Supplementary Material, 772735_supp_mat – The difficulties of discharging hospice patients to care homes at the end of life: A focus group study

<p>Supplementary Material, 772735_supp_mat for The difficulties of discharging hospice patients to care homes at the end of life: A focus group study by Tabitha Thomas, Karin Mack, Gemma Clarke and Stephen Barclay in Palliative Medicine</p

Demographic characteristics, cognition, disability and self-reported health of the study sample.

<p>Demographic characteristics, cognition, disability and self-reported health of the study sample.</p

Attrition and participation in the CC75C study’s qualitative interview wave.

<p>The CC75C study’s population-based sample continued to be representative even in its Year 21 follow-up. Of n = 48 still alive 92% (n = 44) were included in this survey wave. Qualitative data collection for 95% (42/44) of these included recorded interviews with 79% (33/42) of these 95- to 101-year-old participants in person.</p

sj-docx-1-pmj-10.1177_02692163231198372 – Supplemental material for The financial costs of anticipatory prescribing: A retrospective observational study of prescribed, administered and wasted medications using community clinical records

Supplemental material, sj-docx-1-pmj-10.1177_02692163231198372 for The financial costs of anticipatory prescribing: A retrospective observational study of prescribed, administered and wasted medications using community clinical records by Lloyd Morgan, Stephen Barclay, Kristian Pollock, Efthalia Massou and Ben Bowers in Palliative Medicine</p

How are Treatment Decisions Made about Artificial Nutrition for Individuals at Risk of Lacking Capacity? A Systematic Literature Review

<div><p>Background</p><p>Worldwide, the number of individuals lacking the mental capacity to participate in decisions about their own healthcare is increasing. Due to the ageing global population and advancing medical treatments, there are now many more people living longer with neurological disorders, such as dementia, acquired brain injuries, and intellectual disabilities. Many of these individuals have feeding difficulties and may require artificial nutrition. However, little is known about the decision-making process; the evidence base is uncertain and often ethically complex. Using the exemplar of artificial nutrition, the objective of this review is to examine how treatment decisions are made when patients are at risk of lacking capacity.</p><p>Methods and Findings</p><p>We undertook a systematic review according to PRISMA guidelines to determine who was involved in decisions, and what factors were considered. We searched PubMed, AMED, CINAHL, EMBASE, PsychINFO, and OpenSigle for quantitative and qualitative studies (1990–2011). Citation, reference, hand searches and expert consultation were also undertaken. Data extraction and quality assessment were undertaken independently and in duplicate. We utilised Thomas and Harden’s ‘Thematic Synthesis’ for analysis. Sixty-six studies met inclusion criteria, comprising data from 40 countries and 34,649 patients, carers and clinicians. Six themes emerged: clinical indications were similar across countries but were insufficient alone for determining outcomes; quality of life was the main decision-making factor but its meaning varied; prolonging life was the second most cited factor; patient’s wishes were influential but not determinative; families had some influence but were infrequently involved in final recommendations; clinicians often felt conflicted about their roles.</p><p>Conclusions</p><p>When individuals lack mental capacity, decisions must be made on their behalf. Dynamic interactive factors, such as protecting right to life, not unnecessarily prolonging suffering, and individual preferences, need to be addressed and balanced. These findings provide an outline to aid clinical practice and develop decision-making guidelines.</p></div

Four key bio-ethical principles (after Beauchamp and Childress).

<p>Four key bio-ethical principles (after Beauchamp and Childress).</p