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Critically Ill patients ill-equipped to handle end-of life matters

KINGSTON, Ont. –Terminally-ill patients in Canada are not adequately prepared to deal with end-of-life issues- matters concerning resuscitation after a heart attack //or other life-threatening medical complication, says Queen's University professor of Medicine Daren Heyland. A national study has found that only a miniscule number of patients were prepared regarding the different options available to turn the situation around, especially when patients’ condition goes out of hand.

"And if they do have these discussions, elderly patients are ill-equipped to participate in such discussions and to make such decisions," says Dr. Heyland. "The majority of patients do not know much about the process or expected outcomes of resuscitation."

In the study, face-to-face questionnaires were administered at five Canadian hospitals to older patients with end-stage cancer and advanced medical diseases, and where possible to one of their family members. Participants were asked about their information needs regarding the use of CPR as a means of keeping them alive, as well as the decision-making process and the role they wished to play in making this decision.

The Queen's study also underlines the important role of family members, who say they want to be informed and involved in the discussions and decision-making, he adds. Almost 60 per cent of patients and 81 per cent of family members prefer some degree of shared decision-making that includes the family member(s).

"Strategies that improve understanding of resuscitation in the hospital context and that foster discussions between patients, their family members, and physicians may improve the quantity and quality of communication and decision-making at the end of life," Dr. Heyland suggests.

The new findings are published in the September issue of the international journal CHEST, the publication of the American College of Chest Physicians. Also on the research team from Queen'
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