Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill?

BACKGROUND: Recognizing that many Americans draw on religious or spiritual beliefs when confronted by serious illness, some medical educators have recommended that physicians routinely ask about spirituality or religion when conducting a medical history. The most appropriate wording for such an inquiry remains unknown. OBJECTIVE: To examine patient acceptance of including the following question in the medical history of ambulatory outpatients: "Do you have spiritual or religious beliefs that would influence your medical decisions if you become gravely ill?" METHODS: Self-administered questionnaires were completed by 177 ambulatory adult patients visiting a pulmonary faculty office practice at a university teaching hospital in 1997 (83% response rate). RESULTS: Fifty-one percent of the study patients described themselves as religious and 90% believe that prayer may sometimes influence recovery from an illness. Forty-five percent reported that religious beliefs would influence their medical decisions if they become gravely ill. Ninety-four percent of individuals with such beliefs agreed or strongly agreed that physicians should ask them whether they have such beliefs if they become gravely ill. Forty-five percent of the respondents who denied having such beliefs also agreed that physicians should ask about them. Altogether, two thirds of the respondents indicated that they would welcome the study question in a medical history, whereas 16% reported that they would not. Only 15% of the study group recalled having been asked whether spiritual or religious beliefs would influence their medical decisions. CONCLUSION: Many but not all patients surveyed in a pulmonary outpatient practice welcome a carefully worded inquiry about their spiritual or religious beliefs in the event that they become gravely ill.

Advance directives: the emerging body of research.

BACKGROUND: With the passage of the Patient Self-Determination Act in 1990, new procedures and documents became available for planning end-of-life care. These new procedures and documents are now being examined scientifically. OBJECTIVE: To review existing research on the use of advance directives. DATA SOURCES: Computer search using Grateful Med software from the National Library of Medicine with MEDLINE and BIOETHICSLINE databases. STUDY SELECTION: Studies that showed an emerging consensus or reported vastly differing results were selected. Selected studies examined these specific areas: demographic data on patients with advance directives, completion rates, capacity to complete, patients' preferences, stability of patients' decisions over time, treatment choices, proxy decision makers, treatment provided, and cost. RESULTS: The body of important research about advance directives is growing. A profile of their clinical utility is emerging. CONCLUSIONS: The research done so far can stimulate future research and can begin to suggest possible changes in practice. However, the body of research is not yet large enough or well controlled enough to answer conclusively many of the questions about planning of end-of-life care.

Physician-assisted suicide and older patients' perceived duty to die.

Physician-assisted suicide (PAS) may soon be legal in the United States. The legal option of PAS will place certain hardships on older persons. Many older individuals may feel a duty to die to avoid becoming a burden to their families. Moreover, the suicide option becomes attractive because medical care at the end of life is often fragmented, impersonal, and unable to meet the needs of the dying individual. To make suicide less attractive, nurses must help restructure the care of the dying to help meet their needs and reduce the burdens of caregivers.

Lung volume reduction: surgical treatment for emphysema.

BACKGROUND: Lung volume reduction surgery is currently being investigated as a method of improving the respiratory function of patients with end-stage emphysema. PURPOSE: This article reviews the current literature on lung volume reduction surgery and proposes a multidisciplinary team approach to postoperative management. METHODS: We did a MEDLINE search and retrieved relevant articles. We selected and reviewed nine medical articles published in 1993, 1995, and 1996; one medical article from 1959; and one of four nursing articles. Overall, the articles describe the different techniques of median sternotomy and video-assisted thoracoscopic surgery and unilateral versus bilateral procedures. CONCLUSION: Lung volume reduction surgery is beneficial, but further investigation is required.

Readability of advance directive documents.

PURPOSE: To assess the readability of advance directive documents. DESIGN: Descriptive. SAMPLE: Convenience, 10 advance directive documents from various sources. METHODS: Advance directive documents were electronically scanned in 1994 then evaluated using three readability formulas: Flesch-Kincaid Grade Level, Flesch Reading Score, and Gunning's Fog Index. FINDINGS: The average readability (in school grade levels) of the 10 documents was 11.3 using the Flesch-Kincaid Grade Level and 18.2 using the Gunning's Fog Index. CONCLUSIONS: All documents were above reading levels usually recommended for patients. CLINICAL IMPLICATIONS: Patients must be able to read and understand advance directive documents before signing them. Refinement of the documents is recommended to support patient understanding and autonomy in end-of-life care.

Defining and redefining death.

The definition of death, brain death in particular, is increasingly important to critical care professionals. There are essentially three definitions of death from a theoretical perspective: the traditional heart-lung definition, the whole-brain definition, and the higher-brain definition. These definitions use different underlying assumptions within their own theoretical framework. The differing definitions and theoretical frameworks have encouraged physiological, philosophical, spiritual, and ethical analyses, which have led to spirited debate throughout the healthcare community and especially in critical care.

Readability of written materials: implications for critical care nurses.

Written materials are given to patients every day in critical care units. Unfortunately, some of the materials are written at a reading level that is too difficult for patients to read. Patients and families need understandable materials to help them make the difficult decisions they face.

The Human Genome Project: an overview of ethical issues and public policy concerns.

The possibilities of advancement from the Human Genome Project seem endless. But even though we are amazingly similar genetically to other animals, including the mouse, we are uniquely human. And our humanness is our greatest gift. The knowledge of genetic linkages and of how life works does not diminish our religious beliefs or our value system. Understanding the mechanics of human physiology does not decrease the power and beauty of human life. Quite the contrary, this knowledge helps to chart the course in a quest to understand what it means to be human. Let us honor the beauty and uniqueness of human life by making ethically sound decisions surrounding the advances made in this fantastic journey called the Human Genome Project.

Support of patient autonomy in the do not resuscitate decision.

In this study we examined critical care nurses' beliefs concerning the support of patient autonomy in the do not resuscitate (DNR) decision. The study sample consisted of 251 members of the American Association of Critical-Care Nurses (AACN). Subjects were asked to examine four hypothetical cases and select the agent (patient, family member, physician, or nurse) (1) most appropriate to support patient autonomy in the DNR decision and (2) who would actually make the DNR decision, if these hypothetical cases were to occur on the clinical units where the subjects were employed. The nurses' answers concerning the agent best able to support patient autonomy in the DNR decision were in general agreement with the do not resuscitate decision model developed by the principal investigator (B.B.O.) to demonstrate support for patient autonomy in the DNR decision. However, when asked who would actually make the DNR decision on their units, the nurses frequently responded that the physician would make the decision, regardless of the agent selected as best able to support patient autonomy in the case situation. An ethical conflict concerning the DNR decision appeared to exist for the majority of the subjects in this study.

Percutaneous transluminal coronary angioplasty and nursing implications.

Percutaneous transluminal coronary angioplasty is a new procedure used in the treatment of coronary artery disease. The procedure involves the use of a small balloon-tipped catheter that is advanced into the stenotic coronary artery. The soft atheroma is compressed against the arterial wall by the inflation of the balloon across the lesion, thereby reducing the stenosis. Preoperative nursing care of the PTCA patient includes thorough assessment and preoperative teaching. Post-operative nursing care involves close assessment and prompt attention to potential complications.