scholarly journals Healthcare Providers’ Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study

2021 ◽  
Author(s):  
Jun Miyashita ◽  
Ayako Kohno ◽  
Sayaka Shimizu ◽  
Motohiro Kashiwazaki ◽  
Noriki Kamihiro ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Mixed Methods Study ◽  
Care Planning ◽  
Advance Care

Patients’ preferences and factors influencing initial advance care planning discussions’ timing: A cross-cultural mixed-methods study

2020 ◽  
Vol 34 (7) ◽  
pp. 906-916 ◽  
Author(s):  
Jun Miyashita ◽  
Ayako Kohno ◽  
Shao-Yi Cheng ◽  
Su-Hsuan Hsu ◽  
Yosuke Yamamoto ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Mixed Methods Study ◽  
Care Planning ◽  
Factors Affecting ◽  
Factors Associated ◽  
Younger Age ◽  
Outpatient Departments ◽  
Advance Care

Background: Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain. Aim: To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan. Design: Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing. Setting/participants: Patients aged 40–75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited. Results: Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan ( p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers’ initiative. Conclusion: The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients’ preferences and factors associated with acceptance and reluctance to initiate advance care planning.

scholarly journals Experiences with and outcomes of Advance Care Planning in bereaved relatives of frail older patients: a mixed methods study

2019 ◽  
Vol 48 (2) ◽  
pp. 299-306 ◽  
Author(s):  
Anouk Overbeek ◽  
Ida J Korfage ◽  
Bernard J Hammes ◽  
Agnes van der Heide ◽  
Judith A C Rietjens
Keyword(s):  
Mixed Methods ◽  
Advance Care Planning ◽  
Older Patients ◽  
Mixed Methods Study ◽  
Care Planning ◽  
Advance Care

How Do Patients With Parkinson’s Disease Approach Advance Care Planning? A UK-Based Mixed Methods Study

2021 ◽  
pp. 089198872098891
Author(s):  
Deepta Churm ◽  
Claire Dickinson ◽  
Louise Robinson ◽  
Paul Paes ◽  
Thomas Cronin ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Mixed Methods ◽  
Advance Care Planning ◽  
Mixed Methods Study ◽  
Care Planning ◽  
Structured Interviews ◽  
The Future ◽  
Explanatory Mixed Methods ◽  
Advance Care

Background: Advance Care Planning (ACP) allows people the opportunity to plan for a time when they may lose capacity. The aim of this study was to determine the extent people with Parkinson’s disease (PD) were aware of ACP, existing plans they held and to explore their own views, as well as their relatives, on planning for the future. Methods: This was a sequential explanatory mixed methods study with a postal quantitative survey to establish awareness and engagement with planning for the future; and qualitative semi-structured interviews to explore the views of people with PD and their relatives on ACP and future plans. Results: 104 questionnaires were analyzed. 76% of respondents had not heard of ACP, while 69% expressed an interest in finding out more about ACP. 78% had a will, and 23% had appointed lasting power of attorneys. All interviewees acknowledged engaging in some aspect of planning. Plans were mostly practical as opposed to health-care related. Interviewees expressed a preference for ACP to be carried out by their PD team, at home, and at a time relevant to their condition. Conclusion: The awareness and understanding of ACP in people with PD is low. While there is desire to be better informed about ACP, this did not translate into desire to engage in ACP. Health professionals should identify people for whom ACP may serve a positive purpose, and proactively address ACP as a continuum with them, while ensuring awareness is raised about ACP, and there is access for who are interested.

O-32 Developing, implementing and evaluating advance care planning (ACP) in norwegian nursing homes (NHS) – a mixed methods study

2015 ◽  
Vol 5 (Suppl 2) ◽  
pp. A10.2-A10
Author(s):  
Tryge Johannes Lereim Sævareid ◽  
L Lillemoen ◽  
Lisbeth Thoresen ◽  
E Gjerberg ◽  
R Førde ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Nursing Homes ◽  
Advance Care Planning ◽  
Mixed Methods Study ◽  
Care Planning ◽  
Advance Care

scholarly journals Can Persons with Dementia Meaningfully Participate in Advance Care Planning Discussions? A Mixed-Methods Study of SPIRIT

2019 ◽  
Vol 22 (11) ◽  
pp. 1410-1416 ◽  
Author(s):  
Mi-Kyung Song ◽  
Sandra E. Ward ◽  
Kenneth Hepburn ◽  
Sudeshna Paul ◽  
Hyejin Kim ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Advance Care Planning ◽  
Mixed Methods Study ◽  
Care Planning ◽  
Advance Care

scholarly journals ‘It’s almost superstition: If I don’t think about it, it won’t happen’. Public knowledge and attitudes towards advance care planning: A sequential mixed methods study

2021 ◽  
pp. 026921632110158
Author(s):  
Sonja McIlfatrick ◽  
Paul Slater ◽  
Olufikayo Bamidele ◽  
Deborah Muldrew ◽  
Esther Beck ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Advance Care Planning ◽  
Public Awareness ◽  
Community Action ◽  
Care Plan ◽  
Care Planning ◽  
Knowledge And Attitudes ◽  
Sequential Mixed Methods ◽  
Advance Care

Background: Internationally, participation in advance care planning is low. Whilst a community action approach is advocated, what the public know and understand about advance care planning is unknown. Aim: To assess public awareness, knowledge and attitudes towards advance care planning and identify strategies to raise awareness within a public health framework. Design: Sequential mixed methods comprising a cross-sectional survey and focus group/interviews. Setting/participants: A random representative sample of adults from one region of the United Kingdom ( n = 1201; response rate 56%) completed a face-to-face survey. Twenty-five participants consented to an additional focus group/interview held in a secure accessible location or via telephone. Results: Most participants (78.7%) acknowledged the benefits of advance care planning conversations, however, two thirds did not want to think about advance care planning or find out more at present. Respondents were reluctant to broach advance care planning as it was linked to end of life care and funeral plans, and they did not wish to cause distress to their loved one. Respondents trusted their family to respect their wishes and they considered having an advance care plan in place would be of assistance in the future. Top-down leadership, normalisation, and increased education were identified as potential approaches to overcome barriers. Conclusions: Advance care planning was recognised as important despite limited awareness, lack of knowledge and misperceptions. Whilst a community action approach to enhance understanding and engagement was supported, a ‘one size fits all’ approach will not work; rather bespoke targeting is required with educational and media messaging aligned.

Decision-Making Toolkit

2021 ◽  
pp. 60-76
Author(s):  
Jeffrey D. Myers
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Physician Assistant ◽  
Healthcare Providers ◽  
Terminally Ill ◽  
Decision Makers ◽  
Care Planning ◽  
Collaborative Partnership ◽  
Advance Care

Physician assistant (PA) training is rooted in treating the whole patient and developing a trusting and collaborative partnership with patients and their families. This foundation is critical in the advance care planning (ACP) process for patients who are seriously or terminally ill. Understanding the ACP process, the components and reasons behind them, and the tools for successful discussions and decision-making is a key skill set for all healthcare providers, including PAs. This chapter examines the components of ACP, including advance directives, the POLST paradigm, decision-makers, prognostication, documentation, and legacy planning. ACP is key in capturing what is most important to our patients in terms of their health, their life, and their goals related to both.

scholarly journals Patient safety incidents in advance care planning for serious illness: a mixed-methods analysis

2019 ◽  
pp. bmjspcare-2019-001824
Author(s):  
Toby Dinnen ◽  
Huw Williams ◽  
Sarah Yardley ◽  
Simon Noble ◽  
Adrian Edwards ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Advance Care Planning ◽  
Learning System ◽  
Care Planning ◽  
Safety Incident ◽  
Patient Safety Incident ◽  
Advance Care ◽  
National Analysis ◽  
Patient Safety Incidents

ObjectivesAdvance care planning (ACP) is essential for patient-centred care in the last phase of life. There is little evidence available on the safety of ACP. This study characterises and explores patient safety incidents arising from ACP processes in the last phase of life.MethodsThe National Reporting and Learning System collates patient safety incident reports across England and Wales. We performed a keyword search and manual review to identify relevant reports, April 2005–December 2015. Mixed-methods, combining structured data coding, exploratory and thematic analyses were undertaken to describe incidents, underlying causes and outcomes, and identify areas for improvement.ResultsWe identified 70 reports in which ACP caused a patient safety incident across three error categories: (1) ACP not completed despite being appropriate (23%, n=16). (2) ACP completed but not accessible or miscommunicated between professionals (40%, n=28). (3) ACP completed and accessible but not followed (37%, n=26). Themes included staff lacking the knowledge, confidence, competence or belief in trustworthiness of prior documentation to create or enact ACP. Adverse outcomes included cardiopulmonary resuscitation attempts contrary to ACP, other inappropriate treatment and/or transfer or admission.ConclusionThis national analysis identifies priority concerns and questions whether it is possible to develop strong system interventions to ensure safety and quality in ACP without significant improvement in human-dependent issues in social programmes such as ACP. Human-dependent issues (ie, varying patient, carer and professional understanding, and confidence in enacting prior ACP when required) should be explored in local contexts alongside systems development for ACP documentation.

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