The 2000 Helene Hudson Memorial Lecture: Decisional role in seriously ill hospitalized patients near the end of life: The patient's and provider's perspective
Bibliographic record
Abstract
Decisions about whether or not to implement life-sustaining therapies are complex and are becoming more so as the ability to prolong life with advanced technologies and care increases. The objectives of this study were: (1) to determine seriously ill hospitalized patients' preferences for decisional role with respect to decisions about life-sustaining treatments, and (2) to determine if providers were aware of patients' preferences. This prospective, descriptive pilot study was conducted at an Ontario teaching hospital. One hundred and seventeen seriously ill adult patients admitted with cancer and non-cancerous conditions participated in a structured interview. Fifty-three nurses and 63 physicians responsible for the care of the participating patients also participated. Patients and providers were asked similar questions about end-of-life discussions and preference for decisional responsibility for life-sustaining treatments. Most patients (n=89, 77%) had thought about end-of-life issues and nwere willing to discuss these with their physicians and nurses, but few (n=37, 37%) reported such discussions. Preferences for decisional role varied; most indicated a preference for a shared role (n=80, 80%) and there were no differences in patients with or without cancer. Generally, both physicians and nurses were not aware of or did not determine accurately patient preferences for decisional role. The findings from this study show that seriously ill hospitalized patients have thought about and are willing to share in discussions about end-of-life care with their providers, yet many have not.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".