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Susan W Tolle

Publications and source records attributed to Susan W Tolle.

6 recordsLinked to original sources
PubMed2002

Responding to requests for physician-assisted suicide: "These are uncharted waters for both of us...".

Studies of dying patients have shown that about half would like the option of physician-assisted suicide (PAS) to be available for possible future use. Those percentages decrease significantly with each step patients take toward action. Studies show that although about 10% of patients seriously consider PAS, only 1% of dying patients specifically request it, and 1 in 10 of those patients actually receive and take a lethal prescription. However, most patients' desires for PAS diminish as their underlying concerns are identified and addressed directly. To help identify concerns motivating a patient's request for PAS, physicians should talk with patients about their expectations and fears, options for end-of-life care, goals, family concerns and burdens, suffering or physical symptoms, sense of meaning and quality of life, and symptoms of depression. A patient with advanced amyotrophic lateral sclerosis (ALS) who requested PAS illustrates how a hasty response may adversely affect patient care and the health care team. Although physicians should remain mindful of their personal, moral, and legal concerns, these concerns should not override their willingness to explore what motivates a patient to make this request. When this approach is taken, suffering can be optimally alleviated and, in almost all cases, the patient's wishes can be met without PAS.

Advance Directives↗
PubMed2002

Factors associated with lower rates of in-hospital death.

OBJECTIVES: Examine individual and statewide factors associated with hospital as location of death. DESIGN: An observational study using large national databases. PARTICIPANTS: All 1997 U.S. decedents (all ages, all causes.) RESULTS: The West has the lowest percentage of deaths occurring in an acute care hospital, and the highest percentage of deaths at home. Increased hospital bed availability is significantly associated with greater chance of dying in an acute care hospital. Hispanic, nonwhite, and less educated decedents are more likely to die in a hospital (as opposed to home or nursing home). CONCLUSIONS: Hospital bed availability profoundly influences the likelihood of dying in a hospital. Individual characteristics such as race and education affect location of death as well. These three factors account for approximately 75% of the trend in the West to a lower in-hospital death rate and more deaths at home. Additional factors may include formal out of hospital orders to limit transfer.

Aged↗
PubMed2002

Changing end-of-life planning: the Oregon experience.

Large state-by-state variations exist in location of dying and level of aggressive treatment during the final phase of life. This paper describes Oregon's incremental gains toward improving advance planning for end-of-life care in a state with the lowest rate of in-hospital deaths. Action strategies have required data gathering and reporting, and coalition building with a focus on systems change. Also, public education through the news media has proved to be a vital component of Oregon's process of change. The impact of media coverage is complemented by continuing education for health professionals. Special efforts are still needed to improve access to the Physician's Orders for Life-Sustaining Treatment program (POLST) for some rural, minority, and pediatric populations and for persons living at home with a diagnosis other than cancer. However, with enough time, a sustained effort, and a broad coalition of partners, profound change is possible.

Advance Directives↗
PubMedDate not supplied

Sampling challenges in end-of-life research: case-finding for family informants.

BACKGROUND: Research on end-of-life care is hampered by challenges in accessing appropriate subjects for data collection. Although families of decedents are rich sources of research data, they are underutilized, most likely due to the access difficulties they present to investigators. OBJECTIVES: To describe case-finding strategies that can achieve a large and representative sample of family informants for research studies about end-of-life care. METHODS: Case-finding strategies were developed and honed over the course o fthree epidemiological studies on end-of-life care. Family location information was culled from death certificates and a combination of public and commercial sources. RESULTS: The researchers generated large random samples of study-eligible decedents and, using the case-finding strategies described, recruited family members of decedents as informants. By the third study, two-thirds of family members were located and interviewed within the narrow time frame of 2-5 months following the death of their loved one. DISCUSSION: Epidemiological studies on end-of-life, using large random samples of decedents and their family members, are feasible when armed with an array of effective case finding strategies.

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