scholarly journals Advance Care Planning in the Context of COVID-19: Complexities Across a Range of Constituents

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 133-133
Author(s):  
Brian Carpenter ◽  
Karen Hirschman
Keyword(s):  
Undergraduate Students ◽  
Advance Care Planning ◽  
Media Coverage ◽  
Care Planning ◽  
Personal Lives ◽  
Close Proximity ◽  
Before And After ◽  
Advance Care ◽  
New Policies ◽  
Motivating Factor

Abstract The COVID-19 pandemic brought serious illness and death into close proximity for a large number of people, whether through personal experience, infection in family members or friends, or unremitting media coverage on the effects of the virus and widespread mortality. Because of a collective vulnerability to illness and the heightened possibility of death, more people began to contemplate what kinds of medical care they would want if they ever became seriously ill. In other words, more people began the process of advance care planning (ACP). This symposium explores how the COVID-19 pandemic shifted interest in and execution of ACP across a range of groups. The first presentation reviews survey data from a large, community-based sample of older adults about their ACP conversations before and after the start of the pandemic. Shifting to the experience of clinicians, the second presentation summarizes a survey with multidisciplinary healthcare professionals about ACP conversations in their personal lives during the pandemic and how their observations of patients influenced their own plans. The third presentation describes the reactions of undergraduate students to an ACP class exercise, including COVID-19 as a motivating factor for pursuing ACP. The final presentation concludes with a review of two clinical cases that illustrate how COVID-19 has upended traditional ACP and highlighted the need for new policies and processes, with a particular focus on ethics and equity. Together, these presentations offer diverse insights into how ACP may shift in a post-pandemic world.

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 Perceptions of the Importance of Advance Care Planning During the COVID-19 Pandemic Among Older Adults Living With HIV

2021 ◽  
Vol 9 ◽  
Author(s):  
Annie L. Nguyen ◽  
Mariam Davtyan ◽  
Jeff Taylor ◽  
Christopher Christensen ◽  
Brandon Brown
Keyword(s):  
Higher Education ◽  
Older Adults ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Undetectable Viral Load ◽  
Care Planning ◽  
Living Situation ◽  
Before And After ◽  
Advance Care ◽  
Living With Hiv

Background: The importance of advance care planning (ACP) discussions have been heightened during the COVID-19 pandemic. We assessed advance directive completion, healthcare proxy (HCP), and attitudes toward ACP among older adults ages 50+ living with HIV during the COVID-19 pandemic.Methods: Internet-based surveys were administered to 100 participants residing in the Coachella Valley, California from April to June 2020. We examined self-reported completion of an advance directive, HCP, and attitudes toward ACP before and after COVID-19. Adjusted regressions were performed on attitudes toward ACP.Results: Participants' mean age was 64.2 years, most were non-Hispanic white (88.0%), men (96.0%), and identified as sexual minorities (96.0%). Many reported having an advance directive (59.6%) or HCP (67.3%). Most (57.6%) believed ACP to be more important now compared to the pre-pandemic era. Having an advance directive was associated with increase in age, higher education, living with other people, never having an AIDS diagnosis, and current undetectable viral load (p < 0.05). Having a HCP was associated with higher education, being married/partnered, and living with other people (p < 0.05). In a logistic regression model adjusted for education and living situation, the belief that ACP was more important during COVID was associated with not having an advance directive (OR: 5.07, 95% CI: 1.78–14.40) and fear of COVID-19 infection (OR: 4.17, 95% CI: 1.61–10.76.)Conclusions: The COVID-19 pandemic presents a window of opportunity to engage people aging with HIV in ACP discussions, particularly those who do not already have an advance directive.

scholarly journals Evaluating the Conversation Starter Kit in Long Term Care: A Canadian Perspective

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 944-945
Author(s):  
Sharon Kaasalainen ◽  
Tamara Sussman
Keyword(s):  
Health Care ◽  
Advance Care Planning ◽  
Long Term Care ◽  
Family Members ◽  
Care Planning ◽  
Term Care ◽  
Before And After ◽  
Advance Care ◽  
Planning Intervention

Abstract This study evaluated an advance care planning intervention, the Conversation Starter Kit (CSK) booklet, for use in long term care (LTC) homes. This study used a quasi-experimental, one group pre/post design. Quantitative surveys were administered before and after a 3-month advance care planning intervention (CSK booklet). Data were collected at three LTC homes in southern Ontario. We collected data from 55 resident who were able to make decisions on their own paired with 11 family members of these residents. We also collected data from 24 family members of residents who were not able to make decisions on their own. Quantitative surveys were administered before and after the intervention. An additional structured interview was completed at the end of the intervention period, which included both closed and open-ended questions to assess perceptions about the CSK booklet’s use or non-use. Residents reported higher engagement in advance care planning after having completed the CSK booklet than before, particularly related to asking questions to health care providers about health care decisions. Family members reported feeling very certain that they would be able to make decisions on behalf of the resident but they felt less certain after completing the CSK booklet, implying that the CSK booklet raised their awareness of the types of decisions that they might need to make, hopefully triggering them to become more prepared for these decisions in the future. The CSK appears acceptable, easy to use for residents and family members/friends in LTC, and can improve resident engagement in ACP.

Development and validation of support tools for advance care planning in patients with chronic heart failure

2019 ◽  
Vol 25 (10) ◽  
pp. 494-502 ◽  
Author(s):  
Yasuko Takada ◽  
Yasuhiro Hamatani ◽  
Yukie Kawano ◽  
Yuta Anchi ◽  
Michikazu Nakai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Advance Care Planning ◽  
Intervention Group ◽  
Control Group ◽  
Care Planning ◽  
Patient Anxiety ◽  
Support Tool ◽  
Support Tools ◽  
Before And After ◽  
Advance Care

Background: Advance care planning (ACP) is recommended as part of the management of patients with heart failure (HF). Aims: To develop and validate ACP support tools for patients with HF. Methods: An ACP support tool was developed based on a systematic literature review. A multi-center, prospective before and after study was conducted to evaluate the usefulness of the support tool. This study included 21 patients with HF, 11 patients formed the control group and 10 patients were part of the intervention group who received ACP from medical staff using the ACP support tools developed for this study. Participants of the study were surveyed about their experience of ACP using a 6-point Likert scale. Findings: All of the healthcare professionals (n=9) involved in the study found the ACP tool useful and about 90% of patients considered the support tool useful. The score for ‘the patient did not feel anxious about the future after receiving ACP discussion’ was significantly higher (3.5 [3.0, 4.0] vs 2.0 [1.0, 3.0]; P=0.04) in the intervention group that used the ACP tool. Conclusion: ACP support tools are useful to manage patients with HF and could enable effective ACP without increasing patient anxiety.

scholarly journals ADVANCE CARE PLANNING ASSIGNMENTS IN UNDERGRADUATE COURSES: EXAMINING STRESS APPRAISALS, COPING, AND RESPONSES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S538-S538
Author(s):  
Maureen Templeman ◽  
Victoria R Marino ◽  
Debra J Dobbs ◽  
William E Haley
Keyword(s):  
Undergraduate Students ◽  
Advance Care Planning ◽  
Well Being ◽  
The United States ◽  
Coping Resources ◽  
Traumatic Experiences ◽  
Care Planning ◽  
Care Plans ◽  
Advance Care ◽  
Student Reactions

Abstract A common assignment in undergraduate aging courses requires students to consider or complete advance care plans for themselves. Due to the sensitive nature of this topic, it is important to consider student appraisals of such assignments. Using the transactional model of stress and coping, the current study used content analysis to examine student reactions to considering their own advance care planning. Participants included 151 students, diverse in race/ethnicity, in a Psychology of Aging undergraduate course at a large public university in the United States. Students were first exposed to course material related to death, dying, and bereavement, in addition to detailed advance directive forms, and were subsequently asked to discuss the importance of, and their preparedness for, their own advance care planning via a written assignment. Codes represented primary and secondary appraisals, coping efforts, and responses, and data was analyzed using ATLAS.ti software. Findings suggest that primary appraisals (perception of effect on well-being) ranged from positive to threatening, and secondary appraisals (perception of coping resources) focused on availability of internal and/or external resources. Themes such as traumatic experiences with death, feeling ill-prepared due to lack of knowledge or experience, and welcoming the opportunity to consider completing advance care plans emerged. Overall, results suggest that when designing assignments that require completion of advance care plans among undergraduate students, students should have the opportunity to discuss personal concerns first, and that some initial class activities should focus on preparatory tasks rather than just completion of advance care plans.

scholarly journals Insisting on Life Dignity: Advance Care Planning in Taiwan During COVID-19 Pandemic

2021 ◽  
Author(s):  
Chun-Yi Yang ◽  
Ching-Nu Liu ◽  
Chi-Cheng Yang ◽  
Zong-Dar Tsai ◽  
Su-Fei Lin ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Public Awareness ◽  
Participation Rate ◽  
Patient Comfort ◽  
Care Planning ◽  
City Hospital ◽  
Global Public Health ◽  
Health Crisis ◽  
Before And After ◽  
Advance Care

Abstract Background:The coronavirus disease 2019 (COVID-19) outbreak is a global public health crisis that has affected the implementation of advance care planning (ACP) in Taiwan. The purpose of this study is to (1) confirm that COVID-19 significantly reduced public participation in ACP, (2) identify factors influencing the implementation of ACP during the COVID-19 pandemic and how they differ from those before the COVID-19 outbreak.Methods: An observational study from retrospective review of medical chart and clinical information.This is a hospital-based study to examine the characteristics of ACP implementation in Taiwan during COVID-19. A total of 1,253 participants were recruited, including 916 people who had completed ACP from September through December 2019, and 337 people from January through April 2020.Results:This study representing an approximately 65% decrease in ACP participation after COVID-19 outbreak. The cancellation rate of ACP during COVID-19 is higher before outbreak. After COVID-19 outbreak, Participation rate of disadvantaged populations increased from 16.92% to 21.66%. The percentage of participants with caregiver experiences decreased from 31.66%to to 23.44% . Participants who did not wish for their families to bear decision-making responsibilities increased from 44.00% to 52.52%. The percentage of offspring participation increased from 86.57% to 90.80%. The percentage of individuals completing ACP after the outbreak without signing an advance directive increased from 5.57% to 9.20%. The COVID-19 pandemic significantly reduced participation in ACP. Conclusions: This study directly compared the ACP implementation before and after COVID-19, which is a tremendous global health crisis influencing the conceptions of life and death.COVID-19 has threatened the public’s health and has changed ACP in the healthcare system by increasing public awareness of the topic of death. After COVID-19, both medical staff and the public should clearly express their opinions on terminal care.Policy supports and active participation of medical team can encourage disadvantages to complete ACP.Healthcare workers should provide palliative and terminal care services in which patient comfort and dignity are the primary focus of care.Trial registration:This study was approved on 3 June 2020 by the Taipei City Hospital Institutional Review Board (Case No.: TCHIRB-10808008-E).

scholarly journals Training Clinic Providers on Advance Care Planning Improves Provider Self-Efficacy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 768-768
Author(s):  
Jeffrey Graupner ◽  
Sandy Tun ◽  
Carolyn Read ◽  
Amena Qureshi ◽  
Cassie Lee ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Self Efficacy ◽  
Underserved Populations ◽  
Training Session ◽  
Rank Test ◽  
Care Planning ◽  
Training Clinic ◽  
Before And After ◽  
Signed Rank Test ◽  
Advance Care

Abstract Advance care planning (ACP) is a vital step to ensure patients receive and prioritize the care that best aligns with their end-of-life wishes, including discussion and documentation of an advance directive. Significant gaps in ACP among underserved populations have been well documented. Research suggests a successful strategy for increasing the communication between provider and patient about ACP is to educate clinicians on this important issue. Three, 2.5 hour training sessions were provided to healthcare staff of a large chain of older adult primary care clinics across three states. Lecture materials were created and presented by a palliative care (PC) physician and PC nurse practitioner. Presentations were held both in person and virtually. Participants were asked to complete a pre/post-training survey online which included a validated 17-item ACP Self-Efficacy Scale (Baughman, 2017), perceived barriers checklist, and additional quality improvement measures. A total of 131 providers attended one of three training sessions. 76 providers (58.0%) and 47 providers (35.9%) completed pre- and post-training surveys respectively. Scores on a 17-item validated ACP Self-Efficacy Scale were significantly higher after training (Wilcoxon signed rank test, Z= 4.42, p <.001). Participants ranked “lack of time” as the number one barrier to having ACP conversations both before and after the training, whereas “lack of training” ranked 2nd and fell to 7th after the training. These initial results suggest ACP self-efficacy among providers can be increased through a one-time training session. Previous literature has highlighted the importance of provider self-efficacy as factor in increasing ACP conversations with patients.

scholarly journals Dissemination, use, and impact of a community-based, conversational advance care planning intervention: ripple effects of the Swedish DöBra cards

2021 ◽  
Vol 15 ◽  
pp. 263235242110329
Author(s):  
Malin Eneslätt ◽  
Gert Helgesson ◽  
Carol Tishelman
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Media Coverage ◽  
Care Planning ◽  
Action Research Project ◽  
Community Based ◽  
Ripple Effects ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues

Introduction & Aim: Despite increasing interest in community-based advance care planning interventions, few studies investigate the societal impact of such initiatives. The DöBra cards, a Swedish adaptation of the GoWish cards, were first used for advance care planning conversations in a participatory action research project and later, due to popular demand, made available for purchase by the general public. We explore how the DöBra cards were disseminated and used publicly, to understand their impact in the community. Methods: We used Ripple Effects Mapping to follow three dissemination ripples, based on interviews with 20 participants, analyzed with directed content analysis. Findings: Key factors influencing dissemination of the DöBra cards included ‘champions’ with a mandate within their context or organization, policy documents including use of the cards, media coverage, and presentations of the cards in various settings. The DöBra cards were adapted for use individually and in groups in different private, professional, and organizational settings. Perceived benefits of the cards included acting as an icebreaker in initiating end-of-life conversations and having preformulated statements to reflect upon. Other positive experiences included discussions on different interpretations of card statements, thus opening new perspectives regarding end-of-life. The DöBra cards functioned both as means to raise end-of-life issues in different contexts, and as an end in themselves, for example, by facilitating advance care planning conversations for those with serious disease. Impact also included personal development and strengthening of private and professional relationships, with potential to affect end-of-life care. Conclusion: The broad dissemination of the DöBra cards influenced capacity-building in dealing with end-of-life issues in communities, as the topic of dying and death was brought to agendas in new contexts.

Sign in / Sign up

Export Citation Format

Share Document