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Pillen H, Attrill S, Fisher A, Forte S, Brebner C, Robinson S. Educating for supported decision making and shared decision making: a scoping review of educational design and outcomes for education and training interventions. Disabil Rehabil 2024:1-12. [PMID: 38591714 DOI: 10.1080/09638288.2024.2337099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To characterise existing knowledge about the design and learning outcomes of education and training programs for supported or shared decision making. MATERIALS AND METHODS A scoping review was performed to identify academic and grey literature, published between January 2006 and February 2022, that reported on the design and/or learning outcomes of supported or shared decision making education or training programs. Eligible literature was mapped across domains of educational design and Kirkpatrick's hierarchy of learning effectiveness, and then qualitatively synthesised using cross-case analysis. RESULTS A total of 33 articles were identified (n = 7 for supported decision making and n = 26 for shared decision making) that provided education or training to supporters of persons with mental illness or substance use disorders (n = 14), dementia or neurocognitive disorders (n = 6), cognitive disability (n = 5), mixed populations (n = 1), and those receiving end-of-life care (n = 7). In their design, most programs sought specific changes in practice (behaviour) via experiential learning. Reported educational outcomes also focused on supporter behaviour, with limited evidence for how changes in learner attitudes, skills, or knowledge might be contributing to changes in supporter behaviour. CONCLUSIONS Future education and training would benefit from a closer engagement with theories of teaching and learning, particularly those oriented towards co-design.
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Affiliation(s)
- Heath Pillen
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Stacie Attrill
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Alinka Fisher
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sabrina Forte
- Council for Intellectual Disability, Surry Hills, Australia
| | - Chris Brebner
- Office of the Deputy Vice-Chancellor, Flinders University, Adelaide, Australia
| | - Sally Robinson
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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2
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Punia H, Kaasalainen S, Ploeg J, Strachan P, Sussman T. Exploring the Role of Nurses in Advance Care Planning Within Long-Term Care Homes: A Qualitative Study. SAGE Open Nurs 2024; 10:23779608241249335. [PMID: 38690399 PMCID: PMC11060033 DOI: 10.1177/23779608241249335] [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: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
Background Residents in long-term care homes (LTCHs) are often diagnosed with chronic, life-limiting illnesses, and it is now a common site to provide high levels of care and eventual death. There is an urgent need to address communication gaps and uncertainties surrounding resident's end of life preferences. Nurses are well situated to be key facilitators of necessary advance care planning (ACP), ensuring residents have discussions with family, substitute decision-makers and healthcare providers regarding future health and personal care preferences. However, LTCHs present unique challenges for nurses due to not only complex comorbidities but also staffing dynamics. Purpose This study explored the experiences and perceptions of Registered Nurses (RNs) and Registered Practical Nurse (RPNs) in LTCHs regarding their role in engaging residents and families in ACP discussions. Methods Qualitative interpretive descriptive methodology was used. Data were collected from two LTCHs in Southern Ontario with a sample of 15 nurses (7 RNs and 8 RPNs). Analysis involved review of semistructured interviews, field notes, and utilizing constant comparison within an inductive approach. Results Power and authority dynamics in LTCH's was an overarching theme in the data, with four subthemes: (1) Nurses lacking clarity about ACP, (2) nurses' uncertainty regarding their role in ACP, (3) nurses feeling uncomfortable engaging in ACP discussions, and (4) nurses struggling to support families in ACP discussions. Conclusion Recommendations for nurses, healthcare providers, LTCH administrators, and policy makers include: (1) development of policies which support, from a systemic level, nurses to feel safe while engaging in ACP; (2) reassessing LTCH's hierarchical structure, and clarifying RN, RPN, and interdisciplinary team members roles in ACP; (3) developing culture change that allows a team and person-centered approach to ACP; and (4) providing ongoing education and mentorship for nurses to manage family dynamics and expand their understanding of ACP beyond a biomedical lens.
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Affiliation(s)
- Harveer Punia
- School of Nursing, McMaster University, Hamilton, Canada
| | | | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Canada
| | | | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
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3
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Dupont C, De Vleminck A, Deliens L, Gilissen J. Advance Care Planning in Belgium. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:121-126. [PMID: 37391298 DOI: 10.1016/j.zefq.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 07/02/2023]
Abstract
This paper aims to 1) describe current levels of Advance Care Planning (ACP) development since 2002 in Belgium, 2) report on challenges and opportunities to inspire other countries with similar contextual characteristics and 3) support further development of ACP practice and research in Belgium. To address these aims, we consulted local researchers, 12 domain experts and (grey) literature (regulatory documents, reports, policy documents and practice guidelines) on ACP, palliative care, and related healthcare topics. Since 2002, when the Patient's Right Law was passed in the federal Parliament, Belgium has had a specific medicolegal context for ACP. Initiatives to improve the uptake of ACP have been taken, e.g. standardised documentation, reimbursement codes for physicians provided by the government, and implementation of quality indicators in hospitals and nursing homes. Most of these initiatives are grassroots or predominantly oriented towards a single group of professions, e.g. general practitioners, disregarding the role that other professions can play. The patient groups most often targeted are those with cancer and older adults. Limited but growing attention is given to those with low health literacy or other minority groups. Main barriers to ACP in Belgium are: no unified platform to exchange outcomes of ACP discussions or advance directives between healthcare professionals and though efforts are made, ACP is still predominantly oriented towards documentation.
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Affiliation(s)
- Charlèss Dupont
- End-of-Life Care Research Group, Dept of Family Medicine & Chronic Care, Vrije Universiteit Brussel & Dept of Public Health and Primary Care, Universiteit Gent, Belgium.
| | - Aline De Vleminck
- End-of-Life Care Research Group, Dept of Family Medicine & Chronic Care, Vrije Universiteit Brussel & Dept of Public Health and Primary Care, Universiteit Gent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Dept of Family Medicine & Chronic Care, Vrije Universiteit Brussel & Dept of Public Health and Primary Care, Universiteit Gent, Belgium
| | - Joni Gilissen
- End-of-Life Care Research Group, Dept of Family Medicine & Chronic Care, Vrije Universiteit Brussel & Dept of Public Health and Primary Care, Universiteit Gent, Belgium; Senior Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, USA
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4
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Factors associated with the intention to engage in care planning among persons with mild cognitive impairment and dementia. Geriatr Nurs 2023; 50:143-151. [PMID: 36780712 DOI: 10.1016/j.gerinurse.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 02/13/2023]
Abstract
This study examined factors associated with the intention to engage in advance care planning among persons with cognitive impairment. This cross-sectional study recruited 116 persons with cognitive impairment by convenience sampling from two teaching hospitals in Northern Taiwan from November 1, 2018, to December 31, 2020. Fewer than 50% of the participants intended to engage in advance care planning, and less than 10% signed the living will for hospice and palliative care. Multivariate linear regression determined factors influencing advance care planning intention included education level, a proxy signed do-not-resuscitate document, belief that family members would provide a signed do-not-resuscitate at their end-of-life, and necessity of explaining future care in advance. It is recommended to popularize advance care planning education and ensure the rights of persons with cognitive impairment to enable them to fully participate in their own care plans through family-centered advance care planning.
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Gringart E, Adams C, Woodward F. Older Adults' Perspectives on Voluntary Assisted Death: An In-Depth Qualitative Investigation in Australia. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221090066. [PMID: 35422170 DOI: 10.1177/00302228221090066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Interest in voluntary assisted death (VAD) has been growing among researchers, policy makers and the public. This study aimed to explore older adults' perspectives on VAD in Australia. Using purposive sampling, 15 adults ≥65 years participated in in-depth semi-structured interviews. Interpretative phenomenological analysis identified four themes: cultural reflections; beliefs and worldviews; health aspects; and fabric of life. Participants expressed a desire to have control over end-of-life options, challenged by religious beliefs. Participants expressed concern that VAD legislation could leave people vulnerable to coercion and saw a need for safeguards. Reasons for and against supporting and utilising VAD were discussed. Physical illness was seen a more compelling reason for VAD than mental ill-health. Finally, connections to life and other were discussed, and being able to do the things one loved were named aspects of what it meant to live a good life. Implications are discussed along with future research directions.
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Affiliation(s)
- Eyal Gringart
- School of Arts and Humanities, 451835Edith Cowan University, Joondalup, WA, Australia
| | - Claire Adams
- School of Arts and Humanities, 451835Edith Cowan University, Joondalup, WA, Australia
| | - Faye Woodward
- School of Arts and Humanities, 451835Edith Cowan University, Joondalup, WA, Australia
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Wendrich-van Dael A, Gilissen J, Van Humbeeck L, Deliens L, Vander Stichele R, Gastmans C, Pivodic L, Van den Block L. Advance care planning in nursing homes: new conversation and documentation tools. BMJ Support Palliat Care 2021; 11:312-317. [PMID: 34162581 PMCID: PMC8380900 DOI: 10.1136/bmjspcare-2021-003008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023]
Abstract
Although advance care planning (ACP) is highly relevant for nursing home residents, its uptake in nursing homes is low. To meet the need for context-specific ACP tools to support nursing home staff in conducting ACP conversations, we developed the ACP+intervention. At its core, we designed three ACP tools to aid care staff in discussing and documenting nursing home resident's wishes and preferences for future treatment and care: (1) an extensive ACP conversation guide, (2) a one-page conversation tool and (3) an ACP document to record outcomes of conversations. These nursing home-specific ACP tools aim to avoid a purely document-driven or 'tick-box' approach to the ACP process and to involve residents, including those living with dementia according to their capacity, their families and healthcare professionals.
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Affiliation(s)
- Annelien Wendrich-van Dael
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium .,Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Joni Gilissen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium.,Neurology, UCSF, San Francisco, California, USA
| | - Liesbeth Van Humbeeck
- Department of Geriatric Medicine, University Hospital Ghent, Gent, Oost-Vlaanderen, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Chris Gastmans
- Interfacultair Centrum voor Biomedische Ethiek en Recht, KULeuven, Leuven, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
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Goossens B, Sevenants A, Declercq A, Van Audenhove C. Shared decision-making in advance care planning for persons with dementia in nursing homes: a cross-sectional study. BMC Geriatr 2020; 20:381. [PMID: 33008335 PMCID: PMC7532572 DOI: 10.1186/s12877-020-01797-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background Shared decision-making provides an approach to discuss advance care planning in a participative and informed manner, embodying the principles of person-centered care. A number of guided approaches to achieve shared decision-making already exist, such as the three-talk model. However, it is uncertain whether daily practice methods in nursing home wards for persons with dementia comply with the underpinnings of this model. It is also uncertain whether professionals consider shared decision-making to be important in this context, and whether they perceive themselves sufficiently competent to practice this approach frequently. Methods The study has a cross-sectional design, with 65 wards (46 Belgian nursing homes) participating in the study. We compared nursing home professionals’ and residents’ perspectives on the level of shared decision-making during advance care planning conversations with ratings from external raters. Residents and professionals rated the level of shared decision-making by means of a questionnaire, which included the topic of the conversation. External raters assessed audio recordings of the conversations. Professionals filled in an additional self-report questionnaire on the importance of shared decision-making, their competence in practicing the approach, and with what frequency. Results At ward level, professionals and residents rated the average achieved level of shared decision-making 71.53/100 (σ = 16.09) and 81.11/100 (σ = 19.18) respectively. Meanwhile, raters gave average scores of 26.97/100 (σ = 10.45). Only 23.8% of residents referred to advance care planning as the topic of the conversation. Professionals considered shared decision-making to be important (x̄=4.48/5, σ = 0.26). This result contrasted significantly with the frequency (x̄=3.48/5, σ = 0.51) and competence (x̄=3.76/5, σ = 0.27) with which these skills were practiced (P < 0.001). Conclusions Residents with dementia are grateful when involved in discussing their care, but find it difficult to report what is discussed during these conversations. Receiving more information about advance care planning could provide them with the knowledge needed to prepare for such a conversation. External raters observe a discrepancy between the three-talk model and daily practice methods. Training programs should focus on providing professionals with better knowledge of and skills for shared decision-making. They should also promote team-based collaboration to increase the level of person-centered care in nursing home wards for persons with dementia.
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Affiliation(s)
- Bart Goossens
- LUCAS - Centre for care research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal box 5310, 3000, Leuven, Belgium.
| | - Aline Sevenants
- LUCAS - Centre for care research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal box 5310, 3000, Leuven, Belgium.,Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33j, Postal box 7001, 3000, Leuven, Belgium
| | - Anja Declercq
- LUCAS - Centre for care research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal box 5310, 3000, Leuven, Belgium.,Centre for Sociological Research, KU Leuven, Parkstraat 45, Postal box 3601, 3000, Leuven, Belgium
| | - Chantal Van Audenhove
- LUCAS - Centre for care research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal box 5310, 3000, Leuven, Belgium.,Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33j, Postal box 7001, 3000, Leuven, Belgium
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8
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Gaur S, Pandya N, Dumyati G, Nace DA, Pandya K, Jump RLP. A Structured Tool for Communication and Care Planning in the Era of the COVID-19 Pandemic. J Am Med Dir Assoc 2020; 21:943-947. [PMID: 32674824 PMCID: PMC7269955 DOI: 10.1016/j.jamda.2020.05.062] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 11/12/2022]
Abstract
Residents in long-term care settings are particularly vulnerable to COVID-19 infections and, compared to younger adults, are at higher risk of poor outcomes and death. Given the poor prognosis of resuscitation outcomes for COVID-19 in general, the specter of COVID-19 in long-term care residents should prompt revisiting goals of care. Visitor restriction policies enacted to reduce the risk of transmission of COVID-19 to long-term care residents requires advance care planning discussions to be conducted remotely. A structured approach can help guide discussions regarding the diagnosis, expected course, and care of individuals with COVID-19 in long-term care settings. Information should be shared in a transparent and comprehensive manner to allay the increased anxiety that families may feel during this time. To achieve this, we propose an evidence-based COVID-19 Communication and Care Planning Tool that allows for an informed consent process and shared decision making between the clinician, resident, and their family.
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Affiliation(s)
- Swati Gaur
- New Horizons Nursing Facilities, Gainesville, GA
| | - Naushira Pandya
- Department of Geriatrics, Nova Southeastern University, Ft Lauderdale, FL
| | - Ghinwa Dumyati
- Center for Community Health, University of Rochester Medical Center, Rochester, NY
| | - David A Nace
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC), Specialty Care Center of Innovation and Infectious Disease Section, Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC), Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH.
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Kochovska S, Garcia MV, Bunn F, Goodman C, Luckett T, Parker D, Phillips JL, Sampson EL, van der Steen JT, Agar MR. Components of palliative care interventions addressing the needs of people with dementia living in long-term care: A systematic review. Palliat Med 2020; 34:454-492. [PMID: 32013780 DOI: 10.1177/0269216319900141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND People with dementia requiring palliative care have multiple needs, which are amplified in long-term care settings. The European Association for Palliative Care White Paper offers recommendations for optimal palliative care in dementia integral for this population, providing useful guidance to inform interventions addressing their specific needs. AIM The aim of this study is to describe the components of palliative care interventions for people with dementia in long-term care focusing on shared decision-making and examine their alignment to the European Association for Palliative Care domains of care. DESIGN Systematic review with narrative synthesis (PROSPERO ID: CRD42018095649). DATA SOURCES Four databases (MEDLINE, CINAHL, PsycINFO and CENTRAL) were searched (earliest records - July 2019) for peer-reviewed articles and protocols in English, reporting on palliative care interventions for people with dementia in long-term care, addressing European Association for Palliative Care Domains 2 (person-centred) or 3 (setting care goals) and ⩾1 other domain. RESULTS Fifty-one papers were included, reporting on 32 studies. For each domain (1-10), there were interventions found aiming to address its goal, although no single intervention addressed all domains. Domain 7 (symptom management; n = 19), 6 (avoiding overly aggressive treatment; n = 18) and 10 (education; n = 17) were the most commonly addressed; Domain 5 (prognostication; n = 7) and 4 (continuity of care; n = 2) were the least addressed. CONCLUSION Almost all domains were addressed across all interventions currently offered for this population to various degrees, but not within a singular intervention. Future research optimally needs to be theory driven when developing dementia-specific interventions at the end of life, with the European Association for Palliative Care domains serving as a foundation to inform the best care for this population.
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Affiliation(s)
- Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Maja V Garcia
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Frances Bunn
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hertfordshire, UK
| | - Tim Luckett
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Deborah Parker
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Elizabeth L Sampson
- Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Meera R Agar
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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10
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Goossens B, Sevenants A, Declercq A, Van Audenhove C. Improving shared decision-making in advance care planning: Implementation of a cluster randomized staff intervention in dementia care. PATIENT EDUCATION AND COUNSELING 2020; 103:839-847. [PMID: 31818522 DOI: 10.1016/j.pec.2019.11.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/04/2019] [Accepted: 11/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Increasing staff engagement level of shared decision-making in advance care planning for persons with dementia in nursing homes. Perceived importance, competence and frequency of staff members applying shared decision-making were measured. Additionally, facilitators and barriers in the implementation process were described. METHODS In this pretest-posttest cluster randomized trial, 311 staff members from 65 Belgian nursing home wards participated. Key components of the intervention were knowledge on shared decision-making, role-play exercises and internal policies on advance care planning. Audio recordings of advance care planning conversations between residents, families and staff were compared before and after the intervention. Participants filled in questionnaires and provided feedback. RESULTS Wards demonstrated a higher level of shared decision-making after the intervention (p < 0.001) while time spent on the conversations did not increase. This effect persisted at 6 months follow-up (p < 0.001). Participants perceived shared decision-making as more important (p = 0.031) and felt more competent (p = 0.010), though frequency of use did not change (p = 0.201). High staff turnover and difficult co-operation with GP's were barriers. CONCLUSION Nursing home staff benefits from this training in shared decision-making. PRACTICE IMPLICATIONS Learning shared decision-making in advance care planning for persons with dementia is possible and sustainable in the time-constricted context of nursing homes.
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Affiliation(s)
- Bart Goossens
- LUCAS - Centre for Care Research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal Box 5310, 3000, Leuven, Belgium.
| | - Aline Sevenants
- LUCAS - Centre for Care Research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal Box 5310, 3000, Leuven, Belgium; Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33j, Postal Box 7001, 3000, Leuven, Belgium.
| | - Anja Declercq
- LUCAS - Centre for Care Research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal Box 5310, 3000, Leuven, Belgium; Centre for Sociological Research, KU Leuven, Parkstraat 45, Postal Box 3601, 3000, Leuven, Belgium.
| | - Chantal Van Audenhove
- LUCAS - Centre for Care Research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal Box 5310, 3000, Leuven, Belgium; Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33j, Postal Box 7001, 3000, Leuven, Belgium.
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Implementing advance care planning in routine nursing home care: The development of the theory-based ACP+ program. PLoS One 2019; 14:e0223586. [PMID: 31622389 PMCID: PMC6797173 DOI: 10.1371/journal.pone.0223586] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice. Objectives We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner. Design To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling. Setting and participants Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer. Methods The work was carried out by means of 1) operationalization of key intervention components–identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes–into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis. Results The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning. Conclusions The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice.
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Vaccaro L, Butow PN, Lee D, Johnson SB, Bell M, Clayton J, Detering KM, Tattersall M. Fidelity is fundamental: intervention predictors in advance care plans in terminal cancer. BMJ Support Palliat Care 2019; 9:397-403. [PMID: 31537578 DOI: 10.1136/bmjspcare-2019-001917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/26/2019] [Accepted: 09/04/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Assessing whether interventions are implemented as intended (fidelity) is critical to establishing efficacy in clinical research yet rarely applied in advance care planning (ACP) interventions. We aimed to develop and implement a fidelity audit tool for an ACP intervention. METHODS We developed a fidelity audit tool assessing: (A) content; (B) quality (general communication, eliciting EOL preferences and prognostic communication); and (C) family/caregiver involvement. We audited (double-coded) 55 audio-recordings of ACP discussions delivered to advanced cancer patients and caregivers, within a clinical trial. RESULTS Fidelity to content was high: mean=9.38/11 but lower for the quality of general communication (mean=12.47/20), discussion of patient preferences (mean=4.67/7), prognosis (mean=3.9/6) and family/caregiver involvement (mean=2.67/4). Older patient age and caregiver religiosity were associated with higher fidelity. Higher fidelity to content was associated with the trial primary outcome of family caregiver report of patient wishes being discussed and met. CONCLUSIONS Fidelity to content, but not quality, of the ACP intervention is strong. Communication skills training is critical for ACP interventionists. Adherence was higher with older patients and religious carers, factors that may influence acceptance of death and readiness to undertake ACP, making the discussion easier. TRIAL REGISTRATION NUMBER ACTRN12613001288718.
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Affiliation(s)
- Lisa Vaccaro
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis N Butow
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Lee
- School of Psychology, Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie B Johnson
- Nuffield Department of Population Health, Wellcome Centre for Ethics and Humanities and Ethox Centre, University of Oxford, Oxford, UK
| | - Melanie Bell
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Josephine Clayton
- Centre for Learning & Research in Palliative Care, Hammond Care, Greenwich Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Karen Margaret Detering
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia.,Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Martin Tattersall
- Department of Medical Oncology, University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Giger M, Voneschen N, Brunkert T, Zúñiga F. Care workers' view on factors leading to unplanned hospitalizations of nursing home residents: A cross-sectional multicenter study. Geriatr Nurs 2019; 41:110-117. [PMID: 31447139 DOI: 10.1016/j.gerinurse.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/10/2019] [Accepted: 08/12/2019] [Indexed: 12/15/2022]
Abstract
Nursing home residents have a high risk of adverse events during hospitalizations. Since up to two-thirds of hospitalizations of nursing home residents are rated as potentially preventable, this study aimed to describe factors related to unplanned hospitalizations and to describe rates of unplanned hospitalizations, comparing differences between high- and low-hospitalization nursing homes. This cross-sectional multicenter study was conducted in 19 Swiss nursing homes and used questionnaire surveys of ward supervisors (n = 33) and nursing staff (n = 146) and retrospectively assessed hospitalization data. The study revealed several issues regarding unplanned hospitalizations, mostly concerning limitations regarding physicians' availability, lack of acquaintance of on-call physicians with the residents, and health professionals' lack of knowledge about the residents' wishes concerning therapeutic decisions. Our findings suggest that standardizing advance care planning processes and better physician availability might further reduce hospitalizations and improve quality of care in nursing homes.
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Affiliation(s)
- Max Giger
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, Basel 4056, Switzerland.
| | - Nina Voneschen
- Alterszentrum Wiesendamm, Wiesendamm 20, Basel 4057, Switzerland.
| | - Thekla Brunkert
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, Basel 4056, Switzerland.
| | - Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, Basel 4056, Switzerland.
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14
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Goossens B, Sevenants A, Declercq A, Van Audenhove C. 'We DECide optimized' - training nursing home staff in shared decision-making skills for advance care planning conversations in dementia care: protocol of a pretest-posttest cluster randomized trial. BMC Geriatr 2019; 19:33. [PMID: 30717700 PMCID: PMC6360673 DOI: 10.1186/s12877-019-1044-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 01/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Due to the gradual loss of function, it is crucial for persons with dementia to discuss advance care planning in due course. However, nursing home staff, residents and their families feel uncomfortable to start this type of conversation, resulting in unknown (care) preferences. ‘We DECide optimized’ will provide tools to nursing home staff for discussing advance care planning. The primary objective is to enhance the level of shared decision-making in advance care planning conversations. We hypothesize that the training will enhance the perception of the importance, competence and frequency in which participants engage in advance care planning conversations. The secondary objective is to assess barriers and facilitators in the implementation of advance care planning policies at the ward level. Methods ‘We DECide optimized’ will consist of two four-hour workshops and a homework assignment between sessions. Training components will include information on advance care planning and shared decision-making, role-play exercises and group discussions on implementation barriers at the ward level. Participating wards will receive supporting materials to stimulate residents and their families to initiate conversations. The study uses a cluster randomized controlled design, with 65 Flemish nursing home wards taking part (311 staff members). Data will be collected through a pretest-posttest model, with measurements up to 9 months after training. The RE-AIM framework will be used to evaluate the effectiveness of the implementation. Quantitative and qualitative data at the clinical, organizational and resident level will be collected. Discussion This study describes a hands-on, in-depth and multi-level training approach to improve shared decision-making in advance care planning conversations. By providing tools to ward staff, engaging the management and informing residents and their families, ‘We DECide optimized’ aims to decrease evidence-based barriers and to provide all stakeholders with incentives to engage in conversations about (care) preferences in an informative and participatory manner. Electronic supplementary material The online version of this article (10.1186/s12877-019-1044-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bart Goossens
- LUCAS, KU Leuven, Minderbroedersstraat 8, 3000, Leuven, Belgium.
| | - Aline Sevenants
- LUCAS, KU Leuven, Minderbroedersstraat 8, 3000, Leuven, Belgium
| | - Anja Declercq
- LUCAS, KU Leuven, Minderbroedersstraat 8, 3000, Leuven, Belgium
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15
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Abstract
PURPOSE OF REVIEW Dementia is now recognized as a progressive life-limiting illness where many patients can benefit from access to palliative care. RECENT FINDINGS The present review has focused on three areas namely, advanced care planning in supporting palliative care for dementia, hospice provision for people with dementia and provision of care within family home. In advanced care planning, there is little research on systematically developed and implemented advance care planning interventions or whether they achieve desired outcomes for end-of-life care. There is limited research on hospice-based care for patients with dementia and most studies are U.S. based. Equally studies exploring how family carers can be supported and facilitated to care at home for the person with dementia to the end of life are exploratory rather than determining what factors may be important. SUMMARY There are relatively few studies, especially quantitative studies or intervention studies being carried out to determine most effective means of providing palliative care for people with dementia, particularly with respect to advanced care planning, the provision of hospice-based care and support at home. Despite increased public awareness of dementia as a terminal illness, more research is required to support patients with dementia and their families at the end of life.
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16
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Johnson SB, Butow PN, Kerridge I, Bell ML, Tattersall MHN. How Well Do Current Measures Assess the Impact of Advance Care Planning on Concordance Between Patient Preferences for End-of-Life Care and the Care Received: A Methodological Review. J Pain Symptom Manage 2018; 55:480-495. [PMID: 28943359 DOI: 10.1016/j.jpainsymman.2017.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/04/2017] [Accepted: 09/04/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has begun to focus on whether Advance Care Planning (ACP) has the capacity to influence care, and to examine whether ACP can be effective in meeting patients' wishes at the end of their lives. Little attention has been paid, however, to the validity and clinical relevance of existing measures. METHODS A search of Medline and CINHAL identified ACP studies measuring concordance between end-of-life (EoL) preferences and the care received. Databases were searched from 2000 to August 2016. We developed a checklist to evaluate the quality of included studies. Data were collected on the proportion of patients who received concordant care, extracted from manuscript tables or calculated from the text. OUTCOMES Of 2941 papers initially identified, nine eligible studies were included. Proportions of patients who received concordant care varied from 14% to 98%. Studies were heterogeneous and methodologically poor, with limited attention paid to bias/external validity. Studies varied with regards to design of measures, the meaning of relevant terms like "preference" "EoL care" and "concordance," and the completeness of reported data. CONCLUSION Methodological variations and weaknesses compromise the validity of study results, and prevent meaningful comparisons between studies or synthesis of the results. Effectively evaluating whether ACP interventions enhance a patient's capacity to receive the care they want requires harmonization of research. This demands standardization of methods across studies, validating of instruments, and consensus based on a consistent conceptual framework regarding what constitutes a meaningful outcome measure.
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17
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Hill SR, Mason H, Poole M, Vale L, Robinson L. What is important at the end of life for people with dementia? The views of people with dementia and their carers. Int J Geriatr Psychiatry 2017; 32:1037-1045. [PMID: 27515899 DOI: 10.1002/gps.4564] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Approaching end of life is often a time of vulnerability; this is particularly so for people with dementia and their families where loss of capacity and the ability to communicate, make assessment and shared decision-making difficult. Research has consistently shown that improvements in care and services are required to support better quality and more person-centred care for people with dementia towards and at end of life. However, the views of people with dementia about what factors contribute to high-quality care at this time are a neglected area. AIM The aim of this study was to identify the aspects of end-of-life care for people with dementia that are most important to them and their carers. DESIGN Q-methodology, a mixed method combining qualitative and quantitative techniques to study subjectivity, was used to identify the views of people with mild dementia, their family carers and bereaved carers on end-of-life care for people with dementia. Fifty-seven participants were included in the study. RESULTS Four distinct views were identified: family involvement, living in the present, pragmatic expectations and autonomy and individuality. Some areas of consensus across all views included compassionate care, decisions being made by healthcare professionals and information availability when making decisions. CONCLUSION Our findings reveal several different views on what is important about end-of-life care for people with dementia; therefore, a 'one-size-fits-all' approach to care is unlikely to be most appropriate. Notwithstanding the differing viewpoints could provide a framework for service providers and commissioners for future care. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Marie Poole
- Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Newcastle University, Newcastle upon Tyne, UK
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18
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Abstract
The health care system introduced a reimbursement system based on the existing care when the prevalence rate of acute diseases was still. However, the types of diseases in developed countries are mostly noncommunicable diseases such as cancer or vascular disease, and thus, it impossible to fully recover from these chronic diseases. The increase in noncommunicable diseases is related to unhealthy lifestyle habits such as smoking, heavy drinking, and lack of exercise. Thus, the health care system is changing by improving the prevention of diseases and promoting healthy lifestyles. However, multimorbidities have emerged as an important concept in this process. In countries where the population is rapidly aging, those who have multimorbidities have become a burden to the health care system's revenue, manpower, and service quality. Therefore, health care reform to cope with those who are aging and have multimorbidities is necessary to establish. Reform measures can consist of the following suggestions. First, proper medical guidelines for multiple diseases need to be developed. Second, professional manpower should be trained. Third, the reimbursement system should be improved to relieve those with multimorbidities. Fourth, disease prevention services should be improved. Finally, instruments to measure health care service quality for chronic disease need to be developed.
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19
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Ampe S, Sevenants A, Smets T, Declercq A, Van Audenhove C. Advance care planning for nursing home residents with dementia: Influence of 'we DECide' on policy and practice. PATIENT EDUCATION AND COUNSELING 2017; 100:139-146. [PMID: 27544017 DOI: 10.1016/j.pec.2016.08.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 06/23/2016] [Accepted: 08/08/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES (1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. METHODS This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). RESULTS Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. CONCLUSION 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. PRACTICE IMPLICATIONS Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals.
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Affiliation(s)
- Sophie Ampe
- KU Leuven, LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8, Box 5310, 3000, Leuven, Belgium.
| | - Aline Sevenants
- KU Leuven, LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8, Box 5310, 3000, Leuven, Belgium.
| | - Tinne Smets
- Vrije Universiteit Brussel, End-of-Life Care Research Group, VUB Campus Jette, Building K, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Anja Declercq
- KU Leuven, LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8, Box 5310, 3000, Leuven, Belgium.
| | - Chantal Van Audenhove
- KU Leuven, LUCAS, Centre for Care Research and Consultancy, Minderbroedersstraat 8, Box 5310, 3000, Leuven, Belgium.
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Gilissen J, Pivodic L, Smets T, Gastmans C, Vander Stichele R, Deliens L, Van den Block L. Preconditions for successful advance care planning in nursing homes: A systematic review. Int J Nurs Stud 2016; 66:47-59. [PMID: 27987411 DOI: 10.1016/j.ijnurstu.2016.12.003] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/06/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is growing evidence of the potential effectiveness of advance care planning. Yet important knowledge gaps remain regarding the preconditions for successful implementation of advance care planning in the nursing home setting. We aim to identify the preconditions related to successful advance care planning in the nursing home setting. By specifying those, we would be able to make well-founded choices for the future design and planning of advance care planning intervention programs. DESIGN A systematic review. DATA SOURCES PubMed, PsycINFO, EMBASE and CINAHL. REVIEW METHODS Two authors independently screened publications. One author assessed methodological quality and extracted textual data, which was double-checked for a random sample. We extracted textual data and used thematic synthesis to identify "preconditions", defined as requirements, conditions and elements necessary to achieve the desired outcome of advance care planning, i.e. attaining concordance between residents' preferences and actual care or treatment received at the end of life. MAIN FINDINGS Based on 38 publications, we identified 17 preconditions at five different levels: resident, family, health-care professional, facility and community. Most preconditions were situated on multiple levels but the majority addressed professionals and the nursing home itself. We summarized preconditions in five domains: to have sufficient knowledge and skills, to be willing and able to participate in advance care planning, to have good relationships, to have an administrative system in place, and contextual factors supporting advance care planning within the nursing home. CONCLUSION There are multiple preconditions related to successfully implementing advance care planning in the complex nursing home setting that operate at micro, meso and macro level. Future interventions need to address these multiple domains and levels in a whole-system approach in order to be better implementable and more sustainable, while simultaneously target the important role of the health-care professional and the facility itself.
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Affiliation(s)
- Joni Gilissen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Lara Pivodic
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium.
| | - Tinne Smets
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Kapucijnenvoer 35 Box 7001, 3000 Leuven, Belgium
| | | | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
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Shin J, Choi Y, Lee SG, Kim W, Park EC, Kim TH. Relationship between socioeconomic status and mortality after femur fracture in a Korean population aged 65 years and older: Nationwide retrospective cohort study. Medicine (Baltimore) 2016; 95:e5311. [PMID: 27930508 PMCID: PMC5265980 DOI: 10.1097/md.0000000000005311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Femur fracture is an emerging public health concern in aging societies, owing to the substantially high morbidity and mortality. Because the recent increase in femur fracture incidence in Asian populations is comparable to that in the West, it is necessary to investigate the association between socioeconomic status (SES) and mortality after femur fracture in developed Asian societies.Data were obtained from the National Health Insurance Claims Database. During 2002 to 2013, femur fractures were newly diagnosed in 5441 patients among 1025,340 enrollees. Multiple logistic regression and the Cox proportional model were used to investigate the associations between individual SES and probability of surgery and mortality after femur fracture.Of 5441 patients, 1928 (35.4%) received surgery. Patients with low (odds ratio [OR] = 0.87, 95% confidence interval [CI]: 0.75-0.99) and middle (OR = 0.85, 95% CI: 0.74-0.98) income were less likely to undergo surgery than high-income patients. Patients with low (hazard ratio [HR] = 1.12, 95% CI: 1.01-1.24) and middle (HR = 1.20, 95% CI: 1.08-1.33) income had a higher HR for mortality. This difference was more prominent in patients who underwent surgery (low income: HR = 1.07, 95% CI: 0.94-1.21; middle income: HR = 1.18, 95% CI: 1.04-1.33) than in patients with conservative treatment (low income: HR = 1.24, 95% CI: 1.04-1.49; middle income: HR = 1.30, 95% CI: 1.08-1.56).Femur-fracture patients with low SES are less likely to receive surgery for and more likely to die after femur fracture. The difference in mortality risk remained even when only the patients who received surgery were considered, suggesting that we need to consider support measures for these deprived patients.
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Affiliation(s)
- Jaeyong Shin
- Department of Preventive Medicine Institute of Health Services Research, Yonsei University College of Medicine Department of Public Health, Graduate School Department of Hospital Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
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22
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Ampe S, Sevenants A, Smets T, Declercq A, Van Audenhove C. Advance care planning for nursing home residents with dementia: policy vs. practice. J Adv Nurs 2015; 72:569-81. [DOI: 10.1111/jan.12854] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Sophie Ampe
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Aline Sevenants
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
| | - Tinne Smets
- Vrije Universiteit Brussel; End-of-Life Care Research Group; Belgium
| | - Anja Declercq
- KU Leuven; LUCAS; Centre for Care Research and Consultancy; Belgium
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