Phys Clinical Cases · geriatric
End-of-Life Care and Advance Care Planning — DCE Clinical Case
DCE long-case clinical station: comprehensive assessment of an 82-year-old man with end-stage heart failure and chronic kidney disease admitted with a decompensation, who triggers the Surprise Question and requires an advance care planning conversation, a documented goals-of-care plan, a ceiling of treatment, and a prognosis discussion — covering the evidence for advance care planning (Detering, Wright, Brinkman-Stoppelenburg), the SPIKES protocol, the Serious Illness Conversation Guide, the substituted judgement standard, the ethical equivalence of withholding and withdrawing treatment, and the principles of prognosis discussion — structured for FRACP DCE and MRCP PACES.
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DCE long-case clinical station: comprehensive assessment of an 82-year-old man with end-stage heart failure and chronic kidney disease admitted with a decompensation, who triggers the Surprise Question and requires an advance care planning conversation, a documented goals-of-care plan, a ceiling of treatment, and a prognosis discussion — covering the evidence for advance care planning (Detering, Wright, Brinkman-Stoppelenburg), the SPIKES protocol, the Serious Illness Conversation Guide, the substituted judgement standard, the ethical equivalence of withholding and withdrawing treatment, and the principles of prognosis discussion — structured for FRACP DCE and MRCP PACES.
End-of-Life Care and Advance Care Planning — Clinical Case
References9ShowHide
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- [2]Detering KM, Hancock AD, Reade MC, Silvester W The impact of advance care planning on end of life care in elderly patients: randomised controlled trial BMJ, 2010.PMID 20332506
- [3]Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment JAMA, 2008.PMID 18840840
- [4]Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med, 2010.PMID 20818875
- [5]Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial Lancet, 2010.PMID 20816546
- [6]Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer Oncologist, 2000.PMID 10964998
- [7]Bernacki RE, Block SD; American College of Physicians High Value Care Task Force Communication about serious illness care goals: a review and synthesis of best practices JAMA Intern Med, 2014.PMID 25330167
- [8]Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine Crit Care Med, 2008.PMID 18431285
- [9]The SUPPORT Principal Investigators A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators JAMA, 1995.PMID 7474243