scholarly journals Feasibility and Acceptability of an mHealth ACP Tool in Primary Care

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 516-517
Author(s):  
Desh Mohan ◽  
Katelin Cherry ◽  
Tatiana Fofanova ◽  
Taylor Huffman ◽  
Glenn Davis ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Maker ◽  
Advance Care Planning ◽  
Life Support ◽  
Medical Decision ◽  
Care Planning ◽  
Surrogate Decision Maker ◽  
Advance Care ◽  
Surrogate Decision ◽  
Planning Concepts

Abstract With only 7% of Medicare beneficiaries having completed Advance Care Planning with their physicians, engagement in Advance Care Planning in the clinical setting has been historically low. This study investigated the feasibility of introducing the Koda Health Advance Care Planning software platform in the primary care setting, and whether patients would engage in advance care planning through this medium. The Koda platform is a video-driven, web application that guides patients through advance care planning concepts, including values and quality of life exploration, surrogate decision maker selection, life-support treatments, and advance directive completion. The study was completed over a six-month period in two primary care clinics in the Houston, Texas area. Inclusion criteria were age 55 or older, English-speaking, and capacity for medical decision making. 339 patients met eligibility criteria and had a median age of 73 (range 59-89). All participants were offered the platform, and 262 (77%) created an account and began planning for their care. Of the patients that created an account, 87% completed all ACP steps on the platform and 72% identified a surrogate decision maker. The median time spent on the platform was 18 minutes. The Koda platform appears to be a useful tool for patients and providers to improve engagement in advance care planning and improve surrogate decision maker identification. Further research is needed to understand whether the Koda platform aids in providing goal-concordant care.

Feasibility of Advance Care Planning in Primary Care for Homeless Adults

2019 ◽  
Vol 32 (7-8) ◽  
pp. 880-891
Author(s):  
Laura Kaplan-Weisman ◽  
Sara Sansone ◽  
Eve Walter ◽  
Casey Crump
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Routine Care ◽  
Medical Decision ◽  
Homeless Population ◽  
Care Planning ◽  
Health Care Proxy ◽  
Care Plans ◽  
Decision Making Capacity ◽  
Advance Care

Objectives: As the homeless population ages, it is imperative to improve access to advance care planning (ACP) and document preferences in case medical decision-making capacity is lost. Methods: We implemented an ACP Project to discuss and document advance care plans with all patients aged 45 and older who received primary care at our adult Homeless Program clinics. Results: Over 14 months, ACP was discussed with 48% ( n = 138) of the population and health care proxy (HCP) appointment with 91% ( n = 125) of these patients. Most (62%; n = 77) appointed a HCP from personal relationships, though a significant minority (38%; n = 48) could not and were considered “surrogateless.” End-of-life preferences varied. Approximately 20% of patients wanted to defer to a surrogate for each decision. Discussion: ACP is feasible in primary care for adults who have experienced homelessness and should be incorporated into routine 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.

scholarly journals Older Adults More Likely to Discuss Advance Care Plans With an Attorney Than With a Physician

2017 ◽  
Vol 3 ◽  
pp. 233372141774197 ◽  
Author(s):  
Mercedes Bern-Klug ◽  
Elizabeth A. Byram
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Maker ◽  
Online Survey ◽  
Medical Decision ◽  
Surrogate Decision Maker ◽  
Future Health ◽  
Care Plans ◽  
Advance Care ◽  
Surrogate Decision

Adults are encouraged to discuss their end-of-life health care preferences so that their wishes will be known and hopefully honored. The purpose of this study was to determine with whom older adults had communicated their future health care wishes and the extent to which respondents themselves were serving as a surrogate decision maker. Results from the cross-sectional online survey with 294 persons aged 50 and older reveal that among the married, over 80% had a discussion with their spouse and among those with an adult child, close to two thirds (64%) had. Over a third had discussed preferences with an attorney and 23% with a physician. Close to half were currently serving as a surrogate decision maker or had been asked to and had signed papers to formalize their role. 18% did not think that they were a surrogate but were not sure. More education is needed to emphasize the importance of advance care planning with a medical professional, especially for patients with advanced chronic illness. More education and research about the role of surrogate medical decision makers is called for.

scholarly journals INVOLVING FAMILY TO IMPROVE COMMUNICATION IN PRIMARY CARE FOR PRIMARY CARE PATIENTS WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S364-S364
Author(s):  
Jennifer L Wolff ◽  
Sydney Dy ◽  
Jennifer Aufill ◽  
Diane Echavarria ◽  
Cynthia Boyd ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Caregivers ◽  
Advance Care Planning ◽  
Pragmatic Trial ◽  
Information Access ◽  
Patient Portal ◽  
Care Planning ◽  
Care Systems ◽  
Advance Care ◽  
Surrogate Decision

Abstract Family caregivers are at the forefront of managing dementia but are not routinely included in discussions about prognosis and are often poorly prepared to engage in surrogate decision-making. Few interventions target advance care planning in primary care, which is where most persons with dementia are initially diagnosed and medically managed. SHARING CHOICES proactively engages family and support advance care planning in primary care by normalizing advance care planning discussions, clarifying the role of the family during interactions with primary care clinicians, providing ongoing access to a non-clinician trained to lead advance care planning conversations, facilitating registration for the patient portal enable and extending electronic interactions and information access to family caregivers, and providing education and resources about dementia for clinic staff. This presentation will discuss refinement of the SHARING CHOICES protocol and facilitators and challenges of executing a pragmatic trial of this type across two large primary care systems.

Palliative care consultation and advance care planning for adults with poor-risk leukemia admitted to an academic medical center.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 13-13
Author(s):  
Ashley Freeman ◽  
William A Wood ◽  
Alexandra Fox ◽  
Laura C. Hanson
Keyword(s):  
Palliative Care ◽  
Acute Leukemia ◽  
Advance Care Planning ◽  
Life Quality ◽  
Quality Measures ◽  
Care Planning ◽  
Surrogate Decision Maker ◽  
Poor Risk ◽  
Advance Care ◽  
Surrogate Decision

13 Background: Despite high mortality for certain patients with hematologic malignancies, integration of palliative care (PC) and documentation of advance care planning (ACP) is lacking. Our primary objective was to determine the frequency of PC consultation and ACP for inpatients with poor-risk leukemia at our institution. Our secondary objectives were to describe the content of goals of care (GOC) discussions and to characterize PC and end-of-life quality measures. Methods: Chart reviews were conducted for patients with poor risk leukemia (acute leukemia ≥ 65 years or relapsed leukemia > 18 years) admitted to the University of North Carolina from October 1, 2015 to March 31, 2016. The following was abstracted from the chart: demographic data, disease characteristics, presence of a PC consultation, frequency and content of ACP (written advance directive, documented GOC discussion, identified surrogate decision maker), PC quality measures (assessment of pain, dyspnea, nausea, constipation), and end-of-life quality measures (chemotherapy within 14 days of death, ICU stay within 30 days of death, hospice referral less than 3 days prior to death). Results: Thirty-eight subjects were identified. Fifty percent of patients were over age 65 with a new diagnosis of acute leukemia and 50% had relapsed leukemia. The majority of patients (66%) reported pain and 45% reported dyspnea on admission. Sixteen percent of patients died within 30 days of discharge. Eleven percent of patients received PC consultation and 16% had all elements of ACP documented in the chart. GOC discussions without a surrogate decision maker were documented for 37%; content included discussion of values (11%), prognosis (37%), treatment choices (21%), life sustaining preferences (16%), and hospice (21%). Conclusions: In this descriptive study of inpatients with poor-risk leukemia, we found that despite a poor prognosis and high symptom burden, only 11% of patients received PC consultation and 16% had all elements of ACP present in the chart. While our data are limited by documentation, we believe this represents missed opportunities for the delivery of high-quality care.

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