Advance
directives should be prepared after conversations with patients, about their
goals, preferences and their values which can be used to determine their end of
life care. This will help manage care for people in need and should be recorded
with the living will. Apart from the individual, loved ones and the
individual's doctor should be consulted to ensure the line of treatment is in
accordance with the individual's needs and wishes. The presence of the doctor
would aid in highlighting the medical treatments that are available based on
any physical ailment that the individual could be suffering from.
Analyzing Advance
Directives
Dr.
Molly Feely and colleagues from the Mayo Clinic analyzed actual directives from
patients who were undergoing dialysis. The medical records of 808 patients who
received in -hospital dialysis between January 2007 and January 2012 were
studied.
It
was found that among 808 patients -
- 49% had advance directives
- only
10.6% mentioned dialysis
- only 3% mentioned dialysis management specifically at the end
of life
Importantly, among patients who received
dialysis and who had advance directives
- 44.2% mentioned cardiopulmonary resuscitation
-
37.1% mentioned mechanical ventilation
- 34.3%
mentioned artificial nutrition and hydration
- 43.4% mentioned
pain management
- 10.6% mentioned dialysis
There
was considerable thought that went into preparing advance directives and they
were tailored to include conditions of the heart but many people who were on
dialysis had failed to mention the need for one. The directives were particularly important for these patients as
they would have guided the doctors on assessing treatment plans and managing
dialysis.
Dr.
Feely added, "Unfortunately, our study revealed that the advance directives of
our dialysis patients failed to address how our patients wanted to manage their
dialysis at the end of life, an issue of critical importance to this
population. Future research needs to be much more sophisticated in how we
measure the success of advance care planning and advance directive execution
such that we assure that we are actually improving patient outcomes."
Dr.
Sara Combs from The University of Colorado stated along with this study that
The United States had the financial capacity to provide dialysis for nearly
every citizen, even if they did not have the financial resources to fund their
dialysis procedure on their own.
Dialysis is a
life-sustaining procedure and patients' needs to be informed about the
benefits associated with this procedure. The researchers conclude that stopping
dialysis or not taking up dialysis are also viable options that may be
considered.
Dialysis
Dialysis
is a procedure in which some of the functions of the kidney are
performed by a dialysis machine. It is performed in conditions where the kidney
is unable to perform its functions well, resulting in a toxic build-up of
waste.
Dialysis
aids in keeping your body in balance by
- Removing extra water, waste and salt
- Maintaining levels of sodium, potassium and calcium
- Aids
in controlling blood pressure
The
duration of dialysis depends on the stage of kidney disease. In some patients,
dialysis may be needed only for a short period of time, while in people with
end-stage kidney disease; dialysis may have to be carried out for the
rest of their lives. Such people could opt for a kidney transplant.
It
is important for the patient to understand the need for dialysis and to make an
informed mention in the advance directives, to better manage end of life care.
References:
- Dialysis - (https://www.kidney.org/atoz/content/dialysisinfo)
Source: Medindia
