A controlled trial trial to improve care for seriously ill hospitalized patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT)

Article Abstract:

Greater physician contact with seriously ill patients does not appear to improve the quality of care these patients receive during their final days. A two-part trial involved observations of the treatment of seriously ill patients by their doctors, followed by a second phase in which another group of doctors was given more information about the likelihood of survival of their patients. In the second phase, a specially trained nurse communicated with patient, family and physician in order to ensure that the patients' wishes about resuscitation and certain types of life support were known in advance. In the first phase, only 47% of doctors were aware of their patients desire to avoid CPR, and 46% of do-not-resuscitate orders were written within two days of the patient's death. Patients spent an average of 10 days in intensive care, and for half of those that were conscious during their final days, family members said they were in at least moderate pain. None of the outcomes improved in the second phase, suggesting that broader, societal changes will need to take place before physicians recognize the need to improve their care of the seriously ill.

Research, Informed consent (Medical law), Informed consent, Right to die, Critical care medicine

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Initiating End-of-Life Discussions With Seriously Ill Patients: Addressing the "Elephant in the Room"

Article Abstract:

Tips for initiating end-of-life discussions with patients are provided, using the case history of an 81-year-old man with a lung disease called pulmonary fibrosis, type 2 diabetes, a history of stroke, and chronic kidney failure.

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Delirium at the End of Life: Critical Issues in Clinical Practice and Research

Article Abstract:

The causes, diagnosis, and treatment of delirium in terminally ill patients is discussed. Delirium is often transient and reversible, but can occur at the end of life as an irreversible condition.

Care and treatment, Delirium

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