A11-C Identification of Indicators to Monitor Successful Implementation of Advance Care Planning Policies in Alberta: A Delphi Study

With dramatically increasing proportions of older people, global ageing has remarkably influenced healthcare services and policy making worldwide. Older people represent the majority of patients with cancer, leading to the increasing demand of healthcare due to more comorbidities and inherent frailty. The preference of older people with cancer are often ignored, and they are considered incapable of making choices for themselves, particularly medical decisions. This might impede the provision of their preferred care and lead to poor healthcare outcomes. Advance care planning (ACP) is considered an effective intervention to assist older people to think ahead and make a choice in accordance with their wishes when they possess capacity to do so. The implementation of ACP can potentially lead to positive impact for patients and families. However, the assessment of mental capacity among older adults with cancer might be a crucial concern when implementing ACP, as loss of mental capacity occurs frequently during disease deterioration and functional decline. This article aims to answer the following questions by exploring the existing evidence. How does ACP develop for older people with cancer? How can we measure mental capacity and what kind of principles for assessment we should apply? What are the facilitators and barriers when implementing an ACP in this population? Furthermore, a discussion about cultural adaptation and relevant legislation in Asia is elucidated for better understanding about its cultural appropriateness and the implications. Finally, recommendations in relation to early intervention with routine monitoring and examination of capacity assessment in clinical practice when delivering ACP, reconciling patient autonomy and family values by applying the concept of relational autonomy, and a corresponding legislation and public education should be in place in Asia. More research on ACP and capacity assessment in different cultural contexts and policy frameworks is highlighted as crucial factors for successful implementation of ACP.

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What Is Good Advance Care Planning According to Hospitalized Palliative Patients and Their Families? An Explorative Study

Journal of Palliative Care ◽

10.1177/0825859720938583 ◽

2020 ◽

Vol 35 (4) ◽

pp. 236-242

Author(s):

Birgit Vanderhaeghen ◽

Inge Bossuyt ◽

Johan Menten ◽

Peter Rober

Keyword(s):

Advance Care Planning ◽

Implementation Strategies ◽

Implementation Process ◽

Relevant Information ◽

Successful Implementation ◽

Care Planning ◽

Hospital Practice ◽

Recall Procedure ◽

Advance Care ◽

Palliative Patients

Background: Advance care planning is not well implemented in Belgian hospital practice. In order to obtain successful implementation, implementation theory states that the adopters should be involved in the implementation process. This information can serve as a basis for creating better implementation strategies. Aim: For this study, we asked hospitalized palliative patients and their families what they experienced as good advance care planning. Methods: Twenty-nine interviews were taken from patients and families, following the Tape Assisted Recall procedure of Elliot. These interviews were analyzed using content analysis based on grounded theory. To improve reliability, 3 independent external auditors audited the analysis. Results: Results show that hospitalized palliative patients and families want to have advance care planning communication about treatment and care throughout their disease and about different aspects: social, psychological, physical, practical, and medical. They prefer to have these conversations with their supervising physician. They report 4 important goals of advance care planning communication: establishing a trustful relationship with the physician, in which they feel the involvement of the physician; giving and receiving relevant information for the decision process, making a personal decision about which treatment and care are preferred; and finding consensus between the preferred decision of the physician, the patient and the family concerning the treatment and care policy. Conclusion: This study can contribute to advance care planning implementation in hospital practice because it gives in insight into which elements in advance care planning patients and families experience as necessary and when advance care planning is necessary to them.

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The advance care planning nurse facilitator: describing the role and identifying factors associated with successful implementation

Australian Journal of Primary Health ◽

10.1071/py19010 ◽

2019 ◽

Vol 25 (6) ◽

pp. 564 ◽

Cited By ~ 2

Author(s):

Jeremy Rogers ◽

Charlotte Goldsmith ◽

Craig Sinclair ◽

Kirsten Auret

Keyword(s):

Primary Care ◽

Advance Care Planning ◽

Successful Implementation ◽

Care Planning ◽

Process Data ◽

Factors Associated ◽

Patient Screening ◽

Advance Care ◽

Additional Process ◽

Role Description

Advance care planning (ACP) has been shown to improve end-of-life care, yet uptake remains limited. Interventions aimed at increasing ACP uptake have often used a ‘specialist ACP facilitator’ model. The present qualitative study appraised the components of an ACP facilitator intervention comprising nurse-led patient screening and ACP discussions, as well as factors associated with the successful implementation of this model in primary care and acute hospital settings across rural and metropolitan Western Australia. Semistructured interviews were undertaken with 17 health professionals who were directly or indirectly involved in the facilitator ACP intervention among patients with severe respiratory disease. Additional process data (nurse facilitator role description, agreements with participating sites) were used to describe the nurse facilitator role. The interview data identified factors associated with successful implementation, including patient factors, health professional factors, ACP facilitator characteristics and the optimal settings for the intervention. The primary care setting was seen as most appropriate, and time limitations were a key consideration. Factors associated with successful implementation included trusting relationships between the nurse facilitator and referring doctor, as well as opportunities for meaningful encounters with patients. This study suggests a model of ACP nurse facilitation based in primary care may be an acceptable and effective method of increasing ACP uptake.

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An e-Delphi Study to Identify Priority Areas for Education on Advance Care Planning in COPD Management

Respiratory Care ◽

10.4187/respcare.07072 ◽

2019 ◽

Vol 65 (3) ◽

pp. 347-354

Author(s):

Art Burgess Kelleher ◽

Catherine Sweeney ◽

Tony Foley ◽

Ruth M Hally ◽

Elaine Meehan ◽

...

Keyword(s):

Advance Care Planning ◽

Delphi Study ◽

Care Planning ◽

Priority Areas ◽

Advance Care

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Helping hospital professionals to implement Advance Care Planning in daily practice: a European Delphi study from field experts

Journal of Research in Nursing ◽

10.1177/1744987118772604 ◽

2018 ◽

Vol 24 (6) ◽

pp. 433-443 ◽

Cited By ~ 3

Author(s):

Birgit Vanderhaeghen ◽

Inge Bossuyt ◽

Johan Menten ◽

Peter Rober

Keyword(s):

Advance Care Planning ◽

Delphi Study ◽

Emotional Processing ◽

Daily Practice ◽

Patient Characteristics ◽

Descriptive Statistics ◽

Care Planning ◽

Implementation Barriers ◽

Multidisciplinary Cooperation ◽

Advance Care

Background Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience implementation barriers in practice. Aims The aim of this study was to investigate what is valued in having ACP conversations by hospital professionals (physicians, nurses, psychologists and social workers) and what they experience as barriers and facilitating factors for having ACP conversations with patients. Methods A Delphi study consisting of two rounds with respectively 21 and 19 multidisciplinary experts from seven European countries was organised. Data were analysed using content analysis and descriptive statistics. Results Participants agreed that ACP is valued mostly because it is seen to improve transmural continuation of care, emotional processing of the loss of a patient, and serenity at the end of life. Reported barriers are patient characteristics blocking patient-centred communication and a lack of knowledge to have these conversations. An important facilitator is multidisciplinary cooperation. Conclusions There is consensus by experts from different settings and countries suggesting that these results can theoretically be applied to hospital settings in Europe. This study reveals that hospital professionals value ACP in hospital practice, but that they encounter several barriers to its implementation.

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How is advance care planning conceptualised in Australia? Findings from key informant interviews

Australian Health Review ◽

10.1071/ah10883 ◽

2011 ◽

Vol 35 (2) ◽

pp. 197 ◽

Cited By ~ 18

Author(s):

Joel J. Rhee ◽

Nicholas A. Zwar

Keyword(s):

End Of Life ◽

Advance Care Planning ◽

Health Professionals ◽

End Of Life Care ◽

Aged Care ◽

Treatment Preferences ◽

Successful Implementation ◽

Care Planning ◽

Life Care ◽

Advance Care

Objective. Advance Care Planning (ACP) has been gaining prominence as an important component of good end-of-life care. This study explored how ACP is conceptualised by stakeholder organisations and clinicians involved in aged care and end-of-life care in Australia, in particular their views on the aim, appropriate context and settings for ACP, and how ACP should be facilitated. Participants. Twenty-three participants including expert clinicians and representatives of government organisations, professional societies, consumer groups and other organisations involved in aged care and end-of-life care. Design. Qualitative descriptive analysis of semi-structured telephone interviews. Results. Most participants viewed ACP as an ongoing process aimed at enhancing an individual’s autonomy and ensuring good end-of-life care. However, there were significant differences in how this process was conceptualised. Some viewed ACP as a process undertaken by patients to define and communicate their treatment preferences. Others viewed ACP as discussions undertaken by health professionals to gain a better understanding of the patient’s values and goals in order to provide good care. Implications. Our findings highlight significant differences in how ACP is conceptualised in Australia. A shared conceptualisation and agreement on purpose is needed to ensure a successful implementation of ACP in Australia. What is known about the topic? Advance care planning (ACP) has been gaining increasing prominence both internationally and in Australia and is seen as an important component of good end-of-life care. Originally conceptualised as a document outlining a patient’s specific treatment preferences about life-sustaining treatments, ACP has been increasingly recognised in the literature as an ongoing process of discussion, communication and documentation of the patient’s wishes and values regarding end-of-life care. What does this paper add? This paper shows that most expert clinicians and representatives of key stakeholder organisations view ACP as a process that aims to enhance individual autonomy and ensure good end-of-life care. However, our findings show that they often hold contrasting views on ACP – ranging from a consumer-orientated view that sees ACP as undertaken to define and communicate their care preferences; to a care-orientated view that sees ACP as discussions led by health professionals in order to gain an understanding of patients’ values and wishes in order to provide better care. What are the implications for practitioners? Our findings highlight significant differences in how ACP is conceptualised in Australia. This can cause confusion and conflict, leading to reduced effectiveness of ACP. A shared conceptualisation and agreement on purpose is needed to ensure a successful implementation of ACP in Australia.

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Identification and operationalisation of indicators to monitor successful uptake of advance care planning policies: a modified Delphi study

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002780 ◽

2021 ◽

pp. bmjspcare-2020-002780

Author(s):

Konrad Fassbender ◽

Patricia Biondo ◽

Jayna Holroyd-Leduc ◽

Alexei Potapov ◽

Tracy Lynn Wityk Martin ◽

...

Keyword(s):

Healthcare System ◽

Advance Care Planning ◽

Delphi Study ◽

Online Survey ◽

Practice Change ◽

Public Healthcare ◽

Care Planning ◽

Face To Face ◽

Modified Delphi ◽

Advance Care

BackgroundIn 2014, the province of Alberta, Canada implemented a province-wide policy and procedures for advance care planning (ACP) and goals of care designation (GCD) across its complex, integrated public healthcare system. This study was conducted to identify and operationalise performance indicators for ACP/GCD to monitor policy implementation success and sustainment of ACP/GCD practice change.MethodsA systematic review and environmental scan was conducted to identify potential indicators of ACP/GCD uptake (n=132). A purposive sample of ACP/GCD stakeholders was invited to participate in a modified Delphi study to evaluate, reduce and refine these indicators through a combination of face-to-face meetings and online surveys.ResultsAn evidence-informed Donabedian by Institute of Medicine (IOM) framework was adopted as an organising matrix for the indicators in an initial face-to-face meeting. Three online survey rounds reduced and refined the 132 indicators to 18. A final face-to-face meeting operationalised the indicators into a measurable format. Nine indicators, covering 11 of the 18 Donabedian×IOM domains, were operationalised.ConclusionsNine ACP/GCD evidence-informed indicators mapping to 11 of 18 Donabedian×IOM domains were endorsed, and have been operationalised into an online ACP/GCD dashboard. The indicators provide a characterisation of ACP/GCD uptake that could be generalised to other healthcare settings, measuring aspects related to ACP/GCD documentation, patient satisfaction and agreement between medical orders and care received. The final nine indicators reflect the stakeholders’ expressed intent to strike a balance between comprehensiveness and feasibility within a large provincial healthcare system.

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Advance care planning billing practices and documentation quality for cancer patients requiring hospitalization.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e24000 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e24000-e24000

Author(s):

Callie Berkowitz ◽

Jessica Ma ◽

Jared Richard Lowe ◽

Rowena Dolor

Keyword(s):

Cancer Patients ◽

Advance Care Planning ◽

Successful Implementation ◽

Care Planning ◽

Oncology Patients ◽

Code Status ◽

Health Values ◽

Documentation Quality ◽

Advance Care ◽

Healthcare Proxy

e24000 Background: Advance Care Planning (ACP) is an important component of comprehensive cancer care, yet barriers exist to successful implementation. In 2016, Medicare introduced billing codes to provide reimbursement for ACP discussions. Our aim was to evaluate the usage of ACP billing codes and quality of accompanying documentation in patients with a prior oncology admission at an academic medical center. Methods: Using an electronic health record data warehouse tool, we identified a cohort of cancer patients who had been admitted to the inpatient oncology service and had an ACP billing encounter (CPT codes 99497 or 99498) over a 4-year period (8/1/2016 to 8/1/2020). We collected patient and provider demographics and performed descriptive statistics. We assessed ACP documentation quality for 30 patients selected at random based on 5 domains (healthcare proxy, health values or goals, scope of treatment/code status, prognosis/illness understanding, and end of life [EOL]care planning/hospice) previously identified from a literature review. Results: We identified 170 unique patients (180 ACP encounters), representing a small fraction (170/5636, 0.03%) of hospitalized oncology patients over the study period. Patients were 52% female with mean age of 64 (SD 12.9). Mean number of oncology hospitalizations was 2.6 (SD 1.96). ACP encounters took place in both inpatient (135/180; 75%) and outpatient (45/180; 25%) settings. In the outpatient setting, the majority of billing encounters were in palliative care (27/45; 60%), followed by oncology (12/45;27%) and primary care (5/45;11%). Of the sample of patient charts reviewed (n = 30), provider documentation frequently included scope of treatment (27/30; 90%), prognosis (27/30; 90%), EOL planning (21/30; 70%), and health values (19/30, 63%); healthcare proxy was infrequently included (4/30, 13%). Conclusions: ACP billing remains infrequently utilized for a cohort of oncology patients requiring hospitalization at a large academic center. In cases for which an ACP discussion is billed, the accompanied documentation is of high clinical utility and meets several key quality domains. This work lays a foundation for future research and quality improvement efforts to improve ACP and documentation.[Table: see text]

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Delivering an advance care planning facilitated model

International Journal of Palliative Nursing ◽

10.12968/ijpn.2019.25.6.264 ◽

2019 ◽

Vol 25 (6) ◽

pp. 264-273 ◽

Cited By ~ 1

Author(s):

Christine Fretwell ◽

Pat Worlock ◽

Aoife Gleeson

Keyword(s):

Advance Care Planning ◽

Social Care ◽

Public Awareness ◽

Health Board ◽

Successful Implementation ◽

Care Planning ◽

Collaborative Approach ◽

Strategic Objectives ◽

Health And Social Care ◽

Advance Care

Background: Advance care planning is increasingly recognised as an integral part of achieving excellence at the end of life (EoL), but barriers still prevent individuals from having the opportunity to discuss their wishes and preferences for the future. Aim: To describe the development and initial evaluations of an innovative facilitated ACP model, the ACP Triple E, which empowers individuals through education to engage in ACP conversations. Methods: This model uses a collaborative approach involving all sectors of a large university health board to equip all health and social care professionals with the knowledge, skills and confidence to engage in ACP discussion and also raise public awareness of the benefits of ACP. Conclusion: This model includes recognised elements that support successful implementation of ACP. Initial evaluations of the model are extremely positive. Further analysis of the data is now needed to evaluate the model's flexibility and its ability to change practice and achieve strategic objectives.

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Toward Hospital Implementation of Advance Care Planning: Should Hospital Professionals Be Involved?

Qualitative Health Research ◽

10.1177/1049732317735834 ◽

2017 ◽

Vol 28 (3) ◽

pp. 456-465 ◽

Cited By ~ 6

Author(s):

Birgit Vanderhaeghen ◽

Inge Bossuyt ◽

Sybille Opdebeeck ◽

Johan Menten ◽

Peter Rober

Keyword(s):

Content Analysis ◽

Grounded Theory ◽

Social Workers ◽

Advance Care Planning ◽

Implementation Process ◽

Successful Implementation ◽

Care Planning ◽

Hospital Practice ◽

External Auditors ◽

Advance Care

In Belgium, Advance Care Planning (ACP) is not well implemented in hospital practice. One of the premises for successful implementation is involving the adopters in the implementation process. In hospital, important adopters of ACP are physicians, nurses, social workers, and psychologists. First, this study wants to understand what the characteristics are of ACP in hospital, according to professionals. Second, this study aims to give an insight in the experienced value of ACP. Third, the experienced barriers to have ACP conversations are explored. Twenty-four interviews were taken and analyzed with Content Analysis based on Grounded Theory. Three independent external auditors surveilled the analysis. ACP in hospital exists by the grace of the initiative of the actors involved in the case. Professionals perceive fields of tension between one another; barriers to ACP communication. ACP is mainly considered valuable because it is a process that creates time for exploration and reflection.

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