Caring About Cancer—Advance Care Planning Group Visit Intervention (QI744)

Abstract Among older adults without cognitive impairment, a novel advance care planning group visit (ACP-GV) intervention increased ACP documentation and readiness to engage in ACP. A key question is whether an intervention can be adapted to support people with mild cognitive impairment (MCI) and a family care partner. We used a human-centered design process, rapid-cycle prototyping, and qualitative methods to adapt an ACP-GV intervention to individuals with MCI and a study partner. In 2019, we convened a longitudinal cohort of six patient-study partner stakeholders in three focus groups to suggest intervention adaptations. We also conducted a single arm study of four ACP-GV interventions (n=13 dyads total) that were iteratively refined with input from the longitudinal focus groups and intervention participant feedback. Decision tools, resources and videos were used to describe the concept of ACP and flexibility in selecting a medical decision maker. Many ACP-GV participants strongly agreed that the group discussion gave them useful information (81%) and would recommend the ACP-GV to a friend (85%). Pre- and post-ACP readiness surveys indicated that participants were significantly more ready to talk to their medical decision maker about ACP (p=0.028), while study partners perceived their loved ones less ready to speak to their doctor about ACP following the intervention (p=0.031). Use of rapid prototyping allowed testing of different resources and tools aimed at helping individuals with MCI and their study partners discuss ACP. Future work is needed to understand the feasibility of implementing an ACP-GV intervention for individuals with MCI into clinical settings.

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Conducting an advance care planning group among older adults living in residential care homes: An initiative of social workers in Hong Kong

Health & Social Care in the Community ◽

10.1111/hsc.13310 ◽

2021 ◽

Author(s):

Wallace Chi Ho Chan ◽

Tsz Kiu Yu

Keyword(s):

Older Adults ◽

Hong Kong ◽

Social Workers ◽

Residential Care ◽

Advance Care Planning ◽

Care Homes ◽

Care Planning ◽

Advance Care ◽

Planning Group

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‘I AM SO ANGRY AND FRIGHTENED TO BE AT THIS STAGE OF MY LIFE’: OBSERVATIONS OF GRIEF AND LOSS IN COMMUNITY ADVANCE CARE PLANNING GROUP EDUCATION

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2013-000491.38 ◽

2013 ◽

Vol 3 (2) ◽

pp. 239.2-240

Author(s):

L Crowe ◽

J Boddy ◽

L Chenoweth

Keyword(s):

Advance Care Planning ◽

Grief And Loss ◽

Care Planning ◽

Group Education ◽

Advance Care ◽

Planning Group

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Effectiveness of Advance Care Planning Group Visits for Older Adults in Primary Care (CS201C)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2020.04.038 ◽

2020 ◽

Vol 60 (1) ◽

pp. 195-196

Author(s):

Hillary Lum ◽

Rebecca Sudore ◽

Jean Kutner

Keyword(s):

Older Adults ◽

Primary Care ◽

Advance Care Planning ◽

Care Planning ◽

Group Visits ◽

Advance Care ◽

Planning Group

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Effectiveness of Advance Care Planning Group Visits Among Older Adults in Primary Care

Journal of the American Geriatrics Society ◽

10.1111/jgs.16694 ◽

2020 ◽

Vol 68 (10) ◽

pp. 2382-2389

Author(s):

Hillary D. Lum ◽

Joanna Dukes ◽

Andrea E. Daddato ◽

Elizabeth Juarez‐Colunga ◽

Prajakta Shanbhag ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Advance Care Planning ◽

Care Planning ◽

Group Visits ◽

Advance Care ◽

Planning Group

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Group-based educational intervention for advance care planning in primary care: a quasi-experimental study in Japan

Asia Pacific Family Medicine ◽

10.22146/apfm.v18i1.54 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Shuji Tsuda ◽

Mary R. Janevic ◽

Kota Shikano ◽

Tomoko Matsui ◽

Tsukasa Tsuda

Keyword(s):

Primary Care ◽

Advance Care Planning ◽

Advance Directive ◽

Future Research ◽

Care Planning ◽

Group Discussions ◽

Quasi Experimental ◽

Advance Care ◽

The Individual ◽

Planning Group

Background: Older adults who have health conditions with good prognoses typically fall outside the scope of efforts encouraging advance care planning. We developed group and individual versions of an advance care planning program for use in primary care. Methods: We conducted a quasi-experimental trial in a rural family clinic in Japan. Medically stable patients aged ≥65 years were invited to watch an educational video on advance care planning, followed by an individual (n=46) or group-based (n=63) discussion. Advance directive completion was tracked over four months. Participants completed baseline and follow-up questionnaires and reported occurrence of family discussions about advance care planning and attitudes toward advance care planning. Group discussions were recorded and thematically analyzed to identify barriers and facilitators to engaging in advance care planning. Results: Advance directive completion rates were high for both intervention versions but did not significantly differ between arms (85.7% vs. 80.4%, p=0.45). Only one-fifth of patients in both arms discussed advance care planning with their family after the intervention (20.7% and 21.7%, p=0.89). Patients in the group arm rated their experience slightly higher than those in the individual arm (4.2 and 3.9 out of 5, p=0.023). Qualitative analysis of group discussions revealed that patients were affected by their perceptions of societal norms that prioritize family consensus over patient autonomy; however, these perceptions influenced advance care planning behaviors in inconsistent ways. Conclusions: Group-based advance care planning intervention among medically stable older patients is as effective as an individually-focused discussion in promoting advance directive completion. Future research is needed on ways to enhance patients’ ability to discuss advance care planning with their family members.

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A Novel Advance Care Planning Group Medical Visit for Older Adults in Primary Care is Feasible, Acceptable, and Helpful (S761)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2014.11.240 ◽

2015 ◽

Vol 49 (2) ◽

pp. 438-439

Author(s):

Hillary Lum ◽

Jacqueline Jones ◽

Cari Levy ◽

Robert Schwartz ◽

Jean Kutner

Keyword(s):

Older Adults ◽

Primary Care ◽

Advance Care Planning ◽

Care Planning ◽

Medical Visit ◽

Advance Care ◽

Planning Group

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Human-Centered Design of an Advance Care Planning Group Visit for Mild Cognitive Impairment

The Gerontologist ◽

10.1093/geront/gnab181 ◽

2021 ◽

Author(s):

Andrea E Daddato ◽

Elizabeth W Staton ◽

Brianne M Bettcher ◽

Prajakta Shanbhag ◽

Hillary D Lum

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Advance Care Planning ◽

Advisory Panel ◽

Care Planning ◽

Multiple Perspectives ◽

Group Setting ◽

Human Centered Design ◽

Group Visit ◽

Advance Care

Abstract Background and Objectives While advance care planning (ACP) is critical for ensuring optimal end-of-life outcomes among individuals with mild cognitive impairment (MCI), many individuals that may benefit from ACP have not initiated this process. This paper aims to describe the iterative design of a MCI group visit-based intervention, and evaluate feasibility and acceptability of the intervention. Research Design and Methods We used human-centered design, rapid-cycle prototyping, and multiple methods to adapt an Engaging in Advance Care planning Talks (ENACT) Group Visits intervention. We convened an advisory panel of persons with MCI and care partners (n=6 dyads) to refine the intervention and conducted a single-arm pilot of four MCI ENACT intervention prototypes (n=13 dyads). We used surveys and interviews to assess outcomes from multiple perspectives. Results The advisory panel affirmed that ACP is a priority for individuals with MCI, described the need for ACP in a group setting, and suggested refinements to ACP resources for the MCI ENACT intervention. Feasibility of recruitment was limited. MCI ENACT intervention participants strongly agreed that group discussions provided useful information and recommended the intervention. Themes supporting acceptability included: 1) feedback on acceptability of the intervention; 2) previous experiences with ACP; and 3) reasons for participation, including desire for discussions about MCI and how it relates to ACP. Discussion and Implications Despite stakeholder’s positive ratings of acceptability of the MCI ENACT intervention, future work is needed to enhance feasibility of recruitment to support implementation into clinical settings.

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