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Walsh CA, Miller SJ, Smith CB, Prigerson HG, McFarland D, Yarborough S, Santos CDL, Thomas R, Czaja SJ, RoyChoudhury A, Chapman-Davis E, Lachs M, Shen MJ. Acceptability and usability of the Planning Advance Care Together (PACT) website for improving patients' engagement in advance care planning. PEC INNOVATION 2024; 4:100245. [PMID: 38145252 PMCID: PMC10733677 DOI: 10.1016/j.pecinn.2023.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
Objectives Most prior advance care planning (ACP) interventions lack integration of the social context of patients' ACP process, which patients indicate is critically important. The current study developed the Planning Advance Care Together (PACT) website to foster inclusion of loved ones in the ACP process. Methods To provide feedback about the PACT website, patients with advanced cancer (N = 11), their caregivers (N = 11), and experts (N = 10) participated in semi-structured interviews. Patients and caregivers also completed standardized ratings of acceptability and usability. Results Overall, patient (n = 11) and caregiver (n = 11) ratings of acceptability and usability of the website exceeded benchmark cut-offs (≥24 on the Acceptability E-Scale and ≥ 68 on the System Usability Scale). Patients, caregivers, and experts liked the topic of ACP but felt that it could be emotionally challenging. They recommended focusing more on planning and less on end of life. They appreciated being able to include loved ones and recommended adding resources for caregivers. Conclusions Study findings support the preliminary usability and acceptability of the PACT website. Findings will be used to inform a modified prototype of the PACT website that is interactive and ready for field testing with patients with advanced cancer and their loved ones. Innovation We utilized a novel application of the shared mind framework to support patients with advanced cancer in engaging their loved ones in the ACP process.
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Affiliation(s)
- Casey A. Walsh
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Sarah J. Miller
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Cardinale B. Smith
- Division of Hematology and Medical Oncology, Division of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Holly G. Prigerson
- Department of Medicine, Cornell Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, NY, United States of America
| | - Daniel McFarland
- Department of Psychiatry, Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Sarah Yarborough
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Claudia De Los Santos
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
| | - Robert Thomas
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Sara J. Czaja
- Division of Geriatrics and Palliative Medicine, Center on Aging and Behavioral Research, Weill Cornell Medicine, New York, NY, United States of America
| | - Arindam RoyChoudhury
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, United States of America
| | - Eloise Chapman-Davis
- Division of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, United States of America
| | - Mark Lachs
- Department of Medicine, Weill Cornell Medical College, New York, NY, United States of America
- Geriatrics and Palliative Medicine, New York Presbyterian Health Care System, United States of America
| | - Megan J. Shen
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, United States of America
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Coupat C, Allard E. Beyond stages: Comment on Tan et al. (2024) 'Stages of readiness for advance care planning: Systematic review and meta-analysis of prevalence rates and associated factors'. Int J Nurs Stud 2024; 156:104782. [PMID: 38744149 DOI: 10.1016/j.ijnurstu.2024.104782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Clémence Coupat
- Faculty of Nursing, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, QC H3T 1J4, Canada.
| | - Emilie Allard
- Faculty of Nursing, Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, QC H3T 1J4, Canada; Research Center, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, QC, Canada
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Zhang P, Clem S, Rose R, Cagle JG. Exposure to a Loved One's Death and Advance Care Planning: Moderating Effects of Age. Am J Hosp Palliat Care 2024; 41:739-746. [PMID: 37403753 DOI: 10.1177/10499091231188689] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Background: Despite documented benefits of Advance Care Planning (ACP), it is still under-utilized in the U.S. Our study aimed to examine whether experiencing a loved one's death is associated with one's own ACP behavior among adults in the U.S. and the potential moderating effect of age. Method: Using a nationwide cross-sectional survey design with probability sampling weights, our study included 1006 adults in the U.S. who participated in and completed the Survey on Aging and End-of-Life Medical Care. Three binary logistic regression models were established to investigate the relationship between death exposure and different aspects of ACP (i.e., informal conversations with family members and doctors and formal advance directives completion). The moderation analysis was subsequently conducted to examine moderating effects of age. Results: The exposure to a loved one's death was significantly associated with higher odds of having conversations with family about end-of-life medical care preferences among the 3 indicators of ACP (OR = 2.03, P < .001). Age significantly moderated the association between death exposure and ACP conversations with doctors (OR = .98, P = .017). The facilitation effect of death exposure on informal ACP engagement in discussing end-of-life medical wishes with doctors is stronger among younger adults than older adults. Conclusions: Exploring an individual's previous experience with a loved one's death might be an effective way to broach the concept of ACP among adults of all ages. This strategy may be particularly useful in facilitating discussions of end-of-life medical wishes with doctors among younger adults than older adults.
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Affiliation(s)
- Peiyuan Zhang
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Sarah Clem
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Roderick Rose
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - John G Cagle
- University of Maryland School of Social Work, Baltimore, MD, USA
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Konno R, Inoue K, Matsushita Y, Hashimoto K, Wiechula R, To T, Schultz TJ. Barriers to Advance Care Planning in Older Adults With Dementia, Their Families and Healthcare Professionals: An Umbrella Review of Qualitative Evidence. Res Aging 2024; 46:339-358. [PMID: 38242164 DOI: 10.1177/01640275241227909] [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: 01/21/2024]
Abstract
This umbrella review aimed to examine and synthesize qualitative studies that explored the barriers and facilitators of advance care planning for persons with dementia, their families, and their healthcare professionals and caregivers. The modified umbrella review approach developed by the Joanna Briggs Institute was followed. Five major English databases were searched. Four reviews based on 38 primary qualitative studies were included. The methodological quality of the included reviews was moderate to high. The synthesis yielded 16 descriptive themes and five analytical themes: making the wishes/preferences of persons with dementia visible; constructive collaboration based on stakeholders having positive relationships; emotional chaos in facing end-of-life substitute decision-making; initiating the advance care planning process; and preparedness and commitment of healthcare providers to advance care planning. Comprehensive and workable strategies are required to overcome complex and interrelated barriers involving not only healthcare professionals but also organizational and systemic challenges.
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Affiliation(s)
- Rie Konno
- Faculty of Nursing, Hyogo Medical University, Kobe-shi, Japan
| | - Kumiyo Inoue
- School of Nursing, University of Tasmania, Hobart, TAS, Australia
| | | | | | - Richard Wiechula
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Timothy To
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Timothy J Schultz
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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Paulik O, Whitaker R, Mesuria M, Wong D, Swanson K, Green H, Sikhosana N, Fernandez R. Implementation and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT™) in acute care. Australas J Ageing 2024. [PMID: 38558296 DOI: 10.1111/ajag.13308] [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: 12/04/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES The Supportive and Palliative Care Indicators Tool (SPICT™) has been used to identify patients at risk of deteriorating and dying within 1 year. Early identification and integration of advance care planning (ACP) provides the opportunity for a better quality of life for patients. The aims of this study were to identify the number of patients who were SPICT™ positive; their mortality rates at 6 and 12 months of the SPICT™ assessment; and level of adherence to ACP documentation. METHODS A retrospective audit of the Supportive and Palliative Care database was conducted at an acute aged care precinct in a major metropolitan tertiary referral hospital in New South Wales, Australia. Data comprising demographics, clinical conditions, SPICT™ positivity and compliance with ACP documentation were collected. SPICT™-positive patients and mortality were tracked at 6 and 12 months, respectively. RESULTS Data from 153 patients were collected. The mean age of the patients was 84.1 (±7.8) years, and the length of hospital stay was 10 (±24.7) (range 1-269) days. Approximately 37% were from residential care, and 80% had family deciding on their care. About 15% died during hospitalisation, and 48% were discharged to a care facility. The ACP documentation showed various levels of completion. Mortality rates at 6 and 12 months were 36% and 39%, respectively. Most patients (99%) were SPICT™-positive, with indicators correlating with higher mortality rates at both follow-ups. CONCLUSIONS The study emphasises the critical need for addressing ACP and palliative care among older patients with life-limiting conditions. It underscores the importance of timely discussions, documentation, and cessation of futile interventions.
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Affiliation(s)
- Olivia Paulik
- St George Hospital, Sydney, New South Wales, Australia
| | | | | | - Debbie Wong
- St George Hospital, Sydney, New South Wales, Australia
| | - Katie Swanson
- St George Hospital, Sydney, New South Wales, Australia
| | - Heidi Green
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nqobile Sikhosana
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ritin Fernandez
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
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van Doorne I, Willems DL, Baks N, de Kuijper J, Buurman BM, van Rijn M. Current practice of hospital-based palliative care teams: Advance care planning in advanced stages of disease: A retrospective observational study. PLoS One 2024; 19:e0288514. [PMID: 38422038 PMCID: PMC10903912 DOI: 10.1371/journal.pone.0288514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/29/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Specialist palliative care teams are consulted during hospital admission for advice on complex palliative care. These consultations need to be timely to prevent symptom burden and maintain quality of life. Insight into specialist palliative care teams may help improve the outcomes of palliative care. METHODS In this retrospective observational study, we analyzed qualitative and quantitative data of palliative care consultations in a six-month period (2017 or 2018) in four general hospitals in the northwestern part of the Netherlands. Data were obtained from electronic medical records. RESULTS We extracted data from 336 consultations. The most common diagnoses were cancer (54.8%) and organ failure (26.8%). The estimated life expectancy was less than three months for 52.3% of all patients. Within two weeks after consultation, 53.2% of the patients died, and the median time until death was 11 days (range 191) after consultation. Most patients died in hospital (49.4%) but only 7.5% preferred to die in hospital. Consultations were mostly requested for advance care planning (31.6%). End-of-life preferences focused on last wishes and maintaining quality of life. CONCLUSION This study provides detailed insight into consultations of palliative care teams and shows that even though most palliative care consultations were requested for advance care planning, consultations focus on end-of-life care and are more crisis-oriented than prevention-oriented. Death often occurs too quickly after consultation for end-of-life preferences to be met and these preferences tend to focus on dying. Educating healthcare professionals on when to initiate advance care planning would promote a more prevention-oriented approach. Defining factors that indicate the need for timely palliative care team consultation and advance care planning could help timely identification and consultation.
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Affiliation(s)
- Iris van Doorne
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
| | - Dick L. Willems
- Amsterdam UMC Location University of Amsterdam, General Practice, Section of Medical Ethics, Amsterdam, The Netherlands
| | - Nadine Baks
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
| | - Jelle de Kuijper
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
| | - Bianca M. Buurman
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Amsterdam, The Netherlands
| | - Marjon van Rijn
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Amsterdam, The Netherlands
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Golmohammadi M, Ebadi A, Ashrafizadeh H, Rassouli M, Barasteh S. Factors related to advance directives completion among cancer patients: a systematic review. BMC Palliat Care 2024; 23:3. [PMID: 38166983 PMCID: PMC10762918 DOI: 10.1186/s12904-023-01327-w] [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: 02/12/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Advance directives (ADs) has recently been considered as an important component of palliative care for patients with advanced cancer and is a legally binding directive regarding a person's future medical care. It is used when a person is unable to participate in the decision-making process about their own care. Therefore, the present systematic review investigated the factors related to ADs from the perspective of cancer patients. METHODS A systematic review study was searched in four scientific databases: PubMed, Medline, Scopus, Web of Science, and ProQuest using with related keywords and without date restrictions. The quality of the studies was assessed using the Hawker criterion. The research papers were analyzed as directed content analysis based on the theory of planned behavior. RESULTS Out of 5900 research papers found, 22 were included in the study. The perspectives of 9061 cancer patients were investigated, of whom 4347 were men and 4714 were women. The mean ± SD of the patients' age was 62.04 ± 6.44. According to TPB, factors affecting ADs were categorized into four categories, including attitude, subjective norm, perceived behavioral control, and external factors affecting the model. The attitude category includes two subcategories: "Lack of knowledge of the ADs concept" and "Previous experience of the disease", the subjective norm category includes three subcategories: "Social support and interaction with family", "Respecting the patient's wishes" and "EOL care choices". Also, the category of perceived control behavior was categorized into two sub-categories: "Decision-making" and "Access to the healthcare system", as well as external factors affecting the model, including "socio-demographic characteristics". CONCLUSION The studies indicate that attention to EOL care and the wishes of patients regarding receiving medical care and preservation of human dignity, the importance of facilitating open communication between patients and their families, and different perspectives on providing information, communicating bad news and making decisions require culturally sensitive approaches. Finally, the training of cancer care professionals in the palliative care practice, promoting the participation of health care professionals in ADs activities and creating an AD-positive attitude should be strongly encouraged.
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Affiliation(s)
- Mobina Golmohammadi
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hadis Ashrafizadeh
- Student Research Committee, Faculty of Nursing, Dezful University of Medical Sciences, Dezful, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Choi J, Jeon H, Lee I. Characteristics of Life-Sustaining Treatment Decisions: National Data Analysis in South Korea. Asian Bioeth Rev 2024; 16:33-46. [PMID: 38213986 PMCID: PMC10776518 DOI: 10.1007/s41649-023-00266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 01/13/2024] Open
Abstract
This study analyzed the national data on life-sustaining treatment decisions from 2018 to 2020 to find out the characteristics of South Korea's end-of-life procedure according to the decision-making approach and process. We collected the data of 84,422 patients registered with the National Agency for Management of Life-sustaining Treatment. We divided the patients into four groups (G1, G2, G3, and G4) according to the decision-making approach. A descriptive analysis of each group was conducted using indicators such as the patient's age, status, diagnosis, and content of forgoing life-sustaining treatment. Additionally, logistic regression analysis was performed by dividing the patients into self-determining (G1, G2) and non-self-determining patients (G3, G4). Cancer was the most common diagnosis for each group. The period from life-sustaining treatment decision to implementation was 10.76, 1.01, 0.86, and 1.19 days for G1, G2, G3, and G4, respectively. In the logistic regression analysis, the self-determination ratio was higher for 40-49 years old and lower for cardiovascular disease and gastrointestinal disease. Age was has a major impact on life-sustaining treatment decisions (LSTD), and with increase in age, the family, and not the patient, made the LSTD. The LSTD method also differed depending on the disease. The self-determination rates of patients with circulatory or digestive diseases were somewhat lower than that of those with neoplastic diseases. The period from decision-making to implementation is short for end-of-life care.
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Affiliation(s)
- Jiyeon Choi
- Division of Medical Law and Ethics, Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Heejung Jeon
- Department of Nursing, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Ilhak Lee
- Department of Medical Humanities and Social Sciences, College of Medicine, Yonsei University, Seoul, Republic of Korea
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Ekkel MR, Depla MFIA, Sakhizadah Z, Verschuur EML, Veenhuizen RB, Onwuteaka-Philipsen BD, Hertogh CMPM. Advance Care Planning in Huntington Disease: The Elderly Care Physician's Perspective. J Am Med Dir Assoc 2023; 24:1843-1848.e1. [PMID: 37586417 DOI: 10.1016/j.jamda.2023.07.006] [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: 10/26/2022] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE Huntington disease (HD) has a poor prognosis. Decision-making capacity and communication ability may become impaired as the disease progresses. Therefore, HD patients are encouraged to engage in advance care planning (ACP). Elderly care physicians (ECPs) can play an important role in ACP in HD patients. However, little is known about their experiences in this role. The aim of this study is to gain insight into how ECPs practice ACP with HD patients. DESIGN A qualitative interview study. SETTING AND PARTICIPANTS Nine ECPs working in HD-specialized nursing homes in the Netherlands. METHODS We conducted semistructured interviews with ECPs between June 2018 and July 2020. RESULTS Two phases could be identified in the process of ACP. In the first phase, when the feared future seems to be far away, the ECP asks about the patient's wishes for the future in an accommodating manner. In the second phase, when the feared future is closer, future medical treatment and care becomes less hypothetical. Agreement has to be reached on upcoming treatment decisions. In this phase, the ECP takes a more guiding role, and consequently encounters more difficulties, such as maintaining a positive patient/family-physician relationship while dealing with disagreements with patient or family. Most participants shared their experiences with euthanasia when asked about ACP. When making a comparison of ACP between HD patients and patients with other neurodegenerative disorders in nursing homes, the ECPs emphasized the similarities. CONCLUSIONS AND IMPLICATIONS ACP in HD can be classified into 2 phases, which differ in ECPs' approach and the complexity experienced by the ECP. Awareness of this finding may help to further develop training and education in ACP, including dealing with euthanasia, to make ECPs feel better equipped in practicing ACP in HD.
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Affiliation(s)
- Marina R Ekkel
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Huntington Expert Centre Atlant, Apeldoorn, the Netherlands.
| | - Marja F I A Depla
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | - Zahra Sakhizadah
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | | | - Ruth B Veenhuizen
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Huntington Expert Centre Atlant, Apeldoorn, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Department of Public and Occupational Health, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
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Carter RZ, Hassan E, Porterfield P, Barwich D. A model for community-led peer-facilitated advance care planning workshops for the public. Palliat Care Soc Pract 2023; 17:26323524231212515. [PMID: 38033874 PMCID: PMC10685751 DOI: 10.1177/26323524231212515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023] Open
Abstract
Background The core to successful advance care planning (ACP) facilitation is helping people determine their values, beliefs and wishes, and understand substitute decision-making. Recognizing the potential for community members to support public awareness and education we developed a model of ACP education, whereby peer facilitators associated with community organizations host workshops that educate and assist members of the public with ACP. Objectives Describe the development and evaluation of the model for community-led peer-facilitated ACP workshops for the public. Design Descriptive mixed methods. Methods A training curriculum and program model were co-developed with two community organizations that had been successful in delivering ACP workshops independently in their communities. Herein we describe a mixed-methods evaluation of three cycles of implementation and improvement of the model. Results The model centers on three key concepts; the right content (based around three steps Think, Talk, Plan), the right facilitator, and the right approach. A suite of tools was designed to support the three groups involved in the delivery of the ACP workshops: the public participants, the peer facilitators, and the community-based organizations. The peer-facilitator training addresses the facilitator's learning needs of ACP content knowledge, facilitation skills, and understanding change behavior. Training evaluation data from 106 facilitators confirmed that the curriculum prepared them to facilitate the workshops. Qualitative data revealed that support from organizations with established reputations in their community is critical, with mentoring from more experienced facilitators beneficial. Conclusion Our model demonstrates the potential of community-led, peer-facilitated ACP initiatives to enhance the capacity of community to upstream ACP conversations. Reaching a broader audience and creating a supportive, inclusive environment for individuals to comfortably learn about ACP can drive the much-needed culture shift to normalize ACP. Meaningful community engagement, empowerment, and partnerships are essential for the successful development and widespread impact of these initiatives.
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Affiliation(s)
- Rachel Z Carter
- Division of Palliative Care, The University of British Columbia, 6389 Stadium Road, Vancouver, BC V6T 1Z4, Canada
- BC Centre for Palliative Care, PMB 691, 101-1001 W. Broadway, Vancouver, BC V6H 4E4, Canada
| | - Eman Hassan
- BC Centre for Palliative Care, Vancouver, BC, Canada
- Division of Palliative Care, The University of British Columbia, Vancouver, BC, Canada
| | | | - Doris Barwich
- BC Centre for Palliative Care, Vancouver, BC, Canada
- Division of Palliative Care, The University of British Columbia, Vancouver, BC, Canada
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Kato H, Iwasaki T, Ko A, Nishina Y, Tanigaki S, Norikoshi C, Sakai M, Ito M, Harasawa N, Tamura K, Nagae H. Experiences of dialogue in advance care planning educational programs. Nurs Ethics 2023:9697330231166086. [PMID: 37496291 DOI: 10.1177/09697330231166086] [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: 07/28/2023]
Abstract
BACKGROUND Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown. OBJECTIVE To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life. RESEARCH DESIGN This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2 years; 50 women and 16 men) participated in focus group interviews. ETHICAL CONSIDERATIONS This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099). FINDINGS Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values. CONCLUSIONS The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.
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Affiliation(s)
| | | | | | | | | | | | | | - Mari Ito
- Kawasaki Medical School General Medical Center, Japan
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Krawczyk M, Clare E, Collins E, Farr S, Johnson E, Mallmes J, Mallon A, Oberle K, Rigal J. End-of-life doulas: international reflections on a transnational movement. Palliat Care Soc Pract 2023; 17:26323524231186826. [PMID: 37521504 PMCID: PMC10375035 DOI: 10.1177/26323524231186826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023] Open
Abstract
This review article summarizes the findings from the first virtual International End-of-Life Doula Symposium, held over 3 days on 25-27 April 2022. More than 40 people attended from seven countries, predominantly from Australia, Canada, the United States and the United Kingdom, and they were primarily experienced practitioners. In this article, we focus on participants' topics of conversations and experiences that were relevant across international boundaries, organized through the symposium themes of developments, disruptions, dilemmas and directions. All authors took de-identified handwritten notes across the 3 days of discussion, as well as reflexive notes about our own thoughts and perspectives on the topics discussed. We then collated our notes and abductively focussed our analysis on topics that generated significant conversation and/or came up repeatedly within the overall symposium themes, as well as trying to capture any unexpected issues and perspectives. We identify and summarize a wide range of interests and concerns within the development of the end-of-life doula (EOLD) role. We provide a model for integration pathways within existing health care systems, as well as an innovative conceptual framework synthesizing key intersecting developmental issues that are relevant across regional and national boundaries. The symposium was the first opportunity for EOLDs to collectively discuss their work and interests within an international context. Our findings indicate that there are fundamentally similar developmental issues across countries, along with some variations. As the first international event of its kind, our 'state of the field' summary review of the symposium holds significant insights relevant to both national and international contexts, and to a diversity of stakeholders interested in the development of this new care role and emerging transnational movement.
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Affiliation(s)
- Marian Krawczyk
- College of Social Sciences, University of Glasgow, Rutherford/McCowan Building, Crichton University Campus, Dumfries, Scotland DG1 4ZL, UK
| | | | | | - Sarah Farr
- College of Social Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | - Kelly Oberle
- College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Jennifer Rigal
- College of Social Sciences, University of Glasgow, Glasgow, UK
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De Vleminck A, Van den Block L. How to enhance advance care planning research? Palliat Med 2023; 37:660-662. [PMID: 37246312 DOI: 10.1177/02692163231170658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Aline De Vleminck
- Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
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van Doorne I, Mokkenstorm K, Willems D, Buurman B, van Rijn M. The perspectives of in-hospital healthcare professionals on the timing and collaboration in advance care planning: A survey study. Heliyon 2023; 9:e14772. [PMID: 37095949 PMCID: PMC10121622 DOI: 10.1016/j.heliyon.2023.e14772] [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: 09/10/2022] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 04/26/2023] Open
Abstract
Background Hospital admissions are common in the last phase of life. However, palliative care and advance care planning (ACP) are provided late or not at all during hospital admission. Aim To provide insight into the perceptions of in-hospital healthcare professionals concerning current and ideal practice and roles of in-hospital palliative care and advance care planning. Methods An electronic cross-sectional survey was send 398 in-hospital healthcare professionals in five hospitals in the Netherlands. The survey contained 48 items on perceptions of palliative care and ACP. Results We included non-specialists who completed the questions of interest, resulting in analysis of 96 questionnaires. Most respondents were nurses (74%). We found that current practice for initiating palliative care and ACP was different to what is considered ideal practice. Ideally, ACP should be initiated for almost every patient for whom no treatment options are available (96.2%), and in case of progression and severe symptoms (94.2%). The largest differences between current and ideal practice were found for patients with functional decline (Current 15.2% versus Ideal 78.5%), and patients with an estimated life expectancy <1 year (Current 32.6% versus ideal 86.1%). Respondents noted that providing palliative care requires collaboration, however, especially nurses noted barriers like a lack of inter-professional consensus. Conclusions The differences between current and ideal practice demonstrate that healthcare professionals are willing to improve palliative care. To do this, nurses need to increase their voice, a shared vision of palliative care and recognition of the added value of working together is needed.
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Affiliation(s)
- I. van Doorne
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Corresponding author. Amsterdam University Medical Center, University of Amsterdam Department of Internal Medicine, Section of Geriatric Medicine, Room D3-335 Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - K. Mokkenstorm
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - D.L. Willems
- Amsterdam UMC Location University of Amsterdam, General Practice, Section of Medical Ethics, Meibergdreef 9, Amsterdam, the Netherlands
| | - B.M. Buurman
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, the Netherlands
| | - M. van Rijn
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, the Netherlands
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van Lummel EVTJ, Meijer Y, Tjan DHT, van Delden JJM. Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study. BMC Palliat Care 2023; 22:24. [PMID: 36922796 PMCID: PMC10015131 DOI: 10.1186/s12904-023-01139-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Advance Care Planning (ACP) enables patients to define and discuss their goals and preferences for future medical treatment and care. However, the structural implementation of ACP interventions remains challenging. The Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention has recently been developed which takes into account existing barriers and facilitators. We aimed to evaluate the MUTUAL intervention and identify the barriers and facilitators healthcare professionals experience in the implementation of the MUTUAL intervention and also to identify suggestions for improvement. METHODS We performed a sequential exploratory mixed-methods study at five outpatient clinics of one, 300-bed, non-academic hospital. Firstly, semi-structured interviews were performed with a purposive sample of healthcare professionals. The content of these interviews was used to specify the Measurement Instrument for Determinants of Innovations (MIDI). The MIDI was sent to all healthcare professionals. The interviews and questionnaires were used to clarify the results. RESULTS Eleven healthcare professionals participated in the interviews and 37 responded to the questionnaire. Eight barriers and 20 facilitators were identified. Healthcare professionals agreed that the elements of the MUTUAL intervention are clear, correct, complete, and simple - and the intervention is relevant for patients and their proxies. The main barriers are found within the user and the organisational domain. Barriers related to the organisation include: inadequate replacement of staff, insufficient staff, and insufficient time to introduce and invite patients. Several suggestions for improvement were made. CONCLUSION Our results show that healthcare professionals positively evaluate the MUTUAL intervention and are very receptive to implementing the MUTUAL intervention. Taking into account the suggestions for improvement may enhance further implementation.
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Affiliation(s)
- Eline V T J van Lummel
- Department of Intensive Care, Gelderse Vallei hospital, Ede, Netherlands. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Yoeki Meijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dave H T Tjan
- Department of Intensive Care, Gelderse Vallei hospital, Ede, Netherlands
| | - Johannes J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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van Baal K, Wiese B, Müller-Mundt G, Stiel S, Schneider N, Afshar K. Quality of end-of-life care in general practice – a pre–post comparison of a two-tiered intervention. BMC PRIMARY CARE 2022; 23:90. [PMID: 35443614 PMCID: PMC9022313 DOI: 10.1186/s12875-022-01689-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/04/2022] [Indexed: 11/14/2022]
Abstract
Background General practitioners (GPs) play a crucial role in the provision of end-of-life care (EoLC). The present study aimed at comparing the quality of GPs’ EoLC before and after an intervention involving a clinical decision aid and a public campaign. Methods The study was part of the larger interventional study ‘Optimal care at the end of life’ (OPAL) (Innovation Fund, Grant No. 01VSF17028). The intervention lasted 12 months and comprised two components: (1) implementation of the Supportive and Palliative Care Indicators Tool (SPICT-DE™) in general practice and (2) a public campaign in two German counties to inform and connect regional health care providers and stakeholders in EoLC. Participating GPs completed the General Practice End of Life Care Index (GP-EoLC-I) pre- (t0) and post- (t1) intervention. The GP-EoLC-I (25 items, score range: 14–40) is a self-assessment questionnaire that measures the quality of GPs’ EoLC. It includes two subscales: practice organisation and clinical practice. Data were analysed descriptively, and a paired t-test was applied for the pre–post comparison. Results Forty-five GPs (female: 29%, median age: 57 years) from 33 general practices participated in the intervention and took part in the survey at both times of measurement (t0 and t1). The mean GP-EoLC-I score (t0 = 27.9; t1 = 29.8) increased significantly by 1.9 points between t0 and t1 (t(44) = − 3.0; p = 0.005). Scores on the practice organisation subscale (t0 = 6.9; t1 = 7.6) remained almost similar (t(44) = -2.0; p = 0.057), whereas those of the clinical practice subscale (t0 = 21.0; t1 = 22.2) changed significantly between t0 and t1 (t(44) = -2.6; p = 0.011). In particular, items regarding the record of care plans, patients’ preferred place of care at the end of life and patients’ preferred place of death, as well as the routine documentation of impending death, changed positively. Conclusions GPs’ self-assessed quality of EoLC seemed to improve after a regional intervention that involved both the implementation of the SPICT-DE™ in daily practice and a public campaign. In particular, improvement related to the domains of care planning and documentation. Trial registration The study was registered in the German Clinical Trials Register (DRKS00015108; 22/01/2019).
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Perry J. Challenges of anticipation of future decisions in dementia and dementia research. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:62. [PMID: 36376514 PMCID: PMC9663374 DOI: 10.1007/s40656-022-00541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 09/27/2022] [Indexed: 06/16/2023]
Abstract
Anticipation of future decisions can be important for individuals at risk for diseases to maintain autonomy over time. For future treatment and care decisions, advance care planning is accepted as a useful anticipation tool. As research with persons with dementia seems imperative to develop disease-modifying interventions, and with changing regulations regarding research participation in Germany, advance research directives (ARDs) are considered a solution to include persons with dementia in research in an ethically sound manner. However, little is known about what affected people deem anticipatable.This contribution provides a critical reflection of the literature on anticipation and of a qualitative study on the assessment of ARDs with persons with cognitive impairment in Germany. It combines theoretical and empirical reflections to inform the ethical-legal discourse.Anticipation involves the conceptual separation of the past, the present, and the future. Including dimensions such as preparedness, injunction, and optimization helps in establishing a framework for anticipatory decision-making. While dementia may offer a window of time to consider future decisions, individual beliefs about dementia including fears about stigma, loss of personhood, and solitude strongly impact anticipating sentiments. Concepts of anticipation can be useful for the examination of uncertainty, changing values, needs, and preferences interconnected with the dementia trajectory and can serve as a means to make an uncertain future more concrete. However, fears of losing one's autonomy in the process of dementia also apply to possibilities of anticipation as these require cognitive assessment and reassessment of an imagined future with dementia.
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Affiliation(s)
- Julia Perry
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Humboldtallee 36, 37073, Göttingen, Germany.
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Wilson E, Caswell G, Turner N, Pollock K. Talking about death and dying: Findings from deliberative discussion groups with members of the public. MORTALITY (ABINGDON, ENGLAND) 2022; 29:176-192. [PMID: 38293271 PMCID: PMC10824017 DOI: 10.1080/13576275.2022.2136515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Talking about death and dying is promoted in UK health policy and practice, from a perception that to do so encourages people to plan for their end of life and so increase their likelihood of experiencing a good death. This encouragement occurs alongside a belief that members of the public are reluctant to talk about death, although surveys suggest this is not the case. This paper describes findings from a research study in which people participated in deliberative discussion groups during which they talked about a range of topics related to death, including talking about death, the good death, choice and planning and compassionate communities. Here we report what they had to say in relation to talking about death and dying. We identified three themes: 1. The difference between talking about death as an abstract concept and confronting the certainty of death, 2. how death and dying presents issues for planning and responsibility, and 3. approaches to normalising death within society. For our participants, planning was considered most appropriate in relation to wills and funerals, while dying was considered too unpredictable to be easy to plan for; they had complex ideas about the value of talking about death and dying.
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Affiliation(s)
- Eleanor Wilson
- NCARE, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- NCARE, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nicola Turner
- NCARE, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Kristian Pollock
- NCARE, School of Health Sciences, University of Nottingham, Nottingham, UK
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Yang Z, Wang H, Wang A. Psychometric evaluation of the Chinese version of advance care planning self-efficacy scale among clinical nurses. BMC Palliat Care 2022; 21:175. [PMID: 36207699 PMCID: PMC9541061 DOI: 10.1186/s12904-022-01064-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background Nurses are one of the most critical members of advance care planning (ACP) discussion. The evaluation of ACP self-efficacy is of great significance for developing targeted ACP interventions among clinical nurses and update their professional roles. However, there are few instruments to evaluate their ACP self-efficacy in mainland China. The purpose of this study was to translate the ACP self-efficacy scale into Chinese and evaluate its psychometric properties among clinical nurses. Methods A methodological study of the translation and validation of the ACP self-efficacy scale was conducted from January to March 2022. It involved three phases: (1) the translation and revision of the scale; (2) the exploration and evaluation of the item (n = 436); (3) the psychometric evaluation of the scale (n = 674). Results After a rigorous translation and revision, the ACP self-efficacy scale with three dimensions and 16 items was finally formed. In this study, the critical ratios of the item ranged from 8.226 to 17.499, and the item-total correlation coefficients ranged from 0.437 to 0.732, and the factor loadings of the item ranged from 0.638 to 0.882. The content validity index of the scale was 0.946. Supported by the eigenvalues, the three-factor structure explained the cumulative 61.131% of the overall variance. As the results of confirmatory factor analysis, all the recommended fitting indexes were appropriate. The average variance extracted values ranged from 0.570 to 0.756, and the composite reliability values ranged from 0.858 to 0.925. The total Cronbach's α coefficient, split-half reliability coefficient and test–retest reliability coefficient of the scale were 0.896, 0.767 and 0.939, respectively. Conclusion The Chinese version of ACP self-efficacy scale was successfully introduced into China, showing good psychometric properties among clinical nurses, and can effectively assess the ACP self-efficacy. Also, the scale can provide nursing educators with a significant strategy to develop ACP educational procedure and post-intervention measures for clinical nurses to improve nurse-led ACP practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01064-6.
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Affiliation(s)
- Zhen Yang
- The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Huan Wang
- The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China
| | - Aiping Wang
- The First Affiliated Hospital of China Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, China.
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Mallidou AA, Tschanz C, Antifeau E, Lee KY, Mtambo JK, Heckl H. The Medical Orders for Scope of Treatment (MOST) form completion: a retrospective study. BMC Health Serv Res 2022; 22:1186. [PMID: 36131303 PMCID: PMC9492459 DOI: 10.1186/s12913-022-08542-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Advance care planning (ACP) involves discussions about patient and families’ wishes and preferences for future healthcare respecting autonomy, improving quality of care, and reducing overtreatment. The Medical Orders for Scope of Treatment (MOST) form records person preferred level and types of treatment and intervention. Purpose To examine the MOST form use in inpatient units within a British Columbia (Canada) hospital, estimate and compare its completion rate, and inform health policies for continuous, quality and individualized patient care. Methods About 5,000 patients admitted to the participating tertiary acute care hospital during October 2020. Data from 780 eligible participants in medical, surgical, or psychiatry unit were analyzed with descriptive statistics, the chi-square test for group comparisons, and logistic regression to assess predictors of the MOST form completion. Results Participants’ (54% men) age ranged from 20–97 years (mean = 59.53, SD = 19.54). Mainly physicians (99.1%) completed the MOST form for about 60% of them. A statistically significant difference of MOST completion found among the units [Pearson χ2(df=2, n=780) = 79.53, p < .001, φ = .319]. Multivariate logistic regression analysis demonstrated that age (OR = 1.05, 95% CI 1.04 to 1.06) and unit admission (OR = .60, 95% CI 0.36 to 0.99 in psychiatry; and OR = .21, 95% CI 0.14 to 0.31 in surgery) were independently associated with the MOST form completion. Conclusion Our findings demonstrate a need for consistent and broad completion of the MOST form across all jurisdictions using, desirably, advanced electronic systems. Healthcare providers need to raise awareness of the MOST completion benefits and be prepared to discuss topics relevant to end-of-life. Further research is required on the MOST form completion.
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Affiliation(s)
- Anastasia A Mallidou
- School of Nursing, University of Victoria, B236 - HSD Building, 3800 Finnerty (Ring) Road, Victoria, BC, V8P 5C2, Canada.
| | - Coby Tschanz
- School of Nursing, University of Victoria, B236 - HSD Building, 3800 Finnerty (Ring) Road, Victoria, BC, V8P 5C2, Canada
| | - Elisabeth Antifeau
- Palliative Care and End of Life Services, Interior Health, Vancouver, VIC, Canada
| | | | | | - Holly Heckl
- School of Nursing, University of Victoria, B236 - HSD Building, 3800 Finnerty (Ring) Road, Victoria, BC, V8P 5C2, Canada
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Sullivan DR, Iyer AS, Enguidanos S, Cox CE, Farquhar M, Janssen DJA, Lindell KO, Mularski RA, Smallwood N, Turnbull AE, Wilkinson AM, Courtright KR, Maddocks M, McPherson ML, Thornton JD, Campbell ML, Fasolino TK, Fogelman PM, Gershon L, Gershon T, Hartog C, Luther J, Meier DE, Nelson JE, Rabinowitz E, Rushton CH, Sloan DH, Kross EK, Reinke LF. Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/SWHPN Policy Statement. Am J Respir Crit Care Med 2022; 206:e44-e69. [PMID: 36112774 PMCID: PMC9799127 DOI: 10.1164/rccm.202207-1262st] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Patients with serious respiratory illness and their caregivers suffer considerable burdens, and palliative care is a fundamental right for anyone who needs it. However, the overwhelming majority of patients do not receive timely palliative care before the end of life, despite robust evidence for improved outcomes. Goals: This policy statement by the American Thoracic Society (ATS) and partnering societies advocates for improved integration of high-quality palliative care early in the care continuum for patients with serious respiratory illness and their caregivers and provides clinicians and policymakers with a framework to accomplish this. Methods: An international and interprofessional expert committee, including patients and caregivers, achieved consensus across a diverse working group representing pulmonary-critical care, palliative care, bioethics, health law and policy, geriatrics, nursing, physiotherapy, social work, pharmacy, patient advocacy, psychology, and sociology. Results: The committee developed fundamental values, principles, and policy recommendations for integrating palliative care in serious respiratory illness care across seven domains: 1) delivery models, 2) comprehensive symptom assessment and management, 3) advance care planning and goals of care discussions, 4) caregiver support, 5) health disparities, 6) mass casualty events and emergency preparedness, and 7) research priorities. The recommendations encourage timely integration of palliative care, promote innovative primary and secondary or specialist palliative care delivery models, and advocate for research and policy initiatives to improve the availability and quality of palliative care for patients and their caregivers. Conclusions: This multisociety policy statement establishes a framework for early palliative care in serious respiratory illness and provides guidance for pulmonary-critical care clinicians and policymakers for its proactive integration.
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Burghout C, Nahar-van Venrooij LMW, Bolt SR, Smilde TJ, Wouters EJM. Benefits of Structured Advance Care Plan in end-of-Life Care Planning among Older Oncology Patients: A Retrospective Pilot Study. J Palliat Care 2022; 38:30-40. [PMID: 36039518 DOI: 10.1177/08258597221119660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: Studies suggest that advance care planning (ACP) results in improved quality of life and reduced healthcare consumption. We assessed how the use of a structured advance care planning tool (ACPT) in oncology patients relates to their healthcare consumption before death, and to the match between preferred and actual place of death. Methods: We performed a pilot study at a teaching hospital in the Netherlands. Endpoints were 1) healthcare consumption at three and one month(s) before death, and 2) the match between preferred and actual place of death. Results: The study included 75 patients without an ACPT (group 1) and 59 patients with an ACPT (group 2) of whom the preferred place of care or death were documented at least three months before death in 15 patients (subgroup 2b). Compared to group 1, patients in group 2 had significantly more healthcare consumption. However, compared to group 1, patients in subgroup 2b underwent significantly less diagnostic (33.3% (n = 5) versus 69.3% (n = 52), p < 0.05) and laboratory tests (33.3% (n = 5) versus 62.7% (n = 47), p < 0.05) one month before death. Patients in subgroup 2b died at their preferred place more often (76.9%, n = 10) compared to patients in group 1 (58.3%, n = 7) (NS), which meant more deaths at home and less in-hospital-deaths. Conclusions: The results suggest that timely documentation of the preferred place of care or death in a structured ACPT may result in less healthcare consumption and a better match between the preferred and actual place of death.
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Affiliation(s)
- Carolien Burghout
- Department of hemato-oncology, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands.,Jeroen Bosch Academy Research, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands.,Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands
| | | | - Sascha R Bolt
- Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands
| | - Tineke J Smilde
- Department of hemato-oncology, 10233Jeroen Bosch Hospital, Hertogenbosch, Noord Brabant, Netherlands
| | - Eveline J M Wouters
- Department of Tranzo, 120694Tilburg University, School of Social and Behavioral Sciences, Tilburg, Netherlands.,3170Fontys University of Applied Science, School For Allied Health Professionals, Eindhoven, Noord-Brabant, Netherlands
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23
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van Lummel EVTJ, Savelkoul C, Stemerdink ELE, Tjan DHT, van Delden JJM. The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention. BMC Palliat Care 2022; 21:119. [PMID: 35794617 PMCID: PMC9258045 DOI: 10.1186/s12904-022-01005-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients still receive non-beneficial treatments when nearing the end of life. Advance care planning (ACP) interventions have shown to positively influence compliance with end of life wishes. Hospital physicians seem to miss opportunities to engage in ACP, whereas patients visiting the outpatient clinic usually have one or more chronic conditions and are at risk for medical emergencies. So far, implemented ACP interventions have had limited impact. Structural implementation of ACP may be beneficial. We hypothesize that having ACP conversations more towards the end of life and involving the treating physician in the ACP conversation may help patient wishes and goals to become more concrete and more often documented, thus facilitating goal-concordant care. Aim To facilitate timely shared decision making and increase patient autonomy we aim to develop an ACP intervention at the outpatient clinic for frail patients and determine the feasibility of the intervention. Methods The United Kingdom’s Medical Research Council framework was used to structure the development of the ACP intervention. Key elements of the ACP intervention were determined by reviewing existing literature and an iterative process with stakeholders. The feasibility of the developed intervention was evaluated by a feasibility study of 20 ACP conversations at the geriatrics and pulmonology department of a non-academic hospital. Feasibility was assessed by analysing evaluation forms by patients, nurses and physicians and by evaluating with stakeholders. A general inductive approach was used for analysing comments. The developed intervention was described using the template for intervention description and replication (TIDieR). Results We developed a multidisciplinary timely undertaken ACP intervention at the outpatient clinic. Key components of the developed intervention consist of 1) timely patient selection 2) preparation of patient and healthcare professional 3) a scripted ACP conversation in a multidisciplinary setting and 4) documentation. 94.7% of the patients, 60.0% of the nurses and 68.8% of the physicians agreed that the benefits of the ACP conversation outweighed the potential burdens. Conclusion This study showed that the developed ACP intervention is feasible and considered valuable by patients and healthcare professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01005-3.
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Pivodic L, Wendrich-van Dael A, Gilissen J, De Buyser S, Deliens L, Gastmans C, Vander Stichele R, Van den Block L. Effects of a theory-based advance care planning intervention for nursing homes: A cluster randomized controlled trial. Palliat Med 2022; 36:1059-1071. [PMID: 35769038 DOI: 10.1177/02692163221102000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Uptake of advance care planning in routine nursing home care is low. Through extensive literature review, theoretical development, and stakeholder involvement, we developed the ACP+ intervention. AIMS To evaluate the effects of ACP+ on the knowledge and self-efficacy (confidence in own skills) of nursing home care staff concerning advance care planning. DESIGN Cluster randomized controlled trial, conducted between February 2018 and January 2019 (NCT03521206, clinicaltrials.gov). ACP+ is a multicomponent intervention aimed at training and supporting nursing home staff and management in implementing advance care planning in nursing home practice through a train-the-trainer approach over 8 months. Fourteen nursing homes were randomized using a matched-pairing strategy, seven received ACP+, seven followed usual practice. Analyses (intention-to-treat) involved linear mixed models. SETTING/PARTICIPANTS Nursing homes in Flanders (Belgium). RESULTS 694 of 1017 care staff (68% response rate) at baseline and 491 of 989 care staff (50%) post-intervention (8 months) returned questionnaires. Post-intervention, care staff's self-efficacy concerning advance care planning was significantly higher in the intervention than in the control group (baseline-adjusted mean difference 0.57; 95% CI 0.20-0.94; p = 0.003; Cohen's d = 0.30). Advance care planning knowledge (95% CI 0.95-1.15; p = 0.339; ratio: 1.04) did not differ significantly between groups. CONCLUSIONS The ACP+ intervention for nursing homes improved care staff's self-efficacy but not their knowledge concerning advance care planning. Considering the comprehensive and multi-component approach used, these effects were smaller than expected. Reasons for this may be related to the chosen follow-up period, outcomes and measurements, or to the intervention itself and its implementation.
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Affiliation(s)
- Lara Pivodic
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Brussels, Belgium
| | - Annelien Wendrich-van Dael
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Brussels, Belgium
| | - Joni Gilissen
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Atlantic Fellows for Equity in Brain Health, Global Brain Health Institute, University California San Francisco, San Francisco, CA, USA
| | - Stefanie De Buyser
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Luc Deliens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | | | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium.,Vrije Universiteit Brussel (VUB), Department of Family Medicine and Chronic Care, Brussels, Belgium
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Ling A, Herbert F, Wright B, Richfield E. Terminal Choking in Parkinson's Disease. J Pain Symptom Manage 2022; 63:e757-e764. [PMID: 35081446 DOI: 10.1016/j.jpainsymman.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/09/2022] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Andrea Ling
- ST5 Palliative Medicine (Specialist Trainee) (A.L.), Supportive and Palliative Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Infirmary, Bristol, United Kingdom.
| | - Fiona Herbert
- ST5 Geriatric Medicine (Specialist Trainee) (F.H.), Care of the Elderly, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Bethany Wright
- Consultant in Palliative Medicine (B.W.), St Peter's Hospice, Brentry, Bristol, United Kingdom
| | - Edward Richfield
- Consultant in Geriatric Medicine (E.R.), Medicine for Older People, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom
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26
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Trillig AU, Ljuslin M, Mercier J, Harrisson M, Vayne-Bossert P. "I Am Not the Same Man…": A Case Report of Management of Post-COVID Refractory Dyspnea. J Palliat Med 2022; 25:1606-1609. [PMID: 35271384 DOI: 10.1089/jpm.2021.0605] [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: 11/13/2022] Open
Abstract
The SARS-CoV-2 pandemic brings with it a significant number of post-COVID symptoms, including persistent dyspnea and neuropsychological sequelae. The palliative approach in the treatment of these refractory symptoms is effective and widely applicable in different settings. We report the case of a patient with refractory dyspnea admitted to a specialized palliative care unit with a very poor prognosis. The application of different tools of the palliative approach proved to be effective: a detailed advanced care planning and open communication, the respect for the patient's wishes and optimal use of his resources-the salutogenesis- an adaptation of the rhythm of care to that of the patient. The patient was then discharged for rehabilitation, and finally returned home.
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Affiliation(s)
| | - Michael Ljuslin
- Palliative Care Unit, University Hospital Geneva, Geneva, Switzerland
| | - Jérôme Mercier
- Physiotherapy Team, Palliative Care Unit, University of Geneva, University Hospital Geneva, Geneva, Switzerland
| | - Maya Harrisson
- Physiotherapy Team, Palliative Care Unit, University of Geneva, University Hospital Geneva, Geneva, Switzerland
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27
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Lemos Dekker N, Bolt SR. Relating to the end of life through advance care planning: Expectations and experiences of people with dementia and their family caregivers. DEMENTIA 2022; 21:918-933. [PMID: 34978465 PMCID: PMC8996290 DOI: 10.1177/14713012211066370] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Dementia is widely considered a progressive condition associated with changes in
cognitive capacities, which promotes the idea that people with dementia need to
anticipate end-of-life care preferences. There is a growing body of interventions meant
to support advance care planning (ACP) for people with dementia and their families.
However, a deeper understanding of their experiences and expectations regarding planning
the end of life is needed to inform ethically sound and person-centered ACP. This study
explores how end-of-life care planning for people with dementia is experienced and
perceived in practice. Methods We conducted a secondary analysis of qualitative data from in-depth interviews and
ethnographic fieldwork. Participants included people with dementia living in the
community or in nursing homes, family caregivers, and professional caregivers. During
reflective sessions, the researchers moved back and forth between their original data
and overarching topics related to ACP. Both performed deductive coding to filter
relevant information from their data. Ongoing discussions allowed for the fine-tuning of
themes. Results End-of-life care planning for people with dementia can encompass a paradox of control.
While it may foster a sense of being in control, it may also feel like relinquishing
control over future situations. It raises concerns regarding responsibility, as present,
former and future wishes may not align. Family caregivers are often responsible for
concrete end-of-life decision-making, prompting them to weigh previous wishes against
present situations. Further, people with dementia may wish to focus on the present and
distance themselves from the future. Discussion Advance decisions about end-of-life care are often decontextualized and people may find
it difficult to oversee their future conditions and preferences. The widely recognized
purpose of ACP to exert control over end-of-life care may need revision to match the
needs of people with dementia while they are coping with their condition and an
uncertain future.
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Affiliation(s)
- Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, the Netherlands
| | - Sascha R Bolt
- TRANZO Tilburg School of Social and Behavioral Sciences, Tilburg University;, Tilburg, the Netherlands Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Living Lab in Ageing and Long-Term Care, 5211Maastricht University, Maastricht, the Netherlands
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28
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Martínez Ques ÁA, Braña Marcos B, Martín Arribas C, Vázquez Campo M, Rumbo Prieto JM, López Castro J, Herrero Olivera L, Gómez Salgado J. [Design and validation of an instrument about quality of the advance care planning for professionals]. GACETA SANITARIA 2022; 36:401-408. [PMID: 34991901 DOI: 10.1016/j.gaceta.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. METHOD Instrumental questionnaire validation study. SCOPE primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. PARTICIPANTS physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. RESULTS Pilot study with 28 professionals. Reliability ɷ=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. CONCLUSIONS The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.
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Affiliation(s)
- Ángel Alfredo Martínez Ques
- Área Sanitaria de Orense, Verín y Barco de Valdeorras, Servicio Gallego de Salud (Sergas), Orense, España; Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), Vigo, España
| | - Beatriz Braña Marcos
- Área Sanitaria V, Servicio de Salud del Principado de Asturias (SESPA), Gijón, España; Dirección General de Cuidados, Humanización y Atención Sociosanitaria, Consejería de Salud del Principado de Asturias, Oviedo, España; Grupo de Determinantes de la Salud y Profesión Enfermera, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | | | - Miriam Vázquez Campo
- Área Sanitaria de Ourense, Verín y Barco de Valdeorras, Servicio Gallego de Salud (Sergas), Orense, España
| | - José María Rumbo Prieto
- Unidad de Docencia e Investigación, Área Sanitaria de Ferrol, Servicio Gallego de Salud (Sergas), Ferrol, España
| | - José López Castro
- Servicio de Medicina Interna, Área Sanitaria de Lugo, Cervo y Monforte de Lemos (Sergas), Lugo, España
| | - Laura Herrero Olivera
- Facultad de Filosofía, Universidad Nacional de Educación a Distancia, Madrid, España
| | - Juan Gómez Salgado
- Área de Medicina Preventiva y Salud Pública, Departamento de Sociología, Trabajo Social y Salud Pública. Facultad de Ciencias del Trabajo. Universidad de Huelva, Huelva, España; Programa de Posgrado de Seguridad y Salud, Universidad Espíritu Santo, Guayaquil, Ecuador
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Lindvall C, Deng CY, Moseley E, Agaronnik N, El-Jawahri A, Paasche-Orlow MK, Lakin JR, Volandes A, Tulsky TAPIJA. Natural Language Processing to Identify Advance Care Planning Documentation in a Multisite Pragmatic Clinical Trial. J Pain Symptom Manage 2022; 63:e29-e36. [PMID: 34271146 PMCID: PMC9124370 DOI: 10.1016/j.jpainsymman.2021.06.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
CONTEXT Large multisite clinical trials studying decision-making when facing serious illness require an efficient method for abstraction of advance care planning (ACP) documentation from clinical text documents. However, the current gold standard method of manual chart review is time-consuming and unreliable. OBJECTIVES To evaluate the ability to use natural language processing (NLP) to identify ACP documention in clinical notes from patients participating in a multisite trial. METHODS Patients with advanced cancer followed in three disease-focused oncology clinics at Duke Health, Mayo Clinic, and Northwell Health were identified using administrative data. All outpatient and inpatient notes from patients meeting inclusion criteria were extracted from electronic health records (EHRs) between March 2018 and March 2019. NLP text identification software with semi-automated chart review was applied to identify documentation of four ACP domains: (1) conversations about goals of care, (2) limitation of life-sustaining treatment, (3) involvement of palliative care, and (4) discussion of hospice. The performance of NLP was compared to gold standard manual chart review. RESULTS 435 unique patients with 79,797 notes were included in the study. In our validation data set, NLP achieved F1 scores ranging from 0.84 to 0.97 across domains compared to gold standard manual chart review. NLP identified ACP documentation in a fraction of the time required by manual chart review of EHRs (1-5 minutes per patient for NLP, vs. 30-120 minutes for manual abstraction). CONCLUSION NLP is more efficient and as accurate as manual chart review for identifying ACP documentation in studies with large patient cohorts.
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Affiliation(s)
- Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (C.L., CY.D.,E.M., N.A., JR.L., JA.T.), Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital (C.L., JR.L., JA.T.), Boston, Massachusetts; Harvard Medical School, Boston (C.L., N.A., A.EJ., JR.L., A.V., JA.T.), Massachusetts.
| | - Chih-Ying Deng
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (C.L., CY.D.,E.M., N.A., JR.L., JA.T.), Boston, Massachusetts
| | - Edward Moseley
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (C.L., CY.D.,E.M., N.A., JR.L., JA.T.), Boston, Massachusetts
| | - Nicole Agaronnik
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (C.L., CY.D.,E.M., N.A., JR.L., JA.T.), Boston, Massachusetts; Harvard Medical School, Boston (C.L., N.A., A.EJ., JR.L., A.V., JA.T.), Massachusetts
| | - Areej El-Jawahri
- Harvard Medical School, Boston (C.L., N.A., A.EJ., JR.L., A.V., JA.T.), Massachusetts; Department of Medicine, Massachusetts General Hospital (A.EJ., A.V.), Boston, Massachusetts
| | - Michael K Paasche-Orlow
- Department of Medicine, Boston University School of Medicine, Boston Medical Center (MK.PO.), Boston, Massachusetts; ACP Decisions (MK.PO., A.V.), Boston, Massachusetts
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (C.L., CY.D.,E.M., N.A., JR.L., JA.T.), Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital (C.L., JR.L., JA.T.), Boston, Massachusetts; Harvard Medical School, Boston (C.L., N.A., A.EJ., JR.L., A.V., JA.T.), Massachusetts
| | - Angelo Volandes
- Harvard Medical School, Boston (C.L., N.A., A.EJ., JR.L., A.V., JA.T.), Massachusetts; Department of Medicine, Massachusetts General Hospital (A.EJ., A.V.), Boston, Massachusetts; ACP Decisions (MK.PO., A.V.), Boston, Massachusetts
| | - The Acp-Peace Investigators James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (C.L., CY.D.,E.M., N.A., JR.L., JA.T.), Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital (C.L., JR.L., JA.T.), Boston, Massachusetts; Harvard Medical School, Boston (C.L., N.A., A.EJ., JR.L., A.V., JA.T.), Massachusetts
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30
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Stevens J, Deliens L, Pype P, De Vleminck A, Pardon K. Complex advance care planning interventions for chronic serious illness: how do they work: a scoping review. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003310. [PMID: 34610911 PMCID: PMC9380502 DOI: 10.1136/bmjspcare-2021-003310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/02/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Advance care planning (ACP) interventions have the potential to improve outcomes for patients with chronic serious illness. Yet the rationale for outcome choices and the mechanisms by which outcomes are achieved are not always clear. OBJECTIVES To identify and map proposed mechanisms on how complex ACP interventions can impact outcomes for patients with chronic serious illness and to explore factors that might explain intervention outcomes. METHODS This is a scoping review of randomised controlled trials of complex ACP interventions for patients with chronic serious illness which explicitly stated the mechanism(s) by which the intervention was thought to work. We searched six databases and hand-searched key journals and reference lists. RESULTS Inclusion yielded 16 articles. Inclusion procedures and mapping of mechanisms and outcomes indicated that causality between components and outcomes was not always clearly described. Tailoring intervention content to patients' needs was linked to the greatest number of different outcome categories, while promoting competence and confidence to engage in ACP was most often explicitly linked to a primary outcome. Three main factors which might have affected intended outcomes were identified: participant characteristics, such as illness experience or cultural differences; the setting of implementation; or methodological limitations of the study. CONCLUSION Findings highlighted two main points of consideration for future ACP intervention studies: the need for clearly stated logic in how interventions are expected to impact primary outcomes and the importance of considering how an intervention may function for patients with chronic serious illnesses within a specific setting.
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Affiliation(s)
- Julie Stevens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Luc Deliens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Pype
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Aline De Vleminck
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Koen Pardon
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Koeberlein-Neu J, Hoffmann F, Schweda M. 'Value' of advance care plans: health economics revisited. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003192. [PMID: 34470771 DOI: 10.1136/bmjspcare-2021-003192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/17/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Juliane Koeberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Falk Hoffmann
- Department of Health Services Research, University of Oldenburg School of Medicine and Health Sciences, Oldenburg, Niedersachsen, Germany
| | - Mark Schweda
- Department of Health Services Research, University of Oldenburg School of Medicine and Health Sciences, Oldenburg, Niedersachsen, Germany
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Hirakawa Y, Saif-Ur-Rahman KM, Aita K, Nishikawa M, Arai H, Miura H. Implementation of advance care planning amid the COVID-19 crisis: A narrative review and synthesis. Geriatr Gerontol Int 2021; 21:779-787. [PMID: 34318579 PMCID: PMC8444945 DOI: 10.1111/ggi.14237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/13/2021] [Accepted: 06/28/2021] [Indexed: 12/02/2022]
Abstract
Advance care planning is considered an important issue in end‐of‐life care for older adults. The ongoing COVID‐19 pandemic has interrupted the healthcare system and end‐of‐life care tremendously. This review aimed to explore available articles on advance care planning amid the pandemic and analyze qualitatively. PubMed and Google Scholar were searched on February 2021 using the relevant keywords. Retrieved articles were screened applying inclusion criteria. Any article describing advance care planning during the COVID‐19 era was included. A qualitative content analysis was conducted. In total, 20 articles incorporating 5542 participants from five countries were included. Among the articles, eight were primary studies and the rest were perspective papers or secondary analysis. From the qualitative content analysis six major themes emerged namely palliative care, lack of coordination among acute care, hospital palliative care, and long‐term care, community‐based advance care planning, real‐time dissemination of scientific information on the regional pandemic situation, online system and legislation. The COVID‐19 pandemic had decreased the uptake of advance care planning. Findings of the review suggested simplification of the procedure regarding advance care planning, implementation of community‐based advance care planning and utilization of online resources to enhance the process. Geriatr Gerontol Int 2021; 21: 779–787.
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Affiliation(s)
- Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - K M Saif-Ur-Rahman
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan.,Health Systems and Population Studies Division, ICDDRB, Dhaka, Bangladesh
| | - Kaoruko Aita
- University of Tokyo Graduate School of Humanities and Sociology, Tokyo, Japan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hisayuki Miura
- National Center for Geriatrics and Gerontology, Obu, Japan
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Michael N, O'Callaghan C, Georgousopoulou E, Melia A, Sulistio M, Kissane D. Video decision support tool promoting values conversations in advanced care planning in cancer: protocol of a randomised controlled trial. BMC Palliat Care 2021; 20:95. [PMID: 34167538 PMCID: PMC8229383 DOI: 10.1186/s12904-021-00794-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background Views on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation. This study will evaluate the potential utility of a video decision support tool (VDST) that models values-based ACP discussions between cancer patients and their nominated caregivers to enable patients and families to achieve shared-decisions when completing ACP’s. Methods This open-label, parallel-arm, phase II randomised control trial will recruit cancer patient-caregiver dyads across a large health network. Previously used written vignettes will be converted to video vignettes using the recommended methodology. Participants will be ≥18 years and be able to complete questionnaires. Dyads will be randomised in a 1:1 ratio to a usual care (UC) or VDST group. The VDST group will watch a video of several patient-caregiver dyads communicating personal values across different cancer trajectory stages and will receive verbal and written ACP information. The UC group will receive verbal and written ACP information. Patient and caregiver data will be collected individually via an anonymous questionnaire developed for the study, pre and post the UC and VDST intervention. Our primary outcome will be ACP completion rates. Secondarily, we will compare patient-caregiver (i) attitudes towards ACP, (ii) congruence in communication, and (iii) preparation for decision-making. Conclusion We need to continue to explore innovative ways to engage cancer patients in ACP. This study will be the first VDST study to attempt to integrate values-based conversations into an ACP intervention. This pilot study’s findings will assist with further refinement of the VDST and planning for a future multisite study. Trial registration Australian New Zealand Clinical Trials Registry No: ACTRN12620001035910. Registered 12 October 2020. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00794-3.
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Affiliation(s)
- Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia. .,School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia. .,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Clare O'Callaghan
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia.,Departments of Psychosocial Cancer Care, St Vincent's Hospital, Sydney, NSW, Australia
| | - Ekavi Georgousopoulou
- School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia
| | - Adelaide Melia
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia
| | - Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia.,School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia.,School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Abstract
Advance care planning (ACP) is promoted as beneficial practice internationally. This article critically examines different ways of understanding and measuring success in ACP. It has been 50 years since Luis Kutner first published his original idea of the Living Will, which was thought to be a contract between health carers and patients to provide for instructions about treatment choices in cases of mental incapacity. Its purpose was to extend a patient's right to autonomy and protect health carers from charges of wrong-doing. Yet, it can be doubtful whether different types of ACP achieve these goals rather than aiming at secondary gains. My discussion suggests that the current promotion of ACP is not always engaging critically with the original ACP intentions and may even pursue notions of success that may run contrary to respecting autonomy. The risk of this may especially be the case when high participation rates are taken as indicators of success for institutional ACP programs. I further suggest that Kutner's two original aims of protecting patient autonomy and preventing charges of wrong-doing are near impossible to achieve in conjunction, because their simultaneous pursuit fails to acknowledge that patients and carers have opposing needs for reassurance about possible judgment errors. I conclude that the most realistic idea of success of modern ACP is an acknowledgement of the importance of ongoing dialogue about what constitutes appropriate care and a diversity of aims rather than any kind of advance, contractual insurance in the face of controversy.
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van der Steen JT, Heck S, Juffermans CC, Garvelink MM, Achterberg WP, Clayton J, Thompson G, Koopmans RT, van der Linden YM. Practitioners' perceptions of acceptability of a question prompt list about palliative care for advance care planning with people living with dementia and their family caregivers: a mixed-methods evaluation study. BMJ Open 2021; 11:e044591. [PMID: 33846153 PMCID: PMC8048016 DOI: 10.1136/bmjopen-2020-044591] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES In oncology and palliative care, patient question prompt lists (QPLs) with sample questions for patient and family increased patients' involvement in decision-making and improved outcomes if physicians actively endorsed asking questions. Therefore, we aim to evaluate practitioners' perceptions of acceptability and possible use of a QPL about palliative and end-of-life care in dementia. DESIGN Mixed-methods evaluation study of a QPL developed with family caregivers and experts comprising a survey and interviews with practitioners. SETTING Two academic medical training centres for primary and long-term care in the Netherlands. PARTICIPANTS Practitioners (n=66; 73% woman; mean of 21 (SD 11) years of experience) who were mostly general practitioners and elderly care physicians. OUTCOMES The main survey outcome was acceptability measured with a 15-75 acceptability scale with ≥45 meaning 'acceptable'. RESULTS The survey response rate was 21% (66 of 320 participated). The QPL was regarded as acceptable (mean 51, SD 10) but 64% felt it was too long. Thirty-five per cent would want training to be able to answer the questions. Those who felt unable to answer (31%) found the QPL less acceptable (mean 46 vs 54 for others; p=0.015). We identified three themes from nine interviews: (1) enhancing conversations through discussing difficult topics, (2) proactively engaging in end-of-life conversations and (3) possible implementation. CONCLUSION Acceptability of the QPL was adequate, but physicians feeling confident to be able to address questions about end-of-life care is crucial when implementing it in practice, and may require training. To facilitate discussions of advance care planning and palliative care, families and persons with dementia should also be empowered to access the QPL themselves.
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Affiliation(s)
- Jenny T van der Steen
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Sten Heck
- Leiden University, Leiden, The Netherlands
| | - Carla Cm Juffermans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Wilco P Achterberg
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Josephine Clayton
- Centre for Learning & Research in Palliative Care, Hammond Care, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney Northern Clinical School, Sydney, New South Wales, Australia
| | - Genevieve Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Raymond Tcm Koopmans
- Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Radboudumc Alzheimer Center, Radboud university medical center, Nijmegen, The Netherlands
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Milnes SL, Mantzaridis Y, Simpson NB, Dunning TL, Kerr DC, Ostaszkiewicz JB, Keely GT, Corke C, Orford NR. Values, preferences and goals identified during shared decision making between critically ill patients and their doctors. CRIT CARE RESUSC 2021; 23:76-85. [PMID: 38046387 PMCID: PMC10692567 DOI: 10.51893/2021.1.oa7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Examine values, preferences and goals elicited by doctors following goals-of-care (GOC) discussions with critically ill patients who had life-limiting illnesses. Design: Descriptive qualitative study using four-stage latent content analysis. Setting: Tertiary intensive care unit (ICU) in South Western Victoria. Participants: Adults who had life-limiting illnesses and were admitted to the ICU with documented GOC, between October 2016 and July 2018. Intervention: The iValidate program, a shared decision-making clinical communication education and clinical support program, for all ICU registrars in August 2015. Main outcome measures: Matrix of themes and subthemes categorised into values, preferences and goals. Results: A total of 354 GOC forms were analysed from 218 patients who had life-limiting illnesses and were admitted to the ICU. In the categories of values, preferences and goals, four themes were identified: connectedness and relational autonomy, autonomy of decision maker, balancing quality and quantity of life, and physical comfort. The subthemes - relationships, sense of place, enjoyment of activities, independence, dignity, cognitive function, quality of life, longevity and physical comfort - provided a matrix of issues identified as important to patients. Relationship, place, independence and physical comfort statements were most frequently identified; longevity was least frequently identified. Conclusion: Our analysis of GOC discussions between medical staff and patients who had life-limiting illnesses and were admitted to the ICU, using a shared decision-making training and support program, revealed a framework of values, preferences and goals that could provide a structure to assist clinicians to engage in shared decision making.
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Affiliation(s)
- Sharyn L. Milnes
- University Hospital Geelong, Barwon Health, Geelong, Australia
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia
- School of Medicine, Deakin University, Geelong, Australia
| | | | - Nicholas B. Simpson
- University Hospital Geelong, Barwon Health, Geelong, Australia
- School of Medicine, Deakin University, Geelong, Australia
| | - Trisha L. Dunning
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Debra C. Kerr
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | | | - Gerry T. Keely
- University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Charlie Corke
- University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Neil R. Orford
- University Hospital Geelong, Barwon Health, Geelong, Australia
- School of Medicine, Deakin University, Geelong, Australia
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Advance care planning in discussion: a solution or challenge with pitfalls? Public Health 2021; 192:72-73. [PMID: 33652211 DOI: 10.1016/j.puhe.2020.12.015] [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: 10/01/2020] [Revised: 12/17/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Care planning should define care at the end of life in advance. At a later stage, when patients are no longer able to do this themselves, it should serve as a guideline for health care. The aim of this article is to give a first insight into the discussions around this social instrument. STUDY DESIGN The study design was comparing the arguments of proponents and critics. METHODS This is a critical discourse analysis. RESULTS A discussion of proponents and critics shows how closely this social instrument is interwoven with the areas of biopolitics, economics and governmentality. CONCLUSIONS Further research should address the question of what quality assurance can look like.
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Sussman T, Kaasalainen S, Bimman R, Punia H, Edsell N, Sussman J. Exploration of the acceptability and usability of advance care planning tools in long term care homes. BMC Palliat Care 2020; 19:179. [PMID: 33243203 PMCID: PMC7756921 DOI: 10.1186/s12904-020-00689-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives Despite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake amongst the generable population. Yet, their potential for improving ACP uptake in LTC has yet to be examined. This study explored if available ACP tools are acceptable for use in LTC by (a) eliciting staff views on the content and format that would support ACP tool usability in LTC (b) examining if publicly available ACP tools include content identified as relevant by LTC home staff. Ultimately this study aimed to identify the potential for existing ACP tools to improve ACP engagement in LTC. Methods A combination of focus group deliberations with LTC home staff (N = 32) and content analysis of publicly available ACP tools (N = 32) were used to meet the study aims. Results Focus group deliberations suggested that publicly available ACP tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist. Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%). Conclusions ACP tools that include psychosocial content may improve ACP uptake in LTC because they elicit future care issues considered pertinent and can be supported by a range of clinical and non-clinical staff. To increase usability and engagement ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.
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Affiliation(s)
- Tamara Sussman
- McGill University School of Social Work, 3506 Rue University #300, Montréal, QC, H3A 2A7, Canada.
| | - Sharon Kaasalainen
- Health Sciences Centre, McMaster University School of Nursing, 2J20, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Rennie Bimman
- McGill University School of Social Work, 3506 Rue University #300, Montréal, QC, H3A 2A7, Canada
| | - Harveer Punia
- Health Sciences Centre, McMaster University School of Nursing, 2J20, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Nathaniel Edsell
- McGill University School of Social Work, 3506 Rue University #300, Montréal, QC, H3A 2A7, Canada
| | - Jess Sussman
- University of Toronto Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
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Horowitz RK, Hogan LA, Carroll T. MVP-Medical Situation, Values, and Plan: A Memorable and Useful Model for All Serious Illness Conversations. J Pain Symptom Manage 2020; 60:1059-1065. [PMID: 32738279 PMCID: PMC7390732 DOI: 10.1016/j.jpainsymman.2020.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Robert K Horowitz
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA.
| | - Laura A Hogan
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA
| | - Thomas Carroll
- Division of Palliative Care, University of Rochester Medicine, Rochester, New York, USA
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