A quasi-experimental evaluation of advance care planning improves consistency between elderly individuals and their surrogates regarding end-of-life care preferences: Development and application of a decision aid with cartoon pictures

2020 ◽  
Author(s):  
Li-Shan Ke ◽  
Wen-Yu Hu ◽  
Ching-Yu Chen ◽  
Chieh-Yu Liu ◽  
Tai-Yuan Chiu
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Experimental Evaluation ◽  
End Of Life Care ◽  
Decision Aid ◽  
Care Planning ◽  
Life Care ◽  
Elderly Individuals ◽  
Quasi Experimental ◽  
Advance Care

scholarly journals Advance Care Planning Among Patients With Advanced Cancer

2019 ◽  
Vol 15 (1) ◽  
pp. e65-e73 ◽  
Author(s):  
Jane R. Schubart ◽  
Benjamin H. Levi ◽  
Megan M. Bain ◽  
Elana Farace ◽  
Michael J. Green
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Decision Aid ◽  
Family Members ◽  
Care Planning ◽  
Life Care ◽  
Physician Awareness ◽  
Advance Care

Purpose: Advance directives (AD) have been heralded as vehicles to promote patient autonomy and have been decried as ineffective. Efforts to improve advance care planning (ACP) and AD documents are wide ranging but have not been prospectively studied. Materials and Methods: In an institutional review board–approved, single-blind, randomized, controlled trial, we compared an interactive, educational ACP decision aid to standard ACP among patients with advanced cancer. We hypothesized that use of the decision aid would increase physician awareness of patients’ health care wishes and increase physician adherence to patients’ end-of-life wishes compared with standard ACP. Results: A total of 200 patients were randomly assigned to two study arms. We analyzed data from medical records and interviews with physicians and family members for 121 patients who died by August 2016. No differences in physician awareness or adherence were found between the ACP decision aid and standard ACP groups. End-of-life treatment wishes and discussion of wishes were documented for 70% and 64% of the patients, respectively, but only 35% had an actual AD in the medical record. According to family members, end-of-life care was consistent with the patients’ stated wishes 94% of the time. Similarly, according to physicians, it was consistent for 98%. However, according to AD documents, delivered care was consistent with desired care in only 65%. Considerably fewer patients than predicted died, and data from physicians were difficult to obtain. Conclusion: ACP type did not influence documentation of patient wishes or end-of-life care received. Future prospective studies must account for challenges in prognostication and point-of-care data collection at the end of life.

scholarly journals Unraveling the Effects of Social Class and Systemic Racism on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 472-472
Author(s):  
Jenny McDonnell
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Black Americans ◽  
Low Ses ◽  
Care Planning ◽  
Life Care ◽  
Black And White ◽  
Advance Care ◽  
Using Data

Abstract While advance care planning (ACP) is recognized as a key facilitator of high-quality, goal-concordant end-of-life care, black Americans are less likely to participate in ACP than non-Hispanic whites (Carr 2011; Detering et al. 2010). There are divided explanations for why these disparities persist. Some scholars attribute racial disparities in end-of-life care to socioeconomic (SES) differences between black and white Americans citing blacks’ and whites’ differentiated access to, control over, and use of material resources (Wilson 1978; Yearby 2011). Others assert that health care preferences do not solely reflect lack of resources or health literacy, but that the larger social context frames care preferences differently across racial and ethnic groups in American society (Alegria et al. 2011; Sewell and Pingel forthcoming). By turning the analytical lens to class-privileged black Americans, I investigate whether racism overflows the margins of class disadvantage. Using data from the Health and Retirement Study, I ran logistic regression and moderation models. I found that class-privileged blacks are less likely to engage in ACP than both high-SES and low-SES whites. The interaction of race and SES was negatively and significantly associated with ACP (OR=0.91; P<0.05), indicating that SES has a stronger effect on the probability of ACP among whites than among blacks. Predicted probabilities show that 51% of low-SES whites are likely to engage in ACP compared to 32% of high-SES blacks. These findings indicate that racialized disparities in ACP exist independent of SES, and that the effects of SES and race are intersectional rather than simply additive.

545: END-OF-LIFE CARE FOR CHILDREN WITH MEDICAL COMPLEXITY: DOES ADVANCE CARE PLANNING MATTER?

2016 ◽  
Vol 44 (12) ◽  
pp. 213-213
Author(s):  
Danielle DeCourcey ◽  
Melanie Silverman ◽  
Adeolu Oladunjoye ◽  
Joanne Wolfe
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Children With Medical Complexity ◽  
Medical Complexity ◽  
Advance Care

Advance care planning and end-of-life care in a network of rural Western Australian hospitals

2015 ◽  
Vol 23 (4) ◽  
pp. 195-200 ◽  
Author(s):  
Kirsten Auret ◽  
Craig Sinclair ◽  
Barbara Averill ◽  
Sharon Evans
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Advance Care ◽  
Western Australian

13 Exploring patient safety incidents arising from advance care planning for end of life patients: a mixed methods analysis of incident reports

2018 ◽  
Vol 8 (3) ◽  
pp. 364.2-365 ◽  
Author(s):  
Toby Dinnen ◽  
Huw Williams ◽  
Simon Noble ◽  
Adrian Edwards ◽  
Joyce Kenkre ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Advance Care ◽  
Incident Reports ◽  
Patient Safety Incidents

IntroductionAdvance Care Planning (ACP) is an important component of patient centred end-of-life care (Houben et al. 2014; Brinkman-Stoppelenburg et al. 2014). However there is little evidence available on the safety of the process and its impact on quality of care.AimTo characterise the nature of patient safety incidents arising around the ACP process for patients approaching end-of-life.MethodThe National Reporting and Learning System (NRLS) collates patient safety incident reports across England and Wales. We performed a keyword search and manual review to identify relevant reports between 2005 and 2015. A mixed methods process combining structured data coding and exploratory descriptive analysis was undertaken to describe incidents underlying causes and outcomes. A thematic analysis identified areas on which to focus improvement initiatives.ResultsWe identified 67 incident reports in which patients experienced inadequate care due to issues with implementation of ACP. The most common source of error was (mis)communication of ACP (n=27) where documentation was lost or verbal handover was inaccurate. Over one third of reports (n=24) described an ACP not being followed. In the remaining reports (n=16) an ACP was not completed despite being appropriate. The most common contributory factor was inadequate staff knowledge (n=18). Common outcomes were cardiopulmonary resuscitation attempts contrary to a patient’s wishes (n=18). Other outcomes included inappropriate treatment or transfer/admission.ConclusionOur national level analysis identifies key priorities which should be explored in local contexts: specifically improving public and staff understanding and engagement with ACP and developing systems for recording and accessing ACP documentation across healthcare services.References. Brinkman-Stoppelenburg A, Rietjens JA, Van Der Heide A. The effects of advance care planning on end-of-life care: A systematic review. Palliative Medicine2014;28:1000–25.. Houben CH, Spruit MA, Groenen MT, Wouters EF, Janssen DJ. Efficacy of advance care planning: A systematic review and meta-analysis. Journal of the American Medical Directors Association2014;15:477–89.

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