A5012829597- Palliative Care and End-of-Life Issues
- Ethics in medical practice
- Grief, Bereavement, and Mental Health
- Patient Dignity and Privacy
- Childhood Cancer Survivors' Quality of Life
- Family and Patient Care in Intensive Care Units
- Patient-Provider Communication in Healthcare
- Ethics and Legal Issues in Pediatric Healthcare
- Pain Management and Opioid Use
- Healthcare Decision-Making and Restraints
- Health Systems, Economic Evaluations, Quality of Life
- Healthcare Policy and Management
- Medical Malpractice and Liability Issues
- Religion, Spirituality, and Psychology
- Pharmaceutical industry and healthcare
- Geriatric Care and Nursing Homes
- Global Health Care Issues
- Psychotherapy Techniques and Applications
- Counseling, Therapy, and Family Dynamics
- Pharmaceutical Practices and Patient Outcomes
- Family Support in Illness
- Healthcare cost, quality, practices
- Cancer survivorship and care
- Patient Safety and Medication Errors
- Primary Care and Health Outcomes
Harvard University
1990-2024
Northwestern University
2015-2024
Massachusetts General Hospital
1989-2024
Chicago Institute for Psychoanalysis
2017-2023
Robert H. Lurie Comprehensive Cancer Center of Northwestern University
2012-2023
Boston Psychoanalytic Society and Institute
2023
Midwestern University
2002-2023
Northwestern Medicine
2019-2022
University of Humanistic Studies
2021
University of Manitoba
2021
Advance directives for medical care and the designation of proxy decision makers to guide after a patient has become incompetent have been widely advocated but little studied. We investigated attitudes patients toward planning, perceived barriers such treatment preferences in four hypothetical scenarios, feasibility using particular document (the Medical Directive) outpatient setting specify advance directives.
Background: Terminal illness imposes substantial burdens—economic and otherwise—on patients caregivers. The cause of these burdens is not understood. Objective: To determine the mechanism for economic noneconomic terminal to identify potential ameliorating interventions. Design: In-person interviews terminally ill their Setting: Six randomly selected U.S. sites: Worcester, Massachusetts; St. Louis, Missouri; Tucson, Arizona; Birmingham, Alabama; Brooklyn, New York; Mesa County, Colorado....
ContextEuthanasia and physician-assisted suicide (PAS) are highly controversial issues. While there studies of seriously ill patients' interest in euthanasia PAS, no data on the attitudes desires terminally patients regarding these issues.ObjectiveTo determine toward whether they were considering PAS for themselves, stability their desires, factors associated with proportion who die from interventions.DesignProspective cohort primary caregivers surveyed twice between March 1996 July...
In addition to medical care, dying patients often need many types of assistance, including help with transportation, nursing homemaking services, and personal care. We interviewed terminally ill adults their care givers in six randomly selected areas the United States (five metropolitan one rural county) determine how needs for assistance were met frequency which they received such from family members paid volunteer givers.
Today, at the dawn of a new century, genuine medical professionalism is in peril. Increasing-ly, physicians encounter perverse financial incentives, fierce market competition, and erosion patients' trust,17 yet most are ill equipped to deal with these threats.8,9 The role has been so little discussed that it virtually disappeared battle between those who favor competition trillion-dollar industry seek greater government regulation.8 Physicians, feeling trapped camps, turning unionization...
Living wills have been strongly endorsed in principle. Unfortunately, existing living are rarely used clinical practice because they vague and difficult to apply. To remedy this, we propose a new advance care document: the Medical Directive. The Directive delineates four paradigmatic scenarios, defined by prognosis disability of incompetent patients. In each scenario, patients indicate their preferences regarding specific life-sustaining interventions. also provides for designation proxy...
<h3>Background</h3> Discussing end-of-life issues with terminally ill patients is often considered distressing and harmful. This study was conducted to assess whether interviewing their caregivers about death, dying, bereavement stressful and/or helpful. <h3>Methods</h3> Patients from 6 sites in the United States who were estimated have months or less live interviewed person reinterviewed 2 later. Their separately. At end of interviews, asked how helpful interview had been. Of 1131 eligible...
Abstract Background: The emergency department (ED) visit rate for older patients exceeds that of all age groups other than infants. aging population will increase elder ED patient utilization to 35% 60% visits. Older can have complex clinical presentations and be resource‐intensive. Evidence indicates physicians fail provide consistent high‐quality care patients, resulting in poor outcomes. Objectives: objective was develop a consensus document, “Geriatric Competencies Emergency Medicine...
ABSTRACT We articulate an intellectual history and a definition, description model of patient safety. define safety as discipline in the health care professions that applies science methods toward goal achieving trustworthy system delivery. also attribute systems minimizes incidence impact adverse events maximizes recovery from such events. Our includes: why field exists (the high prevalence avoidable events); its nature; essential focus action microsystem); how works (e.g., high-reliability...
Conversations about prognosis are difficult for patients and clinicians. Clinicians should partner with as they integrate prognostic information into goals end-of-life decisions.
ON December 1, 1991, the Patient Self-Determination Act of 1990 (PSDA)1 went into effect. This is first federal statute to focus on advance directives and right adults refuse life-sustaining treatment. The law applies all health care institutions receiving Medicare or Medicaid funds, including hospitals, skilled-nursing facilities, hospices, home personal agencies, maintenance organizations (HMOs). requires that institution provide written information each adult patient admission (in case...
<h3>Background:</h3> Advance directives are intended to extend patient autonomy into periods of mental incompetence. However, for advance fulfill this objective, patients' choices must be reasonably consistent over time. Thus, we assessed the stability treatment decisions patients and members public. <h3>Methods:</h3> In a prospective cohort study 495 outpatients 102 public, studied scenario- treatment-specific choices. Subjects completed an directive, which included four illness scenarios...
The processes surrounding psychological adjustment to losses due advancing and end-stage illness have not been well delineated. While death are often thought of as the bereaved's lot, dying persons experience multiple, accumulating, profound functions, abilities, roles, relationships therefore adjust well. Many people who facing in near future negotiate these losses, still achieving quality life all dimensions. Others fare less It is hard intervene helpfully without a clear understanding how...
Medicine has long acknowledged the role of chaplains in healthcare, but there is little research on relationship between chaplaincy care and health outcomes. The present study examines association services end-of-life service choices.HealthCare Chaplaincy purchased AHA survey database from American Hospital Association. Dartmouth Atlas Health Care was provided to HealthCare by Institute for Policy & Clinical Practice, with permission Co-Principal Investigator Elliot S. Fisher, M.D., M.P.H....
Purpose: Lack of appreciation cultural differences may compromise care for seriously ill minority patients, yet culturally appropriate models palliative (PC) are not currently available in the United States.Rural patients with life-limiting illness at high risk receiving PC.Developing a PC model that considers preferences rural African Americans (AAs) and White (W) citizens is crucial.The goal this study was to develop determine feasibility implementing based tele-consult program Southern AA...
End-of-life care has benefited from the recognition that multiple dimensions exist to patient needs. However, well-designed clinical tools evaluate these are few. Such available for evaluations of pain and other specific areas, but clinicians need a sensitive reliable set bedside questions assess screen individual patients' overall care. We out develop practical tool we called Needs at End-of-Life Screening Tool (NEST). As part larger study, conducted series focus groups interviews with...
Purpose: Palliative medicine is assuming an increasingly important role in patient care. Yet, most physicians did not learn this during their formal training. The Education for Physicians End-of-life Care (EPEC™) Project aims to increase physician knowledge palliative care by disseminating the EPEC Curriculum through a train-the-trainer approach. An assessment of its use help project reach targets was performed. Method: independent evaluation pursued two-step qualitative and quantitative...