News media in The Netherlands show great variety in the extent and ways, in which they realize media accountability online in terms of actor transparency, product transparency and feedback opportunities online. It is suggested that even those news rooms that seem to adhere to transparency and public accountability still need to explore the functionality and application of media accountability instruments (MAI). Both in terms of potentials and pitfalls, news rooms need to consider about what they want to be transparent and in what ways. To the extent that online innovations are visible, traditional news media seem to experiment, as is the case with newsroom blogs or the project of hyper local journalism Dichtbij.nl, part of the Telegraaf Company. Various news media have on-going projects on audience participation, online applications and distribution models. However, since many projects merely aim at finding new applications, processes, platforms and business models, it remains to be seen assess whether projects are indeed reasonably innovative and feasible at the same time. The development of an online and therefore immediate, archived, personalized and interactive context, offers practical and ethical challenges to Dutch journalism. These challenges bring shifts in its role and responsibility to society. It means that changes occur in what journalists are accountable for, as well as ways in how they are accountable. The Dutch media landscape lodges various professional accountability instruments like the press council and both profession-wide and news media specific codes of ethics, but some of these instruments receive only moderate support. Proactive openness is more an exception than the rule and may well be a distinctive indicator for quality journalism. Although news media often acknowledge the importance of media accountability offline and online, they often lack the resources or courage to use them or have different priorities. This ambiguous position may indicate that in relation to media accountability online, Dutch news media are between hope and fear: that it will either improve their relationship with the public and fuel professional quality, or ask too much of resources with too little benefit.
DOCUMENT
Background: end-of-life care is not always in line with end-of-life preferences, so patients do not always die at their preferred place of death (PPD). This study aims to identify factors associated with patients' PPD and changes in PPD. Methods: we prospectively collected data on PPD at four time points within 6 months from 230 acutely hospitalised older patients who were part of the control group in a stepped-wedge randomised controlled trial. Associations between patient characteristics and preferences were calculated using multivariable (multinomial) logistic regression analysis. Results: the mean age of participants was 80.7 years. 47.8% of the patients had no PPD at hospital admission. Patients previously admitted to hospital preferred to die at home (home versus no preference: odds ratio [OR] 2.38, 95% confidence interval [CI] 1.15-4.92; home versus healthcare facility: OR 3.25, 95% CI 1.15-9.16). Patients with more chronic diseases preferred the healthcare facility as their PPD (healthcare facility versus no preference: OR 1.33, 95% CI 1.09-1.61; healthcare facility versus home: OR 1.21, 95% CI 1.00-1.47). 32 of 65 patients changed their preference during follow-up, and most of these had no PPD at hospital admission (home versus no preference: OR 0.005, 95% CI ≤0.001-0.095) and poorer self-rated well-being (OR 1.82, 95% CI 1.07-3.08). Conclusions: almost half of the patients had no PPD at baseline. Previous hospital admission, having more chronic diseases and living alone are associated with having a PPD. Introducing PPD could make older people aware of PPD and facilitate optimal palliative care.
DOCUMENT
Background: Although the number of older patients requiring medical care is increasing, caring for older patients is often seen as unattractive by medical trainees (i.e., medical students, residents, interns, and fellows). Terror Management Theory states that people have a negative attitude towards older people, because they remind people of their own mortality. We hypothesize that ageism, death anxiety, and ageing anxiety among medical trainees negatively affect their attitude towards medical care for older patients. This review aimed to examine and generate an overview of available literature on the relationship between ageism, death anxiety, and ageing anxiety among medical trainees and their attitude towards medical care for older patients. Methods: A systematic review was performed with a review protocol based on the PRISMA Statement. PubMed, Ebsco/PsycInfo, Ebsco/ERIC and Embase were searched from inception to August 2022, using the following search terms, including their synonyms and closely related words: “medical trainees” AND “ageism” OR “death anxiety” OR “ageing anxiety” AND “(attitude AND older patient)”. Results: The search yielded 4072 different studies; 12 eligible studies (10 quantitative and 2 qualitative) were identified and synthesized using narrative synthesis. Findings suggest that a positive attitude towards older people was related to a positive attitude towards medical care for older patients among medical students. The available literature on the relationship between death anxiety and/or ageing anxiety and attitude towards medical care for older patients among medical trainees was limited and had a heterogeneity in focus, which hindered comparison of results. Conclusion: Our findings suggest that a positive attitude towards older people in general is related to a positive attitude towards medical care for older patients among medical students. Future research should focus on further exploring underlying mechanisms affecting the attitude towards medical care for older patients among medical trainees.
MULTIFILE
