| Title |
Decisions at the end of life: have we come of age?
|
|---|---|
| Published in |
BMC Medicine, October 2010
|
| DOI | 10.1186/1741-7015-8-57 |
| Pubmed ID | |
| Authors |
Linda Emanuel, Karen Glasser Scandrett |
| Abstract |
Decision making is a complex process and it is particularly challenging to make decisions with, or for, patients who are near the end of their life. Some of those challenges will not be resolved - due to our human inability to foresee the future precisely and the human proclivity to change stated preferences when faced with reality. Other challenges of the decision-making process are manageable. This commentary offers a set of approaches which may lead to progress in this field. One clearly desirable approach can and should be used more often than it is: the routine inclusion of discussions about the goals of care and documentation with all patients who have a poor prognosis. The match between a patient's goals and the care received should be the gold standard for quality palliative care.Planning for future situations is necessary but hard. In order to achieve efficient elicitation and documentation of advance care planning, research is needed on each individual's thresholds for transitioning from curative to palliative intent and on the trajectory of changed preferences when illness occurs. Another clearly desirable approach is the documentation and use of community preferences, so that proxies making decisions without guidance from the patient can at least know what the majority of people considering similar situations chose to do.Part of the challenge of achieving 'quality dying' may have to do with the still current (mainly Western) tendency to a death-denying culture and the inability of dying people to enter into the dying role. Awareness of the tasks of the dying role and the provision of time and space for those tasks during the delivery of medical care is essential. Medicine needs to continue to enhance the existential maturity of our profession, our patients and the cultures in which we practice. This state of mind should provide for decisions made with a more settled acceptance of mortality and with more awareness of the necessary connection to our survivors and next generation that mortality creates. Specific interventions, such as Dignity Therapy and advance care planning, may aid this state of mind. |
Mendeley readers
The data shown below were compiled from readership statistics for 101 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 2 | 2% |
| France | 1 | <1% |
| Switzerland | 1 | <1% |
| South Africa | 1 | <1% |
| United States | 1 | <1% |
| Unknown | 95 | 94% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Ph. D. Student | 18 | 18% |
| Student > Master | 16 | 16% |
| Other | 14 | 14% |
| Researcher | 13 | 13% |
| Student > Bachelor | 7 | 7% |
| Other | 17 | 17% |
| Unknown | 16 | 16% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 34 | 34% |
| Nursing and Health Professions | 15 | 15% |
| Psychology | 10 | 10% |
| Social Sciences | 10 | 10% |
| Agricultural and Biological Sciences | 3 | 3% |
| Other | 9 | 9% |
| Unknown | 20 | 20% |
Attention Score in Context
This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 08 October 2010.
All research outputs
#4,655,198
of 22,705,019 outputs
Outputs from BMC Medicine
#2,132
of 3,406 outputs
Outputs of similar age
#20,498
of 99,109 outputs
Outputs of similar age from BMC Medicine
#13
of 18 outputs
Altmetric has tracked 22,705,019 research outputs across all sources so far. Compared to these this one has done well and is in the 79th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 3,406 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 43.5. This one is in the 37th percentile – i.e., 37% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 99,109 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 79% of its contemporaries.
We're also able to compare this research output to 18 others from the same source and published within six weeks on either side of this one. This one is in the 22nd percentile – i.e., 22% of its contemporaries scored the same or lower than it.