scholarly journals Advance Care Planning for Care-Dependent Older Persons Living at Home: A Cluster-Randomized Controlled Trial

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 665-665
Author(s):  
Sascha Köpke ◽  
Katharina Silies ◽  
Rieke Schnakenberg ◽  
Änne Kirchner ◽  
Juliane Köberlein-Neu ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Older Persons ◽  
Controlled Trial ◽  
Patient Activation ◽  
Cluster Randomised Controlled Trial ◽  
Care Planning ◽  
Term Care ◽  
Systems Research ◽  
Advance Care ◽  
At Home

Abstract Advance Care Planning (ACP) for care-dependent older persons living at home is an important part of care, but remains difficult to implement, mostly due to access barriers. The aim of this trial is to increase patient activation, family communication and surrogate designation through an ACP-intervention delivered by trained nurses to care-dependent clients in their homes. The intervention is evaluated in a cluster-randomised controlled trial in Germany (DRKS00016886). Primary outcome is patient activation (PAM-13); secondary outcomes cover institutionalisation, ACP-engagement and prevalence of ACP-documents. 28 home care services (HCS) with 20 trained nurses and about 340 participants have been included. First results show that patients and caregivers judged the topic and the discussion with trusted persons as important and seized the opportunity for communication. In conclusion, established relationships can be built upon to ensure access to ACP and thus to avoid involuntary treatment in situations of decisional incapacity. Part of a symposium sponsored by Systems Research in Long-Term Care Interest Group.

scholarly journals Advance Care Planning for frail older adults: Findings on costs in a cluster randomised controlled trial

2018 ◽  
Vol 33 (3) ◽  
pp. 291-300
Author(s):  
Anouk Overbeek ◽  
Suzanne Polinder ◽  
Juanita Haagsma ◽  
Pascalle Billekens ◽  
Kim de Nooijer ◽  
...  
Keyword(s):  
Older Adults ◽  
Randomised Controlled Trial ◽  
Advance Care Planning ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Care Planning ◽  
Frail Older Adults ◽  
Cluster Randomised ◽  
Advance Care ◽  
Randomised Controlled

‘Advance care planning, general practitioners and patients: a phase II cluster-randomised controlled trial in chronic life-limiting illness’

2020 ◽  
pp. bmjspcare-2020-002712
Author(s):  
Sigrid Dierickx ◽  
Koen Pardon ◽  
Peter Pype ◽  
Julie Stevens ◽  
Robert Vander Stichele ◽  
...  
Keyword(s):  
General Practice ◽  
Randomised Controlled Trial ◽  
General Practitioners ◽  
Advance Care Planning ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Care Planning ◽  
Cluster Randomised ◽  
Advance Care ◽  
Randomised Controlled

ObjectivesAlthough general practice is an ideal setting for ensuring timely initiation of advance care planning (ACP) in people with chronic life-limiting illness, evidence on the effectiveness of ACP in general practice and how it can be implemented is lacking. This study aims to evaluate feasibility and acceptability of study procedures and intervention components of an intervention to facilitate the initiation of ACP in general practice for people with chronic life-limiting illness.MethodsPilot cluster-randomised controlled trial testing a complex ACP intervention in general practice versus usual care (ClinicalTrials.gov: NCT02775032). We used a mixed methods approach using detailed documentation of the recruitment process, questionnaires and semi-structured interviews.ResultsA total of 25 general practitioners (GPs) and 38 patients were enrolled in the study. The intervention was acceptable to GPs and patients, with GPs valuing the interactive training and patients finding ACP conversations useful. However, we found a number of challenges regarding feasibility of recruitment procedures, such GP as recruitment proceeding more slowly than anticipated as well as difficulty applying the inclusion criteria for patients. Some GPs found initiating ACP conversations difficult. The content of the patient booklet was determined to potentially be too complex for patients with a lower health literacy.ConclusionAlthough the intervention was well-accepted by GPs and patients, we identified critical points for improvement with regard to the study procedures as well as potential improvements of the intervention components. When these points are addressed, the intervention can proceed to a large-scale, phase III trial to test its effectiveness.

scholarly journals Assisted Living Administrators’ Approaches to Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 66-66
Author(s):  
Elise Abken ◽  
Alexis Bender ◽  
Ann Vandenberg ◽  
Candace Kemp ◽  
Molly Perkins
Keyword(s):  
Advance Care Planning ◽  
Assisted Living ◽  
Staff Training ◽  
Chronically Ill ◽  
External Support ◽  
Care Plan ◽  
Care Planning ◽  
Term Care ◽  
Advance Care ◽  
Eol Care

Abstract Assisted living (AL) communities are increasingly home to frail, chronically ill older adults who remain until death. State laws mandate that AL facilities request copies of any advance care planning documents residents have and make forms available upon request. Using secondary data from a larger study funded by the National Institute on Aging (R01AG047408) that focuses on end-of-life (EOL) care in AL, this project investigated barriers and facilitators to conducting advance care planning in AL. Data included in-depth interviews (of 86 minute average length) with 20 administrators from 7 facilities around the Atlanta metropolitan area and aggregate data collected from each facility regarding facility, staff, and resident characteristics. Findings from thematic analysis of qualitative data showed that key barriers to planning in AL included lack of staff training and reluctance among administrators and families to discuss advance care planning and EOL care. Important facilitators included periodic follow-up discussions of residents’ wishes, often during care plan meetings, educating families about the importance of planning, and external support for staff training and family education from agencies such as hospice and home health. Three study facilities exceeded state requirements to request and store documents by systematically encouraging residents to complete documentation. These facilities, whose administrators discuss advance care planning and residents’ EOL wishes with residents and families during regular care plan meetings, were more likely to have planning documents on file, demonstrating the potential of long-term care communities, such as AL, to successfully promote advance care planning among residents and their family members.

Association of advance care planning with place of death and utilisation of life-sustaining treatments in deceased patients at Taipei City Hospital in Taiwan

2020 ◽  
pp. bmjspcare-2020-002520
Author(s):  
Yung-Feng Yen ◽  
Ya-Ling Lee ◽  
Hsiao-Yun Hu ◽  
Wen-Jung Sun ◽  
Ming-Chung Ko ◽  
...  
Keyword(s):  
Cohort Study ◽  
Advance Care Planning ◽  
Place Of Death ◽  
Care Planning ◽  
City Hospital ◽  
Taipei City ◽  
Advance Care ◽  
Eol Care ◽  
To Receive ◽  
At Home

ObjectiveEvidence is mixed regarding the impact of advance care planning (ACP) on place of death. This cohort study investigated the effect of ACP programmes on place of death and utilisation of life-sustaining treatments for patients during end-of-life (EOL) care.MethodsThis prospective cohort study identified deceased patients between 2015 and 2016 at Taipei City Hospital. ACP was determined by patients’ medical records and defined as a process to discuss patients’ preferences with respect to EOL treatments and place of death. Place of death included hospital or home death. Stepwise logistic regression determined the association of ACP with place of death and utilisation of life-sustaining treatments during EOL care.ResultsOf the 3196 deceased patients, the overall mean age was 78.6 years, and 46.5% of the subjects had an ACP communication with healthcare providers before death. During the study follow-up period, 166 individuals died at home, including 98 (6.59%) patients with ACP and 68 (3.98%) patients without ACP. After adjusting for sociodemographic factors and comorbidities, patients with ACP were more likely to die at home during EOL care (adjusted OR (AOR)=1.71, 95% CI 1.24 to 2.35). Moreover, patients with ACP were less likely to receive cardiopulmonary resuscitation (AOR 0.36, 95% CI 0.25 to 0.51) as well as intubation and mechanical ventilation support (AOR 0.54, 95% CI 0.44 to 0.67) during the last 3 months of life.ConclusionPatients with ACP were more likely to die at home and less likely to receive life-sustaining treatments during EOL care.

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