scholarly journals RELATIONSHIP BETWEEN FAMILY INVOLVEMENT IN CARE PLANNING AND ESTABLISHING AN ADVANCE DIRECTIVE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S772-S772
Author(s):  
Ellen McCreedy ◽  
lacey Loomer ◽  
Jennifer Palmer ◽  
Angelo Volandes ◽  
Susan Mitchell ◽  
...  
Keyword(s):  
Competing Risks ◽  
Family Involvement ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Cumulative Incidence ◽  
Routine Care ◽  
Care Planning ◽  
Observation Window ◽  
Data Set ◽  
Advance Care

Abstract The purpose of this research is to understand the effect of family participation in care planning assessments on the use of advance directives for newly admitted nursing home (NH) residents. This is a retrospective cohort study using data from 115 nursing homes involved in a pragmatic randomized clinical trial testing a video intervention for advance care planning (versus usual care). Data sources included the electronic health record and the Minimum Data Set (MDS). Competing risks regression analyses estimated the cumulative incidence of establishing an advance directive, after accounting for death, discharge from NH, and time censoring (12-month observation window). 18,978 residents admitted to eligible NHs without an advance directive (full code) between April 2, 2016 and August 31, 2017 were followed for one year. 11,905 (63%) died or were discharged without an advance directive; 4,155 (22%) remained in the NH without an advance directive; and 2,918 (15%) established an advance directive. Median time to establishing an advance directive was 75 days (SD: 72, 79). After adjusting for competing risks and resident factors known to be associated with advance directive use, each care planning assessment involving a family member was associated with a 6% increase in the cumulative incidence advance directive use. Involving family members of NH residents in routine care planning assessments may reduce the amount of futile care received by NH residents. As we test interventions to improve advance care planning for NH residents, focus should be placed upstream on the first 90 days after admission.

Intrapersonal Factors Impact Advance Care Planning Among Cancer Patients

2020 ◽  
pp. 104990912096245
Author(s):  
Elizabeth Palmer Kelly ◽  
Brent Henderson ◽  
Madison Hyer ◽  
Timothy M. Pawlik
Keyword(s):  
Medical Treatment ◽  
Cancer Patients ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Planning ◽  
Power Of Attorney ◽  
Intrapersonal Factors ◽  
Advance Care

Background: Cancer patients infrequently engage in advance care planning processes. Establishing preferences for future medical treatment without advance care planning may not be patient-centered, as it fails to consider important factors that influence these important decisions. Objective: The purpose of this study was to assess the influence of patient intrapersonal factors including race, religion, level of depression, and cancer stage on overall preferences for future medical treatment, including the presence of a (DNR), power of attorney, and advance directive. Design: A retrospective chart review design was used. Patients were included who were diagnosed with cancer at The Ohio State University James Comprehensive Cancer Center from 01/2015 to 08/2019. Results: A total of 3,463 patients were included. Median age was 59 years (IQR: 49, 67) and the majority of the patients was female (88.7%). Compared with no religious preference, patients who identified as religious had 61% higher odds (95%CI: 1.08-2.40) of having a DNR and approximately 30% higher odds of having a power of attorney (95%CI: 1.08-1.62) or advance directive (95%CI: 1.02-1.64). Patients with clinically relevant depression had more than twice the odds of having a DNR versus patients with no/lower levels of clinical depression (OR: 2.08; 95%CI: 1.40-3.10). White patients had higher odds of having a power of attorney (OR: 1.57; 95%CI: 1.16-2.13) and an advance directive (OR: 3.10; 95% CI: 1.95-4.93) than African-American/Black patients. Conclusions: Understanding the factors that affect preferences for future medical treatment is necessary for medical professionals to provide proper care and support to patients diagnosed with cancer and their families.

scholarly journals AWARENESS OF ADVANCE CARE PLANNING AND ADVANCE DIRECTIVE AMONG OLDER ADULTS IN JAPAN, HONG KONG, AND KOREA

2018 ◽  
Vol 2 (suppl_1) ◽  
pp. 528-528
Author(s):  
A Kawakami ◽  
N Mikoshiba ◽  
E Kwong ◽  
C Lai ◽  
M Song ◽  
...  
Keyword(s):  
Older Adults ◽  
Hong Kong ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Care Planning ◽  
Advance Care

scholarly journals Association Between Region of Birth and Advance Care Planning Documentation Among Older Australian Migrant Communities: A Multicenter Audit Study

2020 ◽  
Vol 76 (1) ◽  
pp. 109-120
Author(s):  
Craig Sinclair ◽  
Marcus Sellars ◽  
Kimberly Buck ◽  
Karen M Detering ◽  
Ben P White ◽  
...  
Keyword(s):  
Health Professional ◽  
Language Proficiency ◽  
Family Involvement ◽  
Advance Care Planning ◽  
English Language ◽  
Care Facility ◽  
Care Planning ◽  
Cross Sectional ◽  
Term Care ◽  
Advance Care

Abstract Objectives This study explored associations between birth region, sociodemographic predictors, and advance care planning (ACP) uptake. Methods A prospective, multicenter, cross-sectional audit study of 100 sites across 8 Australian jurisdictions. ACP documentation was audited in the health records of people aged 65 years or older accessing general practice (GP), hospital, and long-term care facility (LTCF) settings. Advance care directives (ACDs) completed by the person (“person completed ACDs”) and ACP documents completed by a health professional or other person (“health professional or someone else ACP”) were counted. Hierarchical multilevel logistic regression assessed associations with birth region. Results From 4,187 audited records, 30.0% (1,152/3,839) were born outside Australia. “Person completed ACDs” were less common among those born outside Australia (21.9% vs 28.9%, X2 (1, N = 3,840) = 20.3, p < .001), while “health professional or someone else ACP” was more common among those born outside Australia (46.4% vs 34.8%, X2 (1, N = 3,840) = 45.5, p < .001). Strongest associations were found for those born in Southern Europe: “person completed ACD” (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.36–0.88), and “health professional or someone else ACP” (OR = 1.41, 95% CI = 1.01–1.98). English-language proficiency and increased age significantly predicted both ACP outcomes. Discussion Region of birth is associated with the rate and type of ACP uptake for some older Australians. Approaches to ACP should facilitate access to interpreters and be sensitive to diverse preferences for individual and family involvement in ACP.

scholarly journals Is Advance Care Planning Associated With Decreased Hope in Advanced Cancer?

2020 ◽  
pp. OP.20.00039
Author(s):  
Michael G. Cohen ◽  
Andrew D. Althouse ◽  
Robert M. Arnold ◽  
Hailey W. Bulls ◽  
Douglas White ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Care Planning ◽  
Cross Sectional ◽  
Potential Association ◽  
Advance Care ◽  
P 752 ◽  
Surrogate Decision ◽  
Sectional Analysis

PURPOSE: Providers have cited fear of taking away hope from patients as one of the principal reasons for deferring advance care planning (ACP). However, research is lacking on the relationship between ACP and hope. We sought to investigate the potential association between ACP and hope in advanced cancer. METHODS: This is a cross-sectional analysis of baseline data from a primary palliative care intervention trial. All patients had advanced solid cancers. Three domains of ACP were measured using validated questions to assess discussion with oncologists about end-of-life (EOL) planning, selection of a surrogate decision maker, and completion of an advance directive. Hope was measured using the Hearth Hope Index (HHI). Multivariable regression was performed, adjusting for variables associated with hope or ACP. RESULTS: A total of 672 patients were included in this analysis. The mean age was 69.3 ± 10.2 years; 54% were female, and 94% were White. Twenty percent of patients (132 of 661) reported having a discussion about EOL planning, 51% (342 of 668) reported completing an advance directive, and 85% (565 of 666) had chosen a surrogate. There was no difference in hope between patients who had and had not had an EOL discussion (adjusted mean difference in HHI, 0.55; P = .181 for adjusted regression), chosen a surrogate (adjusted HHI difference, 0.31; P = .512), or completed an advance directive (adjusted HHI difference, 0.11; P = .752). CONCLUSION: In this study, hope was equivalent among patients who had or had not completed 3 important domains of ACP. These findings do not support concerns that ACP is associated with decreased hope for patients with advanced cancer.

Making Advance Directives Visual: Introducing Young Adults to Advance Care Planning With Video-Recorded Advance Directives

2019 ◽  
Vol 25 (4) ◽  
pp. e44-e51
Author(s):  
Cameron Kiersch ◽  
Teddie Potter
Keyword(s):  
Quality Of Life ◽  
Young Adults ◽  
End Of Life ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Planning Process ◽  
Care Planning ◽  
Advance Care ◽  
Definition Of

The complexities surrounding the dying process may distort rational decision-making and impact care at the end of life. Advance care planning, which focuses on identifying the individual's definition of quality of life, holds great potential to provide clarity at the end of life. Currently, young adults are not the intended audience for advance care planning. A quality improvement project engaged 36 college-age adults in structured group advance care planning discussions and evaluated the perceived value of a self-recorded advance directive. Findings from a pre- and postintervention survey suggested that young adults welcomed a conversation about end-of-life care; they wished for more information and expressed that a video-recorded advance directive stimulated thoughts about their own definition of quality of life. Participants' improved self-perception of comfort, confidence, certainty, and knowledge regarding the advance care planning process and end-of-life care indicated young adults may be a willing and eager population for the expansion of advance care planning. In addition to directing advance care planning to a younger audience, a personal video-recorded advance directive may complement the current advance care planning process and aid individuals in defining their quality of life.

Effectiveness of an advance care planning patient navigator on advance directive completion by electronic versus staff-based referrals at a major cancer hospital.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 20-20 ◽  
Author(s):  
Gayle Ito-Hamerling ◽  
Lindsay Emanuel ◽  
Finly Zachariah
Keyword(s):  
Social Workers ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Completion Rate ◽  
Care Planning ◽  
Clinical Social Workers ◽  
Patient Centered ◽  
Advance Care ◽  
Screening Platform

20 Background: Advance Care Planning (ACP) is a central component of patient-centered care, helping ensure patient values and preferences guide clinical decisions. Patient navigators have been utilized effectively in healthcare for numerous roles, and more recently for ACP. At City of Hope National Medical Center (COH), an ACP-focused navigator was hired to support patients, families, and staff with Advance Directive (AD) notarization and primary ACP conversations. Methods: The Department of Supportive Care Medicine at COH with significant institutional collaboration and administrative support created a patient-centered ACP program and marketing campaign, called “Plan Today for Tomorrow.” In 2016, an ACP navigator joined the team to facilitate AD completion. Referral to the ACP navigator occurred either through staff endorsement and/or the institution’s technological screening platform deployed in a majority of COH outpatient clinics. Staff referrals came from physicians, clinical social workers, nurses, or from the Sheri & Les Biller Patient and Family Resource Center. Prior to the ACP navigator, all referrals were addressed by Clinical Social Workers (CSWs). Results: In a review of 14 months of data, the ACP navigator followed up on 1,125 referrals, 574 were from staff, while 551 were from the institutional tablet-based screening platform. Follow-up on staff referrals resulted in an 86% AD completion rate. Follow-up on tablet-based screening resulted in a 23% AD completion rate. Conclusions: The presence of an available onsite ACP-focused navigator was more effective in facilitating AD completion of staff generated AD referrals as compared to AD completion of tablet-based patient screening AD referrals. The presence of the ACP navigator to facilitate AD completion decreased workload for CSWs, creating increased opportunity for CSWs to work at the top of their professional license. Further work is needed to increase the effectiveness of AD completion from tablet-based screening referrals.

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 MO200COVID-19 PANDEMIC INCREASED ADVANCE CARE PLANNING DEMAND

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alessandro Toccafondi ◽  
Giuseppina Simone ◽  
Marco Lombardi ◽  
Pietro Claudio Dattolo
Keyword(s):  
Advance Care Planning ◽  
Advance Directive ◽  
Planning Process ◽  
Structured Interview ◽  
Care Planning ◽  
Dialysis Patients ◽  
Clinical Routine ◽  
Number Of Patients ◽  
Advance Care ◽  
Future Treatments

Abstract Background and Aims Advance care planning (ACP) enables competent patients to define goals and preferences for future treatments and care, to discuss these goals and preferences with relatives, and if appropriate to record these preferences. After many years of political and social debates, in December 2017 the first advance directive and care planning legislation was approved in Italy. Nevertheless, citizens’ awareness of these issues is scarce as well as the integration of the advance care planning process into clinical routine. The latest data reported to the Italian Parliament by the Ministry of Health indicated that advance directives have been completed by 62030 people, approximately 1.1% of Italian adult population. However, during the last months, the COVID-19 pandemic solicited taking steps towards promoting an advance care planning culture. Indeed, the need of proposing ACP to patients have been recently stressed both by medical associations and national and local institutional documents. Method Since November 2020, our nephrology unit adopted a protocol approved by Ethical committee by Physician Order of Florence, aimed to conduct ACP interventions with dialysis patients. Firstly, all patients were informed about the possibility to taking part in one or more advance care planning conversations with their nephrologist. Secondly, a semi-structured guide to the conversation was created in order to support physicians in conducting the ACP intervention. Finally, patients along with nephrologist and their relatives, could documented their preferences for future treatments and care. Results From November to March only one patient asked to receive an ACP intervention. However, since COVID-19 spread in Italy last March, the number of patients who demanded ACP raised up. In the period from April to July, 15 out of 110 hemodialysis patients treated in our center asked for an ACP intervention and filled-in an advance directive. Specifically, no patients required an immediate discontinuation of dialysis, nevertheless 80% of them stated that would not like to continue with dialysis in case he/she was no longer able to self-determine (e.g. permanent loss of capacity to communicate with others). All patients except one have appointed a personal representative (usually their partner). In the eventuality of cardiac arrest, 60% of patients asked for cardiopulmonary resuscitation. Finally, all patients expressed the wish to spend the last days of life at home. Conclusion The COVID-19 pandemic raised up the number of dialysis patients who required to taking part in a advance care planning intervention. In this sense, the pandemic can be an opportunity for consolidate advance care planning in Italy as well as in other countries, where these interventions are not well known by people and not yet regularly offered in the clinical routine. Using a semi-structured interview for the ACP interview can help the nephrologist to discuss future care and end-of-life topics with their patients.

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