The Canadian Researchers at the End of Life Network (CARENET) is a group of health care professionals from across the country that collaborate with each other to understand and improve palliative and end-of-life care.

IKEA has been exploring new ways to offer more space for lower prices with flatpack housing solutions.

However, the Swedish furniture giant is going one step further and is collaborating with sustainable housing BoKlok and the Queen of Sweden on a project called SilviaBo, according to CNN Business.

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Approximately 71% of patients seen in perioperative testing clinics prior to surgery do not have any advanced care directives in place, according to a study published in the Journal of General Internal Medicine.

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If everyone was more aware of dementia, it could improve comfort in a loved one's dying days, say Canadian geriatricians who found distressing medical procedures were common among nursing home residents, especially men.

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"This is a little walk I take every morning, just to spend time with God."

Jack Hall is meandering along a dirt path around the backyard of a modest home on the Northeast Side of San Antonio.

"The wind chimes, when the wind is blowing, these things are beautiful," Hall said, before giving them a tap to demonstrate. He gestured to the right, where there is a prayer wall holding several candles, and then wandered to the other side of the yard, where there is a thick, knotty old oak.

"This is just one strong tree, here,” Hall said. “This tree has stood the test of time, and it'll be here long after we're gone."

Hall has prostate cancer that has spread to his lymph nodes. He’s dying, and is one of the growing number of Americans who are dying with no family nearby.

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How older people plan ahead for ageing in relation to accommodation, care arrangements, healthcare and medical treatment, and end of life decisions has attracted particular attention in recent years and as a result there has been considerable promotion of the importance of planning ahead and executing planning instruments with the aim of making one’s wishes and preferences known in advance. Planning ahead is promoted as allowing older people to have their voices heard, to advance their autonomy, choice and self-determination and to allow them to decide what treatment they may not want to receive. This article provides a critique of advance care planning, based on a subset of findings from a qualitative intergenerational study on ageing in Australia. The findings suggest that advance care planning is a much more complex and at times problematic endeavour, compared to what is promoted about advance care planning, in particular with regard to the use of planning instruments.

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I of all people should know how to do this. As an ICU nurse, I see every day how agonizing it is for families to make end-of-life care decisions for loved ones who have not made their wishes clearly known. I know what I want. I know what the legal options are. But when I sit down to fill out the papers, I stall. 

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A national poll was commissioned by the 'Speak Up' Advance Care Planning in Canada initiative to identify people's current attitudes and behaviors towards planning for their future health and personal care. People in Canada were asked about Advance Care Planning, which includes reflecting on and talking about their wishes for future care in the event they have a serious illness or health crisis. Respondents identified what makes it easier to have a conversation about their wishes and what makes it tough to plan ahead. While attitudes towards Advance Care Planning are overall positive, behavior has not followed; eight in ten Canadians have given end-of-life care some thought, but less than one in five have an advance care plan.

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Rapidly evolving therapies can challenge a physician’s understanding of advanced-stage disease and add complexity to end-of-life decision-making, yielding divergent recommendations from colleagues. Two physician experts examine when it is appropriate for a doctor assuming care at a critical juncture to challenge established goals of care. They also provide suggestions for moving forward in the best interests of the patient.

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The decision seemed straightforward. Bob McHenry’s heart was failing, and doctors recommended two high-risk surgeries to restore blood flow. Without the procedures, McHenry, 82, would die.

The surgeon at a Boston teaching hospital ticked off the possible complications. Karen McHenry, the patient’s daughter, remembers feeling there was no choice but to say “go ahead.”

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Most Americans die in hospitals, but acute care settings are by default focused on saving lives and therefore struggle to deal with death as something other than the unfortunate outcome of having no interventions left to try. An expert in end-of-life care notes that death is an essential part of life for patients and their families and suggests several steps physicians can take to make death a “healthy” experience.

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Despite their high health literacy, Canadian physicians were just as likely as others in the general population to receive aggressive care as they neared death, researchers found.

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Cari Borenko Hoffmann is a Canadian leader in advance care planning (ACP). A major grant is supporting her thesis work exploring health-care providers’ understanding of the legal aspects of ACP—to help ensure that in a health crisis, patients, families and providers are all on the same page.

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The goals of palliative care are to relieve suffering and promote quality of life. Palliative care for older persons has been less prioritised than palliative care for younger people with cancer, which may lead to unnecessary suffering and decreased quality of life at the final stage of life. 

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To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race.

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Empirical work has shown that patients and physicians have markedly divergent understandings of treatability statements (e.g., “This is a treatable condition,” “We have treatments for your loved one”) in the context of serious illness. Patients often understand treatability statements as conveying good news for prognosis and quality of life. In contrast, physicians often do not intend treatability statements to convey improvement in prognosis or quality of life, but merely that a treatment is available. Similarly, patients often understand treatability statements as conveying encouragement to hope and pursue further treatment, though this may not be intended by physicians. This radical divergence in understandings may lead to severe miscommunication. This paper seeks to better understand this divergence through linguistic theory—in particular, H.P. Grice’s notion of conversational implicature. This theoretical approach reveals three levels of meaning of treatability statements: (1) the literal meaning, (2) the physician’s intended meaning, and (3) the patient’s received meaning. The divergence between the physician’s intended meaning and the patient’s received meaning can be understood to arise from the lack of shared experience between physicians and patients, and the differing assumptions that each party makes about conversations. This divergence in meaning raises new and largely unidentified challenges to informed consent and shared decision making in the context of serious illness, which indicates a need for further empirical research in this area.

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To my 87-year-old grandmother, not many subjects are taboo. She was treated for colorectal cancer in 1996, and she still laughs when she recounts experiencing uncontrollable flatulence in front of houseguests. But when death comes up, she has less to say. As my grandfather was dying of lung cancer, she told him his doctors suggested a temporary break from treatment to rebuild his strength – and not that he was actually being enrolled in hospice care, where he would likely live out his last days.

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RALEIGH (WTVD) -- Providing quality care to patients with chronic or life-limiting diagnoses requires staff who have the ability to feel and demonstrate empathy (the ability to walk in someone else's shoes). To instill a heightened level of empathy in healthcare providers, Transitions LifeCare developed an interactive workshop where people can experience first-hand, real-life symptom burdens common at the end of life. 

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Parkinson’s disease (PD) is a chronic and neurodegenerative disease associated with a wide variety of symptoms. The risk of complications increases with progression of the disease. These complications have a tremendous impact on the quality of life of people with PD. The aim of this study was to examine health care professionals’ experiences of potential barriers and facilitators in providing palliative care for people with PD in the Netherlands. 

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Unrepresented patients are those who have no surrogate or advance directive to guide medical decision making for them when they become incapacitated. While there is no perfect solution to the problem of making medical decisions for such vulnerable patients, 3 different approaches are noted in the literature: a physician approach, an ethics committee approach, and a guardianship approach. Recent policies and laws have required an approach that is “tiered” with respect to both who is involved and the gravity of the medical treatment questions at issue. In a general sense, some variant of a tiered approach is likely the best possible solution for jurisdictions and health institutions—both those already with and those without a tiered approach—to the challenging puzzle of treating unrepresented patients.

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PORTLAND — After nearly 40 years as an internist, Dr. Ron Naito knew what the sky-high results of his blood test meant. And it wasn’t good.

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The aging population in the United States is predicted to become one fifth of the population by 2050. With that increase, more individuals in the country will be experiencing chronic health conditions and the need for care, with end of life (EoL) becoming more of a topic that needs to be discussed. This study aims to explore the ways adult children talk to their parents about EoL, death, and dying. We discovered six themes: protection, meeting needs, guilt and regret, control, family dynamics, and communication type. Each of these was prevalent in responses to how adult children cope, how they cared for their parent, and how hope played into the interactions. We believe these themes will be helpful in developing a quantitative scale to study EoL further and be practical in helping adult children cope following death of their parent.

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There is no consensus approach to describe the process or components of goals of care (GOC) conversations.

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Of 535 patients, 60% prioritized relief of discomfort over extending life, 17% prioritized extending life over relief of discomfort, and 23% were unsure. Patients prioritizing extending life were most likely to prefer CPR, with 93% preferring CPR in current health and 67% preferring CPR if dependent on others, compared to 69% and 21% respectively for patients prioritizing relief of discomfort, and 78% and 33% respectively for patients unsure of their prioritized value (p

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 Junior doctors describe a need for greater support and training in end of life care (EoLC) communication skills. The Second Conversation project was designed by a multi-professional steering group as a workplace based training intervention for junior doctors to improve their skills and confidence in undertaking EoLC conversations. Qualitative interviews were carried out with 11 junior doctors and five senior doctors across two sites who took part in, or facilitated, a ‘second conversation’. This is a three-step training intervention that involves 1) observation – the junior doctor observes an EoLC conversation between a senior doctor and patient/caregiver; 2) direct experience – the junior doctor undertakes a follow-up second conversation with the patient/caregiver; and 3) reflection – the junior doctor discusses and reflects on the experience with a senior colleague. Interviews were analysed using framework analysis and findings informed iterative changes to the intervention and its implementation using ‘Plan, Do, Study, Act’ cycles. Benefits that were identified included the flexibility of the intervention and its positive impact on the confidence and skills of junior doctors. The Second Conversation was felt to be of most value to newly qualified doctors and worked well on wards where length of stay was longer and EoLC conversations frequently happen. Further evaluation and exploration of patient and caregiver experiences is required.

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Supporting and managing end of life in emergency departments (EDs) is often difficult and is becoming increasingly commonplace. Patients who present at the end of life are often triaged as low priority as their signs and symptoms are not considered life-threatening and they are often exposed to unnecessary and inappropriate tests and investigations. This results in increased stress and distress for patients and their family and carers in an environment that is not suited to this type of care. There are few specified palliative care pathways that provide the level of care required by these patients. 

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With over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: ‘Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…’ 

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 LGBT (lesbian, gay, bisexual, and transgender) older adults are more likely than their heterosexual peers to age with limited support in stigmatizing environments often poorly served by traditional social services challenging their preparedness for end of life. Fourteen focus groups and three individual interviews were conducted in five Canadian cities with gay/bisexual men (5 groups; 40 participants), lesbian/bisexual women (5 groups; 29 participants), and transgender persons (3 interviews, 4 groups; 24 participants). Four superordinate themes were identified: (a) motivators and obstacles, (b) relationship concerns, (c) dynamics of LGBT culture and lives, and (d) institutional concerns. Several pressing issues emerged including depression and isolation (more common among gay and bisexual men), financial/class issues (lesbian and bisexual women), and uncomfortable interactions with health-care providers (transgender participants). These findings highlight the challenges and complexities in end-of-life preparation within LGBT communities.

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Bob Hall was recovering from yet another surgery in March 2014 when a volunteer walked into his hospital room. It had been a rocky recovery since his lung transplant three months earlier at the William S. Middleton Memorial Veterans Hospital in Madison, Wis. The volunteer wasn’t there to check on his lungs or breathing. Instead, she asked Hall if he wanted to tell his life story. 

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“Maggie would have wanted everything done. She didn’t want to die.”

I’m sitting beside *Maggie’s hospital bed, speaking to her sister, her only surviving next of kin and substitute decision maker. I have known Maggie for over six months. When she was first referred to see me, she was a dynamic 45-year-old woman who had just been diagnosed with metastatic pancreatic cancer.

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LGBTQ advocates fought discrimination to celebrate PRIDE. In their old age, that lingering fear is affecting their health.

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Complication rates are high among the oldest patients. Now a surgeons’ group will propose standards for hospitals operating on the elderly.

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Spain has one of the world’s highest life expectancies, and its rapidly ageing population is putting the health system under strain. Improvement of quality of care for elderly people is an imperative to improve outcomes and reduce costs.

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Use of intensive care unit (ICU) resources in the USA outpaces that of other countries. This increased use is not accompanied by superior clinical outcomes and is at times discordant with patient preferences.

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Little is known about the quality of end of life care in long-term care (LTC) for residents with different diagnostic trajectories. The aim of this study was to compare symptoms before death in LTC for those with cancer, dementia or chronic illness.

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We recognise that critical care is sometimes provided in situations that are unwanted, non-beneficial, or unsustainably resource intense. In this issue of The Lancet Respiratory Medicine, a Series of three articles 1, 2, 3 review the published literature on avoiding unwanted intensive care unit (ICU) care, and identify the drivers of non-beneficial or cost-ineffective ICU use. Although to stop doing something that is unwanted, ineffective, and expensive should be easy, previous attempts to reduce the use of critical care in these situations have not always been met with success. Observational studies have routinely shown that advance care planning documents and palliative care consultation are associated with low rates of ICU use near the end of life. However, prospective interventional studies of palliative care or advance care planning have shown small to modest effects at best, and some have shown concerning negative effects on family members, such as increased rates of post-traumatic stress disorder. Moreover, the resources required to deliver some of these interventions are substantial, and might be hard to justify on the basis of the resources they save or the outcomes that they achieve. The efforts to reduce unwanted, non-beneficial, or unsustainable critical care can themselves be unwanted, non-beneficial, or unsustainable. 

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My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life. Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

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 For a generation of LGBTQ+ people who lived through unprecedented social change, getting older poses new challenges. When it comes to seeking elder care, concerns about lack of services, discrimination, neglect and even abuse threaten to reverse recent progress.

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Home-based care networks differ in size and composition, but little is known about the characteristics of care networks for those nearing the end of their lives. This study aimed to identify different types of home-based care networks of community-dwelling older adults in the Netherlands and to assess the association between care network type and the health status and socio-demographic characteristics of care recipients. 

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Shoppers in south London were disoriented this month by the arrival of an airport departure lounge in the middle of a popular shopping centre. An often used metaphor for the end of life, the pop-up Departure Lounge in Lewisham was designed to encourage passersby to examine what it means to have a “good death.” 

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 Nearly three quarters of GPs have too little time to discuss end of life care with patients - and only just over half feel comfortable doing so, a poll reveals.

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Canadians deserve to live out their lives in comfort and with dignity. They should also have access to care that is appropriate to their needs and that respects their wishes. For this reason, palliative care is a key priority in the Government of Canada's ongoing efforts to improve our health care system.

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With the burgeoning numbers of older people and the strong linkage between aging and Alzheimer’s disease and other dementias, almost all health systems will provide care for individuals with these disorders. This needed care may range from providing information, referring to community-based organizations, and monitoring for those with early disease to delivering intensive care management for those with medical and psychosocial complications. Because of the diversity of needs and range of costs associated with different types of dementia care, a population-based approach that tailors interventions to the needs of subpopulations will best meet the triple aim of better quality, better outcomes, and lower costs for individuals with dementia. We provide an example of how a population-based approach can be implemented and identify strategies for caring for different subpopulations of people with dementia.

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Although heart disease is the leading cause of death in the United States, few patients with heart disease are referred to palliative care, and for those that do receive such a referral this occurs much too late, a new study shows. 

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Most respondents to a recent survey in the U.K. said they aren't sure what will happen in their final days, a sign of the challenges faced by health-care providers there and in Canada when helping aging populations die with dignity. 

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Benjamin Franklin famously quipped that the only certainties in life are death and taxes. Today, most people could justifiably add, "and I don't understand either of them."

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It is often suggested that terminally ill patients favour end-of-life care at home. Yet, it is unclear how these preferences are formed, if the process is similar for patients and family caregivers, and if there are discrepancies between preferences for place of care and place of death. Understanding these nuances is essential to support people in their decision-making and ultimately provide better care at the end-of-life.

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High rates of health care utilization at the end of life may be a marker of care that does not align with patient-stated preferences. We sought to describe trends in end-of-life care and factors associated with dying in hospital.

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The article entitled “Plan now for end-of-life issues” by David Amies (April 26) is a welcome reminder that we are all immortal and need to plan for the eventuality of our death.>

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(HealthDay)—An interdisciplinary care protocol for frail geriatric trauma patients significantly reduces the risk for delirium and 30-day readmission, according to a study published online April 5 in the Journal of the American College of Surgeons.

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Fewer than half of physicians, nurses, and advanced practice registered nurses (APRNs) report always or frequently having end-of-life discussions with older patients with chronic illnesses, according to a recent Medscape poll.

The providers also say many patients put off the discussions as well.

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