Intersectional Inequities In End-Of-Life Care Quality: The Roles Of Race, Ethnicity, And Gender, Jessica A. Yauk

USF Tampa Graduate Theses and Dissertations

Persistent gaps remain in end-of-life care quality (EOLCQ) in the United States. Structural factors within the health care system, as well as discriminatory practices, affect the quality of care received by at-risk populations. This dissertation uses a mixed-methods research design to examine perceived EOLCQ across racial/ethnic and gender groups. Study 1 and Study 2 were guided by the intersectionality and Social Determinants of Health (SDOH) frameworks, and examined ten EOLCQ outcomes: pain, dyspnea, sadness or anxiety, having personal care needs met, having decisions made about care without enough input from decedent or family, whether the proxy or family were kept …

Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

Improving Patient Self-Efficacy, Readiness, And Completion Of Advance Care Planning Documents Using Prepare Documents And Advance Care Planning Group Referral, Marie Vassiliadis

Doctor of Nursing Practice Final Manuscripts

Advance Care Planning (ACP) is an ongoing discussion about medical decision making between a provider, patient, and support person. ACP can also include legal documentation in the form of an advance directive (AD). Nationally, only 36.7% of adults complete any form of AD for end-of-life care. Recently, ACP has become an important quality metric that many organizations are prioritizing. The purpose of this evidence-based project is to improve ACP readiness, self-efficacy, and documentation among patients at an internal medicine clinic using the PREPARE program and referral to an ACP group meeting. PREPARE for Your Care is an online program aimed …

Palliative Care Early In The Care Continuum Among Patients With Serious Respiratory Illness An Official Ats/Aahpm/Hpna/Swhpn Policy Statement, Donald R. Sullivan, Anand S. Iyer, Susan Enguidanos, Christopher E. Cox, Morag Farquhar, Daisy J. A. Janssen, Kathleen O. Lindell, Richard A. Mularski, Natasha Smallwood, Alison E. Turnbull, Anne M. Wilkinson, Katherine R. Courtright, Matthew Maddocks, Mary Lynn Mcpherson, J. Daryl Thornton, Margaret L. Campbell, Tracy K. Fasolino, Patricia M. Fogelman, Larry Gershon, Thayer Gershon, Christiane Hartog, Judy Luther, Diane E. Meier, Judith E. Nelson, Elliot Rabinowitz, Cynda H. Rushton, Danetta H. Sloan, Erin K. Kross, Lynn F. Reinke

Research outputs 2022 to 2026

Background:

Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes.

Goals:

This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this.

Methods:

An international and interprofessional expert committee, …

Positive Ageing And Death Or Dying: A Scoping Review, Robin Otto

Social Work Theses - Archive

This scoping review aims to examine the extent and how research that utilizes successful, active, productive, and healthy ageing framework(s) include death or dying. An examination of peer-reviewed academic articles published between 1980 and 2021 were reviewed following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's five-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A thematic analysis was the qualitative method employed to identify how research utilizes the concepts of death and dying in the context of four …

Cultural Aspects Of End Of Life Advance Care Planning For African Americans: An Ethnonursing Study, John Collins

Electronic Theses and Dissertations

Introduction: Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are impacted by demographic variables, cultural distinctives related to patient autonomy, mistrust of the healthcare system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. End of Life (EOL) advance care planning (ACP) promotes patient and family centered care. The purpose of this study was to identify culturally based meanings, expressions, and traditions of EOL ACP and decision making among African Americans, to better understand and provide culturally congruent nursing …

Managing 'Shades Of Grey': A Focus Group Study Exploring Community-Dwellers’ Views On Advance Care Planning In Older People, N Michael, C O'Callaghan, E Sayers

Medical Papers and Journal Articles

Background: Community-dwelling consumers of healthcare are increasing, many aging with life-limiting conditions and deteriorating cognition. However, few have had advance care planning discussions or completed documentation to ensure future care preferences are acted upon. This study examines the awareness, attitudes, and experiences of advance care planning amongst older people and unrelated offspring/caregivers of older people residing in the community.

Methods: Qualitative descriptive research, which included focus groups with older people (55+ years) and older people’s offspring/caregivers living in an Australian city and surrounding rural region. Data was analysed using an inductive and comparative approach. Sampling was both convenience and purposive. …

Family Communication Concerning End-Of-Life Care Preferences, Lindsay Jo Peterson

USF Tampa Graduate Theses and Dissertations

Communication concerning the care one wishes to receive at the end of life (EOL) is central to ensuring that wishes are honored. Many studies have examined doctor-patient or doctor-family EOL communication. However, relatively few studies have focused on the occurrence of EOL care discussions among family members. This is an important topic, as research suggests that advance directives (ADs) are ineffective if patients have not involved surrogate decision-makers, most of whom are family members. This study examined EOL care discussions among family members. It used quantitative and qualitative data from a diverse sample of older adults from West Central Florida …

Clinicians May Not Administer Life-Sustaining Treatment Without Consent: Civil, Criminal, And Disciplinary Sanctions, Thaddeus Mason Pope

Faculty Scholarship

Both medical and legal commentators contend that there is little legal risk for administering life-sustaining treatment without consent. In this Article, I argue that this perception is inaccurate. First, it is based on an outdated data set, primarily damages cases from the 1990s. More recent plaintiffs have been comparatively more successful in establishing civil liability. Second, the published assessments focus on too-limited data set. Even if the reviewed cases were not outdated, a focus limited to civil liability would still be too narrow. Legal sanctions have also included licensure discipline and other administrative sanctions. In short, the legal risks of …