End-of-Life Communication and Adjustment: Pre-Loss Communication as a Predictor of Bereavement-Related Outcomes.

Record: 1
End-of-Life Communication and Adjustment: Pre-Loss Communication as a Predictor of Bereavement-Related Outcomes.
Authors: Metzger, Patricia L.Gray, Matt J.
Source: Death Studies; Apr2008, Vol. 32 Issue 4, p301-325, 25p, 6 charts, 1 graph
Document Type: Article
Abstract: Although bereavement-related emotional distress usually remits on its own over time, approximately 20% of bereaved individuals experience chronic emotional difficulties following the loss (Prigerson & Jacobs, 2001). Although several factors have been shown to be associated with poor outcomes post-loss, few studies have examined the relationship between pre-loss communication and bereavement-related depression, and none have examined its relationship to complicated grief. The present study examined how pre-loss communication between the bereaved and the deceased is related to post-loss outcomes within a sample of 60 members of online bereavement support groups. Results indicated that developing acceptance of an expected loss is strongly associated with bereavement outcomes. This finding persists even after controlling for relationship closeness and time elapsed post-loss. [ABSTRACT FROM AUTHOR]
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Record: 2
Influence of physicians' life stances on attitudes to end-of-life decisions and actual end-of-life decision-making in six countries.
Authors: Cohen, J.Van Delden, J.Mortier, F.Löfmark, R.Norup, M.Cartwright, C.Faisst, K.Canova, C.0nwuteaka-Philipsen, B.Bilsen, J.
Source: Journal of Medical Ethics; Apr2008, Vol. 34 Issue 4, p247-253, 7p, 5 charts

Abstract:
Aim: To examine how physicians' life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making. Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and Australia received structured questionnaires on end-of-life care, which included questions about their life stance. Response rates ranged from 53% in Australia to 68% in Denmark. General attitudes, intended behaviour with respect to two hypothetical patients, and actual behaviour were compared between all large life-stance groups in each country. Results: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten the patient's death (PAD), physicians with specific religious affiliations had significantly less accepting attitudes, and less willingness to perform it, than non-religious physicians. They had also actually performed PAD less often. However, in most countries, both Catholics (up to 15.7% in The Netherlands) and Protestants (up to 20.4% in The Netherlands) reported ever having made such a decision. Discussion: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients and circumstances. Physicians seem to embrace religious belief in a non-imperative way, allowing adaptation to particular situations. [ABSTRACT FROM AUTHOR]
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Record: 3
MANAGING INTENTIONS: THE END-OF-LIFE ADMINISTRATION OF ANALGESICS AND SEDATIVES, AND THE POSSIBILITY OF SLOW EUTHANASIA.
Authors: DOUGLAS, CHARLESKERRIDGE, IANANKENY, RACHEL
Source: Bioethics; Sep2008, Vol. 22 Issue 7, p388-396, 9p
Document Type:

Abstract:
There has been much debate regarding the ‘double-effect’ of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing ‘slow euthanasia.’ On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In this paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary ‘slow euthanasia’). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a ‘grey’ area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that ‘slow euthanasia’ may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of ‘time’ for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]
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Record: 4
The potential impact of decision role and patient age on end-of-life treatment decision making.
Authors: Zikmund-Fisher, B. J.Lacey, H. P.Fagerlin, A.
Source: Journal of Medical Ethics; May2008, Vol. 34 Issue 5, p327-331, 5p, 5 charts
Document Type:

Background: Recent research demonstrates that people sometimes make different medical decisions for others than they would make for themselves. This finding is particularly relevant to end-of-life decisions, which are often made by surrogates and require a trade-off between prolonging life and maintaining quality of life. We examine the impact of decision role, patient age, decision maker age and multiple individual differences on these treatment decisions.

Methods: Participants read a scenario about a terminally ill cancer patient faced with a choice
between an aggressive chemotherapy regimen that will extend life by two years and palliative treatments to control discomfort for one remaining month. Participants were randomly assigned to one of three decision roles (patient, physician, or an abstract other) and the scenario randomly varied whether the patient was described as 25 or 65-years old. Results: When deciding for a 65-year old patient, approximately 60% of participants selected aggressive chemotherapy regardless of decision role. When deciding for a 25-year old patient, however, participants were more likely to select chemotherapy for a patient (physician role) or another person (abstract other) than for themselves (70%, 67%, and 59%, respectively). In addition, confidence that powerful others (eg, physicians) control one's health, as well as respondents' age and race, consistently predicted treatment choices. Conclusions: Patient age appears to influence medical decisions made for others but not those that we make for ourselves. These findings may help to explain the discord that often occurs when younger cancer patients refuse life-extending treatments. [ABSTRACT FROM AUTHOR]
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