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Advance Directive

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1. A Randomized Controlled Trial Comparing the Letter Project Advance Directive to Traditional Advance Directive. (PubMed)

A Randomized Controlled Trial Comparing the Letter Project Advance Directive to Traditional Advance Directive. Simpler alternatives to traditional advance directives that are easy to understand and available in multiple formats and can be initiated by patients and families will help facilitate advance care planning. The goal of this study was to compare the acceptability of the letter advance directive (LAD) to the traditional advance directive (TAD) of the state of California.A web-based (...) , randomized controlled trial was conducted, in which the participants were randomized to one of two types of advance directives (ADs): the LAD (intervention) or the TAD (control). Primary outcomes were participant ratings of the ease, value, and their level of comfort in the AD document they completed.A total of 400 participants completed the study, with 216 randomized to the LAD and 184 to the TAD by a computerized algorithm. Overall, participants preferred the LAD to the TAD (success rate difference

2018 Journal of palliative medicine

2. Comparison of a Web-based Advance Directive to a Standard Advance Directive

Comparison of a Web-based Advance Directive to a Standard Advance Directive Comparison of a Web-based Advance Directive to a Standard Advance Directive - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more (...) . Comparison of a Web-based Advance Directive to a Standard Advance Directive The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03676426 Recruitment Status : Recruiting First Posted : September 18, 2018 Last Update Posted

2018 Clinical Trials

3. Advance directive: does the GP know and address what the patient wants? Advance directive in primary care (PubMed)

Advance directive: does the GP know and address what the patient wants? Advance directive in primary care Due to the rapid changes in the medical world and the aging population, the need for advanced care planning grows. Despite efforts to make this topic discussed, only a minority of patients discusses the advance directive with their general practitioner (GP). This study aimed to map thresholds: What barriers are identified by GPs and patients in preparing and discussing an advance directive (...) ?A cross section survey in patients and GP's was performed. Citizens were recruited by multimedia and by street interviews. GP's were recruited by mailing.Most of the 502 citizens already heard of an advance directive but only 17 had declared one while 21 never want one. Eighty percent wants to take the initiative themselves but half of the participants wants the GP to be actively involved. Thirty percent finds the document too difficult to understand. The need to draw an advance directive grew

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2018 BMC medical ethics

4. Factors associated with advance directives completion among patients with advance care planning communication in Taipei, Taiwan. (PubMed)

Factors associated with advance directives completion among patients with advance care planning communication in Taipei, Taiwan. Although advance directives (AD) have been implemented for years in western countries, the concept of AD is not promoted extensively in eastern countries. In this study we evaluate a program to systematically conduct advance care planning (ACP) communication for hospitalized patients in Taiwan and identify the factors associated with AD completion.In

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2018 PLoS ONE

5. Default Options and their Effect on Patients? Advance Directives

Default Options and their Effect on Patients? Advance Directives "Default Options and their Effect on Patients’ Advance Directives" by Danielle Bendicksen < > > > > > Title Author Date of Graduation Summer 8-12-2017 Degree Type Capstone Project Degree Name Master of Science in Physician Assistant Studies Rights . Abstract Background: Advance directives (ADs) are a way for patients to state their wishes for care in the case that they are unable to express them. Within the US healthcare system (...) , in the absence of ADs or other legal orders, the default is often to sustain life until no longer medically possible. This systematic review analyzes studies that seek to learn how patients >50 years old make decisions for their care on ADs and if default options on the AD form itself could affect their choices. Methods: Exhaustive search of MEDLINE-PubMed, CINAHL, and Web of Science, using the terms “advance directive” and “default.” Relevant studies were assessed for quality using the Grading

2017 Pacific University EBM Capstone Project

6. Advance directives, personal identity, and the body: what follows if dementia produces a different individual?

Advance directives, personal identity, and the body: what follows if dementia produces a different individual? Advance directives, personal identity, and the body: what follows if dementia produces a different individual? | Journal of Medical Ethics blog by By Govind Persad. I recently published “ ” in JME. In the paper, I argue that even if the psychological changes caused by dementia mean that the individual who existed before dementia is a different individual from the individual who exists (...) afterward, a pre-dementia advance directive can continue to have moral authority to govern what happens to the post-dementia individual. This moral authority stems from the fact that the pre-dementia individual previously occupied the same body that the post-dementia individual does. My interest in this topic began with my senior undergraduate thesis, supervised by , on advance directives. While working as Agnieszka’s research assistant, I became interested in real-life cases where individuals had

2019 Journal of Medical Ethics blog

7. Physicians and nurses' knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia. (PubMed)

Physicians and nurses' knowledge and attitudes towards advance directives for cancer patients in Saudi Arabia. This study aimed to investigate physicians' and nurses' knowledge and attitudes toward advance directives (ADs) for cancer patients, which empower patients to take decisions on end-of-life needs if they lose their capacity to make medical decisions. A cross-sectional study was conducted using convenience sampling. The outcomes were responses to the knowledge and attitude questions

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2019 PLoS ONE

8. Locally advanced gastro-oesophageal cancer: Recent therapeutic advances and research directions. (PubMed)

Locally advanced gastro-oesophageal cancer: Recent therapeutic advances and research directions. Gastric (GC) and gastro-oesophageal (GOJC) adenocarcinomas are often considered as a single entity, even though differences exist in epidemiology, clinical presentation, molecular biology and treatment options. Locally advanced, resectable disease represents a particularly challenging scenario, as many critical issues need to be addressed. In both GC and GOJC among Western countries, systemic (...) chemotherapy demonstrated the greatest benefit when administered before and after surgery and perioperative chemotherapy has been set as a standard in this setting. Nonetheless, multiple chemotherapy regimens have been tested and direct comparisons have been only recently presented. Adjuvant chemoradiotherapy is an option as well, but several trials have questioned its role when more effective combination regimens are used. With regards to GOJC, preoperative chemoradiotherapy is an alternative

2018 Cancer Treatment Reviews

9. Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs (PubMed)

Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options.To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care.This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath (...) . We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs.Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases.The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed

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2018 Journal of palliative medicine

10. Concordance between Proxy Level of Care Preference and Advance Directives among Nursing Home Residents with Advanced Dementia: A Cluster Randomized Clinical Trial. (PubMed)

Concordance between Proxy Level of Care Preference and Advance Directives among Nursing Home Residents with Advanced Dementia: A Cluster Randomized Clinical Trial. Care consistent with goals is the desired outcome of advance care planning (ACP).The objectives of this study were to examine concordance between advance directives and proxy care preferences among nursing home residents with advanced dementia and to determine the impact of an ACP video on concordance.Data were from Educational Video (...) to Improve Nursing home Care in End-stage dementia, a cluster randomized clinical trial conducted in 64 Boston-area facilities (32/arm) from 2013 to 2017. Participants included advanced dementia residents and their proxies (N = 328 dyads). At the baseline and quarterly (up to 12 months), proxies stated their preferred level of care for the resident (comfort, basic, or intensive) and advance directives for specific treatments (resuscitation, hospitalization, tube-feeding, intravenous hydration

2018 Journal of pain and symptom management

11. The Genetics and Epigenetics of PTSD: Overview, Recent Advances, and Future Directions (PubMed)

The Genetics and Epigenetics of PTSD: Overview, Recent Advances, and Future Directions This paper provides a brief summary and commentary on the growing literature and current developments related to the genetic underpinnings of posttraumatic stress disorder (PTSD). We first briefly provide an overview of the behavioral genetic literature on PTSD, followed by a short synopsis of the substantial candidate gene literature with a focus on genes that have been meta-analyzed. We then discuss (...) the genome-wide association studies (GWAS) that have been conducted, followed by an introduction to other molecular platforms used in PTSD genomic studies, such as epigenetic and expression approaches. We close with a discussion of developments in the field that include the creation of the PTSD workgroup of the Psychiatric Genomics Consortium, statistical advances that can be applied to GWAS data to answer questions of heritability and genetic overlap across phenotypes, and bioinformatics techniques

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2017 Current opinion in psychology

12. The effectiveness of advance directives in improving healthcare outcomes for service users with borderline personality disorder: a systematic review

The effectiveness of advance directives in improving healthcare outcomes for service users with borderline personality disorder: a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content

2019 PROSPERO

13. Prevalence of advance directives and device deactivation among patients with implantable cardioverter defibrillator (ICD) at the end of life: a systematic review and meta-analysis

Prevalence of advance directives and device deactivation among patients with implantable cardioverter defibrillator (ICD) at the end of life: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility

2019 PROSPERO

14. Patients' Perspectives on Approaches to Facilitate Completion of Advance Directives. (PubMed)

Patients' Perspectives on Approaches to Facilitate Completion of Advance Directives. Little is understood about the different ways patients complete advance directives (ADs), which is most commonly through lawyers and increasingly using websites.To understand patients' perspectives on different approaches to facilitating AD completion, the value of legal regulation of ADs, and the use of a web-based platform to create an AD.Semi-structured interviews with patients.We purposively sampled 25

2019 American Journal of Hospice and Palliative Medicine

15. Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. (PubMed)

Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study. It is important that the outcomes of advance care planning (ACP) conversations are documented and available at the point of care. Advance care directives (ACDs) are a subset of ACP documentation and refer to structured documents that are completed and signed by competent adults. Other ACP documentation includes informal documentation

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2019 BMJ open

16. Advance directives for future dementia can be modified by a brief video presentation on dementia care: An experimental study. (PubMed)

Advance directives for future dementia can be modified by a brief video presentation on dementia care: An experimental study. To investigate whether life-sustaining measures in medical emergency situations are less accepted for an anticipated own future of living with dementia, and to test whether a resource-oriented, in contrast to a deficit-oriented video about the same demented person, would increase the acceptance of such life-saving measures.Experimental study conducted between September (...) . This is particularly true if the medical threat can be treated efficiently. These findings have implications for the practice of formulating, revising, and supporting advance directives.

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2018 PLoS ONE

17. Advance Euthanasia Directives in the Spotlight

Advance Euthanasia Directives in the Spotlight Advance Euthanasia Directives in the Spotlight | Journal of Medical Ethics blog by Guest Post: David Gibbes Miller, Rebecca Dresser, Scott Y H Kim Paper: Dutch law allows advance directives to authorize euthanasia for people who can no longer make a voluntary and well-considered choice to end their lives. People make advance euthanasia directives (AEDs) with the goal of protecting themselves from the burdens of living with dementia. But it’s become (...) that the doctor could complete the euthanasia. The committee focused on the doctor’s failure to meet two legal requirements: advance euthanasia requests must be voluntary and well-considered; and euthanasia must be performed with “due medical care.” In an unprecedented action, Dutch prosecutors have opened a criminal investigation into the case. Their findings should supply more guidance on the requirements for legal euthanasia based on AED requests. Our own analysis points to three features of the Dutch

2018 Journal of Medical Ethics blog

18. Stability of end-of-life preferences in relation to health status and life-events: A cohort study with a 6-year follow-up among holders of an advance directive. (PubMed)

Stability of end-of-life preferences in relation to health status and life-events: A cohort study with a 6-year follow-up among holders of an advance directive. Stating preferences about care beforehand using advance care planning and advance directives has become increasingly common in current medicine. There is still lack of clarity what happens over the course of time in relation to these preferences. We wanted to determine whether the preferences about end-of-life care of a person owning (...) an advance directive stay stable after the experience of a life-event; how often advance directives are altered and discussed with family members and physicians over time.A longitudinal cohort study with a population consisting of people owning the most common advance directives in the Netherlands, with a follow-up of 6-years from 2005 until 2011. Respondents were recruited using two associations that provided the advance directives, Right to Die-NL (n = 4463) and the Dutch Patient Organisation (n = 1263

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2018 PLoS ONE

19. The addition of paclitaxel to doxorubicin and cisplatin and volume-directed radiation does not improve overall survival (OS) or long-term recurrence-free survival (RFS) in advanced endometrial cancer (EC): A randomized phase III NRG/Gynecologic Oncology G (PubMed)

The addition of paclitaxel to doxorubicin and cisplatin and volume-directed radiation does not improve overall survival (OS) or long-term recurrence-free survival (RFS) in advanced endometrial cancer (EC): A randomized phase III NRG/Gynecologic Oncology G To determine if the addition of paclitaxel (P) to cisplatin and doxorubicin (CD) following surgical debulking and volume-directed radiation therapy improved long-term, recurrence-free survival (RFS) and overall survival (OS) in patients (...) with advanced-stage endometrial cancer (EC).Prospective, randomized GOG trial comparing (CD) (50 mg/m2)/(45 mg/m2) +/- (P) (160 mg/m2) following volume-directed radiation and surgery in advanced EC. A Kaplan-Meier (KM) analysis characterized the relationship between treatment arms and the OS outcome, a log-rank test assessed the independence of treatment with the OS outcome, and the treatment effect on estimated OS was determined using a Cox proportional hazards (PH) model stratified by stage. The PH

2019 Gynecologic Oncology

20. Feasibility of Early Application of an Advance Directive at the Time of First-Line Palliative Chemotherapy in Patients With Incurable Cancer: A Prospective Study. (PubMed)

Feasibility of Early Application of an Advance Directive at the Time of First-Line Palliative Chemotherapy in Patients With Incurable Cancer: A Prospective Study. This study aimed to evaluate the feasibility of an advance directive (AD) at the time of starting first-line palliative chemotherapy. We investigated changes in emotional distress, quality of life (QoL), and attitudes toward anticancer treatments between before and after AD.Patients with advanced cancer who had just started palliative

2019 American Journal of Hospice and Palliative Medicine

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