1) The document discusses health care directives and their importance, especially for oncology patients. It provides background on health care directives and what they involve.
2) It encourages completing an advance directive form called Honoring Choices Minnesota, which facilitates end-of-life planning and appointing a health care agent.
3) The document offers suggestions for encouraging cancer patients to complete advance directives, such as having the forms available during appointments and referring patients to social workers for assistance.
Creating adaptable communities summary from Empowering Adaptable Communities ...Innovations2Solutions
Sodexo was honored to be a featured presenter at the 2nd Annual Atlantic Center for Population Health Sciences Empowering Adaptable Communities Summit. The Summit was held on October 21 and 22, 2015, in Morristown, New Jersey, at the College of Saint Elizabeth. The event was devoted to providing new insights, information, inspiration, and personal connections in our united efforts to empower communities to be more adaptable.
Step-by-step instructions from a physician on how to create an advance directive. I explain what an advance directive includes, how to choose a medical power of attorney (proxy), conversations to have with your family, available popular resources, and legal documents you need to complete. I touch upon a do not resuscitate (DNR) order and a MOLST/MOST/POLST/POST forms.
END OF LIFE CARE (SUBSTANCE USE SPECIFIC)Kevin Jaffray
End of life care is an area that for many is almost a taboo subject. Discussions with GP's and other medical staff can seem awkward considering they are primarily focused on keeping people alive. But how can we ensure dignity in death for people who use, or have used substances?
Consumer-Focused Recovery - a review of the research and literature. Prepared for the Consumer Council of the Mental Health Commission of Canada. Written by Neasa Martin
Creating adaptable communities summary from Empowering Adaptable Communities ...Innovations2Solutions
Sodexo was honored to be a featured presenter at the 2nd Annual Atlantic Center for Population Health Sciences Empowering Adaptable Communities Summit. The Summit was held on October 21 and 22, 2015, in Morristown, New Jersey, at the College of Saint Elizabeth. The event was devoted to providing new insights, information, inspiration, and personal connections in our united efforts to empower communities to be more adaptable.
Step-by-step instructions from a physician on how to create an advance directive. I explain what an advance directive includes, how to choose a medical power of attorney (proxy), conversations to have with your family, available popular resources, and legal documents you need to complete. I touch upon a do not resuscitate (DNR) order and a MOLST/MOST/POLST/POST forms.
END OF LIFE CARE (SUBSTANCE USE SPECIFIC)Kevin Jaffray
End of life care is an area that for many is almost a taboo subject. Discussions with GP's and other medical staff can seem awkward considering they are primarily focused on keeping people alive. But how can we ensure dignity in death for people who use, or have used substances?
Consumer-Focused Recovery - a review of the research and literature. Prepared for the Consumer Council of the Mental Health Commission of Canada. Written by Neasa Martin
The smiling assassin ics case study_welingkar institute of managementSwagat mishra
Strategy to help a Cancer funding organisation to select the right patient,the right hospital and the process of operation. Expansionary policy and cancer awareness
Improving Oral Health Access Migrant and Seasonal WorkersMPCA
Dental disease ranks as one of the top 5 health problems for farmworkers aged 5 - 29 and among the top 20 health problems for farmworkers of other ages,
Transforming the relationship with patients and communities (are we getting t...Jeremy Taylor
Slides to accompany a presentation at Member Engagement Services Challenge 2020 event on 6 July 2016. Is engagement getting better? An overview of policy, practice and lived experience, and what needs to happen next
this dental administration incorporates routine dental examinations or registration, oral wellbeing guidance, scale and cleaning, extractions, fillings, X-beams, crevice sealants and root channel medicines and looks to address all ebb and flow dental concerns.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
The smiling assassin ics case study_welingkar institute of managementSwagat mishra
Strategy to help a Cancer funding organisation to select the right patient,the right hospital and the process of operation. Expansionary policy and cancer awareness
Improving Oral Health Access Migrant and Seasonal WorkersMPCA
Dental disease ranks as one of the top 5 health problems for farmworkers aged 5 - 29 and among the top 20 health problems for farmworkers of other ages,
Transforming the relationship with patients and communities (are we getting t...Jeremy Taylor
Slides to accompany a presentation at Member Engagement Services Challenge 2020 event on 6 July 2016. Is engagement getting better? An overview of policy, practice and lived experience, and what needs to happen next
this dental administration incorporates routine dental examinations or registration, oral wellbeing guidance, scale and cleaning, extractions, fillings, X-beams, crevice sealants and root channel medicines and looks to address all ebb and flow dental concerns.
A presentation designed to inform health care workers about the components and importance of advance directives, with specific information for Massachusetts residents.
The objective of Advance Care Planning (ACP) is to help
ensure that patients receive medical care that is aligned with their
values, goals and preferences.
1 day agoJessica Dunne RE Discussion - Week 10COLLAPSET.docxoswald1horne84988
1 day ago
Jessica Dunne
RE: Discussion - Week 10
COLLAPSE
Top of Form
NURS 6050C: Policy and Advocacy for Improving Population Health
INITIAL POST
Resource Allocation for an Aging Population
Technological advances in medicine and preventative care means that Americans are living longer lives than ever before. Hayutin, Deitz, and Mitchell (2010) assert that by the year 2030 Americans over the age of 65 will account for 20% of the population. There will soon be more elderly Americans than children, and the number of working adults is expected to decrease concurrently. This shift in the population will yield significant economic, political and social challenges. Healthcare needs are also changing. Death and disability rates are declining, yet the incidence of chronic illness within the elderly population continues to rise (Hayutin, Deitz, & Mitchell, 2010). Crippen and Barnato (2011) contend that 20% of the population assume 80% of all healthcare-related costs. As much as 75% of these costs are attributable to chronic diseases (Crippen & Barnato, 2011). Revenues for healthcare are projected to decrease while expenditures are expected to increase. Healthcare providers, policymakers, and industry experts need to work towards solutions that will optimize healthcare dollars and create sustainability for future generations.
Ethical Considerations
The dynamics of healthcare are complicated; financial resources seem insignificant when making life and death decisions. Nonetheless, resources are finite, and therefore, distribution and allocation of funds must be ethical. According to Craig (2010), the theory of distributive justice requires that people with the same health needs have equitable access to all available resources. However, distributive justice also requires that the associated costs also be shared equitably. Fairness is another ethical principle that should be applied in the allocation of healthcare resources. Policies that are fair must be transparent, understandable, and there must be regulatory process to address complaints and resolve conflicts. The idea that healthcare is a human right is outlined in the declaration of independence which guarantees citizens the right to life, liberty, and the pursuit of happiness. The need of the patient should also be considered. A burn patient needs plastic surgery more than a patient that wants rhinoplasty (Craig, 2010).
Nurses provide the best possible care to every single patient regardless of gender, ethnicity, sexual orientation, ability to pay, or age. The American Nurses Association (2012) provides ethical guidelines for nurses to employ in their practice. Provisions one, two, and three promote the principle of beneficence, and the obligation nurses have to advocate for the best interests of their patients. Provisions seven, eight, and nine focus on providing social justice for clients through practice and policy (American Nurses Association, 2012). Nurses should also promote aut.
Consumer Attitudes About Comparative EffectivenessMSL
Evidence as an essential—but insufficient—ingredient for medical decision-making. Presentation to the National Comparative Effectiveness Summit by Chuck Alston, SVP and Director of Public Affairs at MSLGROUP Washington, DC on September 16, 2013.
Explores palliative and end of life care. Outlines advance care planning and provides information about planning ahead to include using advance healthcare directives
Similar to Health care directives what you can do (20)
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Objectives
• Familiarize yourself with our CentraCare packets
• To understand the background and value of the Honoring
Choices Minnesota form
• For each of you to have your own Health Care Directive!
• To look at the unique needs of oncology patients regarding
Health Care Directives
• To examine how we might encourage our patients at Coborn
Cancer Center to have a Health Care Directive
3. Review:
What is a Health Care Directive?
A Health Care Directive is a planning tool and a written legal
document in which a competent adult can communicate health
care instructions in the event that they are no longer able to
communicate their wishes. It can also be used to appoint a
particular person to make health care decisions for a patient
who is unable to do so for him- or herself.
Two elements:
Living wills: the instructions
Medical power of attorney: the agent
4. A compliance issue
Congress enacted the Patient Self–Determination Act (PSDA) in
1991.
This act requires that all health care facilities receiving Medicare
or Medicaid reimbursements must inform patients of their rights
to make choices about the treatment they receive and to
prepare advance directives. Advance directives are not only
focused on what treatments one does not want— they are
equally applicable and viable to indicate all of the treatments
that one does want.
5. What our packet contains
• A welcoming letter
• Health Care Directive information sheet
• Return envelope and authorization to release to other medical
clinics or hospitals
• End-of-Life Decision Making Guide
• Honoring Choices Minnesota
• Wallet card
6. Honoring Choices Minnesota
• Honoring Choices Minnesota (HCM) was began in 2008 with
the Twin Cities Medical Society.
• Advisory Board formed. By 2009 logo chosen, educational
events, and specific directive developed
• Honoring Choices website:
http://www.honoringchoices.org
7. Honoring Choices Minnesota:
It’s for you!
The best teacher is experience! Take it home and fill it out.
Chances are if you have questions, others may as well.
Both elements of living well and ability to name a health care
agent.
8. Why should you have a HCD?
Same reason everyone should have a HCD - you don’t know
what tomorrow holds.
Rational decisions are more difficult to have in a time of crisis –
have the conversation before the crisis.
Most people have strong ideas about the ways they wish to face
the death, yet often, their loved ones or their physicians do not
know these choices.
9. Why should you have a HCD?
It is a gift to your loved ones.
Health Care Directives reduce stress and anxiety on families.
Reduces depression and grief after the loss of a loved one due
to enhanced understanding and the ability to honor wishes.
To facilitate the discussion among patients here at Coborn
Cancer Center.
10. Key points to keep in mind
“It’s about the conversation” – Tagline from the Minnesota
Honoring Choices website
You must share it.
“Communication is the single most important step in advance
care planning. When a loved one communicates their wishes
ahead of time, it decreases the chance of future conflict,
decreases the potential for ethical dilemmas, and takes the
burden off the family. “ – National Association of Social Workers
11. Key points to keep in mind
They can be changed over time.
Who will speak for you? Who in your family can make those
choices and follow through on your wishes? Two components:
willing and able.
It gives a person the chance to explain what does meaningful life
mean to them.
Doesn’t need to be sign by a notary republic although it could
be. Signed by a minimum of 2 witnesses.
The witness cannot be the agent.
No cost.
12. Unique needs of oncology patients
Video: http://www.youtube.com/watch?v=wFMPDUvUPrg
We need to start the conversation because reality is they need it
as much or more than anyone.
“Appropriately honoring patients’ wishes within the overall goals
of care is crucial.” – National Cancer Institute
“The mental and physical effects of end-stage cancer often
render people unable to make decisions for themselves.” – Ditto
& Hawkins, 2005
Cancer is a uniquely feared disease. Therefore, end of life
planning has the potential to relieve some of this fear and the
suffering that surrounds it. - Ditto & Hawkins, 2005
13. Unique needs of oncology patients
They want to “stay positive.” They my feel like focusing on end
of life is negative thinking. - Ditto & Hawkins, 2005
Because of sometimes severe swings in mental and physical
well-being, their desire to complete a HCD may depend on how
they are feeling on the day it is asked. - Ditto & Hawkins, 2005
While it is usually easier for individuals and family members to
discuss end of life care when before a crisis, deteriorating health
was associated with an increasing willingness to make a HCD. –
Hommel & Sahm, 2005
14. Unique needs of oncology patients
Values based HCD are less threatening and more likely to be
filled out than traditional, medical driven HCD . – Prommer,
2010
Empirical research shows that patients usually express positive
attitudes about HCD but seldom complete them. - Prommer,
2010
15. Suggestions
Have your own Health Care Directive.
Confidence. State-wide. Value based components.
Put social workers card in the packet. Refer to her as a resource
who could take the time to sit and go through it with them if
they desire.
Have Honoring Choices forms alone available for spouses or
family members.
Take the packet in the room with you. They are sitting there for
hours at times.
Know that you are planting seeds.
16. References
American Cancer Society. (3013, 5 31). Why do you need an
advance directive?. Retrieved from
http://www.cancer.org/treatment/findingandpayingfortreatmen
t/understandingfinancialandlegalmatters/advancedirectives/adv
ance-directives-why-do-we-need-advance-directives
Conversation Before the Crisis - Helpstartshere.org. (2007, July
19). Helpstartshereorg. Retrieved from
http://www.helpstartshere.org/seniors-and-aging/advanced-
care-planning/advance-care-planning-tip-sheet-conversation-
before-the-crisis.html
Ditto, P., & Hawkins, N. (2005). Advance directive and cancer
decision making near the end of life. Health Psychology, 24(4),
S63-S70. doi: 10.1037/0278-6133.24.4S63
17. References
Hommel, G., Sahm, S., & Will, R. (2005). Attitudes towards and
barriers to writing advance directives amongst cancer patients,
health controls, and medical staff. Journal of Medical Ethics, 31,
437-440. doi: 10.1136/lme.2004.009605
Honoring Choices Minnesota. (2014). Honoring Choices
Minnesota. Retrieved April 24, 2014, from
http://www.honoringchoices.org
National Cancer Institute. (n.d.). Communication in cancer care.
Retrieved from
http://www.cancer.gov/cancertopics/pdq/supportivecare/comm
unication/patient
Prommer, E. (2010, January 16). Using the Values-Based History
to Fine-Tune Advance Care Planning for Oncology Patients.
Journal of Cancer Education, 25, 66-69. doi: 10.1007/s13187-
Editor's Notes
Also called Advanced Directive or Medical Directive. Advance directive is a general term used to describe two types of documents, living wills and medical powers of attorney. Living Wills (sometimes called medical directives) are written instructions for care in the event that a person is not able to make medical decisions for him or herself. A medical power of attorney (sometimes called a health care power of attorney) is a document that appoints a particular person (health care proxy/agent or surrogate) to make health care decisions for a patient who is unable to do so for him-or herself.Contain one or both. Also called health care power of attorney or health care proxy/agent or surrogate.
* Letter: explains the what's in the packet and describes the HCD. It gives them contact information if they would like assistance filling it out. Own social worker here* HCD info sheet: what to do with it when done * Return Envelope once you’ve completed it to return to Medical Records along with an authorization to release to clinics and hospitals. End-of-Life Decision Making: geared toward palliative care, hospice care, defines terms talks about what is CPR, dialysis, ventilators, tube feedings HCM form which is what we are going to talk about What is the card?
- HCM is the meat of the packet and the Directive. - HCM 2008 Twin Cities Medical Society. They held exploratory meetings with community members and senior leaders of hospital systems and health plans. The purpose of both meetings was to gauge the interest level in collaborating and coordinating resources related to advance care planning. Huge interest in collaborating and working together and provide resources could be used statewide. -In 2009, a name and logo were selected,, and educational events began. A new Minnesota-specific health care directive was developed by the advisory committee and is available online at no charge in five languages. What I want you do see When hold this form in your hand is that this is a state-wide collaborative effort and that a lot of research and development and feedback has went into this form. Training provided social worker, Tracy, Mary, Jane have been. .
The best teacher is experience. I filled one out for class7 pages. Pretty straight forward. It takes thought but not a lot of time.Write in feeling thoughts vs checking boxesOrgan donation – let family know – it’s ok, they won’t have to wonder.Doesn’t need to be sign by a notary republic although it could be – signed by a minimum of 2 witnesses. Page 4 part 3 – don’t make it optional
Tragedies and catastrophic events happen all the time. We all have known someone. Why do we think we are immune?It may seem as though there is never a “good time” to talk about death and dying. Oftentimes loved ones are uncomfortable discussing the topic – particularly if they are relatively healthy. Although these conversations are often difficult to have, they are vitally important. We need not wait for a tragedy before anticipating what rational decisions will need to be made in time of crisis. We must have the conversation before the crisis.**Personal example how I do** the physician on the website says “he shares his with patients”
Personal example - ICU
Tag line for Honoring Choices Minnesota.Who do you you share it with? Share especiallyFamily and agent. Think of siblings.If it’s never shared, can’t be honored.Personal example
What is quality of life vs just DNRAdvance care planning has to reflect changing preferences and circumstances; patient’s preferences change over the course of their illnessWho can follow thru? Doesn’t have to be a spouse. Certain child, cousin No attorney no cost!!
Show video The study I read from Health Psychology said that seriously ill individuals have been found to complete living wills at rates only slightly higher than those found in non-patient populations.** Ethical consideration with patients Appropriately honoring patients’ wishes within the context of overall goals of care is crucial. Thoughtful consideration of the role of and relationship with oncology physicians, nurses, palliative care experts, communication barriers, sources of interpersonal conflict, symptom control, and end-of-life care is paramount to optimal management strategies in this patient population. How can we honor if we don’t know their wishes ** Near end of life, cancer patients often endure intense pain, fatigue, delirium, agitation, and a host of symptoms that can severely diminish their quality of life.
Optimism and positive thinking are encouraged for physical and mental health.
Values based means that patients are allowed to expressed beliefs and values rather than simply check boxes and refer to medical terminology. They also focus on quality of life and overall health. They don’t have to feel there is a right answer.
Filling one out for yourself is the best way to begin to help others. It will help you be familiar with the Honoring Choices form and it will lend credibility and platform for you to be able say, “ I have one. I have one. Everyone should have one really.”Be confident. Know the Honoring Choices form has research and feedback when developed and is being used across MN. Value based means people can free write thoughts and feelings about beliefs and quality of life. Let them look it over. We can’t force anyone to do something. But we can offer it. And every time it’s offered we are planting seed and helping them process the idea. Remember the lady in the video