Background: Serious Illness Conversations aim to discuss patient goals. However, on acute medicine units, seriously ill patients may undergo distressing interventions until death. Objectives: To investigate the feasibility of using the Surprise Question, “Would you be surprised if this patient died within the next year?” to identify patients who would benefit from early Serious Illness Conversations and study any changes in the interdisciplinary team’s beliefs, confidence, and engagement as a result of asking the Surprise Question. Design: A prospective cohort pilot (...) study with two Plan-Do-Study-Act cycles. Participants/context: Fifty-eight healthcare professionals working on Acute Medicine Units participated in pre- and post-intervention questionnaires. The intervention involved asking participants the Surprise Question for each patient. Patient charts were reviewed for Serious Illness Conversation documentation. Ethical considerations: Ethical approval was granted by the institutions involved. Findings: Equivocal overall changes in the beliefs, confidence, and engagement of healthcare professionals were observed. Six out of 23 patients were indicated as needing a Serious Illness Conversation; chart review provided some evidence that these patients had more Serious Illness Conversation documentation compared with the 17 patients not flagged for a Serious Illness Conversation. Issues were identified in equating the Surprise Question to a Serious Illness Conversation. Discussion: Appropriate support for seriously ill patients is both a nursing professional and ethical duty. Flagging patients for conversations may act as a filtering process, allowing healthcare professionals to focus on conversations with patients who need them most. There are ethical and practical issues as to what constitutes a “serious illness” and if answering “no” to the Surprise Question always equates to a conversation. Conclusion: The barriers of time constraints and lack of training call for institutional change in order to prioritise the moral obligation of Serious Illness Conversations. (shrink)

This study examines the impact of attitude toward piracy on intention to buy pirated CDs using Chinese samples. Attitude toward piracy is measured by a multi-item scale that has been shown to have a consistent factor structure with four distinct components, namely, social cost of piracy, anti-big business attitude, social benefit of dissemination, and ethical belief. Our findings reveal that social benefit of dissemination and anti-big business attitude have a positive relationship with intention to buy pirated CDs while social cost (...) of piracy and ethical belief have a negative relationship. Among these components, ethical belief tends to most strongly predict intention to buy pirated CDs. Demographic variables such as gender and age also help explain the respondents' intention to buy pirated CDs. In addition, those respondents with experience of buying pirated CDs would tend to be more likely to buy pirated CDs than those without such experience. The results are discussed with a view to helping copyright businesses to effectively suppress piracy, and directions for future research are suggested. (shrink)