The choice of life-prolonging treatments is an important decision for physicians. However, not all physicians consider patient preferences when making such decisions. Nurses, too, may have an important role to play in making life-prolonging treatment decisions. Here, we discuss their role in this process. In addition, we explore the role of nursing staff in these decisions. They are a valuable resource for physicians, especially those tasked with caring for patients with advanced illnesses.
Researchers have investigated the relationship between patients’ preferences for life-prolonging treatments and certain sociodemographic factors. These factors included age, race, gender, financial difficulty, and religious beliefs. The results suggest that religious beliefs are associated with a weaker preference for life-prolonging treatments than other characteristics. Patients’ preferences for life-prolonging treatments were also associated with factors such as comorbidities and family wishes.
The measurement of patient preferences for life-sustaining treatment can help researchers better understand the mechanisms underlying these outcomes. For instance, patients’ preferences for nighttime intensive care staffing differed across trials. The lack of blinding can result in differential practices for eliciting patient preferences. It is also important to account for possible mediators of study outcomes. However, such studies are still limited in the number of participants they have.
A CMS-standardized system to document patients’ preferences for life-sustaining treatments can improve this process. By standardizing the documentation of patient preferences, health care providers can increase the sensitivity and specificity of their responses to medical decisions. It could also improve individual patient autonomy, enhance validity of effectiveness research, and facilitate the development of preference-sensitive measures of healthcare quality. This approach is particularly useful for patient-directed research and clinical practice.
Researchers from the University of California San Francisco have explored the impact of end-of-life care on the patient’s decision-making process. Patients’ preferences for life-prolonging treatments have been found to vary significantly among people with advanced lung cancer. In a recent study, researchers examined the role of family members in cancer care decisions. Further, a study by the Netherlands-based Palliat Support Care published findings from this field.
Although patients’ preferences for life-prolonging treatments can be unreliable and unmeasurable, these data are vital to clinical decision-making and quality assessment. In addition, because decisions to restrict life-sustaining treatments are associated with high risk of mortality, these decisions are not accounted for in routine measures of illness severity. Researchers are not able to account for these preferences because they are not measured, resulting in inaccurate inferences and confounding by indication.
The social commitment of physicians to sustain life and alleviate suffering is the primary duty of a physician, but a patient’s preferences should override these obligations. Physicians should follow the principle of patient autonomy when refusing life-prolonging treatments for patients who lack the capacity to make their own decisions. Among these treatments are mechanical ventilation, renal dialysis, antibiotics, and artificial nutrition.
Life-prolonging treatments involve value judgments and medical expertise, and these are difficult to reconcile. Although these decisions require medical expertise and patient-centered decision-making, they are also fraught with normative issues, such as whether a treatment is beneficial or futile. This article aims to clarify the distinction between medical and normative issues and suggest practical criteria for life-prolonging treatments. These criteria include the patient’s understanding of the medical situation and the treatment’s expected effectiveness and benefit-harm ratio.
Currently, all states have laws related to life-prolonging treatments, and institutional policies often recommend such treatments. Physicians have a crucial role in ensuring that patients receive appropriate care in hospital and other care settings, a fact that was documented in a recent study. However, many patients die without consideration of these issues, and many are subjected to invasive medical treatments against their wishes.
Nurses and other health care professionals can support patients’ wishes by discussing what kind of support they need and value when considering potentially life-prolonging treatments. Nurses can also use advance directives to express their preferences for a potential treatment. These advance directives are legal documents that provide a legal framework for physicians to discuss these topics. In the Netherlands, the government has even developed guidelines to guide physicians when making decisions about potentially life-prolonging treatments.
In one case, a patient’s condition deteriorated quickly and artificial respiration was considered a life-prolonging treatment. The eldest daughter strongly desired artificial respiration for the patient. In addition to being necessary for nutritional intake and ensuring discharge from the hospital, this treatment was not deemed life-threatening by the patient’s family. While the attending physician’s view of life-prolonging treatments was largely negative, the decision to use artificial respiration may have been a compassionate one.
The study examined the factors that affect physician decisions regarding life-prolonging treatments. The study included four variables: patient characteristics, life experiences, and education. The researchers also evaluated the role of nurses in shared decision-making. The findings showed that nurses had a critical role in the process, but they were not involved as often as doctors would like. There are numerous barriers that prevent nurses from fully participating in the process of life-prolonging treatments, and the study results are promising.
Patients often consult with their physician about potential life-prolonging treatments. However, nurses are not typically involved in such discussions. However, their role in shared decision-making is still important. During discussions, patients often share personal information and discuss their preferences, and nurses are often considered a crucial intermediary between patients and physicians. The eldest daughter should have been the patient’s representative, and the eldest daughter’s decision should be supported. Further research is necessary to understand the concepts of advance directives in Japan.
The younger physicians were less likely to withhold decisions and use less OS, thrombosis prophylaxis, and blood transfusion in patients with cancer. Physicians’ decisions about life-prolonging treatments are highly influenced by family appeal and age. For example, younger physicians are less likely to refuse chemotherapy and LST while older physicians are more likely to forgo a blood transfusion.
End-of-life (EOL) decision-making involves complicated, often difficult decisions. Because patients in this state often lack capacity for making their own decisions, family members act as decision-makers. One of the biggest challenges in EOL decision-making is prognostic uncertainty. Physicians and nurses often fear that removing hope and granting up hope too soon will result in an unintended consequence.
Nursing professionals involved in decision-making about potentially life-prolunging treatments often weigh the likelihood of improvement, the risks of the treatment, and the patient’s wishes. They also consider how much the treatment will affect the patient’s quality of life. The most common interventions that were discussed were chemotherapy, radiotherapy, and symptom medications. The chances of success, however, were lower than expected.
Increasingly, end-of-life decisions are being made by patients and their families. The future importance of these decisions should be examined, with research and education of physicians being given greater priority. Open study of nontreatment decisions may also help improve the quality of decision-making, especially if the patients can’t express their wishes. It’s important to note that this study was funded by the Ministry of Health, Welfare, and Sport and the Ministry of Justice.
A recent focus group of twenty-seven nurses found that a majority of nurses (75%) had an active role in the decision-making process when considering the use of potentially life-prolonging treatments. They initiated discussions with physicians, explained the potential consequences of the treatment, and supported patients and their families through the process. Regardless of the situation, the involvement of nurses in decision-making about potentially life-extending treatments is important for patient care and quality of life.
The results of such studies also show that nurses are important decision-makers, but they must be involved in the process. In the present study, nurses have an important role in facilitating communication between patients, their families, and the health care team. Nurses’ communication strategies fall into three categories: giving information to physicians and family members, mediating, and facilitating communication between patients and their health care teams.
Family meetings provide a forum for nurses to advocate for their patients. Family members may feel uncertain about whether to accept a potentially life-prolonging treatment because the risks are so high. In the family meetings, nurses also explain the risks, complications, and side effects of potentially life-prolonging treatments. Family members must consider the patient’s wishes before deciding whether to use aggressive treatment.
These conversations are often difficult to have. Nurses and family members must communicate accurately and provide resources so they can make the right decisions for their loved one. A perspective from a registered nurse helps prospective nurses understand the value of strong communication. Jeanne Erickson, Ph.D., RN, advocates for regular family meetings, in which everyone involved in the care process can better understand the patient’s condition and disease progress.