scholarly journals Voice Your Values, Tailored Advance Care Planning in Persons Living With Mild Dementia: A Feasibility Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 404-404
Author(s):  
Shirin Vellani ◽  
Martine Puts ◽  
Katherine McGilton ◽  
Andrea Iaboni
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Psychological Distress ◽  
Advance Care Planning ◽  
Retention Rate ◽  
Care Planning ◽  
Convenience Sample ◽  
Mild Dementia ◽  
Advance Care ◽  
Distress Scale

Abstract Older adults diagnosed with mild dementia can identify their wishes, values and goals of care with a high degree of accuracy and reliability. However, there is a paucity of research to guide best practices on how to incorporate Advance Care Planning (ACP) in the care of older adults living with mild dementia. Thus, only a minority of them participate in any ACP discussions. We developed an intervention called Voice Your Values (VYV) that healthcare professionals can implement to identify and document values of older adults. This single group pretest and posttest design aimed to determine the feasibility, acceptability and preliminary efficacy of the intervention. A convenience sample of 20 dyads of older adults and their trusted individuals were recruited from 4 geriatric clinics. Tailored VYV intervention was delivered to dyads on a one-on-one basis over two sessions using videoconferencing. Feasibility was determined through recruitment and retention rates, and intervention fidelity. Acceptability was assessed using modified Treatment Evaluation Inventory. Primary outcome was the Surrogate Decision-Making Confidence Scale. Secondary outcomes included an ACP engagement survey to assess older adults’ engagement in ACP; Dementia Knowledge Assessment Tool for trusted individuals; and the Kessler Psychological Distress Scale for all participants. The recruitment rate was 45%, retention rate was 100% and 92% participants rated VYV as highly acceptable. Trusted individuals showed statistically significant improvement in decision-making confidence (p=.02) and psychological distress (p=.02); but no improvement in dementia knowledge (p=.47). Older adults demonstrated statistically significant improvement in ACP engagement (p=<.01). Initial feasibility of VYV was demonstrated.

scholarly journals A Novel Website to Prepare Diverse Older Adults for Decision Making and Advance Care Planning: A Pilot Study (S763)

2014 ◽  
Vol 47 (2) ◽  
pp. 504-505 ◽  
Author(s):  
Rebecca Sudore ◽  
Sara Knight ◽  
Mariko Feuz ◽  
David Farrell ◽  
Ryan McMahan ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Pilot Study ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

Cultural Aspects of End-of-Life Advance Care Planning for African Americans: An Ethnonursing Study

2020 ◽  
pp. 104365962096078
Author(s):  
John W. Collins ◽  
Rick Zoucha ◽  
Joan Such Lockhart ◽  
Sandra J. Mixer
Keyword(s):  
Decision Making ◽  
Data Analysis ◽  
African Americans ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Completion Rates ◽  
Convenience Sample ◽  
Culturally Congruent ◽  
Advance Care

Introduction: Advance directive completion rates among the general population are low, with even lower completion rates among African Americans (AAs). This study’s purpose was to identify culturally based meanings, expressions, and traditions of end-of-life (EOL) advance care planning (ACP) and decision making in order to promote culturally congruent nursing care among African Americans. Methodology: Leininger’s Culture Care Theory and Ethnonursing Research Method guided the study. A convenience sample of 21 informants were interviewed in community settings. Data analysis was guided using Leininger’s phases of ethnonursing data analysis for qualitative data. Results: Three themes emerged that affect EOL decision making: (a) faith in God and belief in life after death, (b) a strong matriarchal family structure, and (c) fear of talking about death and mistrust of the U.S. health care system. Discussion: AA culture, beliefs, and traditions influence EOL ACP and practices, and must be considered while providing culturally congruent care.

scholarly journals Power Dynamics in a Triad Relationship: Advance Care Planning for Older Adults with Dementia in China

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 903-903
Author(s):  
Yifan Lou ◽  
Jinyu Liu ◽  
Bei Wu
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Decision Maker ◽  
Advance Care Planning ◽  
Medical Decision ◽  
Power Dynamics ◽  
Care Planning ◽  
Grounded Theory Method ◽  
Advance Care ◽  
Actual Decision

Abstract Objective: Primary family caregiver (CG), other family members (FM), and medical professionals (MP) play important roles in medical decision-making for older adults with dementia, who often have lost the capacity to make decisions on their own. Power dynamics within the CG-FM-MP triad relationship determine the process and outcome of the decision-making. Guided by Rahl’s relational power model, this study is among the first to understand the experiences of advance care planning among Chinese. Method: This study includes a total of 25 primary CGs or FMs and 5 MPs from 3 neurology departments. Hybrid grounded theory method was used to analyze the preliminary data we had so far. Based on the dimensions of power, we analyzed the power base, means, and scope of each agent in each interview to determine the power comparability. Results: Three types of triadic power relations were categorized: 1) shared-power with shared-decision, in which three agents shared the power of decision-making and CG as the lawful decision-maker makes the final decisions; 2) balanced-power with reversed-patriarchal decisions, in which FM’s power is over both CG and MP and become the actual decision-maker; and 3) unbalanced power with conflicting decisions, in which neither CG and FM has absolute power over each other and MP becomes the actual decision-maker implicitly. Conclusion: The study provides a framework for researchers and practitioners to understand the ACP process for Chinese older adults, which helps develop intervention strategies to improve surrogates’ ACP knowledge and reduce potential conflicts during the stressful process for the population.

How Psychosocial Factors Contribute to Japanese Older Adults’ Initiation of Advance Care Planning Discussions: A Qualitative Study

2020 ◽  
pp. 073346482091153 ◽  
Author(s):  
Jun Miyashita ◽  
Ayako Kohno ◽  
Yosuke Yamamoto ◽  
Sayaka Shimizu ◽  
Teruhisa Azuma ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Qualitative Study ◽  
Psychosocial Factors ◽  
Advance Care Planning ◽  
Family Caregiving ◽  
Care Planning ◽  
Theory Approach ◽  
Advance Care ◽  
Family Centered

Objectives: This study aimed to reveal the features of older adults’ advance care planning (ACP) discussions by identifying psychosocial factors related to their discussions in Japan, where people value family-centered decision making. Methods: A qualitative study using in-depth interviews was conducted with 39 participants (aged ≥65 years) recruited from the outpatient department of a community hospital in Fukushima, Japan. Data were analyzed using the grounded theory approach. Results: Through experiences of family caregiving, participants became aware of their own feelings about the end of life. Equal relationship with family members was important for lowering the threshold for having discussions. Some participants and their families in the same generation reached agreements on ACP; however, they were willing to yield to children’s decision making despite these discussions. Discussions: These findings provide insights into the psychosocial factors in relation to ACP discussions and support for the role of ACP discussions in the family-centered decision-making culture.

scholarly journals A Novel Website to Prepare Diverse Older Adults for Decision Making and Advance Care Planning: A Pilot Study

2014 ◽  
Vol 47 (4) ◽  
pp. 674-686 ◽  
Author(s):  
Rebecca L. Sudore ◽  
Sara J. Knight ◽  
Ryan D. McMahan ◽  
Mariko Feuz ◽  
David Farrell ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Pilot Study ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

The implications of the Mental Capacity Act (MCA) 2005 for advance care planning and decision making

2018 ◽  
Author(s):  
Simon Chapman ◽  
Ben Lobo
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Best Interest ◽  
Policy And Practice ◽  
Advance Care ◽  
Current Context ◽  
Mental Capacity Act ◽  
End Of Life Decision

This chapter provides an overview of the MCA’s impact on end-of-life care. It situates the MCA in the current context of policy and practice. It describes how the MCA can be used to improve care, enable people to express and protect choices, and empower and enable the professional and/or the proxy decision maker. It also presents an introduction and explanation of the role of the IMCA and how it might apply to advance care planning (ACP) and end of life decision making, and an explanation of the legal and ethical process involved in reaching best interest decisions, especially for potentially vulnerable people in care homes and other settings.

An introduction to advance care planning: practice at the frontline

2018 ◽  
Author(s):  
Anjali Mullick ◽  
Jonathan Martin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Communication Skills ◽  
Advance Care Planning ◽  
Use Case ◽  
Care Planning ◽  
Practical Advice ◽  
Future Care ◽  
Case Vignettes ◽  
Advance Care

Advance care planning (ACP) is a process of formal decision-making that aims to help patients establish decisions about future care that take effect when they lose capacity. In our experience, guidance for clinicians rarely provides detailed practical advice on how it can be successfully carried out in a clinical setting. This may create a barrier to ACP discussions which might otherwise benefit patients, families and professionals. The focus of this paper is on sharing our experience of ACP as clinicians and offering practical tips on elements of ACP, such as triggers for conversations, communication skills, and highlighting the formal aspects that are potentially involved. We use case vignettes to better illustrate the application of ACP in clinical practice.

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