Parte I. Il percorso clinico e assistenziale nelle insufficienze croniche d'organo "end-stage". Documento di consenso per una pianificazione condivisa delle scelte di cura

Translated title of the contribution: Part I. End-stage chronic organ failures: A position paper on shared care planning. The integrated care pathway

Giuseppe R. Gristina, Luciano Orsi, Annalisa Carlucci, Ignazio R. Causarano, Marco Formica, Massimo Romanò

Research output: Contribution to journalArticlepeer-review

Abstract

In Italy the birth rate decrease together with the continuous improvement of living conditions on one hand, and the health care progress on the other hand, led in recent years to an increasing number of patients with chronic mono- or multi-organ failures and in an extension of their life expectancy. However, the natural history of chronic failures has not changed and the inescapable disease's worsening at the end makes more rare remissions, increasing hospital admissions rate and length of stay. Thus, when the "end-stage" get close clinicians have to engage the patient and his relatives in an advance care planning aimed to share a decision making process regarding all future treatments and related ethical choices such as patient's best interests, rights, values, and priorities. A right approach to the chronic organ failures end-stage patients consists therefore of a careful balance between the new powers of intervention provided by the biotechnology and pharmacology (intensive care), both with the quality of remaining life supplied by physicians to these patients (proportionality and beneficence) and the effective resources rationing and allocation (distributive justice). However, uncertainty still marks the criteria used by doctors to assess prognosis of these patients in order to make decisions concerning intensive or palliative care. The integrated care pathway suggested in this position paper shared by nine Italian medical societies, has to be intended as a guide focused to identify end-stage patients and choosing for them the best care option between intensive treatments and palliative care.

Translated title of the contributionPart I. End-stage chronic organ failures: A position paper on shared care planning. The integrated care pathway
Original languageItalian
Pages (from-to)9-24
Number of pages16
JournalRecenti Progressi in Medicina
Volume105
Issue number1
DOIs
Publication statusPublished - Jan 2014

ASJC Scopus subject areas

  • Medicine(all)

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