scholarly journals Thoughts about Dying in America: Enhancing the impact of one’s life journey and legacy by also planning for the end of life

2016 ◽  
Vol 113 (46) ◽  
pp. 12908-12912 ◽  
Author(s):  
Philip A. Pizzo
Keyword(s):  
End Of Life ◽  
Social Services ◽  
Advance Care Planning ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
The United States ◽  
Care Planning ◽  
Public And Private ◽  
Advance Care ◽  
The Impact

This Perspective offers a summary of the recommendations in the Institute of Medicine report Dying in America. How we die is a deeply personal issue that each of us will face. However, the approach to end-of-life (EOL) care in the United States needs improvement. Too frequently, healthcare delivery is uncoordinated and has many providers who are not adequately prepared to have meaningful conversations about EOL planning. This is amplified by payment systems and policies that create impediments, misunderstanding, and sometimes misinformation. Dying in America made five recommendations to improve quality and honor individual preferences near the EOL beginning with making conversations with providers and families something that occurs during various phases of the life cycle and not just when one is facing serious illness or possible EOL. It was recommended (i) that public and private payers and care delivery organizations cover the provision of comprehensive care that is accessible and available to individuals on a 24/7 schedule; (ii) that professional societies and other entities establish standards for clinician patient communication and advance care planning and that payers and care delivery organizations adopt them; (iii) that educational institutions, credentialing bodies, accrediting boards, state regulatory agencies, and care delivery organizations establish palliative care training, certification, and/or licensure requirements; (iv) that public and private payers and care delivery organizations integrate the financing of health and social services; and (v) that public and private organizations should engage their constituents and provide fact-based information to encourage advance care planning and informed choice.

Discussion and documentation of future care: a before-and-after study examining the impact of an alternative approach to recording treatment decisions on advance care planning in an acute hospital

2017 ◽  
Vol 10 (2) ◽  
pp. e12-e12 ◽  
Author(s):  
Alexandra C Malyon ◽  
Julia R Forman ◽  
Jonathan P Fuld ◽  
Zoë Fritz
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Decisions ◽  
Care Planning ◽  
New Approach ◽  
Significance Level ◽  
Oncology Ward ◽  
Future Care ◽  
Advance Care ◽  
The Impact

ObjectiveTo determine whether discussion and documentation of decisions about future care was improved following the introduction of a new approach to recording treatment decisions: the Universal Form of Treatment Options (UFTO).MethodsRetrospective review of the medical records of patients who died within 90 days of admission to oncology or respiratory medicine wards over two 3-month periods, preimplementation and postimplementation of the UFTO. A sample size of 70 per group was required to provide 80% power to observe a change from 15% to 35% in discussion or documentation of advance care planning (ACP), using a two-sided test at the 5% significance level.ResultsOn the oncology ward, introduction of the UFTO was associated with a statistically significant increase in cardiopulmonary resuscitation decisions documented for patients (pre-UFTO 52% to post-UFTO 77%, p=0.01) and an increase in discussions regarding ACP (pre-UFTO 27%, post-UFTO 49%, p=0.03). There were no demonstrable changes in practice on the respiratory ward. Only one patient came into hospital with a formal ACP document.ConclusionsDespite patients’ proximity to the end-of-life, there was limited documentation of ACP and almost no evidence of formalised ACP. The introduction of the UFTO was associated with a change in practice on the oncology ward but this was not observed for respiratory patients. A new approach to recording treatment decisions may contribute to improving discussion and documentation about future care but further work is needed to ensure that all patients’ preferences for treatment and care at the end-of-life are known.

The Impact of Personal and Professional Loss on Advance Care Planning and Effective Care Delivery for Healthcare Social Workers

2018 ◽  
Vol 99 (4) ◽  
pp. 358-368
Author(s):  
Cara L. Wallace ◽  
Yit Mui Khoo ◽  
Leslie Hinyard ◽  
Jennifer E. Ohs ◽  
Dulce M. Cruz-Oliver
Keyword(s):  
Social Workers ◽  
Advance Care Planning ◽  
Care Delivery ◽  
Death And Dying ◽  
Care Planning ◽  
Professional Experiences ◽  
Effective Care ◽  
Advance Care ◽  
Past Experiences ◽  
The Impact

Personal experiences can influence the practice of social work. However, the connection between past experiences with death and social workers’ practice has been underexplored. As such, this study surveyed social workers ( N = 74) about their personal and professional experiences of loss, personal advance care planning, and professional practices. Results demonstrated that social workers that experienced prior loss were more likely to complete an advance directive and communicate their end-of-life wishes. Additionally, those who had experienced personal and professional loss showed greater effectiveness on measures of patient- and family-centered communication and care delivery. Findings suggest positive outcomes for encouraging social workers to connect their personal and professional experiences surrounding death and dying to effectively serve in their professional capacity.

Advance care planning for the severely ill in the hospital: a randomized trial

2019 ◽  
pp. bmjspcare-2017-001489 ◽  
Author(s):  
Tanja Krones ◽  
Ana Budilivschi ◽  
Isabelle Karzig ◽  
Theodore Otto ◽  
Fabio Valeri ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Decision Aids ◽  
Intervention Group ◽  
University Hospital ◽  
Care Planning ◽  
Medical Inpatients ◽  
Advance Care ◽  
Attending Physicians ◽  
The Impact

ObjectivesTo investigate the impact of advance care planning (ACP) including decision aids for severely ill medical inpatients.MethodsSingle-centre randomised controlled trial at a Swiss university hospital. Patients were randomly assigned (1:1) to receive an extra consultation with the hospital social service or a consultation with in-house facilitators trained according to an internationally established ACP programme. Trial participants with the exception of the observers were fully blinded. 115 competent severely ill adults, their surrogates and their attending physicians were enrolled and followed for 6 months after discharge or 3 months after death. The patient’s wishes regarding resuscitation (primary outcome), last place of care and other end-of-life wishes were recorded. Knowledge and respect of the patient’s wishes by the surrogates and attending physician were monitored.ResultsCompared with controls, 6 months after the intervention, fewer patients wished to be resuscitated or were undecided (p=0.01), resuscitation wishes were documented more frequently (89% vs 64%, p=0.02) and surrogates and/or attending physicians had greater knowledge of the patient’s wishes (62% vs 30%, p=0.01). Groups were not different with regard to wishes being fulfilled, with the exception of last place of care being achieved more frequently in the intervention group (29% vs 11 %, p=0.05).ConclusionACP including decision aids offered to severely ill medical inpatients leads to greater knowledge, documentation and respect of treatment and end-of-life wishes. Introducing ACP to these patients however may be too late for many patients. Early integration of ACP during the illness trajectory and a broader regional approach may be more appropriate.

Transformative Advance Care Planning: The Honoring Choices Minnesota Experience

2013 ◽  
Vol 19 (4) ◽  
pp. 200-204 ◽  
Author(s):  
Barbara Greene
Keyword(s):  
United States ◽  
Health Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Medical Condition ◽  
Death And Dying ◽  
The United States ◽  
Care Planning ◽  
Advance Care ◽  
Voluntary Community

In the United States, discussing end-of-life wishes and preferences has been taboo ever since death and dying moved from a stage of life to a medical condition. This article describes the transformative nature of a Minnesota health care initiative, Honoring Choices Minnesota (HCM). As the world’s largest nongovernmental, voluntary community-centered initiative, HCM is changing the culture around speaking of death and dying, one conversation at a time.

A Worldwide Bibliometric Analysis of Publications on Advance Care Planning in the Past 3 Decades

2019 ◽  
Vol 37 (6) ◽  
pp. 474-480
Author(s):  
Chia-Jen Liu ◽  
Te-Chun Yeh ◽  
Ming-Hsuan Hsieh ◽  
Lin-Chung Woung ◽  
Sheng-Jean Huang ◽  
...  
Keyword(s):  
United States ◽  
End Of Life ◽  
Bibliometric Analysis ◽  
Advance Care Planning ◽  
Developed Countries ◽  
The United States ◽  
Research Field ◽  
Care Planning ◽  
The Past ◽  
Advance Care

Background: In recent decades, issues related to end-of-life care and advance care planning (ACP) have attracted popular attention. Advance care planning has been broadly discussed as one of the potential solutions to protect a patient’s rights, autonomy, and dignity at the end of life. To better understand publishing on this topic, we conducted this study to demonstrate the worldwide research productivity, trends, and citations of ACP in the past 3 decades by bibliometric analysis. Methods: Articles published on ACP were retrieved from the Web of Science Core Collection database, and the subject terms included “advance directive,” or “advance care planning.” Results: Overall, 2126 publications on ACP were retrieved until January 22, 2019. North America, Western Europe, and Australia were the most productive regions. The top 15 countries published 95.9% of the total number of articles. The United States accounted for approximately three-fifths (61.0%) of all publications. When adjusted for population size, Australia had the highest number of articles per million persons (6.64), followed by the Netherlands (6.14) and Belgium (4.61). The most productive authors were Sudore (n = 37), Deliens (n = 29), and Green (n = 24). Conclusions: The current study revealed that research in terms of publications on ACP has rapidly increased over the past 3 decades. Developed countries, especially the United States, were more concerned with the ACP research field than developing countries were.

Promotion of Advance Care Planning Among Young Adults: A Pilot Study of Health Engagement Workshop Feasibility, Implementation, and Efficacy

2020 ◽  
pp. 104990912095116
Author(s):  
Philip Barrison ◽  
Lindy Grief Davidson
Keyword(s):  
Young Adults ◽  
Pilot Study ◽  
End Of Life ◽  
Advance Care Planning ◽  
Mixed Method ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Advance Care ◽  
The Impact

Objective: This pilot study set out to evaluate the feasibility and efficacy of an interactive, peer-led, health engagement workshop to improve confidence and comprehension related to advance care planning (ACP) among young adults. Secondarily, this study evaluated if such workshops could promote ACP related behavior changes within this population. Methods: This observational cohort study utilized a repeated measures, mixed-method design. Six hour-long, in-person workshops were conducted with undergraduate students during meetings of university student organizations. Participants were evaluated across 3 mixed-method surveys, evaluating confidence, knowledge, and behaviors related to ACP prior to participation, directly after, and during a 2-week follow-up. Results: Workshop participation improved the average participant confidence and knowledge related to ACP as well as encouraged some participants to engage in discussions related to end-of-life care with friends and family. Alongside the impact of the workshops on knowledge and confidence, participants positively evaluated the design of the workshops through collected qualitative feedback. Conclusion: These results are encouraging in assessing this population’s willingness to learn about end-of-life care planning. The tools developed and the corresponding results should be used for further exploration of engaging the young adult population in ACP to promote improved healthcare outcomes.

scholarly journals Goals of Care Conversations and Subsequent Advance Care Planning Outcomes for People with Dementia

2021 ◽  
Vol 83 (4) ◽  
pp. 1767-1773
Author(s):  
Heather Ma ◽  
Rachel E. Kiekhofer ◽  
Sarah M. Hooper ◽  
Sarah Dulaney ◽  
Katherine L. Possin ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Perceived Usefulness ◽  
Care Planning ◽  
Goals Of Care ◽  
People With Dementia ◽  
Advance Care ◽  
End Of Life Decision ◽  
The Impact

Background: Advance care planning has been shown to improve end of life decision-making for people with dementia. However, the impact of goals of care conversations between people with dementia and their caregivers has not been characterized. Objective: In this study, we evaluate the association between goals of care conversations and advance care planning outcomes. Methods: Retrospective advance care planning measures were collected via a questionnaire administered to 166 caregivers after the death of the person with dementia for whom they provided care. Results: At time of death, the majority of decedents with dementia had advance directives, health care agents, and previous goals of care conversations with their caregiver. Goals of care conversations were significantly associated with the perceived usefulness of advance directives, the perceived adherence to advance directives, and decedent dying at their desired place of death, but not with disagreements around end-of-life care. Conclusion: Our findings suggest that goals of care conversations are an important component of advance care planning. These findings support the development of interventions that facilitate such conversations between people with dementia and their caregivers.

scholarly journals Building on Individual, State, and Federal Initiatives for Advance Care Planning, an Integral Component of Palliative and End-of-Life Cancer Care

2011 ◽  
Vol 7 (6) ◽  
pp. 355-359 ◽  
Author(s):  
Andrew S. Epstein ◽  
Angelo E. Volandes ◽  
Eileen M. O'Reilly
Keyword(s):  
Public Policy ◽  
End Of Life ◽  
Advance Care Planning ◽  
Cancer Care ◽  
Care Delivery ◽  
Care Planning ◽  
Individual State ◽  
State Public Policy ◽  
Advance Care ◽  
Federal Initiatives

Recent federal and state public policy focuses on advance care planning, suggesting the promise for care delivery improvements and the means for surmounting barriers.

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