scholarly journals A Longitudinal Study of Retirement Transition and Advance Directive Completion

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 441-441
Author(s):  
Catheryn Koss
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Multinomial Logistic Regression ◽  
Statistical Significance ◽  
Optimal Time ◽  
Retirement Transition ◽  
Multistep Process ◽  
Study Participants ◽  
Retirement Study

Abstract Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of-life care. According to normative life course theory, retirement is a significant role change that signals a transition into the third age and its socially prescribed activities. To the extent that ACP is viewed as something to do when one reaches a more advanced stage in life, retirement may spark recognition that planning for incapacity and the end of life is now personally relevant and appropriate. This study tested whether transitioning from work to retirement prompted AD completion. The sample included Health and Retirement Study participants 65 and older who, in 2012, had no ADs and were not completely retired (N = 919). Retirement was operationalized as both a categorical status and as a multistep process. Three waves of data were analyzed using multinomial logistic regression to test associations between retirement transition and advance directive completion. By 2014, 21% had completed ADs and another 17% completed them by 2016. Those who completely retired between 2012 and 2014 were almost twice as likely to complete ADs between 2014 and 2016. Graduated increase in level of retirement between 2012 and 2014 was associated with higher odds of new AD possession in 2016, but did not reach statistical significance at p < .05. These results suggest the period following retirement may be an optimal time to encourage patients and clients who have not already done so to complete advance directives.

scholarly journals A Longitudinal Study of Retirement Transition and Advance Directive Completion

2020 ◽  
Vol 60 (6) ◽  
pp. 1005-1010
Author(s):  
Catheryn S Koss
Keyword(s):  
Advance Directives ◽  
Advance Directive ◽  
Multinomial Logistic Regression ◽  
Statistical Significance ◽  
Optimal Time ◽  
Role Change ◽  
Retirement Transition ◽  
Study Participants ◽  
Design And Methods ◽  
Retirement Study

Abstract Background and Objectives Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of-life care. According to normative life course theory, retirement is a significant role change that signals a transition into the third age and its socially prescribed activities. This study tested whether transitioning from work to retirement prompted AD completion. Research Design and Methods The sample included Health and Retirement Study participants who, in 2012, had no ADs and were not completely retired (N = 919). Three waves of data were analyzed using multinomial logistic regression to test associations between retirement transition and advance directive completion. Results By 2014, 21% had completed ADs and another 17% completed them by 2016. Those who completely retired between 2012 and 2014 were almost twice as likely to complete ADs between 2014 and 2016. Graduated increase in level of retirement between 2012 and 2014 was associated with higher odds of new AD possession in 2016, but did not reach statistical significance at p < .05. Discussion and Implications The period following retirement may be an optimal time to encourage patients and clients who have not already done so to complete advance directives.

scholarly journals End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 930
Author(s):  
Jan A. Graw ◽  
Fanny Marsch ◽  
Claudia D. Spies ◽  
Roland C. E. Francis
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Medical Center ◽  
Relevant Information ◽  
Number Of Patients ◽  
Before And After ◽  
Ethical Approval

Background and Objectives: Mortality on Intensive Care Units (ICUs) is high and death frequently occurs after decisions to limit life-sustaining therapies. An advance directive is a tool meant to preserve patient autonomy by guiding anticipated future treatment decisions once decision-making capacity is lost. Since September 2009, advance directives are legally binding for the caregiver team and the patients’ surrogate decision-maker in Germany. The change in frequencies of end-of-life decisions (EOLDs) and completed advance directives among deceased ICU patients ten years after the enactment of a law on advance directives in Germany is unknown. Materials and Methods: Retrospective analysis on all deceased patients of surgical ICUs of a German university medical center from 08/2008 to 09/2009 and from 01/2019 to 09/2019. Frequency of EOLDs and advance directives and the process of EOLDs were compared between patients admitted before and after the change in legislation. (No. of ethical approval EA2/308/20) Results: Significantly more EOLDs occurred in the 2019 cohort compared to the 2009 cohort (85.8% vs. 70.7% of deceased patients, p = 0.006). The number of patients possessing an advance directive to express a living or therapeutic will was higher in the 2019 cohort compared to the 2009 cohort (26.4% vs. 8.9%; difference: 17.5%, p < 0.001). Participation of the patients’ family in the EOLD process (74.7% vs. 60.9%; difference: 13.8%, p = 0.048) and the frequency of documentation of EOLD-relevant information (50.0% vs. 18.7%; difference: 31.3%, p < 0.001) increased from 2009 to 2019. Discussion: During a ten-year period from 2009 to 2019, the frequency of EOLDs and the completion rate of advance directives have increased considerably. In addition, EOLD-associated communication and documentation have further improved.

Can Complex Legislation Solve Our End-of-Life Problems?

1994 ◽  
Vol 3 (1) ◽  
pp. 115-124 ◽  
Author(s):  
Brendan Minogue ◽  
James E. Reagan
Keyword(s):  
United States ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
The United States ◽  
The State ◽  
Living Wills ◽  
Life Problems ◽  
State Interference ◽  
Legal Opinion

Over a 20-year period, the United States has developed a consensus of legal opinion concerning living wills and other advance directives. At the heart of this consensus are two interconnected principles. First, the state should minimally interfere with the wishes of patients and surrogates and the decisions of physicians about foregoing life-sustaining treatments. Second, state interference is permissible for the sake of protecting a compelling state interest. The overwhelming majority of states with advance directive laws have attained this balance of minimal interference and compelling state interest in developing their laws.

scholarly journals Facilitating Patient Voice: A Case Study on Advance Directives and the Primary Health Nurse

2021 ◽  
Author(s):  
◽  
Raewyn Anita Davidson
Keyword(s):  
New Zealand ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
End Of Life Care ◽  
Life Care ◽  
Primary Health ◽  
Patient Voice ◽  
Positive Attitudes

<p>Advance directives are just one aspect of advance care planning. According to the New Zealand Nurses Organisation, advance directives are becoming increasingly common in New Zealand. Nurses are well positioned to take on an increasing role in advance directives, particularly in view of the expected burgeoning older population to which New Zealand is no exception. The literature suggests there is a role for primary health nurses in advance directives but no literature to date is available on this role in the New Zealand context. The aim of this research was to determine primary health nurses' role in advance directives. A qualitative case study research approach was used to explore the knowledge, attitudes, experiences, and involvement of primary health nurses in advance directives. Semi-structured interviews were conducted with 13 senior primary health nurses from one New Zealand province. Two propositions informed the analysis: 1) primary health nurses currently do not have a role in advance directives; and 2) primary health nurses believe that advance directives can promote effective-end-of-life care. Watson's Theory of Human Caring was used as the theoretical framework to guide the study. Three themes were identified from the analysis: encountering challenges, facilitating patient voice, and valuing the person. The findings revealed that primary health nurses had little or no significant experience or involvement in advance directives. Participants described knowledge inconsistencies about advance directives, in particular to related legalities. Nevertheless, participants had positive attitudes towards advance directives and believed there was a role for primary health nurses in early advance directive conversations. They emphasised the importance of teamwork and envisaged their role as one of support to both the patient and doctor. Caring praxis underpinned the nurses' positive attitudes towards advance directives. These caring behaviours sustained the core values of patient autonomy and patient advocacy considered fundamental to sensitive advance directive conversations. Many challenges were identified in terms of the nurse's role in advanced directives. These included cultural considerations for Māori in order to respect The Treaty of Waitangi principles and attending to the cultural needs of the individual Pacific Island groupings. Other challenges included unclear guidelines, unclear role delineation, ethical dilemmas and fragmented or complex communication issues across the primary/secondary health sector. Results of this study may inform nurses of the need to establish nurse–patient relationships built upon trust and positive regard in order to support patients in advanced directive discussions. Implications for nurse educators include incorporating education directed at empowering nurses to participate in ethical decision making to enhance patients' end-of-life care. Given the importance of the multi-disciplinary responsibility in establishing advance directives, there is a need for further research regarding how health professionals could function together in the role of advance directive communication to best meet patients' needs.</p>

Making Your Wishes Known: Who Completes an Advance Directive and Shares It With Their Health Care Team or Loved Ones?

2017 ◽  
Vol 38 (12) ◽  
pp. 1746-1762 ◽  
Author(s):  
Megumi Inoue ◽  
Emily Ihara ◽  
Albert Terrillion
Keyword(s):  
Health Care ◽  
Advance Directives ◽  
Health Care Providers ◽  
Advance Directive ◽  
Multinomial Logistic Regression ◽  
Public Awareness ◽  
Behavioral Model ◽  
Health Care Team ◽  
Care Providers ◽  
Educational Training

Using Andersen’s health behavioral model as a framework, this study examined factors associated with the completion of advance directives and the behavior of sharing them with one’s family and health care providers. Data were from the 2014 United States of Aging Survey ( N = 1,153; aged 60 or older), and multinomial logistic regression was used for analysis. We found that 73% of respondents had advance directives. However, 28% have not shared their advance directives with anyone. The sense of having completed a great deal of preparation for the future and the number of illnesses were found to be relevant to the behavior of sharing advance directives. Existing educational training and interventions can be expanded to increase public awareness and encourage people to share their completed advance directives with others. Policies mandating physicians to engage in advance directive conversations with patients during annual checkups might improve completion and sharing of advance directives.

Improving end of life care with advance care planning in a rural cancer center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18637-e18637
Author(s):  
Jacquelyn Barnhart ◽  
Stacy Wells ◽  
Tasha Harris ◽  
Banu Symington
Keyword(s):  
Health Care ◽  
Data Collection ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
End Of Life Care ◽  
Cancer Center ◽  
Life Care ◽  
Care Costs

e18637 Background: We discovered four out of five Medical Oncology patients admitted to the hospital December 2019 and January 2020 were discharged to hospice and died within a week. None of those patients had advance directives. In November and December 2019, all oncology patient charts were reviewed and only 7% (12/174) had advance directives. We believe an established advance directive could have helped avoid unnecessary hospitalization, improved end of life care and reduced wasteful health care costs. This led to the question: Would process changes in a rural cancer center lead to an increase in completion and documentation of Advance Directives, thereby providing more patient goal congruent care? Methods: Data collection and process mapping was performed revealing current processes and overall barriers. This was analyzed and countermeasures were developed leading to process changes and interventions. The interventions included assigning dedicated staff to “own” the advance directives education, follow up and completion, training and certification of staff, and education of the entire Cancer Center on the new process and interventions. The new process included a standardized order set to cue a referral to the dedicated staff, standardized patient education and follow up and documentation consistencies. Results: The initial data collection revealed an advance directive completion rate of 7% in new oncology patients. Process inconsistencies and communication deficiencies, with redundant screening and no follow up, created significant barriers to advance directives. Repeat data collection after creating a position for dedicated staff to educate patients and help with advance directive completion revealed a completion and documentation rate of 6% and thus, was insufficient to lead to change. When a consistent process with formal communication to the dedicated staff was implemented, improvements were noted. Our most recent data collection revealed a 36% completion and documentation rate in advance directives. Conclusions: Lack of effective advance directive programs potentially lead to end of life care incongruent with patients’ wishes and wasteful of health care resources. An advance directive ensures that if a patient is unable to clearly communicate their wishes, these wishes are still honored. In addition, the advance directive can help avoid unnecessary hospitalizations, improve end of life care and reduce wasteful health care costs. As a rural cancer center with a limited service area, we are challenged with a small sample size. Practice will be needed to ensure consistency and efficacy of the current interventions in order to support continued improvement in completion and documentation rates of advance directives. This project will be expanded to address advance directives for all patients.

scholarly journals Race and Educational Disparities in Advance Directive Completion: Encouraging Trends in the United States

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 331-331
Author(s):  
Catheryn Koss ◽  
Rebecca Hensley
Keyword(s):  
Advance Directives ◽  
Advance Directive ◽  
The United States ◽  
Educational Disparities ◽  
The Past ◽  
Exit Survey ◽  
Time Period ◽  
Race Disparities ◽  
Race And Education ◽  
Retirement Study

Abstract Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of- life care. Race and education disparities in advance directive completion have been extensively documented. This study examined five waves of U.S. Health and Retirement Study exit survey data (N = 7,067) to examine to what extent these disparities have expanded or diminished over the past decade. Overall, advance directive completion increased from about 63% among participants who died in 2005-06 to about 73% among those whose deaths occurred between 2015 and 2016. Non-Hispanic whites were almost four times as likely to have advance directives compared to Hispanics or African Americans across this time period (OR=3.90. p&lt;.0001). However, the growth rate in advance directive completion among non-Hispanic whites was significantly slower than for non-whites (OR=.90, p&lt;.01). Compared to those with a high school education or less, those with some college (OR=1.67, p&lt;.0001) and those with at least a college degree (OR=2.02, p&lt;.0001) were significantly more likely to have advance directives across the time period. There were no significant differences in growth rates of advance directive completion for the different educational categories. These results suggest that educational disparities in advance directive completion are fairly stable, but that race disparities may be diminishing.

scholarly journals 533 - “Agitation and End-of-Life: Towards an Advance Directive that Prepare for Agitation and Behavioral Symptoms in Alzheimer’s Disease”

2021 ◽  
Vol 33 (S1) ◽  
pp. 77-78
Author(s):  
Mary Chi Michael
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Behavioral Symptoms ◽  
Behavioral Disturbances ◽  
Psychiatric Advance Directives ◽  
Behavioral Aspects ◽  
Care And Treatment

AbstractAdvance Directives provide legal documentation of a person’s wishes regarding medical treatment and care, allowing people and their families to decide in advance how care and treatment should be provided at end-of-life when a person is no longer capable of making independent decisions. For people living with advanced stages of Alzheimer’s, Advance Directives give specific, life-altering instructions to ensure a person’s will is being met. Yet Advance Directives that anticipate for the eventualities of Alzheimer’s Disease often fail to specifically prepare for the care and treatment decisions prompted by agitation and other behavioral aspects of the disease. This is a major oversight.“Agitation and End-of-Life: Towards an Advance Directive that Prepare for Agitation and Behavioral Symptoms in Alzheimer’s Disease” proposes a framework for how Advance Directives can prepare for the unique decisions that arise as a person experiences agitation and other behavioral symptoms of Alzheimer’s.The framework proposed in this project draws from the recent development of Psychiatric Advance Directives led in part by the American Psychiatric Association, which have pioneered the use of Advance Directives for anticipated behavioral challenges. Specifically, Psychiatric Advance Directives allow individuals to specify in advance which treatments may be administered in response to acute episodes of psychiatric illness at a time when someone is unable or unwilling to provide consent. Our project contends that the mechanisms underlying Psychiatric Advance Directives be modeled but modified to help people, families, and providers prepare for agitation and the behavioral aspects of Alzheimer’s.Specifically, we propose a four-part framework for Advance Directives to prepare for agitation and other behavioral aspects of Alzheimer’s: 1.Psychiatric medications. What treatments may – or may not – be used to manage agitation or other behavioral disturbances?2.Agitation prevention and de-escalation. What strategies and techniques can caregivers employ to mollify agitated behaviors? How should caregivers respond to episodes of agitation?3.Lifestyle preferences and values. What values – religious or otherwise – should guide care and treatment?4.Information sharing and access. When and how should caregivers, medical professionals, and family members be notified – or share information about – behavioral disturbances?It is well established in the scientific and medical literature that agitation and behavioral aspects of Alzheimer’s can cause severe difficulty for families as the disease progresses. Advance Directives that prepare for agitation can help to create a plan and ease the challenges prompted by agitation and other behavioral aspects of Alzheimer’s.

scholarly journals Facilitating Patient Voice: A Case Study on Advance Directives and the Primary Health Nurse

2021 ◽  
Author(s):  
◽  
Raewyn Anita Davidson
Keyword(s):  
New Zealand ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
End Of Life Care ◽  
Life Care ◽  
Primary Health ◽  
Patient Voice ◽  
Positive Attitudes

<p>Advance directives are just one aspect of advance care planning. According to the New Zealand Nurses Organisation, advance directives are becoming increasingly common in New Zealand. Nurses are well positioned to take on an increasing role in advance directives, particularly in view of the expected burgeoning older population to which New Zealand is no exception. The literature suggests there is a role for primary health nurses in advance directives but no literature to date is available on this role in the New Zealand context. The aim of this research was to determine primary health nurses' role in advance directives. A qualitative case study research approach was used to explore the knowledge, attitudes, experiences, and involvement of primary health nurses in advance directives. Semi-structured interviews were conducted with 13 senior primary health nurses from one New Zealand province. Two propositions informed the analysis: 1) primary health nurses currently do not have a role in advance directives; and 2) primary health nurses believe that advance directives can promote effective-end-of-life care. Watson's Theory of Human Caring was used as the theoretical framework to guide the study. Three themes were identified from the analysis: encountering challenges, facilitating patient voice, and valuing the person. The findings revealed that primary health nurses had little or no significant experience or involvement in advance directives. Participants described knowledge inconsistencies about advance directives, in particular to related legalities. Nevertheless, participants had positive attitudes towards advance directives and believed there was a role for primary health nurses in early advance directive conversations. They emphasised the importance of teamwork and envisaged their role as one of support to both the patient and doctor. Caring praxis underpinned the nurses' positive attitudes towards advance directives. These caring behaviours sustained the core values of patient autonomy and patient advocacy considered fundamental to sensitive advance directive conversations. Many challenges were identified in terms of the nurse's role in advanced directives. These included cultural considerations for Māori in order to respect The Treaty of Waitangi principles and attending to the cultural needs of the individual Pacific Island groupings. Other challenges included unclear guidelines, unclear role delineation, ethical dilemmas and fragmented or complex communication issues across the primary/secondary health sector. Results of this study may inform nurses of the need to establish nurse–patient relationships built upon trust and positive regard in order to support patients in advanced directive discussions. Implications for nurse educators include incorporating education directed at empowering nurses to participate in ethical decision making to enhance patients' end-of-life care. Given the importance of the multi-disciplinary responsibility in establishing advance directives, there is a need for further research regarding how health professionals could function together in the role of advance directive communication to best meet patients' needs.</p>

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