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Broese JMC, van der Kleij RMJJ, Verschuur EML, Kerstjens HAM, Engels Y, Chavannes NH. Implementation of a palliative care intervention for patients with COPD - a mixed methods process evaluation of the COMPASSION study. BMC Palliat Care 2022; 21:219. [PMID: 36476592 PMCID: PMC9727973 DOI: 10.1186/s12904-022-01110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Little direction exists on how to effectively implement palliative care for patients with COPD. In the COMPASSION study, we developed, executed, and evaluated a multifaceted implementation strategy to improve the uptake of region-tailored palliative care intervention components into routine COPD care. We evaluated the implementation strategy and assessed the implementation process, barriers, and facilitators. METHODS A mixed methods process evaluation was performed. Primary and secondary healthcare providers in four hospital regions in the Netherlands were trained. Patients identified during hospitalisation for an acute exacerbation received palliative care and were followed for a year. Various sources were used: process data, questionnaires including the End-of-life Professional Caregiver Survey (EPCS), medical records, monitoring meetings, and interviews. The Consolidated Framework of Implementation Research (CFIR) was used to categorize implementation determinants. RESULTS The training sessions with roleplay were positively evaluated and increased professionals' self-efficacy in providing palliative care statistically significantly. Of 98 patients identified, 44 (44.9%) received one or more palliative care conversations at the outpatient clinic. Having those conversations was highly valued by healthcare providers because it led to clarity and peace of mind for the patient and higher job satisfaction. Coordination and continuity remained suboptimal. Most important barriers to implementation were time constraints, the COVID-19 pandemic, and barriers related to transmural and interdisciplinary collaboration. Facilitators were the systematic screening of patients for palliative care needs, adapting to the patient's readiness, conducting palliative care conversations with a pulmonologist and a COPD nurse together, and meeting regularly with a small team led by a dedicated implementation leader. CONCLUSIONS Providing integrated palliative care for patients with COPD is highly valued by healthcare providers but remains challenging. Our findings will guide future implementation efforts. Future research should focus on how to optimize transmural and interdisciplinary collaboration. Trial registration The COMPASSION study is registered in the Netherlands Trial Register (NTR): NL7644. Registration date: 07/04/2019.
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Affiliation(s)
- Johanna M. C. Broese
- grid.10419.3d0000000089452978Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands ,Lung Alliance Netherlands, Amersfoort, The Netherlands
| | - Rianne M. J. J. van der Kleij
- grid.10419.3d0000000089452978Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Huib A. M. Kerstjens
- grid.4494.d0000 0000 9558 4598Respiratory Medicine & Tuberculosis, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yvonne Engels
- grid.10417.330000 0004 0444 9382Anaesthesiology, Pain & Palliative medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Niels H. Chavannes
- grid.10419.3d0000000089452978Public Health & Primary care, Leiden University Medical Centre, Leiden, The Netherlands
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Malhotra C, Shafiq M, Batcagan-Abueg APM. What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials. BMJ Open 2022. [PMCID: PMC9301802 DOI: 10.1136/bmjopen-2021-060201] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To conduct an up-to-date systematic review of all randomised controlled trials assessing efficacy of advance care planning (ACP) in improving patient outcomes, healthcare use/costs and documentation. Design Narrative synthesis conducted for randomised controlled trials. We searched electronic databases (MEDLINE/PubMed, Embase and Cochrane databases) for English-language randomised or cluster randomised controlled trials on 11 May 2020 and updated it on 12 May 2021 using the same search strategy. Two reviewers independently extracted data and assessed methodological quality. Disagreements were resolved by consensus or a third reviewer. Results We reviewed 132 eligible trials published between 1992 and May 2021; 64% were high-quality. We categorised study outcomes as patient (distal and proximal), healthcare use and process outcomes. There was mixed evidence that ACP interventions improved distal patient outcomes including end-of-life care consistent with preferences (25%; 3/12 with improvement), quality of life (0/14 studies), mental health (21%; 4/19) and home deaths (25%; 1/4), or that it reduced healthcare use/costs (18%; 4/22 studies). However, we found more consistent evidence that ACP interventions improve proximal patient outcomes including quality of patient–physician communication (68%; 13/19), preference for comfort care (70%; 16/23), decisional conflict (64%; 9/14) and patient-caregiver congruence in preference (82%; 18/22) and that it improved ACP documentation (a process outcome; 63%; 34/54). Conclusion This review provides the most comprehensive evidence to date regarding the efficacy of ACP on key patient outcomes and healthcare use/costs. Findings suggest a need to rethink the main purpose and outcomes of ACP. PROSPERO registration number CRD42020184080.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Mahham Shafiq
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
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Schichtel M, Wee B, Perera R, Onakpoya I, Albury C. Effect of Behavior Change Techniques Targeting Clinicians to Improve Advance Care Planning in Heart Failure: A Systematic Review and Meta-Analysis. Ann Behav Med 2021; 55:383-398. [PMID: 32926081 DOI: 10.1093/abm/kaaa075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND National and international guidelines recommend advance care planning (ACP) for patients with heart failure. But clinicians seem hesitant to engage with ACP. PURPOSE Our aim was to identify behavioral interventions with the greatest potential to engage clinicians with ACP in heart failure. METHODS A systematic review and meta-analysis. We searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index, and PsycINFO for randomized controlled trials (RCTs) from inception to August 2018. Three reviewers independently extracted data, assessed risk of bias (Cochrane risk of bias tool), the quality of evidence (Grading of Recommendation Assessment, Development, and Evaluation), and intervention synergy according to the behavior change wheel and behavior change techniques (BCTs). Odds ratios (ORs) were calculated for pooled effects. RESULTS Of 14,483 articles screened, we assessed the full text of 131 studies. Thirteen RCTs including 3,709 participants met all of the inclusion criteria. The BCTs of prompts/cues (OR: 4.18; 95% confidence interval [CI]: 2.03-8.59), credible source (OR: 3.24; 95% CI: 1.44-7.28), goal setting (outcome; OR: 2.67; 95% CI: 1.56-4.57), behavioral practice/rehearsal (OR: 2.64; 95% CI: 1.50-4.67), instruction on behavior performance (OR: 2.49; 95% CI: 1.63-3.79), goal setting (behavior; OR: 2.12; 95% CI: 1.57-2.87), and information about consequences (OR: 2.06; 95% CI: 1.40-3.05) showed statistically significant effects to engage clinicians with ACP. CONCLUSION Certain BCTs seem to improve clinicians' practice with ACP in heart failure and merit consideration for implementation into routine clinical practice.
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Affiliation(s)
- Markus Schichtel
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Biomedical Campus, Cambridge, UK
| | - Bee Wee
- Oxford Centre for Education and Research in Palliative Care, Oxford University Hospital Trust, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Igho Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Nassikas NJ, Baird GL, Duffy CM. Improving Advance Care Planning in a Resident Primary Care Clinic. Am J Hosp Palliat Care 2019; 37:185-190. [PMID: 31476887 DOI: 10.1177/1049909119872757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Two-thirds of chronically ill patients do not have an advance directive. The primary aim of this study was to develop an intervention to increase the documentation of advance directives in elderly adults in an internal medicine resident primary care clinic. The secondary aims were to improve resident confidence in discussing advance care planning and increase the number of discussions. METHODS The study was a pre- and postintervention study. The study intervention was a 30-minute educational session on advance care planning. Study participants were patients aged 65 years and older who were seen in an internal medicine residency primary care clinic over a 6-month period and internal medicine residents. Clinic encounters were reviewed for the presence of advance care planning discussions before and after the intervention. Resident confidence was measured on a Likert scale. RESULTS Two hundred ninety-five eligible patients were seen in the clinic from January 1, 2017, to June 30, 2017, and included in the analysis performed between 2017 and 2018. The mean number of documented advance care planning discussions increased from 2.24 (95% confidence interval [CI]: 1.0-4.9) during the preintervention period to 8.94 (95% CI: 5.94-13.24]) during the postintervention period (P = .0011). Following the intervention, residents overall reported increased confidence in discussing advance care planning. CONCLUSION A relatively modest intervention to increase advance care planning discussions is feasible in an internal medicine primary care clinic and can improve the confidence of residents with end-of-life discussion.
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Affiliation(s)
- Nicholas J Nassikas
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Grayson L Baird
- Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI, USA
| | - Christine M Duffy
- Department of Medicine, Warren Alpert Medical School, Providence, RI, USA
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Schichtel M, Wee B, Perera R, Onakpoya I, Albury C, Barber S. Clinician-targeted interventions to improve advance care planning in heart failure: a systematic review and meta-analysis. Heart 2019; 105:1316-1324. [PMID: 31118199 DOI: 10.1136/heartjnl-2019-314758] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/18/2019] [Accepted: 04/25/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Advance care planning (ACP) is widely advocated to contribute to better outcomes for patients suffering from heart failure. But clinicians appear hesitant to engage with ACP. Our aim was to identify interventions with the greatest potential to engage clinicians with ACP in heart failure. METHODS A systematic review and meta-analysis. We searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index and PsycINFO for randomised controlled trials (RCTs) from inception to January 2018. Three reviewers independently extracted data, assessed risk of bias (Cochrane risk of bias tool), the quality of evidence (GRADE) and intervention synergy according to Template for Intervention Description and Replication. ORs were calculated for pooled effects. RESULTS Of 14 175 articles screened, we assessed the full text of 131 studies. 13 RCTs including 3709 participants met all of the inclusion criteria. The intervention categories of patient-mediated interventions (OR 5.23; 95% CI 2.36 to 11.61), reminder systems (OR 3.65; 95% CI 1.47 to 9.04) and educational meetings (OR 2.35; 95% CI 1.29 to 4.26) demonstrated a favourable effect to engage clinicians with the completion of ACP. CONCLUSION The review provides evidence from 13 published RCTs and suggests that interventions that involve patients to change clinical practice, reminder systems and educational meetings have the greatest effect in improving the implementation of ACP in heart failure.
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Affiliation(s)
- Markus Schichtel
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Bee Wee
- Sir Michael Sobell House Study Centre, Oxford University Hospital Trust NHS, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Igho Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Charlotte Albury
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Barber
- Oxford Health NHS, Broadshires Health Centre, Carterton, Oxfordshire, UK
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Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc 2014; 15:477-489. [PMID: 24598477 DOI: 10.1016/j.jamda.2014.01.008] [Citation(s) in RCA: 462] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations. DESIGN Systematic review and meta-analyses. DATA SOURCES Medline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists. STUDY SELECTION Randomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English. DATA EXTRACTION AND SYNTHESIS Fifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: 'advance directives' and 'communication.' MAIN OUTCOMES AND MEASURES Primary outcome measures were completion of advance directives and occurrence of end-of-life discussions. Secondary outcomes were concordance between preferences for care and delivered care, knowledge of ACP, end-of-life care preferences, quality of communication, satisfaction with healthcare, decisional conflict, use of healthcare services, and symptoms. RESULTS Interventions focusing on advance directives as well as interventions that also included communication about end-of-life care increased the completion of advance directives and the occurrence of end-of-life care discussions between patients and healthcare professionals. In addition, interventions that also included communication about ACP, improved concordance between preferences for care and delivered care and may improve other outcomes, such as quality of communication. CONCLUSIONS ACP interventions increase the completion of advance directives, occurrence of discussions about ACP, concordance between preferences for care and delivered care, and are likely to improve other outcomes for patients and their loved ones in different adult populations. Future studies are necessary to reveal the effective elements of ACP and should focus on the best way to implement structured ACP in standard care.
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Barnes S, Gardiner C, Gott M, Payne S, Chady B, Small N, Seamark D, Halpin D. Enhancing patient-professional communication about end-of-life issues in life-limiting conditions: a critical review of the literature. J Pain Symptom Manage 2012; 44:866-79. [PMID: 22819438 DOI: 10.1016/j.jpainsymman.2011.11.009] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/09/2011] [Accepted: 11/13/2011] [Indexed: 01/29/2023]
Abstract
CONTEXT The End of Life Care Strategy for England highlights effective communication between patients and professionals as key to facilitating patient involvement in advance care planning. The strategy emphasizes that, currently, communication in patients with noncancer life-limiting conditions is likely to be inadequate, and research has identified that patients with chronic obstructive pulmonary disease and heart failure have a poor understanding of their condition. OBJECTIVES To identify existing interventions of patient-professional communication developed for life-limiting conditions and explore the applicability of interventions developed within a cancer framework to other diagnostic groups. METHODS A comprehensive literature review of studies describing communication interventions for patients receiving end-of-life care was undertaken. Ten electronic databases were searched. Inclusion criteria were all English language studies relating to patient-professional communication interventions for patients with life-limiting conditions receiving end-of-life care. RESULTS Of the 755 articles initially identified, 16 met the inclusion criteria. Three core themes emerged from the synthesis of the literature: using education to enhance professional communication skills, using communication to improve patient understanding, and using communication skills to facilitate advance care planning. CONCLUSION Although limited, evidence relating to the development and evaluation of communication interventions for patients with life-limiting illnesses would suggest that a successful intervention should include combined components of training, patient discussion, and education. In a context of limited resources and an increasing number of patients living and dying with chronic life-limiting conditions, the need for appropriate and effective communication strategies should be seen as a priority for both research and policy.
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Affiliation(s)
- Sarah Barnes
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
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Durbin CR, Fish AF, Bachman JA, Smith KV. Systematic Review of Educational Interventions for Improving Advance Directive Completion. J Nurs Scholarsh 2010; 42:234-41. [DOI: 10.1111/j.1547-5069.2010.01357.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sato T, Makigami K. [Terminal care education and consultation activities in advance of the critical stage of disease by attending physicians at a rehabilitation unit]. Nihon Ronen Igakkai Zasshi 2008; 45:401-7. [PMID: 18753715 DOI: 10.3143/geriatrics.45.401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM We aimed to examine the effectiveness of information provided by a physician to patients and their family in a geriatric rehabilitation unit for facilitating terminal care decision-making process. METHOD The subjects were 338 patients who entered our rehabilitation unit between July 2005 and June 2007. Of the 338 patients, we provided terminal care consultation for 224 upon admission. We surveyed the 224 patients who received consultation as well as the 114 patients who did not, and examined the effect of the consultations on decision-making regarding terminal care. RESULTS In both the intervention and non-intervention groups, approximately half of the patients' families had an opportunity to discuss terminal care prior to entering the hospital. The intervention group, however, had a significantly higher ratio (42.0%) of having the opportunity to discuss terminal care among their family members after leaving the hospital. In the non-intervention group, 31.4% had the knowledge of an artificial respirator and 37.1% tube feeding. This was low compared to the intervention group, among 60% understood both. Among the intervention group, there were many who desired these consultations to be provided far in advance of the critical stage of disease to allow more time to make end-of-life decisions. Furthermore, 60% of the intervention group indicated that the terminal care consultations were effective and useful. CONCLUSION In light of these results, physicians should provide terminal care consultations before death is imminent. Since this will encourage self decision-making and help clarify the family's intentions, these kinds of consultations should be more actively implemented.
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Walling A, Lorenz KA, Dy SM, Naeim A, Sanati H, Asch SM, Wenger NS. Evidence-Based Recommendations for Information and Care Planning in Cancer Care. J Clin Oncol 2008; 26:3896-902. [PMID: 18688058 DOI: 10.1200/jco.2007.15.9509] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The practice of oncology is characterized by challenging communication tasks that make it difficult to ensure optimal physician-patient information sharing and care planning. Discussions of diagnosis, prognosis, and patient goals are essential processes that inform decisions. However, data suggest that there are deficiencies in this area. We conducted a systematic review to identify the evidence supporting high-quality clinical practices for information and care planning in the context of cancer care as part of the RAND Cancer Quality–Assessing Symptoms, Side Effects, and Indicators of Supportive Treatment Project. Domains of information and care planning that are important for high-quality cancer care include integration of palliation into cancer care, advance care planning, sentinel events as markers for the need to readdress a patient's goals of care, and continuity of care planning. The standards presented here for information and care planning in cancer care should be incorporated into care pathways and should become the expectation rather than the exception.
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Affiliation(s)
- Anne Walling
- From the David Geffen School of Medicine at University of California at Los Angeles; VA Greater Los Angeles Healthcare System, Los Angeles; RAND Health, Santa Monica; University of California, Irvine, Irvine, CA; and Johns Hopkins University, Baltimore, MD
| | - Karl A. Lorenz
- From the David Geffen School of Medicine at University of California at Los Angeles; VA Greater Los Angeles Healthcare System, Los Angeles; RAND Health, Santa Monica; University of California, Irvine, Irvine, CA; and Johns Hopkins University, Baltimore, MD
| | - Sydney M. Dy
- From the David Geffen School of Medicine at University of California at Los Angeles; VA Greater Los Angeles Healthcare System, Los Angeles; RAND Health, Santa Monica; University of California, Irvine, Irvine, CA; and Johns Hopkins University, Baltimore, MD
| | - Arash Naeim
- From the David Geffen School of Medicine at University of California at Los Angeles; VA Greater Los Angeles Healthcare System, Los Angeles; RAND Health, Santa Monica; University of California, Irvine, Irvine, CA; and Johns Hopkins University, Baltimore, MD
| | - Homayoon Sanati
- From the David Geffen School of Medicine at University of California at Los Angeles; VA Greater Los Angeles Healthcare System, Los Angeles; RAND Health, Santa Monica; University of California, Irvine, Irvine, CA; and Johns Hopkins University, Baltimore, MD
| | - Steven M. Asch
- From the David Geffen School of Medicine at University of California at Los Angeles; VA Greater Los Angeles Healthcare System, Los Angeles; RAND Health, Santa Monica; University of California, Irvine, Irvine, CA; and Johns Hopkins University, Baltimore, MD
| | - Neil S. Wenger
- From the David Geffen School of Medicine at University of California at Los Angeles; VA Greater Los Angeles Healthcare System, Los Angeles; RAND Health, Santa Monica; University of California, Irvine, Irvine, CA; and Johns Hopkins University, Baltimore, MD
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Marr W. Review of an article: Badger S, Soong C, O'Donnell M, Boreman C, McGuigan K. Benefits of a supervised exercise program after lower limb bypass surgery. Vasc Endovascular Surg 2007;41(1):27-32. JOURNAL OF VASCULAR NURSING 2007; 25:55-6. [PMID: 17723911 DOI: 10.1016/j.jvn.2007.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Wendy Marr
- Vancouver Hospital, Vancouver, BC, Canada
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Jezewski MA, Meeker MA, Sessanna L, Finnell DS. The effectiveness of interventions to increase advance directive completion rates. J Aging Health 2007; 19:519-36. [PMID: 17496248 DOI: 10.1177/0898264307300198] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Despite federal and state laws governing advance directives (ADs), interventions to increase rates of legally completed ADs have not produced significant results. This study synthesizes the state of the science regarding effectiveness of interventions to increase AD completion rates. METHODS Garrard's method for conducting a systematic literature review was followed. In all, 25 studies meeting inclusion criteria were reviewed. Interventions fell into two types: (a) didactic-information distributed through an educational program or clinical encounter or by a mailing and (b) interactive-person-to-person interaction where participants had the opportunity to ask questions and/or receive assistance completing the forms. RESULTS Postintervention rates of AD completion were: didactic = no change to 34% increase; interactive = 23% to 71% increase. DISCUSSION Education without the ability to ask questions does not significantly increase the AD completion rate. Didactic interventions did not usually increase completion rates higher than the predicted average rate for the general population.
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Affiliation(s)
- Mary Ann Jezewski
- School of Nursing, University at Buffalo, the State University of New York, 921 Kimball Tower, Buffalo, NY 14214-3079, USA.
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Easson AM. Should research be part of advance care planning? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2005; 9:10-1. [PMID: 15693972 PMCID: PMC1065115 DOI: 10.1186/cc3029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Advance care planning is a process to help people to formulate and communicate their preferences regarding future care during critical illness. Reviews of the advance care planning process in its current form have been disappointing. Improvements in care at the end of life and palliative care are necessary for the provision of modern medical care. Medical research has led to many improvements at the physiological and technological levels. It is only by applying the same rigour of scientific study and research ethics that improvements in the advance care planning process can be made.
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Affiliation(s)
- Alexandra M Easson
- University of Toronto, Department of Surgical Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada.
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