Prevalence, perceived barriers and sociodemographic correlates of advance care planning in a sample of outpatients

2020 ◽  
Vol 26 (1) ◽  
pp. 76
Author(s):  
Elise Mansfield ◽  
Sarah Jeong ◽  
Amy Waller ◽  
Sally Chan
Keyword(s):  
Advance Care Planning ◽  
Healthcare Providers ◽  
Perceived Barriers ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
South Wales ◽  
Sociodemographic Correlates ◽  
Advance Care ◽  
Advance Care Directive

This study aimed to examine the prevalence and perceived barriers to uptake of advance care planning (ACP), including appointment of an enduring guardian (EG) and completion of an advance care directive (ACD) among Australian adults attending hospital outpatient clinics. Sociodemographic correlates of not completing ACP were also assessed. A cross-sectional survey exploring the uptake of ACP was conducted with outpatients and their accompanying persons aged >18 years (n=191) at one regional hospital in New South Wales, Australia. Rates of completion of an ACD and appointment of an EG were 20% (n=37) and 35% (n=67) respectively. The most common reason for non-completion of an ACD and not appointing an EG was: ‘didn’t think I needed this’. Younger age was associated with not having appointed an EG (OR 3.8, 95% CI 1.2–12.1, P=0.02). No sociodemographic characteristics were significantly associated with non-completion of ACDs. Uptake of ACP is suboptimal among outpatients. Community-based healthcare providers are well positioned to promote ACP with outpatients.

scholarly journals Advance care planning and palliative care in ACHD: the healthcare providers’ perspective

2020 ◽  
Vol 30 (3) ◽  
pp. 402-408
Author(s):  
Jill M. Steiner ◽  
Erwin N. Oechslin ◽  
Gruschen Veldtman ◽  
Craig S. Broberg ◽  
Karen Stout ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Physical Symptoms ◽  
Care Planning ◽  
Psychosocial Needs ◽  
Cross Sectional ◽  
Advance Care

ABSTRACTBackground:Advance care planning and palliative care are gaining recognition as critical care components for adults with CHD, yet these often do not occur. Study objectives were to evaluate ACHD providers’ 1) comfort managing patients’ physical symptoms and psychosocial needs and 2) perspectives on the decision/timing of advance care planning initiation and palliative care referral.Methods:Cross-sectional study of ACHD providers. Six hypothetical patients were described in case format, followed by questions regarding provider comfort managing symptoms, initiating advance care planning, and palliative care referral.Results:Fifty providers (72% physicians) completed surveys. Participants reported low levels of personal palliative care knowledge, without variation by gender, years in practice, or prior palliative care training. Providers appeared more comfortable managing physical symptoms and discussing prognosis than addressing psychosocial needs. Providers recognised advance directives as important, although the percentage who would initiate advance care planning ranged from 18 to 67% and referral to palliative care from 14 to 32%. Barriers and facilitators to discussing advance care planning with patients were identified. Over 20% indicated that advance care planning and end-of-life discussions are best initiated with the development of at least one life-threatening complication/hospitalisation.Conclusions:Providers noted high value in advance directives yet were themselves less likely to initiate advance care planning or refer to palliative care. This raises the critical questions of when, how, and by whom discussion of these important matters should be initiated and how best to support ACHD providers in these endeavours.

scholarly journals Experiences and needs of patients with incurable cancer regarding advance care planning: results from a national cross-sectional survey

2020 ◽  
Vol 28 (9) ◽  
pp. 4211-4217 ◽  
Author(s):  
Mariken E. Stegmann ◽  
Olaf P. Geerse ◽  
Dorien Tange ◽  
Carol Richel ◽  
Linda Brom ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Incurable Cancer ◽  
Cross Sectional ◽  
Advance Care

scholarly journals Paediatric advance care planning survey: a cross-sectional examination of congruence and discordance between adolescents with HIV/AIDS and their families

2017 ◽  
Vol 9 (1) ◽  
pp. e22-e22 ◽  
Author(s):  
Maureen E Lyon ◽  
Ronald H Dallas ◽  
Patricia A Garvie ◽  
Megan L Wilkins ◽  
Ana Garcia ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Paediatric Hospital ◽  
Life Threatening Illness ◽  
Patient Reported ◽  
Registration Number ◽  
Life Threatening ◽  
Advance Care

ObjectivesTo identify patient-reported paediatric advance care planning (pACP) needs of adolescents living with HIV and to examine the congruence with their family’s perception of their needs.MethodsA cross-sectional survey among six paediatric hospital-based outpatient HIV specialty clinics. Participants included 48 adolescent/family dyads (n=96 participants) within a larger study facilitating pACP. The main outcome measure was the Lyon Advance Care Planning Survey – Adolescent and Surrogate Versions-Revised.ResultsAdolescents’ mean age was 18 years (range ≥14–<21); 54% male; 92% African-American; 27% with prior AIDS diagnosis. If dying, 92% believed in completing an advance directive; 85% preferred to die at home;88% knowing how to say good bye; 71% being off machines that extend life and 77% dying a natural death. Best timing for end-of-life (EOL) decisions was while healthy (38%), when first diagnosed (17%), when first sick from a life-threatening illness (4%), when first hospitalised (8%), if dying (4%) and all of the above (19%). Prevalence-adjusted bias-adjusted Kappa (PABAK) measured congruence in pACP needs within adolescent/family dyads. There was substantial congruence in that being free from pain (PABAK=0.83), and understanding your treatment choices (PABAK=0.92) were very important or important. There was discordance about being off machines that extend life (PABAK=0.08) and when is the best time to bring up EOL decisions (PABAK=0.32).ConclusionsAreas of discordance were associated with life-sustaining choices and when to have the EOL conversation. Targeted, adolescent/family-centred, evidence-based pACP interventions are needed to improve family understanding of youth’s EOL wishes.Trial registration numberNCT01289444; Results.

scholarly journals Advance care planning participation by people with dementia: a cross-sectional survey and medical record audit

2021 ◽  
pp. bmjspcare-2020-002550
Author(s):  
Jamie Bryant ◽  
Marcus Sellars ◽  
Amy Waller ◽  
Karen Detering ◽  
Craig Sinclair ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Aged Care ◽  
Residential Aged Care ◽  
Health Record ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Substitute Decision Maker ◽  
People With Dementia ◽  
Advance Care

ObjectivesTo describe among individuals with dementia: (1) self-reported awareness of, and engagement in, advance care planning; (2) presence of advance care planning documentation in the health record and (3) concordance between self-reported completion of advance care planning and presence of documentation in the health record.MethodsAn Australian prospective multicentre audit and cross-sectional survey. Individuals diagnosed with dementia who were able to speak English and were judged by a healthcare provider as having decision-making capacity were recruited from self-selected hospitals, residential aged care facilities and general practices across Australia.ResultsFifty-two people with dementia completed surveys and were included. Overall, 59.6% of participants had heard about advance care planning and 55.8% had discussed advance care planning with someone, most often a family member (48.1%). While 38.5% of participants had appointed a medical substitute decision maker, only 26.9% reported that they had written down their values and preferences for future care. Concordance between self-reported completion of advance care planning and presence of documentation in the health record was low (56.8%, κ=0.139; 57.7%, κ=0.053).ConclusionEffective models that promote discussion, documentation and accessible storage of advance care planning documents for people with dementia are needed.

Baseline Knowledge Attitudes Satisfaction and Aspirations With Advance Care Planning: A Cross-Sectional Study

2021 ◽  
pp. 104990912110304
Author(s):  
Jojo Yorke ◽  
Emmanuel Yobo-Addo ◽  
Kanwardeep Singh ◽  
Ali Muzzam ◽  
Imran Khan ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Cross Sectional Study ◽  
Care Plan ◽  
Medical Decision ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Informal System ◽  
Baseline Knowledge ◽  
Advance Care

Background: Studies have consistently demonstrated low rates of adoption of Advance Care Planning in the community. Methods: We studied Medicare enrollees age 65 and over and non-Medicare patients using a cross-sectional survey undertaken in February and March 2019 using questionnaires completed by out-patients attending a teaching hospital clinic in East Tennessee USA. We evaluated patient knowledge, attitudes, satisfaction and aspirations towards Advance Care Planning. Results: 141 properly completed questionnaires were used. All Medicare enrollees were aware of Advanced Care Planning compared to 43% in the non-Medicare group. 70% of the Medicare enrollees and 94% of non-Medicare group were not ready to complete a written Advanced Care Plan. Of the respondents, 46% had appointed spouses, 24% adult children, 11% siblings, 10% parents, 3.6% friends and 1.2% aunts as their surrogate medical decision makers. 41% agreed that they were satisfied with their current advance care planning arrangements. This research identified that individual’s knowledge, attitudes and aspirations influenced the adoption of Advance Care. Conclusions: Patients have adopted the Advance Care Plan concept but have modified it to reduce their concerns by using family and loved ones to convey their wishes instead of filling the required legal documents. Clinicians could improve this informal system and increase the observability of the treatment choices including the use of video and web-based tools.

scholarly journals How do Lawyers Assist Their Clients With Advance Care Planning? Findings From a Cross-Sectional Survey of Lawyers in Alberta

2018 ◽  
Author(s):  
Nola M. Ries ◽  
Maureen Douglas ◽  
Jessica Simon ◽  
Konrad Fassbender
Keyword(s):  
Advance Care Planning ◽  
Care Plan ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Future Health ◽  
Cross Sectional ◽  
Legal Professionals ◽  
Advance Care Plan ◽  
Future Health Care ◽  
Advance Care

Advance care planning (ACP) is the process of thinking about, discussing and documenting one’s preferences for future health care. ACP has important benefits: people who have a written directive are more likely to receive care that accords with their preferences, have fewer hospitalizations, and die in their preferred location. This article focuses on the important role that legal professionals have in advising and assisting clients with ACP. Studies report that people who have a written advance care plan are more likely to have received assistance in preparing the document from a lawyer than from a doctor. Yet virtually no research engages with the legal profession to understand lawyers’ attitudes, beliefs, and practices in this important area. This article starts to fill this gap by reporting the findings of a survey of lawyers in the province of Alberta. The results reveal lawyers’ practices in relation to ACP, their perceptions of their professional role and factors that support or hinder lawyers in working with clients on ACP, and their preferences for resources to assist them in helping their clients. To the authors’ knowledge, this is the first survey of lawyers on their practices in relation to ACP.

scholarly journals Differences in perspectives of pediatricians on advance care planning: a cross-sectional survey

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
In Gyu Song ◽  
Sung Han Kang ◽  
Min Sun Kim ◽  
Cho Hee Kim ◽  
Yi Ji Moon ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Pediatric Patients ◽  
Medical Society ◽  
Care Planning ◽  
Aggressive Treatment ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Comfort Care ◽  
Care Plans ◽  
Advance Care

Abstract Background The increase in the number of pediatric patients with complex health conditions necessitates the application of advance care planning for children. Earlier, withdrawal of life-sustaining treatment was taboo in the medical society in South Korea due to the history of such practice being punishable by law, and physicians tended to pursue aggressive treatment. With changes in public opinion on end-of-life care, the Korean government enacted a new law that protect human dignity by respecting patients’ self-determination and facilitating advance care planning. However, little is known about current state of advance care planning for pediatric patients. The study aimed to assess perceptions regarding advance care planning among South Korean pediatricians and clarify any differences in perception among pediatric subspecialties. Methods This study was an observational cross-sectional survey that used a web-based self-report questionnaire. Participants comprised of pediatricians currently caring for children with life-limiting conditions in 2018. Results Of the 96 respondents, 89 were included in the analysis. In a hypothetical patient scenario, more hemato-oncologists and intensivists than neonatologists and neurologists preferred to provide comfort care than aggressive treatment. While 72.2% of hemato-oncologists reported that they usually or always discuss advance care plans with parents during treatment, more than half of other pediatricians reported that they seldom do so. Furthermore, 65% of respondents said that they never discuss advance care planning with adolescent patients. Moreover, there were no notable differences among subspecialties. The most prevalent answers to factors impeding advance care planning were lack of systemic support after performing advance care planning (82.0%) and uncertain legal responsibilities (70.8%). Conclusions The pediatricians differed in their experiences and attitudes toward advance care planning based on their subspecialty. Consequently, institutional support and education should be provided to physicians so that they can include children and families in discussions on prognosis.

Church-Based Health Promotion Focused on Advance Care Planning and End-of-Life Care at Black Baptist Churches: A Cross-Sectional Survey

2016 ◽  
Vol 19 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Danetta Hendricks Sloan ◽  
Theodora Peters ◽  
Kimberly S. Johnson ◽  
Janice V. Bowie ◽  
Yang Ting ◽  
...  
Keyword(s):  
Health Promotion ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Baptist Churches ◽  
Advance Care
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