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Attitudes on palliative care for adults with developmental disabilities

SUE, Kyle ; MAR, Nicole
JOURNAL OF PALLIATIVE MEDICINE, 28/07/2020, Pagination inconnue

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Thème : Soins.

DEMARCHE PALLIATIVE ; PSYCHIATRIE ; FIN VIE ; CANADA ; BESOIN FONDAMENTAL

Background: Intellectual and Developmental Disabilities (IDD) are defined as physical/mental impairments before age 18. Not only are many IDD patients living into adulthood, but deinstitutionalization has also led to most living in community settings. Little is known about end-of-life needs in these adults, and existing literature does not examine attitudes of Canadian providers.
Objective: Thematic and content analysis examined attitudes of Canadian Pediatric Palliative Care (PPC) practitioners on caring for adults with IDD to identify components of care, which could be improved.
Design: An anonymized survey was created (Surveymonkey.com) using open-ended and Likert-scale questions, with thematic/subthematic coding on NVivo11. Initial coding included a codebook, which was refined. Independent coding was compared with initial coding. Coded data were reanalyzed after demographic stratification, results discussed, and consensus reached.
Settings/Subjects: All Canadian PPC centers responded through snowball sampling (25 of 36 [70%] practitioners).
Measurements/Results: Major themes covered communication and decision making, lack of resources (including access to appropriate services), and knowledge/skill/experience gaps among adult palliative care and generalist practitioners. Gaps included complex medical conditions of IDD patients, trajectories, and related management. Knowledge ratings of adult palliative care and generalist practitioners by respondents were evenly distributed, but only pediatricians gave ratings of poor or worse. PPC practitioners are comfortable being consulted by adult palliative care and generalist colleagues. However, frequency of consults varied dramatically, from one to two times/month in British Columbia to never.
Conclusions: PPC practitioners across Canada identified several major issues and barriers to optimal palliative care for adults with IDD.

Origine : PubMed

Euthanasia and assisted suicide in patients with personality disorders - a review of current practice and challenges

MEHLUM, Lars ; SCHMAHL, Christian ; BERENS, Ann ; DOERING, Stephan ; HUTSEBAUT, Joost ; KAERA, Andres ; KRAMER, Ueli ; MORAN, Paul Anthony ; RENNEBERG, Babette ; RIBAUDI, Joaquim Soler ; SIMONSEN, Sebastian ; SWALES, Michaela ; TAUBNER, Svenja ; DI GIACOMO, Ester
Borderline personality disorder and emotion dysregulation, 2020, vol.7, p. 1-7

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Thème : Ethique et déontologie. Cote : eD13

EUTHANASIE ; SUICIDE MEDICALEMENT ASSISTE ; REVUE LITTÉRATURE ; PSYCHIATRIE

Background: Over the last two decades an increasing number of countries have legalized euthanasia and physician-assisted suicide (EAS) leading to considerable debate over the inherent ethical dilemmas. Increasing numbers of people with personality disorders, faced with unbearable suffering, have requested and received assistance in terminating their lives. EAS in people with personality disorders has, however, received very sparse attention from clinicians and researchers. In this paper, we examine the literature on the practice and prevalence of EAS in people with personality disorders to date and discuss the associated challenges for research and practice.
Methods: Narrative review of the literature combined with the authors' collective experience and knowledge of personality disorders.
Results: In six of the eight countries where EAS is currently legal, mental disorders are accepted as disorders for which EAS may be granted. In four of these countries, EAS in minors with mental disorders is also accepted. Our literature search resulted in 9 papers on the subject of EAS in people with personality disorders. These studies suggest that most clinicians who grant EAS have indeed perceived their patients' suffering as chronic, unbearable and untreatable without prospect of improvement. The majority of patients with personality disorders had tried some form of psychotherapy, but very few had received any of the relevant evidence-based treatments. The decision to grant EAS based on a perception of the patient's illness as being untreatable with no prospect of improvement, could, thus, in many cases fail to meet the due care criteria listed in EAS laws. People with personality disorders more often wish for death for extended periods of time than people without these disorders. However, there is ample empirical data to show that suicidal tendencies and behaviour can be treated and that they fluctuate rapidly over time.
Conclusions: In light of our findings, we believe that the current legislation and practice of EAS for people with personality disorders is based on an inadequate understanding of underlying psychopathology and a lack of awareness about the contemporary treatment literature. Moreover, we assert that this practice neglects the individual's potential for having a life worth living.

Origine : PubMed

Assessment of patient decision-making capacity in the context of voluntary euthanasia for psychic suffering caused by psychiatric disorders - a qualitative study of approaches among belgian physicians

SCHWEITSER, Frank ; STUY, Johan ; DISTELMANS, Wim ; RIGO, Adelheid
Journal of medical ethics, 03/08/2020, Pagination inconnue

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The engagement of psychiatrists in the assessment of euthanasia requests from psychiatric patients in Belgium - a survey study

VERHOFSTADT, Monica ; AUDENAERT, Kurt ; VAN DEN BROECK, Kris ; DELIENS, Luc ; MORTIER, Freddy ; TITECA, Koen ; PARDON, Koen ; DE BACQUER, Dirk ; CHAMBAERE, Kenneth
BMC psychiatry, 08/08/2020, vol.20, n°1, p. 1-11

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Severe mental illness and palliative care - patient semistructured interviews

KNIPPENBERG, Inge ; ZAGHOULI, Nasira ; ENGELS, Yvonne ; VISSERS, Kris C. P. ; GROOT, Marieke M.
BMJ supportive and palliative care, 11/08/2020, p. 1-7

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Supportive and palliative care for people with respiratory problems and preexisting serious mental illness

PERYER, Guy ; BARNES, Sylvia ; FARQUHAR, Morag
Current opinion in supportive and palliative care, 09/2020, vol.14, n°3, p. 190-196

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Do doctors differentiate between suicide and physician-assisted death? - a qualitative study into the views of psychiatrists and general practitioners

PRONK, Rosalie ; WILLEMS, Dick L. ; VAN DE VATHORST, Suzanne
Culture, medicine and psychiatry, 24/08/2020, p. 1-14

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Survey of mental health care providers’ perspectives on the everyday ethics of medical-aid-in-dying for people with a mental illness

MONTREUIL, Marjorie ; SÉGUIN, Monique ; GROS, Catherine ; RACINE, Eric
Canadian journal of bioethics, 20/07/2020, vol.3, n°1, p. 1-25

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Working at the intersection of palliative end-of-life and mental health care - provider perspectives

PARK, Tanya ; HEGADOREN, Kathy ; WORKUN, Bernadette
JOURNAL OF PALLIATIVE CARE, 18/08/2020, Pagination inconnue

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Thème : Médecine.

DEMARCHE PALLIATIVE ; FIN VIE ; PSYCHIATRIE ; COOPERATION ; INTERDISCIPLINARITE

OBJECTIVE: Palliative, end-of-life care (PEOLC) providers are poorly resourced in addressing the needs of patients with mental health challenges, and the dying experiences of this cohort-particularly those with a comorbid, chronic and persistent mental illness (CPMI)-are poorly documented. We sought to explore the experiences of PEOLC providers with regard to caring for patients with mental health challenges, and gather insights into ways of improving accessibility and quality of PEOLC for these patients.
METHOD: Twenty providers of PEOLC, from different disciplines, took part in semi structured interviews. The data were coded and analyzed using a reflexive, inductive-deductive process of thematic analysis.
RESULTS: The most prominent issues pertained to assessment of patients and differential diagnosis of CPMI, and preparedness of caregivers to deliver mental health interventions, given the isolation of palliative care from other agencies. Among the assets mentioned, informal relationships with frontline caregivers were seen as the main support structure, rather than the formal policies and procedures of the practice settings. Strategies to improve mental health care in PEOLC centered on holistic roles and interventions benefiting the entire palliative population, illustrating the participants saw little point in compartmentalizing mental illness, whether diagnosed or not.
SIGNIFICANCE OF RESULTS: Continuity of care and personal advocacy can significantly improve quality of life for end-of-life patients with mental health challenges, but bureaucracy and disciplinary siloing tend to isolate these patients and their caregivers. Improved interdisciplinary connectivity and innovative, hybridized roles encompassing palliation and psychiatry are 2 strategies to address this disconnect, as well as enhanced training in core mental health care competencies for PEOLC providers.

Origine : PubMed

Belgian psychiatrists' attitudes towards, and readiness to engage in, euthanasia assessment procedures with adults with psychiatric conditions - a survey

VERHOFSTADT, Monica ; AUDENAERT, Kurt ; VAN DEN BROECK, Kris ; DELIENS, Luc ; MORTIER, Freddy ; TITECA, Koen ; PARDON, Koen ; CHAMBAERE, Kenneth
BMC psychiatry, 16/07/2020, vol.20, n°1, p. 1-10

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End-of-life care among patients with bipolar disorder and cancer - a nationwide cohort study

FOND, Guillaume ; BAUMSTARCK, Karine ; AUQUIER, Pascal ; PAULY, Vanessa ; BERNARD, Cecile ; ORLEANS, Veronica ; LLORCA, Pierre-Michel ; LANCON, Christophe ; SALAS, Sebastien ; BOYER, Laurent
Psychosomatic medicine, 13/07/2020, Pagination inconnue

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End of life care in individuals with serious mental illness

SHALEV, Daniel ; FIELDS, Lauren ; SHAPIRO, Peter A.
Psychosomatics, 12/06/2020, p. 1-8

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“Nothing hurts less than being dead” - psychological pain in case descriptions of psychiatric euthanasia and assisted suicide from the Netherlands

LENGVENYTE, Aiste ; STRUMILA, Robertas ; COURTET, Philippe ; KIM, Scott Y. H. ; OLIE, Emilie
The Canadian journal of psychiatry, 05/06/2020, Pagination inconnue

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Should euthanasia and assisted suicide for psychiatric disorders be permitted? - a systematic review of reasons

NICOLINI, Marie E. ; KIM, Scott Y. H. ; CHURCHILL, Madison E. ; GASTMANS, Chris
Psychological medicine, 06/2020, vol.50, n°8, p. 1241-1256

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Last months of life of people with intellectual disabilities - a UK population-based study of death and dying in intellectual disability community services

TODD, Stuart ; BERNAL, Jane ; SHEARN, Julia ; WORTH, Rhian ; JONES, Edwin ; LOWE, Kathy ; MADDEN, Phil ; BARR, Owen ; FORRESTER JONES, Rachel ; JARVIS, Paul ; KROLL, Thilo ; MCCARRON, Mary ; READ, Sue ; HUNT, Katherine
Journal of applied research in intellectual disabilities, 31/05/2020, p. 1-14

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Subspecialty training - hospice and palliative medicine

BRASSIL, Michelle ; GALLEGOS-KEARIN, Vanessa ; TOLCHIN, Dorothy
American journal of physical medicine and rehabilitation, 10/06/2020, Pagination inconnue

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The creation of a psychiatry-palliative care liaison team - using psychiatrists to extend palliative care delivery and access during the Covid-19 crisis

SHALEV, Daniel ; NAKAGAWA, Shunichi ; STROEH, Oliver M. ; ARBUCKLE, Melissa R. ; RENDLEMAN, Rebecca ; BLINDERMAN, Craig D. ; SHAPIRO, Peter A.
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 06/2020, p. 1-5

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Ethics of finitude - nursing and the palliative approach in geriatric and forensic psychiatry

SKINNER, Elise ; JACOB, Jean Daniel ; VANDERSPANK-WRIGHT, Brandi ; WRIGHT, David Kenneth
Global qualitative nursing research, 01/2020, vol.7, p. 1-77

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The lack of adequate scientific evidence regarding physician-assisted death for people with psychiatric disorders is a danger to patients

SINYOR, Mark ; SCHAFFER, Ayal
The Canadian journal of psychiatry, 26/05/2020, Pagination inconnue

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Embracing slippery slope on physician-assisted suicide and euthanasia could have significant unintended consequences

BUTUROVIC, Zeljka
Journal of medical ethics, 27/03/2020, Pagination inconnue

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