Barry Ashpole Media Watch (#464)

The latest issue of  Media Watch, compiled and annotated by Barry R. Ashpole (Ontario, Canada) can now be downloaded here. More reports can be found at IPCRC.NET

Article highlighted to be of particular interest:

We doctors can’t prescribe a “good death”

U.K. | The Guardian – 22 May 2016 – Each new month seems to bring with it another well-intentioned report on death and end-of-life care. So far in 2016 we have had the ‘End of Life Care Audit: Dying in Hospital’ from the Royal College of Physicians, a report from the British Medical Association (‘End-of-Life Care and Physician-Assisted Dying’), and a review from the Care Quality Commission (‘A Different Ending: End of Life Care’).1,2,3 Western ideas about death are informed by secularism and individualism. The current discussion on death and dying, however, has been hijacked by the extremists on both sides. In the barren and neglected middle ground are truths that we have conveniently ignored. As contemporary issues, assisted suicide and advance directives are both a symptom of a deeper malaise (namely the obsession with personal autonomy and control) and a distraction. They are a distraction because the real issues are elsewhere. Death, we are constantly told, has become “medicalised.” Roughly half of all people dying in Britain or Ireland do so in a general hospital. Just over 20% die at home, and only 5% in a hospice. Large general hospitals are the best place to be when you are very sick, but are ill-equipped to meet the needs of the dying. The Liverpool Care Pathway, a rather quixotic, tick-boxy attempt to give hospice-type care to people dying in general hospitals, was an abject failure.4 Acute hospitals are criticised, with some justification, for failing to care properly for the dying, yet society has handed over most of the responsibility for such care to these institutions. http://goo.gl/UUmzhP

Articles from Asia Pacific Region

Australia – Listening to patients at the end of their lives is crucial – so why don’t doctors do it?

AUSTRALIA | The Guardian (U.K.) – 25 May 2016 – The timeless business of dying has never had a higher profile, which is why the results of a recent survey by the Royal Australasian College of Physicians (RACP) make for sobering reading.1 The RACP end-of-life working party, of which I was a member, surveyed more than 1,500 physicians to identify their knowledge and practice of advance care planning and end-of-life care (EOLC). Unsurprisingly, the majority reported routinely caring for patients who were likely to die within 12 months. On a weekly basis, one third of doctors observed provision of treatments inconsistent with known patient wishes and one-third observed treatment with little chance of benefit. And while doctors overwhelmingly agreed that discussing EOLC was important, only a minority actually translated the intention into action. Barriers included a lack of time, but just under half of the physicians felt insufficiently trained to undertake what is easily one of the most consequential conversations in the doctor-patient relationship. As a result, a dismal 17% of physicians expressed confidence in knowing the end of life preferences of their patients. http://goo.gl/EDQpWi

Pakistan – Barriers and perceptions regarding code status discussion with families of critically ill patients in a tertiary care hospital of a developing country: A cross-sectional study 

PALLIATIVE MEDICINE | Online – 25 May 2016 – In Asian societies, including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. A total of 77 (57.4%) physicians responded [to a survey]. Family-related barriers were found to be the most common. They include family denial (74.0%), level of education of family (66.2%), and conflict between individual family members (66.2%). Lack of knowledge regarding prognosis (44.1%), personal discomfort in discussing death (29.8%), and fear of legal consequences (28.5%) were the top most personal barriers. In hospital-related barriers, time constraint (57.1%), lack of hospital administration support (48.0%), and suboptimal nursing care after do not resuscitate (48.0%) were the most frequent. There were significant differences among opinions of trainees when compared to those of attending physicians. Family-related barriers are the most frequent roadblocks in the end-of-life care (EOLC) discussions for physicians in Pakistan. Strengthening communication skills of physicians and family education are the potential strategies to improve EOLC. Large multi-center studies are needed to better understand the barriers of code status discussion in developing countries. http://goo.gl/q2m6oq