Has the COVID-19 Pandemic Increased Advance Care Planning Discussions Held by Older Adults?

Abstract In an online survey exploring older Canadians’ experiences during the COVID-19 pandemic, 3989 respondents aged 55-99 indicated whether they had discussed their future care preferences and with whom, prior to and since the outbreak. Pre-pandemic, 62% had held such discussions; since the pandemic 43% did so, 11% for the first time. Rates were significantly higher among white respondents than among persons of color, women than men, and those 65+ than younger respondents. Respondents were most likely to have talked, respectively, with their spouse (58% before; 40% since), family (35%; 22%), and friends (12%; 10%)—with higher rates for white, women and older respondents. Surprisingly, only 4% before and 2% since the pandemic had discussed their care preferences with a doctor. Initiation of some new discussions was encouraging but there were fewer than expected, perhaps due to denial, superstition, or disbelief of pandemic severity. Advance care planning remains an under-utilized resource.

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SHARING Choices: A Pilot Study to Engage Family in Advance Care Planning of Older Adults With and Without Cognitive Impairment in the Primary Care Context

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120978771 ◽

2020 ◽

pp. 104990912097877

Author(s):

Jennifer L. Wolff ◽

Danny Scerpella ◽

Kimberly Cockey ◽

Naaz Hussain ◽

Tara Funkhouser ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Cognitive Impairment ◽

Advance Care Planning ◽

Advance Directive ◽

Agenda Setting ◽

Care Planning ◽

Future Care ◽

Advance Care ◽

Electronic Health Information

Context: Few advance care planning (ACP) interventions proactively engage family or address the needs of older adults with and without cognitive impairment in the primary care context. Objectives: To pilot a multicomponent intervention involving: an introductory letter describing a new clinic initiative and inviting patients to complete a patient-family pre-visit agenda-setting checklist, share their electronic health information with family, and talk about their wishes for future care with a trained ACP facilitator (SHARING Choices). Methods: SHARING Choices was delivered to 40 patient-family dyads from 3 primary care clinics. Facilitators completed post-ACP reports. Patient and family participants completed baseline and 6-week surveys. Results: Patients were on average 75 years (range 65-90). Family were spouses (85.0%) or adult children (15.0%). At 6 weeks, nearly half of dyads participated in ACP conversations (n = 19) or used the agenda-setting checklist (n = 17), one-third (n = 13) registered family to access the patient’s portal account, and most (n = 28) provided the primary care team with a new or previously completed advance directive. Of 12 patients who screened positive for cognitive impairment, 9 completed ACP conversations and 10 provided the clinic with an advance directive. ACP engagement, measured on a 4-point scale, was comparatively lower at baseline and 6 weeks among family (3.05 and 3.19) than patients (3.56 and 3.54). Patients remarked that SHARING Choices clarified communication and preferences while family reported a better understanding of their role in ACP and communication. Conclusion: SHARING Choices was acceptable among older adults with and without cognitive impairment and may increase advance directive completion.

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Preparing Spanish-speaking Older Adults for Advance Care Planning and Medical Decision-Making—The PREPARE Trial

10.25302/05.2020.cdr.130601500 ◽

2020 ◽

Author(s):

Rebecca Sudore ◽

Dean Schillinger ◽

Aiesha Volow ◽

Ying Shi ◽

John Boscardin ◽

...

Keyword(s):

Older Adults ◽

Decision Making ◽

Advance Care Planning ◽

Medical Decision Making ◽

Medical Decision ◽

Care Planning ◽

Spanish Speaking ◽

Advance Care

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An introduction to advance care planning: practice at the frontline

10.1093/oso/9780198802136.003.0003 ◽

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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Advance care planning: the future

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002304 ◽

2020 ◽

pp. bmjspcare-2020-002304

Author(s):

Judith Rietjens ◽

Ida Korfage ◽

Mark Taubert

Keyword(s):

Advance Care Planning ◽

Public Awareness ◽

Care Planning ◽

Decisional Capacity ◽

Best Interest ◽

Awareness Campaigns ◽

People With Dementia ◽

Future Care ◽

Advance Care ◽

Improve Patient

ObjectivesThere is increased global focus on advance care planning (ACP) with attention from policymakers, more education programmes, laws and public awareness campaigns.MethodsWe provide a summary of the evidence about what ACP is, and how it should be conducted. We also address its barriers and facilitators and discuss current and future models of ACP, including a wider look at how to best integrate those who have diminished decisional capacity.ResultsDifferent models are analysed, including new work in Wales (future care planning which includes best interest decision-making for those without decisional capacity), Asia and in people with dementia.ConclusionsACP practices are evolving. While ACP is a joint responsibility of patients, relatives and healthcare professionals, more clarity on how to apply best ACP practices to include people with diminished capacity will further improve patient-centred care.

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Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

Innovation in Aging ◽

10.1093/geroni/igaa057.1347 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 417-418

Author(s):

Hyo Jung Lee ◽

Giyeon Kim

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Relative Risk ◽

End Of Life ◽

Advance Care Planning ◽

Multinomial Logistic Regression ◽

Quality Care ◽

Care Planning ◽

Advance Care ◽

Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

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7 Exploring healthcare professionals’ attitudes to future care planning with older adults in hospital: qualitative research co-design through multi-professional patient and carer involvement

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2018-mariecurie.7 ◽

2018 ◽

Vol 8 (3) ◽

pp. 362.2-362

Author(s):

Anna-Maria Bielinska ◽

Stephanie Archer ◽

Catherine Urch ◽

Ara Darzi

Keyword(s):

Older Adults ◽

Decision Making ◽

End Of Life Care ◽

Healthcare Professionals ◽

List Type ◽

Care Planning ◽

Life Care ◽

Topic Guide ◽

Future Care ◽

Advance Care

IntroductionDespite evidence that advance care planning in older hospital inpatients improves the quality of end-of-life care (Detering 2010) future care planning (FCP) with older adults remains to be normalised in hospital culture. It is therefore crucial to understand the attitudes of healthcare professionals to FCP in older patients in the hospital setting. Co-design with patients carers and healthcare professionals can generate more detailed meaningful data through better conversations.AimsTo co-design a semi-structured interview (SSI) topic guide to explore healthcare professionals’ attitudes to FCP with older adults in hospital.MethodsA multi-professional research group including a panel of patient and carer representatives co-designed an in-depth topic guide for a SSI exploring healthcare professionals’ attitudes to FCP with older adults in hospital.ResultsThe co-designed topic guide encourages participants to explore personal and system-level factors that may influence attitudes to FCP and practice in hospital amongst healthcare staff. Co-designed topics for inclusion in the SSI schedule include:Potential differences between specialist and generalist approaches to FCPThe influence of perceived hierarchy and emergency–decision making ability in professionals on FCP discussionsThe relevance to transitions of careAttitudes to FCP beyond the biomedical paradigm including perceived well–being and psychosocial aspects of careDigital FCP tools including patient–led FCP.ConclusionCo-designing qualitative research with older people and multi-disciplinary professionals may narrow translational gaps in implementing FCP by setting joint research priorities. Data generated from a co-designed study may expand understanding of hospital-based anticipatory decision-making with older adults.Reference. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ23 March 2010;340:c1345.

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