlighten. New to the second edition: BL New chapters to address issues of growing interest such as continuity of care, and the special needs of dementia patients and their loved ones. BL Details on trajectories of care and how these affect decisions at the end of life BL Updated and expanded information on pain management, advance care planning, ventilator withdrawal, depression and delirium, advanced heart and lung disease, and more BL Scores of new insights, measurement approaches, and tips based on the experiences of hundreds of improvement teams nationwide BL Thoroughly updated references The sourcebook speaks to all managers of health care systems serving people with serious illnesses, including doctors in offices, nurse managers on hospital units, social workers in long-term care facilities, administrators of home care and hospice agencies, hospital chaplains, directors of volunteer services, and others.

DVDs

Being mortal / [videorecording : DVD]. by Gawande, Atul.
Call Number: Shelfmark Copy Number Reservations Availability BANKSTOWN Medical Library WB 310/BEI/1 DVD
Publication Date: 2015
Frontline teams up with writer and surgeon Atul Gawande to examine how doctors care for terminally ill patients. In conjunction with Gawande's new book, Being Mortal, the film explores the relationships between doctors and patients nearing the end of life, and shows how many doctors, including himself, struggle to talk honestly and openly.
Facing death : confronting end-of-life choices / [videorecording : DVD] by Navasky, Miri. ; O'Connor, Karen. ;
Call Number: BANKSTOWN Medical Library WB 310/FAC/1 DVD
Publication Date: 2010
Originally broadcast Nov. 23, 2010 as an episode of the television program Frontline; copyright held by WGBH Educational Foundation.
Summary How far would you go to sustain the life of someone you love or your own? When the moment comes, and you're confronted with the prospect of 'pulling the plug', do you know how you'll respond? Unfounded rumors of federal 'death panels' grabbed headlines last summer, but the real decisions of how we die, the questions that most of us prefer to put off, are being made quietly behind closed doors, increasingly on the floors of America's intensive care units.
The patient's choice : quality at the end of life / [videorecording : DVD]. by Norman Swan
Call Number: BANKSTOWN Medical Library WB 310/PAT/1:1 DVD
Publication Date: 2011
The DVD explores the issues involved in end of life care. It looks at the need for patients to have accurate information and a specific assessment of their situation. It examines the use of advance care plans, and it explores the latest developments in palliative and end of life care.