scholarly journals Exploring Collaboration Enjoyment and Decisional Uncertainty: Actor-Partner Effects in Advanced Care Planning

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 755-755
Author(s):  
Shirin Hiatt ◽  
Jia-Wen Guo ◽  
Lee Ellington ◽  
Djin Tay
Keyword(s):  
Secondary Data ◽  
Decisional Conflict ◽  
Future Research ◽  
Care Planning ◽  
Interpersonal Processes ◽  
Actor Partner Interdependence Model ◽  
Before And After ◽  
Life Sustaining Treatment ◽  
Advance Care ◽  
Almost All

Abstract Caregivers are often engaged in decision making with and for patients. However, the role of patient-caregiver interpersonal processes on decisions about advance care planning (ACP) are not well known. This secondary data analysis examined the effects of patient-caregiver enjoyment about collaboration regarding choices for life-sustaining treatment on patients’ and caregivers’ decisional uncertainty following a dyadic ACP intervention. A purposive sample of 18 adult home health patients and their informal caregivers (N=36) participated in a one-group pretest posttest study. The Interpersonal Enjoyment subscale of the Perceptions of Collaboration Questionnaire and the Decisional Uncertainty subscale of the Decisional Conflict Scale were administered using parallel questionnaires. The Actor-Partner Interdependence Model (APIM) was used to examine actor and partner effects of patients and caregivers’ interpersonal enjoyment on their uncertainty in decisions about ACP before and after the intervention. The mean age was 68.2±9.6 years for patients and 61.3±13.6 years for caregivers. The majority of patients (61.1%) and caregivers (72.2%) were female and married (55.6% and 66.7%, respectively). Almost all were non-Hispanic White (97.0%). Patients’ and caregivers’ interpersonal enjoyment and uncertainty scores were similar before the intervention. A significant partner effect between greater interpersonal enjoyment among caregivers at pretest and greater patient uncertainty at posttest (β=0.44, p=.037) was found. Previous analyses found that overall patients improved in decisional uncertainty at posttest. However, these findings suggest that for some dyads, interpersonal factors can negatively affect patients’ decisional certainty. Future research is needed to verify this finding with a larger sample.

scholarly journals Virtual Reality Video Promotes Advance Care Planning Effectiveness

2019 ◽  
Author(s):  
Wan-Ting Hsieh
Keyword(s):  
Advance Care Planning ◽  
Patient Autonomy ◽  
Care Planning ◽  
Good Decision ◽  
Legal Effect ◽  
Before And After ◽  
Post Test ◽  
Accurate Perception ◽  
Life Sustaining Treatment ◽  
Advance Care

Abstract Introduction: In 2019, the Patient Autonomy Act has gone into effect, allowing Taiwanese citizens to establish an advance decision(AD) with legal effect. In an effort to secure more realistic and accurate perception of patients as the basis for them to explore their values, a VR video was developed to supplement the traditional way of decision making before advance care planning(ACP). Methods: Participants were asked to complete pre-test questionnaires and were then asked to read a handout with information about life-sustaining treatment and the legal process of making an effective AD. Participants then viewed a six-minute 360-degree VR video on a portable VR headset with a smartphone inside to play it and then completed the post-test questionnaire followed by feedback on the help of the VR. Results: Of the 120 participants, 71.1% had heard about of AD. The increased percentage of the certainty of their preferences for the five kinds of life-sustaining treatments before and after participants read the handout and viewed the VR video was noted. Conclusion and Discussion: The decrease in the number of participants who couldn’t make decision indicates indicate that VR video may be helpful for users to make decision and clarify users’ preference. According to feedback of VR video, highly agreement also lied in its help of equipping users with better understanding of medical scenarios and it is a good decision aid tool for preparing our users before ACP.

scholarly journals Evaluation of a Video Decision Aid to Reduce Decisional Conflict in Physician Orders for Life-Sustaining Treatment (POLST) Decision-Making

2020 ◽  
Vol 35 (4) ◽  
pp. 243-247
Author(s):  
Jarred V. Gallegos ◽  
Barry Edelstein ◽  
Alvin H. Moss
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Decision Aid ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Community Dwelling ◽  
Care Planning ◽  
Life Sustaining Treatment ◽  
Advance Care ◽  
Decisional Satisfaction

Background/Objectives: Physician Orders for Life-Sustaining Treatment (POLST) is recommended as a preferred practice for advance care planning with seriously ill patients. Decision aids can assist patients in advance care planning, but there are limited studies on their use for POLST decisions. We hypothesized that after viewing a POLST video, decision aid participants would demonstrate increased knowledge and satisfaction and decreased decisional conflict. Design: Pre-and postintervention with no control group. Setting/Participants: Fifty community-dwelling adults aged 65 and older asked to complete a POLST based on a hypothetical condition. Interventions: Video decision aid for Sections A and B of the POLST form. Measurements: Pre- and postintervention participant knowledge, decisional satisfaction, decisional conflict, and acceptability of video decision aid. Results: Use of the video decision aid increased knowledge scores from 11.24 ± 2.77 to 14.32 ± 2.89, P < .001, improved decisional satisfaction 10.14 ± 3.73 to 8.70 ± 3.00, P = .001, and decreased decisional conflict 12 ± 9.42 to 8.15 ± 9.13, P < .001. All participants reported that they were comfortable using the video decision aid, that they would recommend it to others, and that it clarified POLST decisions. Conclusions: Participants endorsed the use of a POLST video decision aid, which increased their knowledge of POLST form options and satisfaction with their decisions, and decreased their decisional conflict in POLST completion. This pilot study provides preliminary support for the use of video decision aids for POLST decision-making. Future research should evaluate a decision aid for the entire POLST form and identify patient preferences for implementing POLST decision aids into clinical practice.

scholarly journals Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients

2015 ◽  
Vol 12 (10) ◽  
pp. 1528-1533 ◽  
Author(s):  
Jared Chiarchiaro ◽  
Praewpannarai Buddadhumaruk ◽  
Robert M. Arnold ◽  
Douglas B. White
Keyword(s):  
Critically Ill ◽  
Advance Care Planning ◽  
Critically Ill Patients ◽  
Decisional Conflict ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance care planning evaluation: a scoping review of best research practice

2021 ◽  
pp. bmjspcare-2021-003193
Author(s):  
Sophie Gloeckler ◽  
Tanja Krones ◽  
Nikola Biller-Andorno
Keyword(s):  
Advance Care Planning ◽  
Scoping Review ◽  
Retrospective Chart Review ◽  
Evidence Base ◽  
Future Research ◽  
Care Planning ◽  
Completion Rates ◽  
Future Care ◽  
Actual Care ◽  
Advance Care

Various indicators have been used to evaluate advance care planning, including completion rates, type of care received, and satisfaction. Recent consensus suggests, though, that receiving care consistent with one’s goals is the primary outcome of advance care planning and assessment should capture this metric. Goal concordant care is challenging to measure, and there is little clarity about how best to do so. The aim of this scoping review is to explore what methods have been used to measure goal concordant care in the evaluation of advance care planning. PubMed, Embase, PsycINFO, CINAHL and Cochrane were searched in September 2020 to identify studies that aimed to track whether advance care planning affected the likelihood of patients receiving care that matched their preferred care. 135 original studies were included for review. Studies used retrospective chart review (36%, n=49), questionnaire (36%, n=48) and interview (31%, n=42), focusing on both patients and proxies. Studies considered both actual care received (55%, n=74) and hypothetical scenarios anticipating possible future care (49%, n=66); some studies did both. While the reviewed studies demonstrate the possibility of working towards a solid methodology, there were significant weaknesses. Notably, studies often lacked enough reporting clarity to be reproducible and, relatedly, key concepts, such as end-of-life or preferred care, were left undefined. The recommendations that follow from these findings inform future research approaches, supporting the development of a strong evidence base to guide advance care planning implementation in practice.

Advance care planning: eliciting patient preferences for life-sustaining treatment

1995 ◽  
Vol 26 (1-3) ◽  
pp. 353-361 ◽  
Author(s):  
Robert A. Pearlman ◽  
William G. Cole ◽  
Donald L. Patrick ◽  
Helene E. Starks ◽  
Kevin C. Cain
Keyword(s):  
Advance Care Planning ◽  
Patient Preferences ◽  
Care Planning ◽  
Life Sustaining Treatment ◽  
Advance Care

Advance care planning in different settings for people with dementia: A systematic review and narrative synthesis

2019 ◽  
Vol 17 (6) ◽  
pp. 707-719 ◽  
Author(s):  
Adele J. Kelly ◽  
Tim Luckett ◽  
Josephine M. Clayton ◽  
Liam Gabb ◽  
Slavica Kochovska ◽  
...  
Keyword(s):  
Systematic Review ◽  
Advance Care Planning ◽  
Future Research ◽  
Care Planning ◽  
People With Dementia ◽  
Future Care ◽  
Advance Care ◽  
Surrogate Decision ◽  
The Individual ◽  
Person With Dementia

AbstractBackgroundAdvance care planning (ACP) is identified as being an important process for people with dementia. However, its efficacy for improving outcomes relevant for the individual, carers and the health system has yet to be established.AimWe conducted a systematic review with the aims of testing the efficacy of ACP for people with dementia and describing the settings and population in which it has been evaluated.MethodsA search was completed of electronic databases in August 2016. Articles were included if they described interventions aimed at increasing planning for future care of people with dementia, delivered to the person with dementia, their carers and/or health professionals.ResultsOf 4,772 articles returned by searches, 30 met the inclusion criteria, testing interventions in nursing home (n= 16) community (n = 10) and acute care (n = 4) settings. Only 18 interventions directly involved the person with dementia, with the remainder focusing on surrogate decision-makers. In all settings, interventions were found effective in increasing ACP practice. In nursing homes, ACP was found to influence care and increase the concordance between end of life wishes and care provided. Interventions in the community were found to improve patient quality of life but were not shown to influence concordance.ConclusionFuture research should focus on ways to involve people with dementia in decision-making through supported means.

scholarly journals Preferences on the Timing of Initiating Advance Care Planning and Withdrawing Life-Sustaining Treatment between Terminally-Ill Cancer Patients and Their Main Family Caregivers: A Prospective Study

2020 ◽  
Vol 17 (21) ◽  
pp. 7954
Author(s):  
Cheng-Pei Lin ◽  
Jen-Kuei Peng ◽  
Ping-Jen Chen ◽  
Hsien-Liang Huang ◽  
Su-Hsuan Hsu ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Advance Care Planning ◽  
Medical Decision Making ◽  
Terminally Ill ◽  
Medical Decision ◽  
Care Planning ◽  
Terminally Ill Cancer Patients ◽  
Life Sustaining Treatment ◽  
Advance Care ◽  
A Prospective Study

Background: The Western individualistic understanding of autonomy for advance care planning is considered not to reflect the Asian family-centered approach in medical decision-making. The study aim is to compare preferences on timing for advance care planning initiatives and life-sustaining treatment withdrawal between terminally-ill cancer patients and their family caregivers in Taiwan. Methods: A prospective study using questionnaire survey was conducted with both terminally-ill cancer patient and their family caregiver dyads independently in inpatient and outpatient palliative care settings in a tertiary hospital in Northern Taiwan. Self-reported questionnaire using clinical scenario of incurable lung cancer was employed. Descriptive analysis was used for data analysis. Results: Fifty-four patients and family dyads were recruited from 1 August 2019 to 15 January 2020. Nearly 80% of patients and caregivers agreed that advance care planning should be conducted when the patient was at a non-frail stage of disease. Patients’ frail stage of disease was considered the indicator for life-sustaining treatments withdrawal except for nutrition and fluid supplements, antibiotics or blood transfusions. Patient dyads considered that advance care planning discussions were meaningful without arousing emotional distress. Conclusion: Patient dyads’ preferences on the timing of initiating advance care planning and life-sustaining treatments withdrawal were found to be consistent. Taiwanese people’s medical decision-making is heavily influenced by cultural characteristics including relational autonomy and filial piety. The findings could inform the clinical practice and policy in the wider Asia–Pacific region.

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