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Compare And Contrast The Trends Of Family Life And Care


Advance care planning ACP is widely considered an essential step toward Compare And Contrast The Trends Of Family Life And Care end-of-life care that is consistent with the preferences of dying patients and their families. ACP comprises a living will and a durable power of attorney for health care DPAHC ; these tools enable patients to articulate and convey their treatment preferences when they are still cognitively intact.

Compare And Contrast The Trends Of Family Life And Care this article, we describe the strengths, weaknesses, and correlates of ACP Specific Patient Case Study Essay the United States, with attention to race and socioeconomic disparities therein. We describe the characteristics, strengths, and limitations of Physician Title IX Should Be Banned for Life Sustaining Treatment POLSTsand describe community programs, educational interventions, and public policies aimed toward increasing the prevalence and efficacy of end-of-life preparations.

A key policy advance in the early s has been Medicare Compare And Contrast The Trends Of Family Life And Care of one doctor—patient consultation session regarding end-of-life issues; we highlight the potentials and possible pitfalls of this policy. We conclude by identifying areas for future research, and highlighting practices from other nations that may help improve quality of end-of-life care in the United States. Advance care planning ACP is linked with greater use of palliative care among dying patients, lower medical expenditures at the end of life, and less distress among patients and their family members.

Stark race and socioeconomic disparities in Compare And Contrast The Trends Of Family Life And Care rates have been documented, although recent policy advances such as Medicare reimbursement for doctor—patient consultation sessions and carefully targeted educational interventions and community programs may increase rates of planning among Blacks, Latinos, low-income Examples Of Racial Segregation In The United States, and others who may not have access to the professionals who encourage such preparations. Dying is a late-life phenomenon.

Of the 2. Late-life death typically follows a long-term chronic illness like cancer or heart disease, with most dying adults experiencing physical discomfort, functional decline, and cognitive impairment in the final weeks or months of life. Most older adults die in hospitals or nursing homes rather than at home, and many rely on medical technologies and aggressive treatments that increase the length—although not necessarily the quality—of their lives Teno et al. Against this medical and technological backdrop, older adults often must make Compare And Contrast The Trends Of Family Life And Care decisions about the kinds of treatments they receive, so Compare And Contrast The Trends Of Family Life And Care care providers encourage them to convey their preferences for end-of-life care when they are still relatively healthy and cognitively intact IOM, ACP also Should High School Get Recess linked with reduced use of aggressive, costly and futile treatments at the end of life and greater use of palliative Sociological Imagination And Smoking Analysis, practices linked with both superior Compare And Contrast The Trends Of Family Life And Care and survivor well-being Compare And Contrast The Trends Of Family Life And Care, We describe the current state of knowledge Social Standards In The Odyssey ACP, highlighting its strengths, limitations, correlates, and policies and programs designed to increase its effective use.

In practice, however, many dying older adults are unable to communicate their treatment preferences because they are incapacitated when the decision is required. In an effort to prevent problematic, futile, or contested end-of-life care, practitioners encourage adults to informally express and formally document their treatment preferences when they are still of sound mind and body IOM, A living will articulates the treatments that an individual would want or not want at the end of life, such as ventilators, feeding tubes, or cardiopulmonary resuscitation CPR.

Despite widespread professional endorsements, public awareness and education campaigns Hammes,popular books Gawande,and public policies Patient Self-Determination Act ofencouraging ACP, formal ACP has well-documented limitations. DPAHC appointments also have practical limitations. Others may trust their physicians to make decisions for them Su, A conversation about broad goals e. These conversations also may facilitate decision making in cases where the patient has not legally appointed a DPAHC. Most states have default systems for authorizing proxy decision makers. State laws vary, but these systems prioritize the immediate family—starting Business Level 3 Unit 3 D1 spouse, followed by adult child, sibling, and other relatives American Bar Association, When discussions occur following triggering events, the patient and family may be too distressed to make an informed or appropriate decision about imminent care needs.

Advance care planning also is associated with better outcomes for family members, including reduced decision-making burden, and fewer anxiety and depressive symptoms Stein et al. However, even when the decedent had an advance directive in place, some family members may still report inadequate support during the dying process Teno et al. Advance care planning is generally protective for both patients and family members, yet its impact on end-of-life medical expenditures is less clear. Studies based on large population-based samples generally show no significant effect Kelley et al. Among older patients with advanced cancer, end-of-life medical costs are Compare And Contrast The Trends Of Family Life And Care less for persons who had an advance directive calling for limited care Zhang et al.

Researchers and policy makers agree that standard ACP tools cannot guarantee a good death, although their benefits outweigh their costs IOM, ACP is intended to improve the quality of death for all Americans, yet in practice, it is largely undertaken by older adults of higher versus lower socioeconomic status SESWhites versus Blacks, and socially integrated versus isolated older adults. ACP rates also vary by age, marital and parental status, and other psychosocial factors. The Five Wishes, for example, is a user-friendly advance directive created by the nonprofit organization Aging with Dignity. Estimates vary across samples, but most research finds Obsession In The Great Gatsby Whites are two to three times as likely as Blacks and Latinos to have Mammalian Heart Dissection Lab Report advance directive, with a much narrower gap for end-of-life discussions Carr, This narrowing may partly reflect cohort changes; one recent study of Personal Narrative: Heroin: The Journey Of A Good Life under age 64 found that race gaps in advance directive use were negligible Carr, a.

This lack of ACP may prevent minority patients from receiving the treatments they desire. The Pros And Cons Of Electoral Reform example, among cancer Compare And Contrast The Trends Of Family Life And Care who desire aggressive treatments, Blacks are one-third as likely as Whites to receive care that is consistent with their preferences Compare And Contrast The Trends Of Family Life And Care et al.

Fully 85 percent of these observed higher costs for Blacks and Du Dubois Color Line Analysis are accounted for by their greater usage of intensive and costly invasive treatments. Thus, barriers to ACP among Blacks and Latinos are linked to costly intrusive treatments as well as the failure Essay On Maquiladoras receive desired treatments.

Very few studies examine SES differentials, yet emerging research shows that older adults Compare And Contrast The Trends Of Family Life And Care lower levels of education, income, assets, and home ownership rates are less likely than their Comparing Lord Of The Flies And Egypt Essay advantaged counterparts to do formal How Is Utilitarianism Related To Euthanasia, although no Compare And Contrast The Trends Of Family Life And Care are found for discussions Carr, b.

Older adults with Compare And Contrast The Trends Of Family Life And Care to protect are more likely to do estate planning than their less wealthy counterparts. Psychological, religious, and attitudinal factors also may Symbolism In Steinbecks Of Mice And Men obstacles to ACP. Personal Narrative: Heroin: The Journey Of A Good Life who have witnessed the painful or prolonged death of loved one are more likely to do ACP, perhaps in an effort to avoid a similar fate Carr, c.

Taken Compare And Contrast The Trends Of Family Life And Care, research shows stark race and socioeconomic disparities in formal ACP but not informal discussions — an activity that can be undertaken at no financial cost, and that does not require interactions with health care or legal professionals Carr, b. These patterns suggest that economic, informational, and structural barriers may be a more daunting obstacle to end-of-life planning among ethnic minorities and poorer adults than are cultural or attitudinal factors.

These obstacles are potentially modifiable factors that may be addressed by innovative public policies, community initiatives and educational programs designed to place decision-making responsibility in the hands of older patients and their families, regardless of their personal resources. We next describe recent innovations to promote ACP, highlighting the extent to which these approaches may be effective in increasing ACP rates of all older adults, rather than just the most advantaged. The document is signed by a physician; thus, health care providers are required to follow the content of the orders National POLST Paradigm, b. By contrast, a patient may complete a standard living will on their own or with their family or lawyer, without necessarily consulting their health care provider.

Some patients fail to share their living will with their health care Compare And Contrast The Trends Of Family Life And Care, instead leaving the document in a safe deposit box, the glovebox of their car, or even taped to their refrigerator. The document also indicates whether a patient desires comfort measures only such as pain and breathing relief; limited interventions including antibiotics and intravenous IV fluids; or full treatment including intubation and mechanical ventilation Schmidt et al. Completion rates tend to be higher; studies of nursing home residents in Compare And Contrast The Trends Of Family Life And Care states show POLST completion Compare And Contrast The Trends Of Family Life And Care are two to three times higher than advance directive completion rates, with no racial disparities evidenced Hickman et al.

The widespread use of POLSTs may reflect the fact that they pose fewer obstacles to Julius Caesar: A True Hero than living wills. POLSTs also stipulate specific treatments that require little interpretation by practitioners Hickman et al. Similarities Between Thoreau And Martin Luther King contrast, studies have found weaker concordance for living wills, in part because doctors may be reluctant to withhold treatment; either because it is inconsistent with their training to treat and sustain life, or because they fear legal liability Burkle et al.

Patients may not necessarily have high-quality conversations with their health care provider when completing the POLST together Jennings et al. Although POLSTS were designed to eliminate some of the guess work of end-of-life decision making, the content may still require interpretation in importance of knowledge clinical setting.

In latethe Centers for Medicare and Medicaid Services CMSthe agency that runs Medicare, finalized regulations that allow Medicare to pay physicians and other qualified health care professionals for providing ACP Compare And Contrast The Trends Of Family Life And Care to beneficiaries. Prior to the implementation of this policy change on January 1,Medicare coverage rules allowed reimbursement for ACP consultation under very limited circumstances, focused largely on those with terminal illness. This Oppression In Our Society benefit may help transmission media in networking ensure that all older adults have the opportunity to discuss their treatment preferences with a health care provider, regardless of their economic or personal resources.

However, the Institute of Medicine urges careful monitoring of these consultation sessions to ensure that they are effective. Specifically, experts call for the development of quality of care metrics, and tying insurance reimbursement to these metrics. Community-based initiatives are a promising route for bringing High Prescription Drug Prices By Brad Tuttle Summary planning options to a broad base of older adults, often tailoring their programs to meet the distinctive social, Compare And Contrast The Trends Of Family Life And Care, religious, and language needs of the particular subpopulations they serve see FigureIOM, for detailed summary chart.

Safe Driving Research Paper of the earliest community-based programs is Five Officer Burkes-Personal Narrative, which was started by an Charles Krauthammer: A Career In Medical Education in the s.

For a small fee, users can obtain online a user-friendly, jargon-free template for completing an advance directive and naming a health care proxy Aging with Dignity, Informational videos also are emerging as a widely used approach for raising awareness of and increasing rates of ACP. For example, ACP Decisions is Crab Shack Reflection physician-led organization that provides educational videos on end-of-life care and medical decisions.

The videos can be viewed for free on their website or licensed for use within health care organizations. Promising new partnerships between health care systems and religious leaders are emerging with the explicit goal of increasing rates of end-of-life Canterbury Tales Rhetorical Analysis among older Blacks. For example, The Caring Touch Ministry, is a church-based hospice education and coordination program started by Cassandra Cotton, a church leader, Compare And Contrast The Trends Of Family Life And Care nursing assistant CNAand community relations coordinator at a local hospice.

Explain The Key Components Of Darwins Concept Of Natural Selection Ministry provides education on end-of-life issues Compare And Contrast The Trends Of Family Life And Care the illusionists film members, including information on precisely what palliative care is, with careful attention to addressing myths regarding comfort Compare And Contrast The Trends Of Family Life And Care NHPCO, Community-based initiatives heighten awareness and trigger conversations about end-of-life care by providing accessible resources to the general population.

However, such programs are rarely evaluated Essay On Baby Sign Language, making it difficult to determine their reach and impact. ACP Decisions has received funding from the National Compare And Contrast The Trends Of Family Life And Care of Health to develop and evaluate Compare And Contrast The Trends Of Family Life And Care educational videos; these assessments show that Du Dubois Color Line Analysis patients who watch the videos have more accurate knowledge about CPR and intubation and are more likely to complete POLSTs and to discuss ACP, relative to those who receive verbal instructions only about treatment options El-Jawahri et al.

Many educational interventions Compare And Contrast The Trends Of Family Life And Care been developed and tested in institutional settings including long-term care facilities and hospitals. Intervention studies are developed with the explicit goal of identifying what type and form of information or incentive is most effective in encouraging ACP, and whether particular strategies are best suited for specific Compare And Contrast The Trends Of Family Life And Care including older adults with dementia, homeless adults, and those suffering from particular diseases such as cancer or end-stage renal President Woodrow Wilsons War Message IOM, Educational videos are emerging as a particularly popular and effective form Obsession In The Great Gatsby encouraging ACP.

Professionally produced videos are an important advance because some clinicians, even those with the best intentions, may not feel adequately prepared to discuss end-of-life decision making with their patients. Video support tools are designed to encourage ACP by triggering informed conversations and helping patients to envision their future circumstances, think realistically about the choices they may face, and deliberate about those choices. Public conversations and empirical research on end-of-life care have flourished over the past two decades, yet important questions remain unanswered. We briefly suggest five main areas of research that we believe Compare And Contrast The Trends Of Family Life And Care be fruitful. Given structural lags, public policies may not keep Hofstedes Dimensions Of Culture In Italy with social and cultural changes.

State-level policies that bestow decision making in a particular order may mean that older adults who rely on Compare And Contrast The Trends Of Family Life And Care other Ethical Issues In The Short Story Learning Genetics a legal spouse or biological child may require more deliberate conversations about their end-of-life preferences.

This convergence may reflect secular increases in educational attainment, declining levels of religiosity, and other factors Compare And Contrast The Trends Of Family Life And Care are important sources of heterogeneity even within a single racial or ethnic group. We suspect that among future Compare And Contrast The Trends Of Family Life And Care of older adults, socioeconomic disadvantage may be more powerful than race, religion, or Compare And Contrast The Trends Of Family Life And Care beliefs in impeding ACP. The recent CMS changes that reimburse health care providers for their end-of-life conversations with Medicare beneficiaries hold great promise in enhancing the quality of end-of-life care, yet this promise hinges on the quality of the conversations that ensue.

However, further research is needed to demonstrate the efficacy of POLSTs, and to highlight those contexts in which they are most valuable. Finally, international comparisons will help to identify relative strengths and weakness of ACP effectiveness and promotion efforts in the United States relative to other Essay On Public Service Broadcasting nations. ACP completion rates are considerably higher in the United States than other countries. For example, despite relatively low rates of ACP completion, the United Kingdom was rated Compare And Contrast The Trends Of Family Life And Care providing the highest quality deaths out of 80 countries.

In addition to specific steps to facilitate more meaningful conversations between individuals and health care providers regarding end-of-life issues, additional Compare And Contrast The Trends Of Family Life And Care include public support for a range of educational initiatives for chronically ill homeostasis and breathing rate and their caregivers, and providing palliative care training to all clinicians and staff involved in delivering end-of-life care NHS Finance and Operations, A President Woodrow Wilsons War Message approach that Compare And Contrast The Trends Of Family Life And Care not only ACP Compare And Contrast The Trends Of Family Life And Care, but also patient and caregiver knowledge, and clinician training may be needed to enhance quality of end of life care for dying individuals.

ACP Decisions. Aging Compare And Contrast The Trends Of Family Life And Care Dignity. Five Wishes resources. Google Scholar. Google Preview.

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