With the explosion of advancing medical technology, clinicians now have the power to identify, treat and, in some instances, cure conditions previously thought to be irreversible.
Hospitals can now keep our older frail patients alive for longer when coming a natural end of their life.
Many older people will die in hospital enduring procedures, surrounded by machines, rather than at home surrounded by their family. Contributing factors include Ebony lewis recognition of the dying trajectory, uncertainty about the time until death, fear of litigation, family pressures to keep treating, and the culture of heroic medicine.
This "Ebony lewis" prevalent worldwide, with a recent review of ten countries finding that more than a third of older people near the end of life are subjected to non-beneficial treatments instead of being allowed dignified deaths. Why is this still happening? One reason is that patients have not discussed preferences with their family; another is the absence of honest conversation between the clinician, the patient and caregivers.
End-of-life Ebony lewis and advance care planning are happening too late in the dying trajectory, prolonging patient suffering. When possible, people should be given the right to express their values and preferences for what they consider acceptable or unacceptable management.
Even more challenging, and a pending question, is: It is commonly known that these conversations can often be difficult for clinicians. Accordingly, we at The Simpson Centre aimed to determine whether presenting clinicians with written documentation helps engage them to have honest end-of-life conversations with older patients and their caregivers.
Our review included nearly 24, subjects from 10 countries. Despite an absence of high-level evidence or quantitative study designs, we that the majority of clinicians were supportive of ACDs in principle. However, this could only be assessed via their beliefs, perceptions and attitudes.
It is promising that clinicians anticipate its benefits but there needs to be more discussion and debate on the effectiveness of ACDs in engaging clinicians in timely conversations. There is also a need for more living wills to be available before we know whether they actually trigger those important