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Physicians Should Stop Breaking Bad News [Editorial]

Berger, Jeffrey T; Ribeiro Miller, Dana
PMID: 35411537
ISSN: 1525-1497
CID: 5204322

I've Got the Power: Nurses' Moral Distress and Perceptions of Empowerment

DiGangi Condon, Kathleen A; Berger, Jeffrey T; Shurpin, Kathleen M
BACKGROUND:Nurses experience moral distress when they feel disempowered or impeded in taking the ethically right course of action. Research suggests an inverse relationship between moral distress and empowerment. In the intensive care unit, providing palliative care services may reduce moral distress because palliative care is often provided in situations that give rise to moral distress. OBJECTIVE:To evaluate the effect of nurses' use of a palliative care screening tool on their moral distress and perceptions of empowerment. METHODS:A pretest-posttest pilot study was conducted involving day-shift medical intensive care unit nurses. The nurses administered a palliative care screening tool to their assigned patients daily for 8 weeks and communicated the results to an attending physician or fellow. Demographic information was collected, along with data on nurses' moral distress and perceptions of structural and workplace empowerment before and after the intervention. Moral distress was evaluated using the Moral Distress Scale-Revised. Perceptions of structural and workplace empowerment were quantified using the Conditions for Work Effectiveness Questionnaire-II and the Global Empowerment Scale, respectively. RESULTS:Preintervention and postintervention surveys were completed by 17 nurses. Paired-sample t tests revealed a significant decrease in the frequency of moral distress (t16 = -2.22, P = .04) and a significant increase in workplace empowerment (t16 = -2.75, P = .01). No significant changes in moral distress intensity or structural empowerment were found. CONCLUSION:Nurses' sense of empowerment and the frequency of moral distress are favorably affected by active participation in assessing and communicating patients' palliative care needs.
PMID: 34719711
ISSN: 1937-710x
CID: 5037742

The Impact of COVID-19 Surge on Clinical Palliative Care: A Descriptive Study from a New York Hospital System

Moriyama, Derek; Scherer, Jennifer S; Sullivan, Ryan; Lowy, Joseph; Berger, Jeffrey T
CONTEXT/BACKGROUND:In spring 2020, New York experienced as surge of patients hospitalized with severe acute respiratory syndrome coronavirus 2 (COVID-19) disease, as part of a global pandemic. There is limited data on populations of COVID-19 infected patients seen by palliative care services. OBJECTIVE:To describe a palliative care population at one New York hospital system during the initial pandemic surge. METHODS:This repeated cross sectional, observational study collected data on palliative care patients in a large health system seen during the COVID-19 outbreak and compared it to pre-COVID data. RESULTS:Palliative service volume surged from 678 (4% of total admissions) pre-COVID-19 to 1,071 (10% of total admissions) during the COVID-19 outbreak. During the outbreak, 695 (64.9%) of palliative patients tested positive for the virus. Compared with a pre-outbreak group, this COVID-19 positive group had higher rates of male (60.7% vs 48.6%, p < 0.01) and Latino (21.3% vs 13.3%; p < 0.01) patients and less white patients (21.3% vs 13.3%; p < 0.01). Our patient's with COVID-19 also had greater prevalence of obesity and diabetes and lower rates of end-stage organ disease and cancers. The COVID-19 positive group had a higher rate of intensive care unit admissions (58.9% vs 33.9%; p < 0.01) and in-hospital mortality rate (57.4% vs 13.1%; p < 0.01) compared to the pre-outbreak group. There was increased odds of mortality in palliative care patients who were COVID-19 positive (OR = 3.21; 95% CI = 2.43 - 4.24) and those admitted to the ICU (OR = 1.45; 95% CI = 1.11 - 1.9). CONCLUSION/CONCLUSIONS:During the initial surge of the COVID-19 pandemic in New York, palliative care services experienced a large surge of patients who tended to be healthier at baseline and more acutely ill at time of admission than pre-COVID palliative patients.
PMID: 33359217
ISSN: 1873-6513
CID: 4731312

Corona and Community: The Entrenchment of Structural Bias in Planning for Pandemic Preparedness [Comment]

Berger, Jeffrey T; Miller, Dana Ribeiro
PMID: 32716812
ISSN: 1536-0075
CID: 4546512

"Being Do Not Resuscitate" [Letter]

Berger, Jeffrey T; Miller, Dana Ribeiro
PMID: 32105546
ISSN: 1557-7740
CID: 4604892

Marginally Represented Patients and the Moral Authority of Surrogates

Berger, Jeffrey T
Incapacitated adult patients are commonly divided into two groups for purposes of decision making; those with a surrogate and those without. Respectively, these groups are often referred to as represented and unrepresented, and the relative ethics of decision making between them raises two particular issues. The first issue involves the differential application of the best interests standard between groups. Second is the prevailing notion that representedness and unrepresentedness are categorical phenomena, though it is more aptly understood as a multidimensional and continuous variable based on relational moral authority. This paper examines the nature of representedness as it relates to ethical norms of surrogate decision making.
PMID: 31990251
ISSN: 1536-0075
CID: 4294912

Attention Measures of Accuracy, Variability, and Fatigue Detect Early Response to Donepezil in Alzheimer's Disease: A Randomized, Double-blind, Placebo-Controlled Pilot Trial

Vila-Castelar, Clara; Ly, Jenny J; Kaplan, Lillian; Van Dyk, Kathleen; Berger, Jeffrey T; Macina, Lucy O; Stewart, Jennifer L; Foldi, Nancy S
Objective/UNASSIGNED:Donepezil is widely used to treat Alzheimer's disease (AD), but detecting early response remains challenging for clinicians. Acetylcholine is known to directly modulate attention, particularly under high cognitive conditions, but no studies to date test whether measures of attention under high load can detect early effects of donepezil. We hypothesized that load-dependent attention tasks are sensitive to short-term treatment effects of donepezil, while global and other domain-specific cognitive measures are not. Method/UNASSIGNED:This longitudinal, randomized, double-blind, placebo-controlled pilot trial (ClinicalTrials.gov Identifier: NCT03073876) evaluated 23 participants newly diagnosed with AD initiating de novo donepezil treatment (5 mg). After baseline assessment, participants were randomized into Drug (n = 12) or Placebo (n = 11) groups, and retested after approximately 6 weeks. Cognitive assessment included: (a) attention tasks (Foreperiod Effect, Attentional Blink, and Covert Orienting tasks) measuring processing speed, top-down accuracy, orienting, intra-individual variability, and fatigue; (b) global measures (Alzheimer's Disease Assessment Scale-Cognitive Subscale, Mini-Mental Status Examination, Dementia Rating Scale); and (c) domain-specific measures (memory, language, visuospatial, and executive function). Results/UNASSIGNED:The Drug but not the Placebo group showed benefits of treatment at high-load measures by preserving top-down accuracy, improving intra-individual variability, and averting fatigue. In contrast, other global or cognitive domain-specific measures could not detect treatment effects over the same treatment interval. Conclusions/UNASSIGNED:The pilot-study suggests that attention measures targeting accuracy, variability, and fatigue under high-load conditions could be sensitive to short-term cholinergic treatment. Given the central role of acetylcholine in attentional function, load-dependent attentional measures may be valuable cognitive markers of early treatment response.
PMID: 29635383
ISSN: 1873-5843
CID: 3388032

Self-Inflicted Moral Distress: Opportunity for a Fuller Exercise of Professionalism

Berger, Jeffrey T; Hamric, Ann B; Epstein, Elizabeth
Moral distress is a phenomenon increasingly recognized in healthcare that occurs when a clinician is unable to act in a manner consistent with his or her moral requirements due to external constraints. We contend that some experiences of moral distress are self-inflicted due to one's under-assertion of professional authority, and these are potentially avoidable. In this article we outline causes of self-inflicted moral distress and offer recommendations for mitigation.
PMID: 31851622
ISSN: 1046-7890
CID: 4252002

Denial and Dyads: Patients Whose Surrogates and Physicians Are Unrealistically Optimistic [Comment]

Berger, Jeffrey T; Miller, Dana Ribeiro
PMID: 30235103
ISSN: 1536-0075
CID: 3387682

Informed Consent Is Inadequate and Shared Decision Making Is Ineffective: Arguing for the Primacy of Authenticity in Decision-Making Paradigms

Berger, Jeffrey
PMID: 29111926
ISSN: 1536-0075
CID: 3387672