Topic: Health services, long-term care and technology
Kaufman, “dying people are not wanted in medical institutions, and it shows.” SUPPORT Study The author informs us about the results of the SUPPORT study (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment), in which it was determined that much of end-of-life care was characterized by unrelenting technology. In the subsequent follow-up intervention study, the results were ominous: Interventions designed to better inform doctors about patient preferences about the use of heroic measures, DNR orders, avoiding CPR, or the management of pain were largely unsuccessful. Kaufman writes that she feels that this pressure to help patients understand that if the family does not speak up against CPR, it will happen, leads to significant family guilt that they have indeed chosen their loved one's death. Complicating this is the impact of organ donation and the use of the mechanical ventilator so that death is divided into the physical phenomenon associated with it and brain activity. ‘Death-in-Life’ Ventilators allowed what the author calls “three varieties of death-in-life: the brain dead, the comatose, and the inhabitants of some other location in the gray zone of indistinction.” Another observation: “The last year in which one could die of ‘old age’ or from simply being ‘worn out’ was 1913.” Death is defined by the International Classification of Diseases (ICD) so that there must be a diagnosis to explain that death has occurred, rather than from being too old to continue living. Treatments governed how long care was paid for, and treatments were determined by “watching the numbers” or the results of blood chemistries to spell out organ function and the state of the patient's medical course. What results is that dying is often not acknowledged until the very end, when someone stops the tests, treatments, or procedures that characterize “moving things along.” Code-status decisions are made far too late and hospitals are criticized for an inhumane death that families are in no way prepared for. We wait for test results, consultations to happen, for the patient's condition to stabilize, for discharge decisions to be made, for families to make decisions about life sustaining care, in other words, for things to ‘move along.’” Vividly shown is the tension between families and staff, which often results in obstructive waiting, with each side seeing the other as the culprit in the hospital dance.
Key findings
- Kaufman, “dying people are not wanted in medical institutions, and it shows.” SUPPORT Study The author informs us about the results of the SUPPORT study (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment), in which it was determined that much of end-of-life care was characterized by unrelenting technology.
- In the subsequent follow-up intervention study, the results were ominous: Interventions designed to better inform doctors about patient preferences about the use of heroic measures, DNR orders, avoiding CPR, or the management of pain were largely unsuccessful.
- Kaufman writes that she feels that this pressure to help patients understand that if the family does not speak up against CPR, it will happen, leads to significant family guilt that they have indeed chosen their loved one's death.
- Complicating this is the impact of organ donation and the use of the mechanical ventilator so that death is divided into the physical phenomenon associated with it and brain activity. ‘Death-in-Life’ Ventilators allowed what the author calls “three varieties of death-in-life: the brain dead, the comatose, and the inhabitants of some other location in the gray zone of indistinction.” Another observation: “The last year in which one could die of ‘old age’ or from simply being ‘worn out’ was 1913.” Death is defined by the International Classification of Diseases (ICD) so that there must be a diagnosis to explain that death has occurred, rather than from being too old to continue living.
- Treatments governed how long care was paid for, and treatments were determined by “watching the numbers” or the results of blood chemistries to spell out organ function and the state of the patient's medical course.
Study details
- Evidence strengthLow
How this study scored 34/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 20 of the 58 points we could judge it on, which is 34 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Oncology Times) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2005 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 20 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 20 of the 58 points we could judge it on is 34 out of 100. |
| Total | 34 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Kaufman, S. R. (2005). ‘AND A TIME TO DIE. Oncology Times. https://doi.org/10.1097/01.cot.0000290066.06231.57
Vancouver
Kaufman SR. ‘AND A TIME TO DIE. Oncology Times. 2005. doi:10.1097/01.cot.0000290066.06231.57.
BibTeX
@article{kaufman2005-c62b84c8,
author = {Kaufman, Sharon R.},
title = {{‘AND A TIME TO DIE}},
journal = {Oncology Times},
year = {2005},
doi = {10.1097/01.cot.0000290066.06231.57},
url = {https://doi.org/10.1097/01.cot.0000290066.06231.57}
}