scholarly journals Older Couples’ Advance Care Planning Engagement Patterns and Associations with Individual and Spousal Factors

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 778-778
Author(s):  
Hyo Jung Lee ◽  
Bon Kim
Keyword(s):  
Advance Care Planning ◽  
Psychological Health ◽  
Latent Class ◽  
Care Planning ◽  
Multinomial Regression ◽  
Older Couples ◽  
Advance Care ◽  
Using Data ◽  
High Level ◽  
Retirement Study

Abstract This study examines older couples’ dyadic patterns of informal and formal advance care planning (ACP) and determines the associations of these patterns with their own and spousal characteristics. Using data from the 2014 and 2016 Health and Retirement Study, we performed a) latent class analysis to identify distinctive ACP engagement patterns and b) multinomial regression models to describe related characteristics of older couples (N = 1,545 couples). We identified four dyadic patterns of ACP engagement: a) high ACP engaging couple (45%); b) high engaging husband – low engaging wife (13%); c) high engaging wife – low engaging husband (11%); and d) low engaging couple (31%). Engagement in informal and formal ACP was associated with both individual and spousal factors: Older couples with advanced age or higher levels of education and wealth were more likely to engage in both informal and formal ACP, whereas only wife’s high level of constrain or husband’s greater number of depressive symptoms was associated with discordant ACP engagements. Couple-based approach to promote ACP merits older couples with limited resources or poorer psychological health in both or either spouse.

Advance care planning: a personal view and stories from the frontline

2018 ◽  
Author(s):  
Tony Bonser
Keyword(s):  
Advance Care Planning ◽  
Good Practice ◽  
Societal Implications ◽  
National Council ◽  
Care Planning ◽  
Personal View ◽  
Positive Effects ◽  
Health And Social Care ◽  
Advance Care ◽  
High Level

This chapter includes a personal view of advance care planning (ACP) from Tony Bonser, whose son, Neil died aged 35 and who now works for the National Council for Palliative Care, with examples from others. It describes the importance and impact of ACP on people nearing the end of life and their families, and recommends that ACP should be mainstreamed across health and social care as part of good practice, and become part of the public debate through movements like Dying Matters. It affirms that ACP: enables a dialogue to be started; must be centred on patients and enable the implementation of patient wishes; will centre on giving advice rather than prescribing outcomes; has positive effects; needs high-level communication skills; helps restore control; and has societal implications.

scholarly journals Unraveling the Effects of Social Class and Systemic Racism on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 472-472
Author(s):  
Jenny McDonnell
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Black Americans ◽  
Low Ses ◽  
Care Planning ◽  
Life Care ◽  
Black And White ◽  
Advance Care ◽  
Using Data

Abstract While advance care planning (ACP) is recognized as a key facilitator of high-quality, goal-concordant end-of-life care, black Americans are less likely to participate in ACP than non-Hispanic whites (Carr 2011; Detering et al. 2010). There are divided explanations for why these disparities persist. Some scholars attribute racial disparities in end-of-life care to socioeconomic (SES) differences between black and white Americans citing blacks’ and whites’ differentiated access to, control over, and use of material resources (Wilson 1978; Yearby 2011). Others assert that health care preferences do not solely reflect lack of resources or health literacy, but that the larger social context frames care preferences differently across racial and ethnic groups in American society (Alegria et al. 2011; Sewell and Pingel forthcoming). By turning the analytical lens to class-privileged black Americans, I investigate whether racism overflows the margins of class disadvantage. Using data from the Health and Retirement Study, I ran logistic regression and moderation models. I found that class-privileged blacks are less likely to engage in ACP than both high-SES and low-SES whites. The interaction of race and SES was negatively and significantly associated with ACP (OR=0.91; P<0.05), indicating that SES has a stronger effect on the probability of ACP among whites than among blacks. Predicted probabilities show that 51% of low-SES whites are likely to engage in ACP compared to 32% of high-SES blacks. These findings indicate that racialized disparities in ACP exist independent of SES, and that the effects of SES and race are intersectional rather than simply additive.

scholarly journals Current Engagement in Advance Care Planning in Japan and Its Associated Factors

2019 ◽  
Vol 5 ◽  
pp. 233372141989269 ◽  
Author(s):  
Megumi Inoue ◽  
Kyoko Hanari ◽  
Jun Hamano ◽  
Joshua Gallagher ◽  
Nanako Tamiya
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Associated Factors ◽  
Current Status ◽  
Care Planning ◽  
Multinomial Regression ◽  
Practice Experience ◽  
Dying Patients ◽  
Advance Care

Using the Ministry of Health, Labour and Welfare national data on perspectives toward medical care at the end of life, this study examined the current status of engagement in advance care planning (ACP) activities among physicians and nurses in Japan and associated factors. Only 28.7% of physicians and 27.6% of nurses answered that they were engaging their patients/clients in ACP. Multinomial regression analysis revealed that more frequent involvement in caring for dying patients was associated with ACP engagement for both physicians and nurses. Increased years of clinical practice experience and working in a hospital were associated with decreased likelihood of nurses’ ACP engagement. Completion of training designed to promote patient self-determination at the end of life was associated with both physicians’ and nurses’ ACP engagement. It is recommended that health care professionals be encouraged to complete such training to promote patients’ autonomy through ACP.

Where There’s a Will: The Link Between Estate Planning and Disparities in Advance Care Planning by White and Black Older Adults

2017 ◽  
Vol 40 (3) ◽  
pp. 281-302 ◽  
Author(s):  
Catheryn S. Koss ◽  
Tamara A. Baker
Keyword(s):  
Older Adults ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Home Ownership ◽  
Care Planning ◽  
Estate Planning ◽  
Financial Variables ◽  
Race Disparities ◽  
Advance Care ◽  
Retirement Study

Data from the Health and Retirement Study ( n = 6,946) were used to test whether differences in estate planning accounted for disparities in advance care planning between White and Black older adults. White participants were more likely to have advance directives after controlling for demographic, health, and financial variables. When estate planning was also controlled, the odds of having an advance directive were equal for White and Black participants. In contrast, Whites remained more likely to discuss end-of-life preferences after controlling for demographic, health, financial, and estate planning variables. White participants were almost four times as likely to have wills or trusts. Wealth, income, and home ownership were predictive of estate planning. Financial disparities contributed to lower rates of estate planning which in turn explained in large part why Black older adults were less likely to have advance directives but did not account for race disparities in advance care discussion.

Advance Care Planning—Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT

2021 ◽  
pp. 104990912199180
Author(s):  
Maureen E. Lyon ◽  
Sarah Caceres ◽  
Rachel K. Scott ◽  
Debra Benator ◽  
Linda Briggs ◽  
...  
Keyword(s):  
African American ◽  
End Of Life ◽  
Advance Care Planning ◽  
Latent Class ◽  
Congruence Class ◽  
Care Planning ◽  
Post Intervention ◽  
Persons Living With Hiv ◽  
Advance Care ◽  
End Of Life Treatment

Context: The effect of advance care planning (ACP) interventions on the trajectory of end-of-life treatment preference congruence between patients and surrogate decision-makers is unstudied. Objective: To identify unobserved distinctive patterns of congruence trajectories and examine how the typology of outcome development differed between ACP and controls. Methods: Multisite, assessor-blinded, intent-to-treat, randomized clinical trial enrolled participants between October 2013 to March 2017 from 5 hospital-based HIV clinics. Persons living with HIV(PLWH)/surrogate dyads were randomized to 2 weekly 60-minute sessions: ACP (1) ACP facilitated conversation, (2) advance directive completion; or Control (1) Developmental/relationship history, (2) Nutrition/Exercise. Growth Mixed Modeling was used for 18-month post-intervention analysis. Findings: 223 dyads (N = 449 participants) were enrolled. PLWH were 56% male, aged 22 to 77 years, and 86% African American. Surrogates were 56% female, aged 18 to 82 years, and 84% African American. Two latent classes (High vs. Low) of congruence growth trajectory were identified. ACP influenced the trajectory of outcome growth (congruence in all 5 AIDS related situations) by latent class. ACP dyads had a significantly higher probability of being in the High Congruence latent class compared to controls (52%, 75/144 dyads versus 27%, 17/62 dyads, p = 0.001). The probabilities of perfect congruence diminished at 3-months post-intervention but was then sustained. ACP had a significant effect (β = 1.92, p = 0.006, OR = 7.10, 95%C.I.: 1.729, 26.897) on the odds of being in the High Congruence class. Conclusion: ACP had a significant effect on the trajectory of congruence growth over time. ACP dyads had 7 times the odds of congruence, compared to controls. Three-months post-intervention is optimal for booster sessions.

Using a collaborative approach for rapid deployment of advance care planning in the outpatient oncology setting.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 255-255
Author(s):  
Jane Alcyne Severson ◽  
Jeffrey B. Smerage ◽  
Jamie Lindsay ◽  
Laura Petersen ◽  
Keith Mark Swetz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Role Play ◽  
Care Planning ◽  
Standard Work ◽  
National Quality ◽  
Advance Care ◽  
Using Data ◽  
Oncology Practice ◽  
Rapid Deployment

255 Background: The Michigan Oncology Quality Consortium (MOQC) is a quality collaborative supported by Blue Cross Blue Shield of Michigan with the goal of improving cancer care in Michigan by using data gathered as part of the national Quality Oncology Practice Initiative (QOPI) program. In spring 2014, MOQC launched a statewide collaborative focused on advance care planning (ACP) with the following aim: to provide training and resources on how to engage patients in a discussion of goals, preferences, and priorities for care. Methods: The collaborative was comprised of three half day learning sessionsthat included an overview of legal and documentation requirements, and facilitator-lead role play with patient actors. Lean resources (templates, workflows) to support standard work in the clinic were disseminated. Eight oncology practices participated ranging in size from 1-25 physicians. ASCO QOPI data were analyzed pre and post collaborative in spring 2014 and spring 2015. Results: Improvement in QOPI performance from spring 2014 to 2015 on “hospice enrollment, palliative care referral/services, or documented discussion” (73.8% to 77.6%) and “for patients not referred, hospice or palliative care discussed within the last 2 months of life” (17.7% to 23.9%) was noted for participating practices (n = 8). Collaborative participants also compared favorably to all other MOQC practices (n = 47) in spring 2015 on “hospice enrollment, palliative care referral or documented discussion” (77.6% vs. 66.2%) (p < 0.001). Conclusions: Use of a collaborative education modelthat includes facilitator-lead role play and dissemination of lean resources to create standard work may be an efficient and effective approach to improve discussion and documentation of advance care planning.

scholarly journals Do Perceptions of Own and Spouse Survival Affect Advance Care Planning?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 964-964
Author(s):  
Deborah Carr ◽  
Yifan Lou
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Multivariate Analyses ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Full Sample ◽  
Wisconsin Longitudinal Study ◽  
Advance Care ◽  
Using Data

Abstract COVID-19 has intensified the need for advance care planning (ACP), or formal preparations for end-of-life care, prior to the time such decisions are required. We propose that older adults’ perceived chances of survival, and one’s perceptions of whether they will outlive their spouse may be powerful motivators of ACP. Using data from the Wisconsin Longitudinal Study (WLS, n=4908, M age = 65), we examine the extent to which: (a) one’s perceived 10- and 20-year survival and (b) projections of dying before, after, or at the same time as one’s spouse affect three aspects of ACP (living will, durable power of attorney for health care designations (DPAHC), and discussions). Multivariate analyses are adjusted for health, demographics, socioeconomic characteristics, and death anxiety. In the full sample, women who perceived a high likelihood of 20-year survival were less likely (OR=.604, p &lt; .05) whereas their male counterparts were more likely (OR = 1.4, p &lt;.01) to name a DPAHC (relative to those who perceived a medium likelihood of survival). Among married persons only (n=3860), people who perceive that they will pre-decease their spouse are 1.5 times as likely to name their spouse as DPAHC (vs. no DPAHC), but are no more likely to name a different person to the role (relative to those who perceive that they and spouse will die at the same time). Practitioner and family conversations about older patients’ projected survival and how it shapes decision making are especially important as COVID-19 may require rapid decisions about end-of-life treatments.

Demenz aus palliativmedizinischer Perspektive: warum ein krankheitsspezifisches Advance Care Planning wichtig ist

2018 ◽  
Vol 75 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Ralf J. Jox ◽  
Francesca Bosisio ◽  
Eve Rubli Truchard
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care ◽  
Menschen Mit Demenz

Zusammenfassung. Die Palliative Care muss sich im Zuge des demographischen Wandels vieler Gesellschaften rund um den Globus tiefgreifend wandeln. Sie muss mehr und mehr mit der Geriatrie zusammenarbeiten und geriatrische Expertise integrieren. Eine der zentralen Herausforderungen Geriatrischer Palliative Care ist die ethisch angemessene Therapieentscheidung für Menschen, die nicht mehr urteilsfähig sind. Nachdem der bisherige Ansatz herkömmlicher Patientenverfügungen erwiesenermassen enttäuscht hat, wird aktuell, gerade auch in deutschsprachigen Ländern, das systemische Konzept des Advance Care Planning (ACP) verfolgt. In diesem Artikel wird zunächst ACP mit seinen Zielen, Elementen und Effekten vorgestellt. Sodann wird gezeigt, weshalb es für Menschen mit Demenz eines adaptierten ACP-Programms bedarf und was ein solches demenzspezifisches ACP beinhalten muss.

Die Patientenverfügung «Plus» – das Konzept des Advance Care Planning (ACP)

Praxis ◽  
2017 ◽  
Vol 106 (25) ◽  
pp. 1369-1375 ◽  
Author(s):  
Barbara Loupatatzis ◽  
Tanja Krones
Keyword(s):  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

Zusammenfassung. Advance Care Planning ist ein begleiteter, strukturierter Prozess, der es Patienten und ihren Angehörigen ermöglicht, sich mit ihren Einstellungen zu Leben und Sterben sowie möglichen Behandlungen für den Fall einer Urteilsunfähigkeit mit Hilfe eines ausgebildeten Beraters auseinander zu setzen. Das Konzept kombiniert die individuelle Beratung des Patienten mit einem regionalen, systemischen Ansatz, der sicherstellt, dass alle Beteiligten die verwendeten Dokumente kennen und auch in einer Notfallsituation korrekt anwenden können. Ziel ist es, die Behandlung von urteilsunfähigen Patienten besser im Sinne ihrer Wünsche und Bedürfnisse zu koordinieren und dadurch die Patientenautonomie zu stärken.

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