Appropriateness of intensive care treatments near the end of life during the COVID-19 pandemic

The patient and family perspective on the appropriateness of intensive care unit (ICU) treatments involves preferences, values and social constructs beyond medical criteria. The clinician’s perception of inappropriateness is more reliant on clinical judgment. Earlier consultation with families before ICU admission and patient education on the outcomes of life-sustaining therapies may help reconcile these provider–patient disagreements. However, global emergencies like COVID-19 change the usual paradigm of end-of-life care, as it is a new disease with only scarce predictive information about it. Pandemics can also bring about the burdensome predicament of doctors having to make unwanted choices of rationing access to the ICU when demand for otherwise life-saving resources exceeds supply. Evidence-based prognostic checklists may guide treatment triage but the principles of shared decision-making are unchanged. Yet, they need to be altered with respect to COVID-19, defining likely outcomes and likelihood of benefit for the patient, and clarifying their willingness to take on the risks inherent to being in an ICU for 2 weeks for those eligible. For patients who are admitted during the prodrome of COVID-19 disease, or those who deteriorate in the second week, clinicians have some lead time in hospital to have appropriate discussions about ceilings of treatments offered based on severity

Are We Making Progress on Communication with People Who Are Near the End of Life in the Australian Health System? A Thematic Analysis

Initiating end-of-life (EoL) discussions with patients is often delayed or avoided altogether by healthcare practitioners even in light of imminent death. This continues despite the availability of guidelines and conceptual frameworks on how to communicate prognoses at EoL. We surveyed healthcare practitioners to elicit their exposure to and confidence in EoL discussions and to better understand factors that enable or challenge the initiation of discussions in Australian healthcare settings. Thematic analysis identified that EoL discussions could be emotionally burdensome for healthcare practitioners but were regarded as valuable. Effective communications were challenged by conflict with families and between healthcare practitioners as to appropriate care goal transition, and by prognostic uncertainty. Communication skills appeared to be developed more from experience, and beneficial strategies such as role play and mentoring particularly for younger nurses and doctors were identified. Specific training in EoL communications should target undergraduates and new healthcare practitioners

The relationship between spiritual, religious and personal beliefs and disordered eating psychopathology

Links between religiosity, spirituality and disordered eating have been posited theoretically and empirically, though most studies have accessed predominantly Christian or Jewish samples from private educational institutions, using surveys which contain a heavy Judeo-Christian bias. The aim of the current study is to explore the relationship between disordered eating psychopathology (DEP) and spiritual, religious and personal beliefs (SRPBs) in a diverse sample of students with a wide range of cultural, religious and spiritual affiliations. Using a cross-sectional design, female students (n = 687) across two universities in Sydney, Australia completed the Eating Disorder Inventory-3 and the SRPB portion of the World Health Organisation Quality of Life – Spiritual, Religious and Personal Beliefs bref (WHOQOL-SRPB bref) questionnaire. While both existential and religious beliefs were significantly correlated with lower levels of DEP, multivariate analysis found that existential beliefs alone predicted DEP (p < 0.001). These results reveal that spiritual and personal beliefs may have a greater role in predicting lower levels of DEP than religious beliefs in a secular university setting. Furthermore, the findings may have important clinical implications including the exploration of existential and religious mechanisms within current treatment models