End of Life Care

The goal of this clinical trial is to evaluate whether the Die-logue program can improve attitudes toward death, coping with death, and readiness for advance care planning (ACP) among community-dwelling middle-aged adults aged 40-60 years who have not completed any advance directives and not diagnosed with any life limiting diseases. This study aims to address the following research questions: * Does the Die-logue program improve community-dwelling middle-aged adults' attitudes towards death, ability to cope with death, readiness and uptake for Advanced Care Planning (ACP). * What are community-dwelling middle-aged adults' perceptions of advance care planning, death and dying, and their experiences of participation in the Die-logue program. Researchers will compare participants who receive the Die-logue program (death conversation and online ACP education) with participants who receive only the online ACP education to see if informal death conversations improve attitudes toward death, coping with death, and readiness for ACP. Participants will: * Complete online questionnaires measuring attitudes toward death, coping with death, and readiness for advance care planning. * Participate in a facilitator-led group discussion session about perceptions of death, coping with death, and readiness for ACP (intervention group only). * Complete an asynchronous online ACP education session consisting of short recorded videos and an online discussion forum (both intervention and control group). * Complete follow-up surveys, including a 6-month follow-up assessing whether they have undertaken advance care planning.

The CRxDpeer intervention, delivered by a trained peer navigator, in practice called a "peer mentor", includes three evidence-based components: (a) focused education about common social (e.g., food and housing insecurity) and caregiving (e.g., respite and end of life care) needs, (b) activation of personalized community resource information for social and caregiving needs through delivery of a resource list (HealtheRx) at the baseline encounter and coaching on how to communicate with service providers, coordinate services and manage social support (e.g., connect with their peer navigator, reach out to friends or relatives for support, identify support groups, etc.) and (c) ongoing navigation-focused support meant to boost the baseline intervention, including a series of proactive text messages over 12 months. During this time, the subject can respond to and communicate with the peer navigator for ongoing support.

Background: Recent electroencephalography (EEG) data indicate that the transition from clinical death to cellular death is marked by highly organized neurophysiological events, including significant surges in gamma-band power, cross-frequency coupling, and distinct spreading depolarization waves. This prospective, observational feasibility study utilizes rapid-deployment, high-density, noninvasive BCI hardware paired with proprietary AI analytics to detect, classify, and securely archive these terminal neurocognitive signals. Objectives: (1) Quantify transient gamma-band activity and cross-frequency connectivity post-clinical death; (2) Validate the efficacy of machine learning models for real-time signal classification in high-noise clinical environments; (3) Establish a highly secure, encrypted bio-informational archive of peri-life EEG data. Design: Prospective, open-label, multicenter, observational cohort (n\>20).

Medical TV dramas have become very popular in recent years. These shows are mainly created for entertainment and often do not reflect what really happens in hospitals. However, television plays an important role in sharing information, shaping how people think, and teaching the public about medicine. Death and dying in hospitals, especially in Intensive Care Units (ICUs), are highly emotional experiences. In real life, these situations often turn out very differently from what patients and families expect. Because of this, it is important to understand how medical TV shows portray major hospital events such as end-of-life care, death, and the delivery of bad news. When what is shown on TV does not match the reality of ICU care, it can lead to unrealistic expectations, false hope, and greater distress for patients and their families at the end of life. At the same time, violence and aggression towards healthcare providers have increased in recent years. This can include verbal abuse as well as physical attacks. Looking at how healthcare workers are treated in medical TV shows may help us understand whether these programmes influence what behaviour is seen as acceptable. Since violence against healthcare staff has become especially concerning since the COVID-19 pandemic, the possible role of media should not be ignored, even though many factors are involved. This study aims to describe how death and dying are shown in popular medical TV series and to explore how violence or aggression towards healthcare providers is portrayed in these settings.

Summary of the Research on Withdrawing and Withholding Life-Sustaining Treatment for Critically Ill Children Background Medical treatments require regular evaluation to ensure they align with the patient's best interests, particularly in intensive care where quality of life is often compromised. In the context of critically ill children, the challenge increases as patients may not be fully conscious or capable of expressing their needs and preferences. While intensive care can extend life, end-of-life situations necessitate careful consideration to avoid providing futile treatments that do not benefit the patient. Decision-Making Complexity Identifying when further treatment is beneficial poses significant challenges, influenced by various factors including the wishes of the patient and guardians. Previous studies indicate variability among healthcare providers in treatment decisions, often stemming from personal experiences and emotional responses. However, comparable research focusing on critically ill children in Nordic contexts remains scarce. Medical decisions often require balancing potential benefits against the risks of extended suffering or loss of valuable time at the end of life. A previous survey on end-of-life care in Europe indicated similar attitudes across regions but highlighted the need for cultural considerations. Sweden's distinct social and cultural values, characterized by individualism and secularism, may influence practices surrounding life-sustaining treatment. Research Aims This research aims to investigate the factors affecting decision-making regarding the withdrawal and withholding of life-sustaining treatments for critically ill children in Swedish and Nordic intensive care units (ICUs). It will examine practitioners' experiences, attitudes, and the relative impact of children's autonomy in these decisions, excluding neonatal care. Key scientific questions focus on Physicians' attitudes and challenges regarding treatment withdrawal. Methodology Semi-structured interviews in multiple ICUs to explore ethical dilemmas faced by physicians.

This observational study aims to explore the real-time experiences, perceptions, and challenges faced by intensive care unit (ICU) physicians during goals-of-care discussions-specifically Do Not Attempt Resuscitation (DNAR) and end-of-life decision-making conversations-with families of critically ill patients in a Muslim-majority healthcare setting. The study seeks to identify factors that influence whether a DNAR decision is reached after physician-family discussions, and how physician experience, family dynamics, religious perspectives, and institutional support affect communication outcomes and care transitions. Participants will include ICU physicians (residents, fellows, and consultants) who routinely conduct DNAR discussions as part of clinical care. After each discussion, physicians will complete a brief structured questionnaire about their perceptions of the interaction, family emotions, and decision outcomes. These responses will be anonymously linked to limited, de-identified patient-level data (e.g., diagnosis, ICU course, and outcome) extracted retrospectively from the electronic medical record. No patients or family members will be contacted directly. Data collection will occur prospectively over two years at King Faisal Specialist Hospital \& Research Centre-Jeddah. Findings from this study are expected to provide culturally grounded insights that inform physician training, enhance family-centered communication, and guide policy development for DNAR and end-of-life discussions in Muslim-majority intensive care units.

End-of-life care is a core topic for geriatricians. One of the key aspects of end-of-life management is deciding when to discontinue active care measures (for example blood pressure monitoring, blood tests and X-rays) in favor of exclusive comfort care. In this retrospective observational study, the investigators looked at the care measures, treatments and paraclinical exams received by geriatric patients both one week and 24 hours before their death.

This study systematically observes in a pragmatic trail under real world conditions the association between strategies of therapy (maximal therapy, withhold, withdraw) and treatment success in three endpoint related initial risk groups (high, intermediate, low risk) regarding three endpoints (burden, mortality and supply costs).