A review and content analysis of U.S. Department of Corrections end-of-life decision making policies

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Victoria Helmly ◽  
Marisol Garica ◽  
Brie Williams ◽  
Benjamin A. Howell
Keyword(s):  
Decision Making ◽  
Content Analysis ◽  
Quality Of Care ◽  
End Of Life ◽  
Medical Decision Making ◽  
Quality Care ◽  
Medical Decision ◽  
Content Type ◽  
Prison Systems

Purpose With a rapidly growing population of older adults with chronic illness in US prisons, the number of people who die while incarcerated is increasing. Support for patients’ medical decision-making is a cornerstone of quality care for people at the end of life (EOL). This study aims to identify, describe, and analyze existing policies regarding EOL decision-making in U.S. Departments of Corrections. Design/methodology/approach This study performed an iterative content analysis on all available EOL decision-making policies in US state departments of corrections and the Federal Bureau of Prisons. Findings This study collected and reviewed available policies from 37 of 51 prison systems (73%). Some areas of commonality included the importance of establishing health-care proxies and how to transfer EOL decision documents, although policies differed in terms of which patients can complete advance care planning documents, and who can serve as their surrogate decision-makers. Practical implications Many prison systems have an opportunity to enhance their patient medical decision-making policies to bring them in line with community standard quality of care. In addition, this study was unable to locate policies regarding patient decision-making at the EOL in one quarter of US prison systems, suggesting there may be quality-of-care challenges around formalized approaches to documenting patient medical wishes in some of those prison systems. Originality/value To the best of the authors’ knowledge, this is the first content analysis of EOL decision-making policies in US prison systems.

scholarly journals Inpatients’ opinion on quality of health care

Medicina ◽  
2009 ◽  
Vol 45 (3) ◽  
pp. 226 ◽  
Author(s):  
Daiva Brogienė ◽  
Romualdas Gurevičius
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Factor Analysis ◽  
Quality Of Care ◽  
Quality Of Health Care ◽  
Health Care Services ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Care Services

The aim of the study was to assess the inpatients’ opinion on the quality of hospital care based on the factor analysis and to identify the problem-oriented fields in quality of care. Material and methods. A multistage stratified probability sampling was performed in 22 general hospitals in Lithuania. A total of 2060 questionnaires were distributed during November 2006 and February 2007. The response rate was 97.38%; 2006 inpatients responded to the questionnaire; 1917 questionnaires (93.06%) were eligible for analysis. The modified survey instrument of Picker Institute Europe was used for inpatients. The method of survey was follows: each discharged inpatient filled out the questionnaire on the day of his/her discharge. The assessment of quality of care involved such aspects as patients’ communication with medical personnel, organizational issues and coordination of care, patients’ possibility of participation in medical decision-making, physical environment, accessibility to services, and safety of health care. Results. Six dimensions were identified from the factor analysis, explaining 51.48% of the variance. Cronbach alpha was 0.7931 for all dimensions. The majority (91.9%) of respondents evaluated health care services as good and very good. Inpatients were most satisfied with communication with their doctors. Even 91.5% of respondents noted that the doctors provided enough information about their health and treatment. The majority of inpatients gave high positive responses on respect showed to them and confidence with doctors. Correlation analysis confirmed a stronger positive correlation among three items of the global assessment of the quality and patients’ ratings on respect and confidence. Several problems were highlighted in the field of patients’ autonomy. The possibility of participation in medical decision-making was the dimension with the lowest level of patients’ rating. Less than half (42.3%) of inpatients noted that they did not have a possibility of participation in medical decision-making to the extent they were willing. Conclusions. Patients gave highly positive responses on the overall evaluation of the quality of health care services. The priority field in the improvement of health care quality is to create more possibilities for patients’ participation in medical decision-making. Results of the present study indicate that future studies need to include more detailed measurements of patients’ autonomy as dynamic changes are observed today in this field.

scholarly journals Family Matters: Dyadic Agreement in End-of-Life Medical Decision Making

2009 ◽  
Vol 50 (2) ◽  
pp. 226-237 ◽  
Author(s):  
B. Schmid ◽  
R. S. Allen ◽  
P. P. Haley ◽  
J. DeCoster
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Medical Decision Making ◽  
Medical Decision

Reducing overuse by recognising the unintended harms of good intentions

2019 ◽  
pp. bmjebm-2019-111247
Author(s):  
David Slawson ◽  
Allen F Shaughnessy
Keyword(s):  
Decision Making ◽  
Medical Decision Making ◽  
Clinical Care ◽  
Critical Role ◽  
Medical Decision ◽  
Wide Acceptance ◽  
Hierarchy Of Evidence ◽  
Healthcare Interventions

Overdiagnosis and overtreatment—overuse—is gaining wide acceptance as a leading nosocomial intervention in medicine. Not only does overuse create anxiety and diminish patients’ quality of life, in some cases it causes harm to both patients and others not directly involved in clinical care. Reducing overuse begins with the recognition and acceptance of the potential for unintended harm of our best intentions. In this paper, we introduce five cases to illustrate where harm can occur as the result of well-intended healthcare interventions. With this insight, clinicians can learn to appreciate the critical role of probability-based, evidence-informed decision-making in medicine and the need to consider the outcomes for all who may be affected by their actions. Likewise, educators need to evolve medical education and medical decision-making so that it focuses on the hierarchy of evidence and that what ‘ought to work’, based on traditional pathophysiological, disease-focused reasoning, should be subordinate to what ‘does work’.

Incorporating patient preferences and priorities into end-of-life care.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 41-41
Author(s):  
Eric Rackow ◽  
Afua Ofori ◽  
Wendy Rodkey ◽  
Roy A. Beveridge
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
End Of Life Care ◽  
Medical Decision Making ◽  
Case Managers ◽  
Readiness For Change ◽  
Medical Decision ◽  
Decision Making Process ◽  
Life Care

41 Background: Patients with advanced illness often face painful conversations and difficult decisions. A program was deployed to help patients identify, communicate, and incorporate their personal preferences and priorities into decisions about their care. The program was assessed by measuring movement along the readiness for change continuum. Methods: Patients residing in the home and participating in a chronic care program were referred by their case managers based on clinical conditions and whether the patient appeared to be in their last 12 months of life. Counseling sessions with patients or family caregiver/s were designed to move participants toward the following actions: be fully informed about their medical situation, describe their detailed quality of life priorities, articulate a self-defined medical decision making process, effectively communicate to their family and physicians, and implement and repeat the aforementioned steps. After 5 months (Sept-2014 to Feb-2015), movement along the readiness for change continuum (pre-contemplation, contemplation, preparation, action, maintenance, and advocacy) was reported. Results: Of the 427 patients referred, 33 could not be reached, 116 were ineligible, 50 declined or did not engage. Of the 228 participants, 191 (84%) moved at least one step in readiness for change continuum over the 5-month period. In Nov-2014, 13% of participants were in action, maintenance, or advocacy, which increased to 19% by Feb-2015. The largest observed movement to action, maintenance, or advocacy was in defining quality of life priorities: 2% Nov-2014 to 21% Feb-2015. The least movement to action, maintenance, or advocacy was observed in articulating a self-defined medical decision making process: 3% Nov-2014 to 16% Feb-2015. Case managers reported discomfort in referring members based on their assessment of length of life. Early surveys show high levels of satisfaction. Conclusions: A very high percentage of patients progressed in incorporating their preferences and priorities into end of life care as measured by the readiness to change continuum. This program is currently expanding and the referral process is changing from case manager to algorithm based identification referrals.

Informed Consent and Advance Directives

2004 ◽  
Vol 94 (2) ◽  
pp. 198-205
Author(s):  
Jay M. Baruch
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
End Of Life ◽  
Advance Directives ◽  
Medical Decision Making ◽  
Informed Decision ◽  
Ethical Framework ◽  
Medical Decision ◽  
Informed Decision Making ◽  
Popular Belief

Contrary to popular belief, a patient’s signature on a piece of paper does not constitute informed consent. This article describes the ethical framework of consent in the context of the larger process of informed decision making. The elements of informed consent are examined in practical terms. Common pitfalls are addressed, with strategies to help anticipate and resolve possible dilemmas. These important tools are integral to all levels of medical decision making, including those at the end of life. (J Am Podiatr Med Assoc 94(2): 198-205, 2004)

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