scholarly journals An Advance Care Planning Group Visit Intervention for Individuals With Mild Cognitive Impairment

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 242-243
Author(s):  
Andrea Daddato ◽  
Prajakta Shanbhag ◽  
Brianne Bettcher ◽  
Hillary Lum
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Focus Groups ◽  
Advance Care Planning ◽  
Medical Decision ◽  
Care Planning ◽  
Group Visit ◽  
Study Partner ◽  
Advance Care ◽  
Planning Group

Abstract Among older adults without cognitive impairment, a novel advance care planning group visit (ACP-GV) intervention increased ACP documentation and readiness to engage in ACP. A key question is whether an intervention can be adapted to support people with mild cognitive impairment (MCI) and a family care partner. We used a human-centered design process, rapid-cycle prototyping, and qualitative methods to adapt an ACP-GV intervention to individuals with MCI and a study partner. In 2019, we convened a longitudinal cohort of six patient-study partner stakeholders in three focus groups to suggest intervention adaptations. We also conducted a single arm study of four ACP-GV interventions (n=13 dyads total) that were iteratively refined with input from the longitudinal focus groups and intervention participant feedback. Decision tools, resources and videos were used to describe the concept of ACP and flexibility in selecting a medical decision maker. Many ACP-GV participants strongly agreed that the group discussion gave them useful information (81%) and would recommend the ACP-GV to a friend (85%). Pre- and post-ACP readiness surveys indicated that participants were significantly more ready to talk to their medical decision maker about ACP (p=0.028), while study partners perceived their loved ones less ready to speak to their doctor about ACP following the intervention (p=0.031). Use of rapid prototyping allowed testing of different resources and tools aimed at helping individuals with MCI and their study partners discuss ACP. Future work is needed to understand the feasibility of implementing an ACP-GV intervention for individuals with MCI into clinical settings.

scholarly journals Human-Centered Design of an Advance Care Planning Group Visit for Mild Cognitive Impairment

2021 ◽  
Author(s):  
Andrea E Daddato ◽  
Elizabeth W Staton ◽  
Brianne M Bettcher ◽  
Prajakta Shanbhag ◽  
Hillary D Lum
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Advance Care Planning ◽  
Advisory Panel ◽  
Care Planning ◽  
Multiple Perspectives ◽  
Group Setting ◽  
Human Centered Design ◽  
Group Visit ◽  
Advance Care

Abstract Background and Objectives While advance care planning (ACP) is critical for ensuring optimal end-of-life outcomes among individuals with mild cognitive impairment (MCI), many individuals that may benefit from ACP have not initiated this process. This paper aims to describe the iterative design of a MCI group visit-based intervention, and evaluate feasibility and acceptability of the intervention. Research Design and Methods We used human-centered design, rapid-cycle prototyping, and multiple methods to adapt an Engaging in Advance Care planning Talks (ENACT) Group Visits intervention. We convened an advisory panel of persons with MCI and care partners (n=6 dyads) to refine the intervention and conducted a single-arm pilot of four MCI ENACT intervention prototypes (n=13 dyads). We used surveys and interviews to assess outcomes from multiple perspectives. Results The advisory panel affirmed that ACP is a priority for individuals with MCI, described the need for ACP in a group setting, and suggested refinements to ACP resources for the MCI ENACT intervention. Feasibility of recruitment was limited. MCI ENACT intervention participants strongly agreed that group discussions provided useful information and recommended the intervention. Themes supporting acceptability included: 1) feedback on acceptability of the intervention; 2) previous experiences with ACP; and 3) reasons for participation, including desire for discussions about MCI and how it relates to ACP. Discussion and Implications Despite stakeholder’s positive ratings of acceptability of the MCI ENACT intervention, future work is needed to enhance feasibility of recruitment to support implementation into clinical settings.

scholarly journals Caring About Cancer—Advance Care Planning Group Visit Intervention (QI744)

2019 ◽  
Vol 57 (2) ◽  
pp. 480
Author(s):  
Jeanie Youngwerth ◽  
Nancy Robertson ◽  
Erin Nielsen ◽  
Hillary Lum
Keyword(s):  
Advance Care Planning ◽  
Care Planning ◽  
Group Visit ◽  
Advance Care ◽  
Planning Group

scholarly journals Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 417-418
Author(s):  
Hyo Jung Lee ◽  
Giyeon Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Relative Risk ◽  
End Of Life ◽  
Advance Care Planning ◽  
Multinomial Logistic Regression ◽  
Quality Care ◽  
Care Planning ◽  
Advance Care ◽  
Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

P-43 Capacity assessment for advance care planning in older people with cognitive impairment

2015 ◽  
Vol 5 (Suppl 2) ◽  
pp. A56.3-A57
Author(s):  
O Kiriaev ◽  
Emme Chacko ◽  
JD Jurgens ◽  
Meagan Ramages ◽  
P Malpas ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Advance Care Planning ◽  
Capacity Assessment ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance care planning in people with early cognitive impairment

2014 ◽  
Vol 5 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Kenny Cheong ◽  
Paul Fisher ◽  
Jenny Goh ◽  
Lynette Ng ◽  
Hui Mien Koh ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

Engaging persons with dementia in advance care planning: Challenges and opportunities

Dementia ◽  
2020 ◽  
pp. 147130122097305
Author(s):  
Tamara Sussman ◽  
Rebecca Pimienta ◽  
April Hayward
Keyword(s):  
Focus Groups ◽  
Family Caregivers ◽  
Advance Care Planning ◽  
Service Providers ◽  
Care Planning ◽  
Reflective Process ◽  
Challenges And Opportunities ◽  
Future Care ◽  
Advance Care ◽  
Positive Engagement

This study reports findings from a series of focus groups with persons with dementia and family caregivers intended to explore: (1) perceptions of and experiences with advance care planning (ACP); (2) concerns related to future care including, but not limited to, end-of-life care; and (3) practices that may support positive engagement with ACP. A total of 18 participants including 10 persons with dementia and eight family caregivers participated in five focus groups held in two urban cities in Canada. All focus group deliberations were audio recorded, transcribed verbatim, and analyzed in five stages using a semantic thematic approach. All participants expressed some form of engagement in ACP, but understandings were limited and divergence was expressed regarding the timing of more expansive conversations about future care. Although some persons with dementia were ready to engage in future care discussions, most preferred focusing on the present and suggested their families did not require direction. This placed families in the complex dilemma of protecting their loved ones while compromising their own needs for dialogue. Although individually focused models of ACP engagement hold promise for those persons with dementia ready to engage in future planning, our findings suggest that early engagement of families in the reflective process may go a long way in supporting ACP activation. Our findings further suggest that persons with dementia who do not have close family/friends may require extensive ACP encouragement and support from service providers.

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