T R Fried

..A case of COPD in an 81-year-old man hospitalized with severe dyspnea and respiratory failure highlights both the challenges in managing COPD in the elderly and the limitations in applying guidelines to geriatric patients...

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..The questions patients are asked about their preferences with regard to life-sustaining treatment usually focus on specific interventions, but the outcomes of treatment and their likelihood affect patients' preferences...

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..To examine the adequacy of caregiver-patient communication in serious illness and its relationship to caregiver burden...

..To develop and test a simple tool to elicit the preferences of older persons based on prioritization of universal health outcomes...

..To examine changes in patients' and caregivers' understanding of prognosis with progression of the patient's illness...

..There are conflicting assumptions regarding how patients' preferences for life-sustaining treatment change over the course of serious illness...

..Instructional forms of advance care planning depend on the ability of patients to predict their future treatment preferences. However, preferences may change with changes in patients' health states...

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..Traditional approaches to advance care planning (ACP) have many limitations; new approaches are being developed with the goal of improving end-of-life care...

..We examined older persons' willingness to take medication for primary cardiovascular disease prevention according to benefits and harms...

..To examine agreement between older persons and their surrogates regarding participation in advance care planning (ACP)...

..To examine agreement between patients, caregivers, and clinicians regarding prognosis communication and to examine patients' and caregivers' desire for prognostic information...

..Little is known about patients' preferences for site of terminal care...

..Although the home is expanding as a potential site for acute illness treatment, little is known about patients' preferences for home vs the hospital...

..To explore whether models of health behavior change can help to inform interventions for advance care planning (ACP)...

..This study sought to determine the relationship between functional status and government-reimbursed health care services in older persons...

..Understanding how primary care clinicians approach treatment decision making for these patients is critical to the design of interventions to improve the decision-making process...

..The purpose of this study was to develop a patient-centered measure of treatment preference applicable across a range of diseases and treatment decisions...

..However, little work has been done to elicit from patients themselves the aspects of treatment decision-making most important to them when making end-of-life treatment decisions...

..Although studies have examined how well surrogates agree with patients' preferences for specific treatment interventions, agreement regarding the valuation of health states as treatment outcomes is unknown...

..To determine whether preferences for future attempts at life-sustaining treatment change over time in a consistent and predictable manner...

..However, many report having limited training and substantial gaps in knowledge about hospice among this group of nurses, suggesting greater attention to palliative care and hospice may be warranted in nursing educational programs...

..When expected outcomes at the two sites are similar, the challenge to the health care system will be incorporating patient preference about the process of care into decisions about the appropriate site of care...

..Clinicians should consider factors such as these when targeting caregivers for interventions to alleviate burden...

..In some cases, such documented discussions may be important catalysts for subsequent discussions of patient and family preferences regarding treatment and future care...

..Honoring patients' treatment preferences is a key component of high-quality end-of-life care...

..Tools that help physicians identify seriously ill patients who could benefit from palliative care may also serve to increase appropriate referrals...

..The objectives of our study were to determine (1) the prevalence of a range of symptoms among older persons with advanced chronic disease and (2) whether the prevalence of symptoms is similar across diagnoses...

..Our objectives were to determine how frequently informed consent is obtained when tPA is given to stroke patients in clinical practice and whether the person providing consent (patient or surrogate) was the appropriate decision-maker...

..To examine subjective ratings of quality of life (QoL) in older adults with advanced illness...

..Improving care for patients with comorbidities will require substantive increases in the efforts and resources allocated to the collection and dissemination of outcome data for patients with varying comorbidities...

..An additional benefit of the analytical approach presented is that it allows for assessment of the utility of triggered sampling in longitudinal studies...

..The benefit obtained from incorporating both the intensity and bothersome nature of a longer list of symptoms may outweigh the potential increase in respondent burden...

..Little is known about the frequency or outcomes of treatment refusal among these patients...

..Symptoms are a central component of health status; however, little is known about the full range and trajectory of symptoms experienced by persons with chronic diseases other than cancer...

..To develop a choice task for eliciting priorities in the face of competing cardiovascular disease (CVD) outcomes, medication-related symptoms, and fall injuries...

..The purpose of this study is to present empirical evidence about whether religious patients are more or less willing to undergo the risks associated with potentially life-sustaining treatment...

..To determine the priority that older adults with coexisting hypertension and fall risk give to optimizing cardiovascular outcomes versus fall- and medication symptom-related outcomes...

..These findings suggest that interventions targeting these symptoms could improve several health-related outcomes...

..CONCLUSIONS: While evolution to greater patient involvement in medication decision making may be possible, and desirable to some older patients, findings suggest that the transition will be challenging...

..Although many studies have documented problems in communication between physicians and patients, few have focused on discussions regarding prognosis among community dwelling patients with terminal illness...

..Culturally sensitive, literacy-appropriate tools are needed to address decisional uncertainty and to help patients prepare for decision making about their future health care...

..7, 95% CI 3.1, 10.6). This effect persisted after adjusting for patient age, gender, marital status, documented discussions of prognosis, prior hospice use, and type of cancer...

..To understand the bathing experiences, attitudes, and preferences of older persons in order to inform the development of effective patient-centered interventions...

..Clinicians' discussions about hospice with patients and families are important as a means of communicating end-of-life options...

..To determine whether patient preferences are a barrier to hospice enrollment...

..We denote this study design feature as "triggered sampling" (TS)...

..In addition, the research and mentorship programs will utilize and continue to build the interdisciplinary relationships Dr. Fried has established with medical subspecialties, psychiatry, and the Schools of Nursing and Public Health. ..

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..Fried s continued success, Yale offers the resources necessary to ensure Dr. Fried s continued development as an independent investigator. ..

..This study utilizes a unique cohort of community-dwelling older persons identified as having a terminal illness by objective criteria. ..