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Song D, Yu T, Zhi S, Chang C, Sun J, Gao S, Gu Y, Sun J. Experiences and perspectives on the optimal timing for initiating advance care planning in patients with mild to moderate dementia: A meta-synthesis. Int J Nurs Stud 2024; 154:104762. [PMID: 38613968 DOI: 10.1016/j.ijnurstu.2024.104762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Advance care planning is typically initiated during the last six months of a patient's life. However, due to the progressive decline in the decision-making process in individuals with dementia, their involvement in advance care planning is limited to the early stages of the disease. Currently, there is no consensus on the optimal timing for initiating advance care planning for people with dementia, and a comprehensive review of the literature addressing this matter is lacking. OBJECTIVE To explore the experiences and perspectives of people with dementia, their family caregivers, and health care professionals with regard to the optimal timing for initiating advance care planning. DESIGN A meta-synthesis was conducted. DATA SOURCE The following eight electronic databases were searched: PubMed, Embase, Web of Science, Cochrane Library, CINAHL and CNKI, WanFang and Vip. REVIEW METHODS This review uses thematic synthesis to systematically synthesize qualitative evidence and report findings according to The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and the Joanna Briggs Institute Manual for Evidence Synthesis. Study selection and data extraction were conducted independently by two researchers, and quality was evaluated using the Joanna Briggs Institute's Qualitative Research Standard Assessment tool. FINDINGS Twenty-one studies were selected for this review. This review involved an overarching theme: The utilization of pivotal elements to transition from delayed initiation to comprehensive implementation. Three themes emerge, including the prerequisites for initiating advance care planning, not ready to start advance care planning and struggling along narrow roads. For health care professionals, the selection of an opportune moment to initiate advance care planning for people with dementia is not only a challenge but also a crucial prerequisite for the successful implementation of advance care planning. Health care professionals' experience, attitude toward advance care planning, trust relationship with patients, cultural differences among people with dementia and their caregivers, and economic disparities all influence health care professionals' judgment of the timing for initiating advance care planning. CONCLUSIONS Determining the optimal timing for initiating advance care planning is a complex process that requires a comprehensive consideration of the realities faced by health care professionals, people with dementia and their caregivers. Therefore, it is imperative to provide relevant training to health care professionals to ensure the successful implementation of advance care planning.
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Affiliation(s)
- Dongpo Song
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Tao Yu
- The First Hospital of Jilin University, No.1 Xinmin Street, Changchun 130021, Jilin, People's Republic of China.
| | - Shengze Zhi
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Cheng Chang
- The First Hospital of Jilin University, No.1 Xinmin Street, Changchun 130021, Jilin, People's Republic of China.
| | - Juanjuan Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Shizheng Gao
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Yanyan Gu
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
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Reigada C, Sandgren A, Rivas S, Carvajal A, Hermida-Romero S, Benítez E, Ripoll G, Olza I, Centeno C, Gómez B. Palliative care stay room - designing, testing and evaluating a gamified social intervention to enhance palliative care awareness. BMC Palliat Care 2023; 22:46. [PMID: 37081434 PMCID: PMC10116670 DOI: 10.1186/s12904-023-01166-9] [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: 09/22/2022] [Accepted: 04/03/2023] [Indexed: 04/22/2023] Open
Abstract
INTRODUCTION The message of palliative care can be promoted using creative thinking and gamification. It can be an innovative strategy to promote changes in behaviour, promote thinking, and work on skills such as empathy. AIM Design, test and evaluate a gamified social intervention to enhance palliative care awareness among young university students from non-health background. METHODS Participatory action research study with mixed methods, Design Thinking and using the Public Engagement strategy. Forty-three undergraduate students participated in a Palliative Care Stay Room and completed the Test of Cognitive and Affective Empathy (TECA) before and after the game. At the end of the game, a ten-minute debriefing was held with the participants, which was concluded with an open conversation. The content analysis was done independently and the sum of the scores of each dimension was compared before and after the activity. FINDINGS The Stay Room improved the participants' knowledge and new perspectives about palliative care. Before the game, their views focused on the end of life and after the game on their values, highlighting the dedication of the healthcare professionals who do not treat death but the life until death. After de game, participants (N = 43: female = 23; male = 20; x̄ 19.6 years old) presented higher values in perspective adoption (intellectual ability to put oneself in the other's place) p = 0.046 and in emotional understanding (ability to recognize emotional states) p = 0.018, and had high scores on empathic joy (p = 0.08). CONCLUSION Gamification can be used in teaching and transmitting positive attitudes. Palliative Care and can help young university students to think positively about care issues.
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Affiliation(s)
- Carla Reigada
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Sonia Rivas
- School of Education and Psychology, University of Navarra, Pamplona, Spain
| | - Ana Carvajal
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
- School of Nursing, University of Navarra, Pamplona, Spain.
| | - Santiago Hermida-Romero
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Edgar Benítez
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Guillem Ripoll
- School of Economics and Business, University of Navarra, Pamplona, Spain
| | - Inés Olza
- Emotional Culture and Identity Project, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Beatriz Gómez
- School of Communication, University of Navarra, Pamplona, Spain
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Abstract
OBJECTIVE There has been increasing recognition of the potential of games in health; however, knowledge of their application in palliative care is lacking. Therefore, this study aimed to identify and map the available evidence on the use of games in palliative care, analyzing how research has been conducted on this topic and identifying gaps in knowledge. METHOD A scoping review was carried out. The literature search was conducted using the respective descriptors and search syntax appropriate to each of the databases searched. The review included all study types with no time limits. RESULTS Of the 685 articles initially identified, 53 were included for final analysis. Several different game types were identified, with the majority of studies using role-play (n = 29) and card games (n = 17). The games analyzed were essentially aimed at empowering patients (n = 14), and in some cases, extended to families or caregivers, as well as to medical and nursing students. The analysis of the articles in this review resulted in two major themes: Role-playing for training in palliative care and card games to discuss end-of-life care. SIGNIFICANCE OF RESULTS Games allow space for the expression of emotions and promote creativity. They can be applied both in a training context, to enable health professionals to develop essential skills in palliative care, and for patients, families, and caregivers, allowing them to talk about serious things while playing.
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Van Scoy LJ, Levi BH, Bramble C, Calo W, Chinchilli VM, Currin L, Grant D, Hollenbeak C, Katsaros M, Marlin S, Scott AM, Tucci A, VanDyke E, Wasserman E, Witt P, Green MJ. Comparing two advance care planning conversation activities to motivate advance directive completion in underserved communities across the USA: The Project Talk Trial study protocol for a cluster, randomized controlled trial. Trials 2022; 23:829. [PMID: 36180899 PMCID: PMC9523194 DOI: 10.1186/s13063-022-06746-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is a process involving conversations between patients, loved ones, and healthcare providers that consider patient preferences for the types of medical therapies received at the end of life. Underserved populations, including Black, Hispanic, rural, and low-income communities are less likely to engage in ACP than other communities, a health inequity that results in lower-quality care and reduced hospice utilization. The purpose of this trial is to compare efficacy of two interventions intended to motivate ACP (particularly advance directive completion) for those living in underserved communities. METHODS This 3-armed cluster, randomized controlled mixed methods design is being conducted in 75 community venues in underserved communities across the USA. The goal of the trial is to compare the efficacy of two interventions at motivating ACP. Arm 1 uses an end-of-life conversation game (Hello); Arm 2 uses a nationally utilized workshop format for ACP conversations (The Conversation Project); and Arm 3 uses an attention control game (TableTopics). Events are held in partnership with 75 local community-based host organizations and will involve 1500 participants (n=20 per event). The primary outcome is completion of a visually verified advance directive at 6 months post-event. Primary analyses compare efficacy of each intervention to each other and the control arm. Secondary mixed methods outcomes include (a) other ACP behaviors and engagement; (b) communication quality; (c) impact of sociocultural environment on ACP (via qualitative interviews); and (d) implementation and sustainability. Subgroup analyses examine outcomes for Black, Hispanic, and rural groups in particular. DISCUSSION This trial will add to the evidence base behind various conversational ACP interventions, examine potential mechanisms of action for such interventions, and provide qualitative data to better understand the sociocultural environment of how community-based ACP interventions are experienced by underserved populations. Results will also provide important data for future researchers to learn whether visual verification of advance directives is necessary or whether reliance on self-reported outcomes is of comparable value. Data from this study will inform ways to effectively motivate underserved communities to participate in advance care planning. TRIAL REGISTRATION ClinicalTrials.gov NCT04612738. Registered on October 12, 2020. All information from the WHO Trial Registration Data Set can be found within the protocol.
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Affiliation(s)
- Lauren J. Van Scoy
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Benjamin H. Levi
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
- Department of Pediatrics, Penn State College of Medicine, Suite 4400, Mail Code A444, Hershey, PA 17033 USA
| | - Cindy Bramble
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - William Calo
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Lindsey Currin
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Denise Grant
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Christopher Hollenbeak
- Department of Health Policy and Administration, The Pennsylvania State University, 604E Donald H. Ford Bldg., University Park, PA 16802 USA
| | - Maria Katsaros
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Sara Marlin
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Allison M. Scott
- Department of Communication, University of Kentucky, 275 Blazer Dining Hall, University of Kentucky, Lexington, KY 40506 USA
| | - Amy Tucci
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Erika VanDyke
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Pamela Witt
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Michael J. Green
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
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Trang J, Herbert A, Sansom-Daly UM. How can advance care planning tools help young people's voices be heard? J Paediatr Child Health 2022; 58:1317-1322. [PMID: 35758055 DOI: 10.1111/jpc.16095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022]
Abstract
The integration of the child or young person (CYP) in conversations around advance care planning (ACP) is an important area of paediatric practice. These discussions provide CYP with the opportunity to voice their values, goals and preferences, enabling health-care professionals to ensure they are aligned with their planned course of treatment. This process, often undertaken within the context of the child's family, empowers children to participate in decisions and experience the dignity of self-determination. It also facilitates an increased understanding between the CYP and those involved in their care. The objectives of this paper are to highlight the importance of these conversations for paediatricians and identify barriers, both real and perceived, that may prevent them from engaging with a CYP about their preferences for future care including focusing more on discussion with the parents, and concern about or not having the skills to engage the child in such sensitive conversations. Triggers that can prompt clinicians to undertake ACP are also discussed. A further complexity is that after seeking their perspective, it may become apparent that the CYP may hold different views and perspectives to their parents and/or clinician. This review article will especially examine elements of end-of-life conversations that are critical to support the important goal of listening to the voice of the CYP. This includes considerations around timing, legal aspects, ethical tensions that arise when amplifying a child's voice, clinician/team-member roles, clinical process considerations, and the use of specific interventions and ACP tools to facilitate these conversations with CYP.
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Affiliation(s)
- Jacinta Trang
- Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Anthony Herbert
- Children's Health Queensland Hospital and Health Service, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia.,Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine & Health, Randwick Clinical Campus, University of New South Wales Sydney, Sydney, New South Wales, Australia.,Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital, Sydney, New South Wales, Australia
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Margavio Striley K, Tenzek KE, Field-Springer K. Difficult dialogues about death: applying risk orders theory to analyse chaplains’ provision of end-of-life care. HEALTH, RISK & SOCIETY 2022. [DOI: 10.1080/13698575.2022.2056582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Katie Margavio Striley
- Interpersonal Communication, Department of Communication, The University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Kelly E. Tenzek
- Department of Communication, University of Wisconsin-Milwaukee (Data Collection)1
- Department of Communication, University at Buffalo, North Campus, Buffalo, New York, USA
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Johansson T, Tishelman C, Eriksson LE, Cohen J, Goliath I. Use, usability, and impact of a card-based conversation tool to support communication about end-of-life preferences in residential elder care – a qualitative study of staff experiences. BMC Geriatr 2022; 22:274. [PMID: 35366816 PMCID: PMC8976536 DOI: 10.1186/s12877-022-02915-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Proactive conversations about individual preferences between residents, relatives, and staff can support person-centred, value-concordant end-of-life (EOL) care. Nevertheless, prevalence of such conversations is still low in residential care homes (RCHs), often relating to staff’s perceived lack of skills and confidence. Using tools may help staff to facilitate EOL conversations. While many EOL-specific tools are script-based and focus on identifying and documenting treatment priorities, the DöBra card tool is developed to stimulate reflection and conversation about EOL care values and preferences. In this study, we explore staff’s experiences of use, usability, and perceived impact of the DöBra cards in supporting discussion about EOL care in RCH settings.
Methods
This qualitative study was based on data from two participatory action research processes in which RCH staff tested and evaluated use of DöBra cards in EOL conversations. Data comprise 6 interviews and 8 group meetings with a total of 13 participants from 7 facilities. Qualitative content analysis was performed to identify key concepts in relation to use, usability, and impact of the DöBra cards in RCH practice.
Results
Based on participants’ experiences of using the DöBra cards as an EOL conversation tool in RCHs, we identified three main categories in relation to its usefulness. Outcomes of using the cards (1) included the outlining of content of conversations and supporting connection and development of rapport. Perceived impact (2) related to enabling openings for future communication and aligning care goals between stakeholders. Use and usability of the cards (3) were influenced by supporting and limiting factors on the personal and contextual level.
Conclusions
This study demonstrates how the DöBra cards was found to be useful by staff for facilitating conversations about EOL values, influencing both the content of discussion and interactions between those present. The tool encouraged reflection and interaction, which staff perceived as potentially helpful in building preparedness for future care-decision making. The combination of providing a shared framework and being adaptable in use appeared to be key features for the DöBra cards usability in the RCH setting.
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Fernandes CS, Lourenço M, Vale B. Patient card games in palliative care: integrative review. BMJ Support Palliat Care 2021:bmjspcare-2021-003300. [PMID: 34706866 DOI: 10.1136/bmjspcare-2021-003300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In the context of palliative care, a new approach has been documented that allows for sensitive end-of-life conversations to be established through a game of cards. OBJECTIVE This study aimed to identify the use of card games with patients in palliative care, assess self-reported satisfaction and synthesise findings on the effectiveness of its application. DESIGN We performed an integrative review study. The studies were collected from five databases, with no time limit until February 2021: Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Psychology and Behavioral Sciences Collection, SCOPUS and Scientific Electronic Library Online. The inclusion criteria were studies describing the use of card games in adult patients undergoing palliative care, in which the authors performed some type of evaluation. The methodological evaluation of the studies was carried out using the different standardised assessment tools from the Joanna Brigg's Institute. RESULTS Of the 685 articles identified, 9 met the inclusion criteria. Regarding methodological aspects, 4 studies were quantitative, 4 mixed-method methodologies, and 1 was qualitative. Card games have been in use for the last decade. The use of card games not only allows for participation in the game without any inhibitions and with a high degree of satisfaction, but also allows for the discussion of sensitive topics related to the end of life, motivating participants to engage in advanced care planning behaviours. CONCLUSION Our findings suggest that using a card game to facilitate conversations with patients in palliative care is a useful and effective approach to discussing uncomfortable topics of death, dying and end-of-life care.
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Affiliation(s)
- Carla Silvia Fernandes
- Nursing School of Porto, Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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Starr JS, Skelton WP, Rahmanian KP, Guenther R, Allen WL, George TJ, Moseley RE. Systematic Analysis of Extracting Data on Advance Directives from Patient Electronic Health Records (EHR) in Terminal Oncology Patients. J Palliat Care 2021; 36:211-218. [PMID: 33711237 DOI: 10.1177/08258597211001153] [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: 11/16/2022]
Abstract
BACKGROUND Advance directives are legal documents that include living wills and durable health care power of attorney documents. They are critical components of care for seriously ill patients which are designed to be implemented when a patient is terminally ill and incapacitated. We sought to evaluate potential reasons for why advance directives were not appropriately implemented, by reviewing the electronic health record (EHR) in patients with terminal cancer. METHODS A retrospective analysis of the EHR of 500 cancer patients from 1/1/2013 to 12/31/2016 was performed. Data points were manually collected and entered in a central database. RESULTS Of the 500 patients, 160 (32%) had an advance directive (AD). The most common clinical terminology used by physicians indicating a terminal diagnosis was progressive (36.6%) and palliative (31%). The most common clinical terminology indicating incapacity was altered mental status (25.6%), and not oriented (14%). 34 (6.8%) patients met all criteria of having a terminal diagnosis, a documented AD, and were deemed incapacitated. Of these patients who met all of these data points, their ADs were implemented on average 1.7 days (SD: 4.4 days) after which they should have been. This resulted in a total of 58 days of additional care provided. DISCUSSION This study provided insight on to how ADs are managed in day to day practice in the hospital. From our analysis it appears that physicians are able to identify when a patient is terminal, however, it is typically later than it should have been recognized. Further studies should be performed focusing on harnessing the power of the EHR and providing physicians formative and evaluative feedback of practice patterns to ensure that ADs are honored when appropriate.
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Affiliation(s)
- Jason S Starr
- Division of Hematology & Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.,Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA.,* Jason S. Starr and William Paul Skelton IV contributed equally to this work
| | - William Paul Skelton
- Division of Hematology & Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.,Division of Medical Oncology, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, FL, USA.,* Jason S. Starr and William Paul Skelton IV contributed equally to this work
| | - Kiarash P Rahmanian
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Robert Guenther
- Department of Clinical and Health Psychology, University of Florida College of Public Health & Health Professions, Gainesville, FL, USA
| | - William L Allen
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Thomas J George
- Division of Hematology & Oncology, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA
| | - Ray E Moseley
- Department of Community Health and Family Medicine, University of Florida College of Medicine, Gainesville, FL, USA
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Van Scoy LJ, Green MJ, Witt PD, Bramble C, Richardson C, Putzig I, Toyobo O, Wasserman E, Chinchilli VM, Tucci A, Levi BH. Low Skepticism and Positive Attitudes About Advance Care Planning Among African Americans: a National, Mixed Methods Cohort Study. J Gen Intern Med 2021; 36:705-712. [PMID: 32948953 PMCID: PMC7947044 DOI: 10.1007/s11606-020-06224-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND African Americans have low engagement in advance care planning (ACP). This has been attributed to healthcare distrust and skepticism about ACP. A better understanding of these attitudes is needed to address health disparities related to end-of-life care. OBJECTIVE To explore the ACP-related values and beliefs of diverse African American communities across the USA and then the perceived value of an inexpensive end-of-life conversational game. DESIGN Prospective, convergent, mixed methods cohort study involving fifteen underserved, African American communities across the USA. PARTICIPANTS Of the 428 who attended events at purposively sampled sites, 90% consented to the research; 37% participated in one of 15 focus groups (n = 141). INTERVENTION An end-of-life conversation game, played in groups of 4-6. MAIN MEASURES The validated, 7-item ACP values and beliefs questionnaire (scaled 7 = least skeptical, 49 = most skeptical) was administered pre-game. Post-game focus groups explored perceptions about ACP and the intervention. KEY RESULTS Participants had positive attitudes (low skepticism) about ACP with a median score of 12.00 (7.00, 20.00). Values and beliefs did not significantly differ by geographical region; however, rural areas were observed to be slightly more skeptical than urban areas (median score 14.00 vs. 11.00, p = 0.002). Themes from focus groups converged with survey data showing participants valued the ACP process and consider further engagement in ACP to be worthwhile. Subthemes emphasized the need for and value of ACP. CONCLUSIONS Skepticism about ACP may contribute to low rates of ACP engagement in underserved African American communities. The positive attitudes uncovered in our study either negate previous findings or suggest reduced skepticism. TRIAL REGISTRATION This study has been registered at clinicaltrials.gov ( NCT03456921 ).
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Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA.
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
| | - Michael J Green
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Pamela D Witt
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Irene Putzig
- Hospice Foundation of America, Washington, DC, USA
| | - Olubukola Toyobo
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Amy Tucci
- Hospice Foundation of America, Washington, DC, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
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Kamran R, Dal Cin A. Designing a Mission statement Mobile app for palliative care: an innovation project utilizing design-thinking methodology. BMC Palliat Care 2020; 19:151. [PMID: 33023545 PMCID: PMC7542118 DOI: 10.1186/s12904-020-00659-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Eliciting individual values and preferences of patients is essential to delivering high quality palliative care and ensuring patient-centered advance care planning. Despite advance care planning conserving healthcare costs by up to 36%, reducing psychological distress of patients and caregivers, and ensuring palliative care delivery in line with patient wishes, less than 33% of adults engage in it. We aimed to develop a mobile application intervention to address the challenges related to advance care planning and improve the delivery of palliative care. METHODS Design-thinking methodology was used to develop a mobile application, in response to issues prominently identified in current palliative care literature. RESULTS Issues surrounding communication of patient values from both the patient and provider side is identified as a main issue in palliative care. We designed a mobile application intervention prototype to address this. CONCLUSIONS Our "Mission Statement" mobile application will allow patients to create a mission statement identifying what they want their care team to know about them, as well as space to identify important values and preferences. Patients will be able to evolve their mission statement and values and preferences over the course of their palliative care journey through the application. Design-thinking methodology is an effective tool to drive healthcare innovation and bridge the gap between research findings and implementation.
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Affiliation(s)
- Rakhshan Kamran
- Michael G. DeGroote School of Medicine, McMaster University, MDCL 3114, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada.
| | - Arianna Dal Cin
- Division of Plastic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 K1, Canada
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A Methodological Review of Mixed Methods Research in Palliative and End-of-Life Care (2014-2019). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113853. [PMID: 32485830 PMCID: PMC7312170 DOI: 10.3390/ijerph17113853] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 01/26/2023]
Abstract
Mixed methods research has been increasingly recognized as a useful approach for describing and explaining complex issues in palliative care and end-of-life research. However, little is known about the use of this methodology in the field and the ways in which mixed methods studies have been reported. The purpose of this methodological review was to examine the characteristics, methodological features and reporting quality of mixed methods articles published in palliative care research. The authors screened all articles published in eight journals specialized in palliative care between January 2014 and April 2019. Those that reported a mixed methods study (n = 159) were included. The Good Reporting of a Mixed Methods Study (GRAMMS) criteria were used to assess reporting quality. Findings showed that 57.9% of the identified studies used a convergent design and 82.4% mentioned complementarity as their main purpose for using a mixed methods approach. The reporting quality of the articles generally showed a need for improvement as authors usually did not describe the type of mixed methods design used and provided little detail on the integration of quantitative and qualitative methods. Based on the findings, recommendations are made to improve the quality of reporting of mixed methods articles in palliative care.
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Van Scoy LJ, Levi BH, Witt P, Bramble C, Richardson C, Putzig I, Levi AR, Wasserman E, Chinchilli V, Tucci A, Green MJ. Association of Participation in an End-of-Life Conversation Game With Advance Care Planning Behavior and Perspectives Among African American Individuals. JAMA Netw Open 2020; 3:e204315. [PMID: 32383747 PMCID: PMC7210487 DOI: 10.1001/jamanetworkopen.2020.4315] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
Abstract
Importance Less than 25% of African American individuals have completed advance directives and are thus vulnerable to poor end-of-life care. Low-cost interventions are needed to increase engagement in advance care planning (ACP). Objectives To investigate whether an end-of-life conversation game motivates African American attendees to engage in ACP and to assess whether the game is well received and endorsed. Exposures Attendance at an end-of-life conversation game (Hello) played in groups of 4 to 6 participants for 60 minutes. Design, Setting, and Participants Prospective, mixed-methods cohort study conducted from 2018 to 2019 with a 3- to 11-month follow-up interview. Game events were held in 53 community venues across the US; 15 were purposively sampled for onsite research procedures. Of 428 attendees at purposively sampled sites, 386 (90%) consented to research procedures (6 attendees were removed from analysis for protocol deviation). Of 367 attendees who provided accurate contact information, 232 (63%) were contacted, and 220 were included in follow-up analyses. Main Outcomes and Measures The primary outcome was advance directive completion rates after the intervention. Secondary outcomes included rates of other ACP behaviors, ACP engagement, conversation satisfaction and realism, and participants' Net Promoter Score (a measure of endorsement). Follow-up telephone interviews explored the game experience and relevant ACP behaviors of attendees. Results Of 380 individuals who participated (mean [SD] age, 62.2 [13.8] years; 304 were female [80%], and 348 were [92%] African American), none withdrew because of an adverse event. After the intervention, 91 of 220 attendees (41%) completed a new advance directive; 176 of 220 attendees (80%) discussed end-of-life wishes with loved ones, and 214 of 219 attendees (98%) completed at least 1 ACP behavior. There was a moderate increase in the self-efficacy domain on the ACP Engagement Survey (mean [SD] change from before to after the game, 0.54 [0.98]; P < .001). The mean (SD) conversation satisfaction score was 6.21 (0.93) (range, 1-7, with 7 being highest satisfaction), and the overall Net Promoter Score was 57.89 (range, -100 to 100, with 100 being highest endorsement). Interviews revealed 5 themes about the game: (1) it was a useful forum for ACP; (2) it provided new information and perspective; (3) it was emotionally beneficial; (4) it increased appreciation for ACP; and (5) it empowered and motivated participants to perform ACP. Mixed-methods integration showed convergence across data sets. Conclusions and Relevance Among a nationwide sample of African American individuals, the end-of-life conversation game appeared to be well received and was associated with high rates of ACP behavior. This low-cost and scalable tool may help reduce health disparities associated with end-of-life care.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Benjamin H. Levi
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Pamela Witt
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | | | - A. Rose Levi
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vernon Chinchilli
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Amy Tucci
- Hospice Foundation of America, Washington, DC
| | - Michael J. Green
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
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Donesky D, Anderson WG, Joseph RD, Sumser B, Reid TT. TeamTalk: Interprofessional Team Development and Communication Skills Training. J Palliat Med 2020; 23:40-47. [DOI: 10.1089/jpm.2019.0046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- DorAnne Donesky
- School of Nursing, Touro University of California, Vallejo, California
| | - Wendy G. Anderson
- Division of Palliative Medicine, University of California, San Francisco (UCSF), San Francisco, California
| | - Rev Denah Joseph
- Division of Palliative Medicine, University of California, San Francisco (UCSF), San Francisco, California
| | - Bridget Sumser
- Division of Palliative Medicine, University of California, San Francisco (UCSF), San Francisco, California
| | - Thomas T. Reid
- Division of Palliative Medicine, University of California, San Francisco (UCSF), San Francisco, California
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Van Scoy LJ, Green MJ, Volpe R. Evaluating an Advance Care Planning Curriculum: a Lecture, a Game, a Patient, and an Essay. MEDICAL SCIENCE EDUCATOR 2019; 29:453-462. [PMID: 34457502 PMCID: PMC8368620 DOI: 10.1007/s40670-019-00713-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Curricula on advance care planning are commonly absent or inadequate in the majority of medical schools. This study assessed an advance care planning mini-curriculum involving a lecture, an end-of-life conversation game, a patient encounter during which students facilitated completion of an advance directive, and a subsequent reflective essay. METHODS This convergent, mixed methods study used a pre-post, longitudinal design. Confidence having end-of-life conversations was assessed at three timepoints. A linear mixed effects model compared mean confidence at the three timepoints. Focus groups and open-ended questionnaires (analyzed using content analysis) explored student perceptions of the curricula. RESULTS Sixty-nine of 149 students completed the questionnaires; 18 students participated in the focus groups. Confidence scores increased by 10.3 points (+ 4.2 post-lecture/game; + 6.1 post-patient assignment/essay; p < 0.001 for all timepoints). Students felt the game (1) was a good "starting point" for learning to initiate end-of-life conversations; (2) fostered internal and external reflections about advance care planning; and (3) allowed exploration of the complexities of end-of-life discussions. Qualitative exploration suggested that high-level learning-interpreted through the lens of Bloom's taxonomy-occurred. CONCLUSION Mixed methods data suggest that the advance care planning mini-curriculum effectively increased student confidence having end-of-life conversations. Qualitative analyses revealed student learning covering all of tiers of Bloom's taxonomy.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Medicine, Humanities and Public Health Sciences, Pennsylvania State University College of Medicine, 500 University Drive, H041, PO Box 850, Hershey, PA 17033 USA
| | - Michael J. Green
- Humanities and Medicine, Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850, Hershey, PA 17033 USA
| | - Rebecca Volpe
- Humanities, Pennsylvania State University College of Medicine, 500 University Drive, PO Box 850, Hershey, PA 17033 USA
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