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Biomedical subjects

T E Finucane

Publications and source records attributed to T E Finucane.

44 records · Page 3Linked to original sources
PubMed1989

Dialysis patients' attitudes about cardiopulmonary resuscitation and stopping dialysis.

Dialysis patients are a unique population because of their chronic dependence on complex medical technology. Furthermore, their illness forces them to make critical decisions about medical care (mode of dialysis, renal transplantation, withdrawal from dialysis). The reasons dialysis patients discontinue therapy are not well understood, nor is it known whether they view dialysis therapy differently from other life-support interventions. We asked four groups of patients - in-center hemodialysis (HD), peritoneal dialysis (PD), renal transplant, and ambulatory elderly - questions about their wishes for (1) medical information, (2) participation in medical decision-making, (3) life-supporting therapy including cardiopulmonary resuscitation (CPR) and ventilatory support, and (4) stopping dialysis at the time of the study and in certain hypothetical situations. All groups wanted information and involvement in making medical decisions. Most patients desired CPR (96% of renal transplant, 76% of HD, 63% of PD, 82% of elderly), but PD patients chose CPR less often in all circumstances (at study, p = 0.004; in coma, p = 0.004; in permanent coma, p = 0.04), and they were less willing to undergo chronic ventilation (p = 0.001). PD patients were more likely to stop dialysis (p = 0.02) in coma than were HD patients. PD patients attended religious services more frequently and were less comfortable with machines, but these differences did not correlate with their decisions about life-support therapy. Dialysis patients have rarely considered stopping dialysis; they are similar to ambulatory elderly patients with regard to decisions about CPR and desire for involvement in medical decision-making. PD patients are a distinct subgroup worthy of further study.

Adolescent↗
PubMedDate not supplied

Planning with elderly outpatients for contingencies of severe illness: a survey and clinical trial.

The authors examined whether elderly patients would report positive or adverse emotional effects after their doctor, during a routine clinic visit, asked them to begin planning for future serious illness. Seventy-four patients, 65 years old or older, who were followed at a university hospital medical clinic were randomly allocated to an intervention or a control group. The intervention was a detailed discussion with the patient's physician of the patient's wishes about decision making and life support therapy in the event of extreme or incapacitating illness. A blinded interviewer then asked all consenting patients how they felt about the physician, the clinic visit, and their medical care. Intervention-group patients were questioned about their reactions to the physician and the discussion. Four important findings emerged: 1) Some emotional uncertainty was created when doctors raised these questions unexpectedly: one patient became visibly upset during the discussion, and three who gave consent to be interviewed afterward said that the discussion had made them wonder about their health. Nonetheless, all patients who received the intervention and completed the study were pleased that their doctor had asked. 2) Only 44% of all consenting patients reported having discussed these issues previously; only one had done so with a doctor. 3) 97% of patients who responded wanted to be kept informed by the doctor about their medical situations in times of serious illness. 4) Patients' replies to specific questions about life-sustaining therapy in the event of their own severe illnesses were quite variable. During routine clinic visits doctors can encourage most elderly patients to begin specific planning for potential severe illnesses.

Aged↗
PubMedDate not supplied

Racial bias in presentation of cases.

To investigate whether medical housestaff report race information differently during case presentations of black patients and white patients, a prospective observational study was performed. Without informing housestaff, a chief resident recorded data during consecutive case presentations over two months. For each presentation, the data included: 1) whether, where, and how often race was identified; 2) whether certain prospectively selected, "possibly unflattering characteristics" were mentioned; and 3) whether any "justifying" diagnoses were considered during presentation or subsequent discussion. Justifying diagnoses were those in which a patient's race was important in considering the likelihood of possible diagnoses. Twenty-three house officers presented 18 black and 35 white patients. A single East Indian patient was excluded from analysis. Race was specified more often during presentations of black than of white patients (16 of 18 for blacks vs. 19 of 36 for whites; p less than 0.01). For two black patients, a justifying diagnosis was considered, but excluding these patients did not change the results. Two other differences did not achieve statistical significance. Race was more often specified prominently and repeatedly during presentations of black patients. Among patients to whom "possibly unflattering" characteristics were attributed, race was more likely to be specified for blacks (10 of 10) than for whites (4 of 9). These case presentations appeared to show a subtle bias.

Black or African American↗