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At least 19 recordsLinked to original sources
PubMed2006

Experience of dying: concerns of dying patients and of carers.

BACKGROUND: Terminally ill patients frequently express concerns about what dying will be like: how their bodies may change as disease progresses, how medication may alter the effect of these changes and whether and how their preferences will be respected as they become more ill. METHODS: Thirty-six patients admitted to a hospice were interviewed and 18 carers of patients of the Palliative Care service, who had died participated in focus groups. Thirty-three patients had advanced malignant disease, 13 were women; their mean age was 68 years (range 44-92 years). RESULTS: The areas of concern consistently identified by patients were (i) privacy and autonomy, principally in regard to families, (ii) a lack of information about physical changes and medication use as death approached and (iii) the desire to shorten life, which was expressed by all patients. Carers recalled problems accessing services and support and had needed more help with practical issues such as medication timing and dose. They believed that not enough information about the patients' illnesses had been given to them and they were insistent that carers should have information against the wishes of patients. CONCLUSION: Some of the patients' and carers' concerns can be readily addressed. Others, particularly access to confidential information, cannot be addressed without a realignment of professional ethical standards and community expectations. The patients' discussions of their desire to shorten life may have implications for the debate on euthanasia and physician-assisted suicide.

Adult↗
PubMed2004

Development and testing of a new instrument for measuring concerns about dying in health care providers.

A new measure of concerns about dying was investigated in this psychometric study. The Concerns About Dying instrument (CAD) was administered to medical students, nursing students, hospice nurses, and life sciences graduate students (N = 207) on two occasions; on one occasion they also completed three related measures. Analyses included descriptive statistics, factor analysis, Cronbach's alpha, test-retest correlations, t tests, and correlations with other measures. Results suggest the CAD measures three distinct but related areas: general concern about death, spirituality, and patient-related concern about death. Reliability estimates were good, and correlations with related measures were strong. Between-group differences suggest scores are related to actual differences in level of concern and beliefs about death and dying. The CAD has the advantage of being very brief and of explicitly assessing concerns about working with patients who are dying.

Adult↗
PubMed1990

A factor analytic investigation of home-bound elderly individuals' concerns about death and dying, and their coping responses.

One hundred and seventy-eight home-bound elderly men and women participated in an investigation of death and dying concerns and coping responses used to deal with these anxieties. A semi-structured interview procedure was used to obtain responses from the subjects. The data subsequently were subjected to two factor analyses. The resulting factors from the interview and checklist responses of the elderly showed three major categories of elderly subjects' fears, which consisted of factors of (1) physical pain and suffering; (2) risk to personal safety; and (3) threat to self-esteem and the uncertainty of life beyond death. The four major categories of their coping responses consisted of factors related to internal self-control, social support, prayer, and preoccupation with objects of attachment.

Adaptation, Psychological↗
PubMed1982

[Training in thanatology ; a map of the world.].

To contribute to the training of workers in health and social fields concerning dying raises the whole question of their relationship to the world. And the very fact that, here in Quebec, we "give ourselves the luxury" of offering a training program on dying may be significant of new practices concerning dying. The possible social uses and the stakes of such training are briefly explored here : specialization of knowledge allowing for the emergence of a new "thanatocracy of death" ; the liberating of speech into behavioural models, etc. In reply to these stakes, a paradigm : it is the living who die, who, by their communication, may give rise to the development of a method of investigation of dying : in our relations with those who die, in our relation with the institution and more globally, in the types of death which our society generates.

English Abstract↗
PubMed1998

Beliefs concerning death, dying, and hastening death among older, functionally impaired Dutch adults: a one-year longitudinal study.

OBJECTIVES: Population surveys have documented increasing public support for euthanasia and assisted suicide but have not focused on the population of chronically ill older persons, obtained detailed sociocultural or health status information, or performed repeat assessments. This study seeks to describe the views of functionally-impaired Dutch elders on death, dying, and hastened death and to relate these to sociocultural and health status. DESIGN: One-year prospective epidemiologic survey. SETTING AND PARTICIPANTS: Community-dwelling participants in the longitudinal component of the Groningen Longitudinal Aging Study were assessed at home by interview and questionnaire in 1994 (n = 632) and again in 1995 (n = 575). MEASUREMENTS: Independent variables were sociocultural characteristics (eg, age, sex, income, education, religious affiliation, strength of religious belief), physical health status (number of chronic medical conditions, functional impairments), and mental health status (life satisfaction, self-efficacy, anxiety, depression, and neuroticism). Dependent variables were preoccupation with and fear of death, fears of the dying process, and attitudes toward hastened death. RESULTS: Low and stable rates of preoccupation with death and fear of death were found. Occasional but not persistent fears about the dying process were common. Fears of death and dying were most closely related to health status, especially mental health status. Views concerning hastening death were most strongly related to sociocultural variables, especially religious belief and affiliation. There was little change over the 1-year follow-up, with a trend toward less fears of death and dying and less support for hastened death. Significant changes in fears of death and dying and attitudes toward hastened death were not seen even in the 25% of subjects with the greatest deterioration in activities of daily living or greatest increase in anxiety and depression during the 1-year follow-up. CONCLUSION: Beliefs about death, dying, and hastened death are stable over 1-year follow-up. Fears of death and dying are most strongly related to mental health in this community sample. Attitudes about hastening death are primarily related to religious belief and secondarily to mental health. Mental health factors may determine the distress associated with the prospect of death and dying, whereas religion may dictate the actions considered proper when dying.

Aged↗
PubMed2004

Thoughts of patients with advanced heart failure on dying.

OBJECTIVE: To explore, over a one-year period, the ideas and attitudes of patients with end-stage cardiac failure concerning dying. DESIGN: Prospective longitudinal multiple case study using qualitative interview techniques. PARTICIPANTS: Thirty-one patients from two hospitals who fulfilled one or more of the following criteria: NYHA III or IV, ejection fraction < 25%, at least one hospitalization for heart failure. MAIN OUTCOMES: Statements of patients with advanced heart failure, expressed in semi-structured interviews, concerning the quality of dying and medical decisions at the end of life. RESULTS: Many respondents only thought about death during exacerbations. Mentioned aspects of appropriate dying include: a degree of usefulness, prognostic knowledge, appropriate duration and mental awareness. Few respondents were in favour of euthanasia or suicide, but all wanted life-prolonging treatment to be withheld or withdrawn when appropriate. CONCLUSIONS: Our study found some elements of 'appropriate dying' that differ from other studies and that are relatively specific for advanced heart failure. The tendency of patients not to think about death raises ethical concerns.

Aged↗
PubMed1989

Concerns for the dying patient and family.

Some of the special concerns of the dying patient have been addressed. Loss of control, adequate pain control, and sexuality represent only a small portion of the enormity of caring for dying patients. Great strides have been made in recent years both in the areas of special concerns and recognizing the anticipatory grief that patients and families need to experience. Perhaps the most important concern today for patients and families is that professional caregivers validate their feelings and allow them to make their own choices.

Ethics, Nursing↗
PubMed1998

Physician-assisted suicide reconsidered: dying as a Christian in a post-Christian age.

The traditional Christian focus concerning dying is on repentance, not dignity. The goal of a traditional Christian death is not a pleasing, final chapter to life, but union with God: holiness. The pursuit of holiness requires putting on Christ and accepting His cross. In contrast, post-traditional Christian and secular concerns with self-determination, control, dignity, and self-esteem make physician-assisted suicide and voluntary active euthanasia plausible moral choices. Such is not the case within the context of the traditional Christian experience of God, which throughout its 2000 years has sternly condemned suicide and assisted suicide. The wrongness of such actions cannot adequately be appreciated outside the experience of that Christian life. Traditional Christian appreciations of death involve an epistemology and metaphysics of values in discordance with those of secular morality. This difference in the appreciation of the meaning of dying and death, as well as in the appreciation of the moral significance of suicide, discloses a new battle in the culture wars separating traditional Christian morality from that of the surrounding society.

Attitude to Death↗
PubMed2005

Direct care workers' response to dying and death in the nursing home: a case study.

OBJECTIVES: This paper is based on research that explored the cultural construction of dying and death in nursing homes and assisted living facilities in a large Northeastern city. It focuses on direct care workers' responses to elders' dying and death within the facility. METHODS: Data were gathered in a multiyear, multisite study through formal ethnographic interviews, informal conversations, and on-site observations of staff members. RESULTS: We introduce the case of Jayson, an activities director in a for-profit nursing home. We show how his belief system and experiences outside the facility, especially those concerning dying and death, shape his view of the nature and content of his work and his reaction to residents' deaths. DISCUSSION: We suggest caretaking at the intersection of gender, race, socioeconomic status, and the inside and outside life of direct care workers as topics for future research.

Adult↗
PubMed1991

Taking charge: death control as an emergent women's issue.

Advances in medical technology in recent decades have produced an array of life-sustaining technologies which can delay the moment of death for almost everyone, making the timing and circumstances of death more a matter of deliberate choice than ever before in human history. Continuing proliferation of such technologies, their escalating social and economic costs, a growing population of older people, and the feminization of old age make right-to-die concerns ever more compelling. This paper points out how such issues are particularly salient for aged women as consumers of long-term care, both in the formal and informal sectors. The dual dilemmas of "premature" versus "delayed" death are also explored in each context. Finally, the implications of social change are interpreted in light of feminist health care goals.

Aged↗
PubMed1999

[Attitude of general practitioners facing patients at the end of life in home care].

OBJECTIVES: General practitioners (GPs) are directly confronted with patients experiencing end-of-life situations in their homes. We conducted a survey to ascertain the GPs' approach as there has been little work in France concerning this type of situation. METHODS: A questionnaire was sent to 478 general practitioners in the Essonne department who are corresponding physicians at the Louis-Michel hospital in Evry. There were 233 responses (49.8%). RESULTS: The main findings demonstrated that important decisions concerning dying patients are made on a consensus basis in 58.8% of the cases. Problems related to end-of-life situations are discussed with persons close to patients with incurable conditions (for 85% of the responding GPs) and with the patient (74%). Patients participating in the discussion express the desire to continue living in 65.7% of the cases. The familial situation appears to be the essential element for managing these patients in their home and is the number one reason for hospitalization. This contrasts with the opinion of general practitioners who favor home management (82% of the responding physicians). CONCLUSION: Our study demonstrates an important gap in medical education since 66.5% of the practitioners felt they had not received appropriate training in this area. It also emphasizes the lack of sufficient communication between general practitioners and hospital physicians and the need to organize a network which would better respond to patient, family, and physician demands.

Aged↗
PubMed1991

[Hartmann's procedure. Indications, results. Apropos of 105 cases].

The authors report in this retrospective study, 105 cases of patients operated with Hartmann's technic since 1979 to 1990. There were 55 men and 50 women with average age of 70 years (34-90 years old), 71 patients were strucked down by malign disease, 34 by benign disease. 42 surgical operations were performed immediately, 63 were delayed, 26 operations were immediately performed for serious sepsis, 11 for occlusives syndromes. Delayed surgical operations were performed for malignant diseases in 50 cases, elsewhere, there were 6 sigmoiditis with malignant aspect. The upper half rectum was resected at a rate of 38%, the original technic was performed at a rate of 65%. Post operatory mortality was at a rate of 13% (14 died) concerning 25% of immediately operated patients and 6% of delayed operations. Post operatory mortality was at a rate of 15.4% for malignant disease and 8.8% for benign disease. Post operatory results were complicated with 4 occlusives syndromes, 3 fistula from the rectum, 1 cholecystis, 1 small intestine perforation. There were 10 parietal complications and 10 general complications with 7 urinary infections, 4 lung infections and 2 venous thrombosis. The colon anastomosis was performed in a manual way in 23.4% of cases, in a mechanical way in 23% of cases (with EEA or PCEA forceps) with a 8 month average interval between the 2 surgical operations. The mortality rate of this surgical operation is high because patients are old and have heavy deficiencies and are immediately operated for serious diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Bioethical issues concerning death: death, dying, and end-of-life rights.

Ethical issues about death, dying, and a person's right to make end-of-life decisions have become one of the most legally complex and culturally sensitive areas to emerge in our time. Sensitive issues associated with a terminally ill individual's right to make end-of-life decisions and the disposition of those who are unable to make such decisions for themselves will keep healthcare professionals, medical ethicists, counselors, families, lawyers, judges, and legislators busy for years to come. Americans find it difficult to deal with end-of-life issues and would rather focus on what more can be done to save a life.

Advance Directives↗