Key elements and checklist of shared decisionmaking conversation on life-sustaining treatment in emergency:a multispecialty study from China

BACKGROUND:Shared decision-making(SDM)has broad application in emergencies.Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice.This study is to investigate the optimal application of SDM to guide life-sustaining treatment(LST)in emergencies.METHODS:This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education.Participants were identified based on their expertise in medicine,law,administration,medical education,or patient advocacy.All individual items and questions in the questionnaire were scored using a 5-point Likert scale,with responses ranging from"very unimportant"(a score of 1)to"extremely important"(a score of 5).The percentages of the responses that had scores of 4-5on the 5-point Likert scale were calculated.A Kendall’s W coefficient was calculated to evaluate the consensus of experts.RESULTS:A two-level framework consisting of 4 domains and 22 items as well as a ready-touse checklist for the informed consent process for LST was established.An acceptable Kendall’s W coefficient was achieved.CONCLUSION:A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions,research studies,medical education,and policy initiatives.

Critical care nurses＇ attitude towards life-sustaining treatments in South East Iran

BACKGROUND:Life-sustaining treatments(LSTs)may prolong life but greatly decrease the quality of death.One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses.This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran.METHODS:In this cross-sectional study,"Ethnicity and Attitudes towards Advance Care Directives Questionnaire"was used to investigate the attitude of 104 critical care nurses towards lifesustaining treatments in three hospitals affiliated to Kerman University of Medical Sciences.RESULTS:The findings of this study indicated that although a majority of critical care nurses(77%)did not have personal desire for use of LSTs including CPR and mechanical ventilation,they had moderately negative to neutral attitude towards general use of LSTs(2.95 of 5).CONCLUSIONS:These findings suggest that nurses'attitude towards LSTs can be changed by inclusion of specific courses about death,palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula.Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes.

An overview of end-of-life issues in a cardiology department. Is the mode of death worse in the cardiac intensive care unit?

Introduction Cardiovascular (CV) diseases are the most common causes of death and causes frequent hospital admissions.[1] The increase in life expectancy and the appearance of new treatments,[2] is changing in the clinical profile of CV disease, with a rise in chronic processes and concomitant comorbidities.[ 3] These changes are probably reflected in the current profile of patients admitted to cardiology departments, and in their causes of mortality.