scholarly journals INCOMPLETE ADVANCE CARE PLANNING? CORRELATES OF PLANNING WITHOUT PERSONAL CONVERSATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S425-S426
Author(s):  
Kathrin Boerner ◽  
Deborah Carr ◽  
Katherine M Ornstein ◽  
Sara Moorman
Keyword(s):  
Health Care ◽  
Social Isolation ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Living Will ◽  
Community Dwelling ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Abstract In the course of advance care planning (ACP), people may elect any of the following: a living will, a durable power of attorney for health care, and discussions with family members and health care providers. A small proportion of planners complete legal documents without discussing them with others (formal planning only, FPO). If people who have done FPO become incapacitated, their family and health care professionals may lack guidance on how to direct their care. To better understand this group, we drew on four large surveys of community-dwelling adults. Social isolation, measured by living alone and lack of a confidante, increased the odds of FPO across all studies. We also found some evidence that economic disadvantage and depressive symptoms were linked with FPO. We discuss implications for policy and practice, underscoring that ACP is yet another important domain affected by the crisis of social isolation in old age.

Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations

2020 ◽  
Vol 76 (1) ◽  
pp. 104-108
Author(s):  
Kathrin Boerner ◽  
Sara M Moorman ◽  
Deborah Carr ◽  
Katherine A Ornstein
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Multinomial Logistic Regression ◽  
Living Will ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Abstract Objectives Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP. Method Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP. Results A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one’s only preparation or in tandem with formal preparations. Discussion Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.

Health-Care Provider Personal Religious Preferences and Their Perspectives on Advance Care Planning With Patients

2018 ◽  
Vol 35 (12) ◽  
pp. 1565-1571
Author(s):  
Marjorie Bowman ◽  
Sarah St. Cyr ◽  
Adrienne Stolf i
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Religious Affiliation ◽  
Living Will ◽  
Care Planning ◽  
Care Providers ◽  
Power Of Attorney ◽  
Religious Preference ◽  
Advance Care

Objective: To understand how health-care providers’ (HCPs) religious preferences influence their willingness to undertake advance care planning (ACP) with patients and their acceptance of other HCP’s involvement. Methods: Online anonymous survey distributed to HCPs in hospital, ambulatory offices, and hospice settings in Dayton, Ohio. We evaluated the associations of HCP religion with their personal ACP, willingness to facilitate ACP, and acceptance of other HCPs’ ACP participation. Results: 704 respondents: nurses (66.2%), physicians (18.8%), other HCPs (15.0%), white (88.9%), and primarily Catholic (23.3%) or Protestant (32.0%). “No religion” was marked by 13.9%. Respondents were favorable to ACP with patients. Religious respondents were more likely to have a living will ( P = .035) and health-care power of attorney ( P = .007) and more accepting of clergy as ACP decision coaches ( P = .030). HCP’s religion was not associated with willingness to facilitate ACP discussions. There were minor differences between Catholics and Protestants. Conclusions: Personal religious preference is associated with HCP’s own ACP but had little relationship with their willingness to facilitate ACP conversations with patients or acceptance of other professional types of HCPs involvement in ACP conversations. Regardless of religious affiliation, HCPs have interest in undertaking ACP and endorse other HCPs ACP involvement. As results of this study suggest that personal religious affiliation is not a barrier for HCPs engaging in ACP with patients, attempts to overcome barriers to increasing ACP should be directed to other factors.

Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review

2018 ◽  
Vol 35 (8) ◽  
pp. 1123-1132 ◽  
Author(s):  
Jeff Myers ◽  
Roxanne Cosby ◽  
Danusia Gzik ◽  
Ingrid Harle ◽  
Deb Harrold ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Decision Making ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Care Planning ◽  
Care Providers ◽  
Provider Education ◽  
Goals Of Care ◽  
Advance Care

Background: Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person’s wishes are known and can guide the person’s substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person’s goals guide this process. Aim: To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. Data sources: A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. Conclusions: Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.

Advance Care Planning for Mechanical Ventilation: A Qualitative Study on Health-Care Providers’ Approaches to Cross-Cultural Care

2017 ◽  
Vol 80 (2) ◽  
pp. 305-330 ◽  
Author(s):  
Ayah Nayfeh ◽  
Isabelle Marcoux ◽  
Jeffrey Jutai
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
End Of Life ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Care Planning ◽  
Care Providers ◽  
Care Plans ◽  
Beliefs And Values ◽  
Advance Care

Advance care planning (ACP) is a method used for patients to express in advance their preferences for life-sustaining treatments at the end of life. With growing ethnocultural diversity in Canada, health-care providers are managing an increasing number of diverse beliefs and values that are commonly associated with preferences for intensive mechanical ventilation (MV) treatment at the end of life. This study aimed to identify and describe the approaches used by health-care providers to set advance care plans for MV with seriously ill patients from diverse ethnocultural backgrounds. Semistructured interviews were conducted with health-care providers from acute-care settings. Using a value-based approach in ACP was deemed an effective method of practice for managing and interpreting diverse beliefs and values that impact decisions for MV. However, personnel, organizational, and systemic barriers that exist continue to hinder the provision of ACP across cultures.

scholarly journals Muslim perspectives on advance care planning: a model for community engagement

2021 ◽  
Vol 15 ◽  
pp. 263235242199715
Author(s):  
Alya Abbas Heirali ◽  
Sidra Javed ◽  
Zaheed Damani ◽  
Rahim Kachra ◽  
Sabira Valiani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Care Provider ◽  
Cultural Beliefs ◽  
Care Planning ◽  
Care Providers ◽  
Future Health ◽  
Advance Care

Background: Advance care planning is the process of communicating and documenting a person’s future health care preferences. Despite its importance, knowledge of advance care planning is limited, especially among the Islamic community. In addition, little is known about how the Islamic community views advance care planning in the context of their religious and cultural beliefs. Objectives: We aimed to increase knowledge of the importance of advance care planning, to improve health care provider and public knowledge, and to encourage dialogue between the community and health care providers. Methods: We organized a community event and assembled a multi-disciplinary panel. Through a moderated discussion, the panel members offered their perspectives of advance care planning within a Muslim context. Results: Approximately 100 individuals attended the event including community members, health care providers, medical students, and faith leaders. More than 90% of respondents rated the event as very good or excellent, found the session useful and were encouraged to reflect further on advance care planning. Conclusion: This event was successful in raising awareness about advance care planning within the Islamic community as well as educating health care providers on Islamic views. This model of community and health care provider engagement may also be beneficial for other faith groups wishing to discuss advance care planning within their respective religious and cultural contexts.

scholarly journals Barriers in Advance Care Planning and Goals of Care Discussion With Oncology Patients: The Perspective of Brazilian Medical Residents

2021 ◽  
Author(s):  
Laiane Moraes Dias ◽  
Mayra Almeida Frutig ◽  
Mirella Rebello Bezerra ◽  
Williams Fernandes Barra ◽  
Luísa Castro ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Medical Residents ◽  
Care Planning ◽  
Care Providers ◽  
Cross Sectional ◽  
Goals Of Care ◽  
Early Palliative Care ◽  
Advance Care

Abstract Background. Advance care planning (ACP) and goals of care discussions involve the exploration of what is most important to a person to prepare for health-care decision-making. Despite their well-established benefits, they are still not frequently performed in clinical oncology practice. The awareness of physicians’ barriers enables the development of tailored interventions to improve professional practice. Considering the scarcity of studies about the difficulties of medical residents in discussing goals of care, this study aims to determine, from the perspective of medical residents, the barriers to the discussion goals of care and ACP with patients with cancer. Methods. A previously published survey (Decide-Oncology) to assess barriers to goals of care discussion among health care providers was adapted to Portuguese language and distributed to Brazilian medical residents from three hospitals in Brazil in a cross-sectional pilot study. Residents were asked to rank the importance of various barriers to discuss goals of care (ranging from 1-extremely unimportant to 7-extremely important). Results: Twenty-nine residents answered the questionnaire (30.9%). The most reported barriers were related to patients and their families' difficulty in understanding and accepting the diagnostic and the prognosis, patients’ desire to receive full active treatment and the lack of an advance directive. Furthermore, the physician and external factors such as lack of training and lack of time to have these conversations were also very important barriers. The identification of the key barriers that limit the discussion of ACP and early palliative care referrals can certainly help to prioritize the next steps for future studies aimed at improving ACP and goals of care discussions.

Association between religious beliefs and discussions regarding advance care planning: A nationwide survey

2021 ◽  
pp. 026921632110295
Author(s):  
Jun Miyashita ◽  
Sayaka Shimizu ◽  
Shunichi Fukuhara ◽  
Yosuke Yamamoto
Keyword(s):  
Health Care Providers ◽  
Advance Care Planning ◽  
Religious Beliefs ◽  
Nationwide Survey ◽  
Care Planning ◽  
Care Providers ◽  
Logistic Regression Models ◽  
Japanese Buddhism ◽  
Advance Care ◽  
Quota Sampling

Background: The relationship between advance care planning and religious beliefs, which are important for palliative care, is controversial in Western countries and has not been verified in Asian countries. Aim: To investigate the association between advance care planning discussions and religious beliefs in Japan. Design: A nationwide survey conducted in 2016 using a quota sampling method to obtain a representative sample of Japan’s general population. Setting/participants: We analyzed responses from 3167 adults aged 20–84 years (mean age ± standard deviation, 50.9 ± 16.8 years). The outcome was measured by asking whether the respondents had ever discussed advance care planning, and the main exposure by whether they had any religious beliefs or affiliations, and if so, their degree of devoutness. We analyzed religious beliefs, affiliations, and devoutness in relation to the occurrence of discussions using multivariable logistic regression models adjusted for possible sociodemographic covariates. Results: Compared with respondents without, those with religious beliefs had significantly higher odds of having had discussions (adjusted odds ratio: 1.45, 95% confidence interval: 1.22–1.73). The devoutness of religious belief was proportional to the propensity of the occurrence of discussions ( p for trend < 0.001). In addition, Buddhists and Christians had higher odds of having had discussions than did nonbelievers. Conclusion: The results suggest that holding religious beliefs, especially in Japanese Buddhism and Christianity, facilitates advance care planning discussions among Japanese adults, and thus, may help health-care providers identify those prioritized for facilitating engagement in advance care planning, especially in palliative and spiritual care settings.

scholarly journals Advance care planning in Norwegian nursing homes – limited awareness of the residents’ preferences and values? A qualitative study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lisbeth Thoresen ◽  
Reidar Pedersen ◽  
Lillian Lillemoen ◽  
Elisabeth Gjerberg ◽  
Reidun Førde
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Qualitative Content Analysis ◽  
Care Planning ◽  
Next Of Kin ◽  
Medical Issues ◽  
Interdisciplinary Approaches ◽  
Advance Care

Abstract Background 52% of all deaths in Norway occur in nursing homes. Still advance care planning (ACP) is scarce and heterogeneous. To improve the implementation and practice of ACP in nursing homes, knowledge about health care professionals’ views on ACP is vital. The objective of this study is to explore nurses and physicians’ aims and experiences with carrying out ACP in nursing homes. Methods Semi-structured group interviews were conducted with 20 health care professionals, recruited from nursing homes where ACP was performed regularly. Qualitative content analysis was used to analyse the data. Results The primary aim of the nursing home professionals when doing ACP in nursing homes were to build alliances with next of kin to avoid misunderstandings and future conflicts. Two main experiences with ACP were described: i) due to the sensitivity of ACP issues, it was important to balance directness with being sensitive, and ii) when the physicians raised questions concerning future medical treatment, the answers from residents as well as next of kin were often hesitant and unclear. Conclusion Our study add insights into how ACP is practiced in nursing homes and the professionals’ agenda. A focus on medical issues and achieving consensus with next of kin may result in lack of involvement of the residents and limited awareness of the residents’ needs. Interdisciplinary approaches, ACP-training and tailored guidelines may improve the implementation and practice of ACP.

Improving Medication Management by Understanding Patient and Caregiver Preferences for Medication Packaging

2020 ◽  
Vol 35 (10) ◽  
pp. 446-464
Author(s):  
Joshua Chou ◽  
Merton Lee ◽  
Taylor Kaminsky ◽  
Tarlan Namvar ◽  
Catherine E. Cooke ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Medication Management ◽  
The United States ◽  
Community Dwelling ◽  
Care Providers ◽  
Font Size ◽  
Visual Appearance ◽  
June July

OBJECTIVE: To assess older adults' perceptions and preferences when comparing multi-medication packaging products.<br/> DESIGN: Qualitative study involving focus group interviews (FGIs) and key informant interviews (KIIs).<br/> SETTING: Interviews were conducted in multiple cities within the United States during June-July 2019.<br/> PATIENTS, PARTICIPANTS: FGI participants (N=36) included community dwelling adults, 65 years of age or older, who took 5+ chronic medications, or their caregivers. KII participants (N=15) included health care professionals caring for similar populations.<br/> INTERVENTIONS: Participants were given samples of blister packs and pouches and asked about medication management and appearance and usability of medication packaging. Interviews were audio-recorded with participants' consent, then transcribed and coded using Atlas. ti. Recurrent and emergent themes were identified, and selected quotes served as examples of identified themes.<br/> MAIN OUTCOME MEASURE: Participants' perceptions regarding medication packaging.<br/> RESULTS: Participants' preferences varied for different multi-medication packaging systems. Similarly, most FGI participants did not communicate a strong attitude for or against their existing management systems. However, many FGI participants perceived a need for larger font size than seen on the either of the multimedication packaging samples. KII participants also preferred a larger font size on both packagings. KII participants thought the blister packs offered better visual organization and enabled caregivers to quickly assess adherence. However, KII participants expressed concern about integrating as-needed and short-term use medications and noted difficulty opening both types of packages.<br/> CONCLUSION: Visual appearance is important to both patients and health care providers. Continued research in this area is vital for tailoring packaging types and technology to patients.

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