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Verfasst von:Laryionava, Katsiaryna [VerfasserIn]   i
 Mehlis, Katja [VerfasserIn]   i
 Winkler, Eva C. [VerfasserIn]   i
Titel:Development and evaluation of an ethical guideline for decisions to limit life-prolonging treatment in advanced cancer
Titelzusatz:protocol for a monocentric mixed-method interventional study
Verf.angabe:Katsiaryna Laryionava, Katja Mehlis, Elena Bierwirth, Friederike Mumm, Wolfgang Hiddemann, Pia Heußner, Eva C. Winkler
E-Jahr:2018
Jahr:15.06.18
Umfang:9 S.
Fussnoten:Gesehen am 25.02.2020
Titel Quelle:Enthalten in: JMIR Research Protocols
Ort Quelle:Toronto, 2012
Jahr Quelle:2018
Band/Heft Quelle:7(2018,6) Artikel-Nummer e157, 9 Seiten
ISSN Quelle:1929-0748
Abstract:Background: Many patients with advanced cancer receive chemotherapy close to death and are referred too late to palliative or hospice care, and therefore die under therapy or in intensive care units. Oncologists still have difficulties in involving patients appropriately in decisions about limiting tumor-specific or life-prolonging treatment. Objective: The aim of this Ethics Policy for Advanced Care Planning and Limiting Treatment Study is to develop an ethical guideline for end-of-life decisions and to evaluate the impact of this guideline on clinical practice regarding the following target goals: reduction of decisional conflicts, improvement of documentation transparency and traceability, reduction of distress of the caregiver team, and better knowledge and consideration of patients’ preferences. Methods: This is a protocol for a pre-post interventional study that analyzes the clinical practice on treatment limitation before and after the guideline implementation. An embedded researcher design with a mixed-method approach encompassing both qualitative and quantitative methods is used. The study consists of three stages: (1) the preinterventional phase, (2) the intervention (development and implementation of the guideline), and 3) the postinterventional phase (evaluation of the guideline’s impact on clinical practice). We evaluate the process of decision-making related to limiting treatment from different perspectives of oncologists, nurses, and patients; comparing them to each other will allow us to develop the guideline based on the interests of all parties. Results: The first preintervention data of the project have already been published, which detailed a qualitative study with oncologists and oncology nurses (n=29), where different approaches to initiation of end-of-life discussions were ethically weighted. A framework for oncologists was elaborated, and the study favored an anticipatory approach of preparing patients for forgoing therapy throughout the course of disease. Another preimplementational study of current decision-making practice (n=567 patients documented) demonstrated that decisions to limit treatment preceded the death of many cancer patients (62/76, 82% of deceased patients). However, such decisions were usually made in the last week of life, which was relatively late. Conclusions: The intervention will be evaluated with respect to the following endpoints: better knowledge and consideration of patients’ treatment wishes; reduction of decisional conflicts; improvement of documentation transparency and traceability; and reduction of the psychological and moral distress of a caregiver team. Registered Report Identifier: RR1-10.2196/9698 [JMIR Res Protoc 2018;7(6):e157]
DOI:doi:10.2196/resprot.9698
URL:Bitte beachten Sie: Dies ist ein Bibliographieeintrag. Ein Volltextzugriff für Mitglieder der Universität besteht hier nur, falls für die entsprechende Zeitschrift/den entsprechenden Sammelband ein Abonnement besteht oder es sich um einen OpenAccess-Titel handelt.

Volltext: https://doi.org/10.2196/resprot.9698
 Verlag: https://www.researchprotocols.org/2018/6/e157/
 DOI: https://doi.org/10.2196/resprot.9698
Datenträger:Online-Ressource
Sprache:eng
K10plus-PPN:1690896442
Verknüpfungen:→ Zeitschrift

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