Search

Patients with serious illnesses often do not engage in discussions about end-of-life care decision-making, or do so reluctantly. These discussions can be useful in facilitating advance care planning and connecting patients to services such as palliative care that improve quality of life. Terror Management Theory, a social psychology theory stating that humans are motivated to resolve the discomfort surrounding their inevitable death, has been discussed in the psychology literature as an underlying basis of human decision-making and behavior. This paper explores how Terror Management Theory could be extended to seriously ill populations and applied to their healthcare decision-making processes and quality of care received., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: End-of-life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end-of-life care in metastatic cancer., Methods: This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011-12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates., Results: Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter., Conclusions: Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end-of-life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end-of-life care., (© 2021 John Wiley & Sons Ltd.)

Objective: To assess the reporting of critical incidents by anaesthetic trainees using personal digital assistants. The project also identified the reporting of 'near miss' incidents by anaesthetic trainees., Design: Comparison of electronic incident reporting with retrospective case note review of cases in which no incident was reported., Setting: A 400-bed university teaching hospital in Victoria., Participants: Fourteen accredited Australian and New Zealand College of Anaesthetists (ANZCA) registrars and their training supervisors., Interventions: Registrars and supervisors underwent initial training for 1 hour and were provided with ongoing support. The cases and incidents reported to the database using the portable digital assistants were analysed., Main Outcome Measures: These were the total number of anaesthetics reported to the database; the number of incidents reported to the database; the outcome severity of incidents reported; and the number of incidents detected in the case note review that were not reported to the database., Results: An incident was reported for 156 (3.5%) of 4441 anaesthetic procedures reported to the database. Of these incidents, 72 (46.2%) were 'near misses'. One incident was identified in a review of 208 case notes, which had no incidents reported electronically, and was not reported to the database electronically. This gives a reporting rate of 99.52% [95% confidence interval (CI) 96.9-100%]., Conclusions: ANZCA trainees in routine anaesthetic practice can reliably use mobile computing technology to report critical incidents and 'near miss' incident data.

There have been recent exposures of poor health care performance in many countries with western health care systems. The poor performance has either related to poor or criminal practices routinely going undetected or to organizational indifference or hostility to staff raising concerns about perceived poor standards of care. The demonstration that routine performance data monitoring would have detected and prevented many of the deaths attributed to poor surgical standards in the Bristol Royal Infirmary paediatric cardiac surgery scandal and criminal behaviour in the Harold Shipman scandal has highlighted the need for routine data collection to demonstrate to both health care administrators and patients that minimum standards of clinical practice are being achieved. The recent proposal that surgical report cards represent an important minimum ethical standard for health care consent will force the medical profession to engage in the debate surrounding routine data collection for performance monitoring and other purposes. This article considers the cultural background to data collection in the medical profession and the cost implications of failing to improve data collection in the areas of performance monitoring and incident reporting. A potential solution developed by the Geelong hospital group and in use in Australia is proposed as a novel, technologically appropriate and working example of practical data collection. This model is endorsed by the professional specialties and supported by modern regulatory theory. The individual, local and system wide benefits of such personal professional data collection are outlined and the necessary prerequisites are detailed.