scholarly journals Human-Centered Design of an Advance Care Planning Group Visit for Mild Cognitive Impairment

2021 ◽  
Author(s):  
Andrea E Daddato ◽  
Elizabeth W Staton ◽  
Brianne M Bettcher ◽  
Prajakta Shanbhag ◽  
Hillary D Lum
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Advance Care Planning ◽  
Advisory Panel ◽  
Care Planning ◽  
Multiple Perspectives ◽  
Group Setting ◽  
Human Centered Design ◽  
Group Visit ◽  
Advance Care

Abstract Background and Objectives While advance care planning (ACP) is critical for ensuring optimal end-of-life outcomes among individuals with mild cognitive impairment (MCI), many individuals that may benefit from ACP have not initiated this process. This paper aims to describe the iterative design of a MCI group visit-based intervention, and evaluate feasibility and acceptability of the intervention. Research Design and Methods We used human-centered design, rapid-cycle prototyping, and multiple methods to adapt an Engaging in Advance Care planning Talks (ENACT) Group Visits intervention. We convened an advisory panel of persons with MCI and care partners (n=6 dyads) to refine the intervention and conducted a single-arm pilot of four MCI ENACT intervention prototypes (n=13 dyads). We used surveys and interviews to assess outcomes from multiple perspectives. Results The advisory panel affirmed that ACP is a priority for individuals with MCI, described the need for ACP in a group setting, and suggested refinements to ACP resources for the MCI ENACT intervention. Feasibility of recruitment was limited. MCI ENACT intervention participants strongly agreed that group discussions provided useful information and recommended the intervention. Themes supporting acceptability included: 1) feedback on acceptability of the intervention; 2) previous experiences with ACP; and 3) reasons for participation, including desire for discussions about MCI and how it relates to ACP. Discussion and Implications Despite stakeholder’s positive ratings of acceptability of the MCI ENACT intervention, future work is needed to enhance feasibility of recruitment to support implementation into clinical settings.

scholarly journals An Advance Care Planning Group Visit Intervention for Individuals With Mild Cognitive Impairment

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 242-243
Author(s):  
Andrea Daddato ◽  
Prajakta Shanbhag ◽  
Brianne Bettcher ◽  
Hillary Lum
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Focus Groups ◽  
Advance Care Planning ◽  
Medical Decision ◽  
Care Planning ◽  
Group Visit ◽  
Study Partner ◽  
Advance Care ◽  
Planning Group

Abstract Among older adults without cognitive impairment, a novel advance care planning group visit (ACP-GV) intervention increased ACP documentation and readiness to engage in ACP. A key question is whether an intervention can be adapted to support people with mild cognitive impairment (MCI) and a family care partner. We used a human-centered design process, rapid-cycle prototyping, and qualitative methods to adapt an ACP-GV intervention to individuals with MCI and a study partner. In 2019, we convened a longitudinal cohort of six patient-study partner stakeholders in three focus groups to suggest intervention adaptations. We also conducted a single arm study of four ACP-GV interventions (n=13 dyads total) that were iteratively refined with input from the longitudinal focus groups and intervention participant feedback. Decision tools, resources and videos were used to describe the concept of ACP and flexibility in selecting a medical decision maker. Many ACP-GV participants strongly agreed that the group discussion gave them useful information (81%) and would recommend the ACP-GV to a friend (85%). Pre- and post-ACP readiness surveys indicated that participants were significantly more ready to talk to their medical decision maker about ACP (p=0.028), while study partners perceived their loved ones less ready to speak to their doctor about ACP following the intervention (p=0.031). Use of rapid prototyping allowed testing of different resources and tools aimed at helping individuals with MCI and their study partners discuss ACP. Future work is needed to understand the feasibility of implementing an ACP-GV intervention for individuals with MCI into clinical settings.

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

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.

P-43 Capacity assessment for advance care planning in older people with cognitive impairment

2015 ◽  
Vol 5 (Suppl 2) ◽  
pp. A56.3-A57
Author(s):  
O Kiriaev ◽  
Emme Chacko ◽  
JD Jurgens ◽  
Meagan Ramages ◽  
P Malpas ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Older People ◽  
Advance Care Planning ◽  
Capacity Assessment ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance care planning in people with early cognitive impairment

2014 ◽  
Vol 5 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Kenny Cheong ◽  
Paul Fisher ◽  
Jenny Goh ◽  
Lynette Ng ◽  
Hui Mien Koh ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

scholarly journals Evaluation of the national implementation of the VA Diffusion of Excellence Initiative on Advance Care Planning via Group Visits: Protocol for a quality improvement evaluation

2020 ◽  
Author(s):  
Monica M. Matthieu ◽  
Songthip T. Ounpraseuth ◽  
Jacob Painter ◽  
Angie Waliski ◽  
James “Silas” Williams ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Advance Care Planning ◽  
Implementation Strategies ◽  
Care Planning ◽  
National Program ◽  
Group Setting ◽  
Group Visits ◽  
National Implementation ◽  
Advance Care ◽  
The Impact

Abstract Background Traditionally system leaders, service line managers, researchers, and program evaluators, hire specifically dedicated implementation staff to ensure that a healthcare quality improvement effort can “go to scale”. However, little is known about the impact of hiring dedicated staff and whether funded positions, amid a host of other delivered implementation strategies, is the main difference among sites with and without funding used to execute the program, on implementation effectiveness and cost outcomes. Methods/Design In this mixed methods program evaluation, we will determine the impact of funding staff positions to implement, sustain, and spread a program, Advance Care Planning (ACP) via Group Visits (ACP-GV), nationally across the entire United States Department of Veterans Affairs (VA) healthcare system. In ACP-GV, Veterans, their families, and trained clinical staff with expertise in ACP meet in a group setting to engage in discussions about ACP and the benefits to Veterans and their trusted others of having an Advance Directive (AD) in place. To determine the impact of the ACP-GV National Program, we will use a propensity score matched control design to compare ACP-GV and non-ACP-GV sites on the proportion of ACP discussions in VHA facilities. To account for variation in funding status, we will document and compare funded and unfunded sites on the effectiveness of implementation strategies (individual and combinations) used by sites in the National Program on ACP discussion and AD completion rates across the VHA. In order to determine the fiscal impact of the National Program and to help inform future dissemination across VHA, we will use a budget impact analysis. Finally, we will purposively select, recruit, and interview key stakeholders, who are clinicians and clinical managers in the VHA who offer ACP discussions to Veterans, to identify the characteristics of high-performing (e.g., high rates or sustainers) and innovative sites (e.g., unique local program design or implementation of ACP) to inform sustainability and further spread. Discussion As an observational evaluation, this protocol will contribute to our understanding of implementation science and practice by examining the natural variation in implementation and spread of ACP-GV with or without funded staff positions.

Ethical Issues in Older Patients

2014 ◽  
Author(s):  
Julian C. Hughes
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Older Patients ◽  
Ethical Issues ◽  
Best Interests ◽  
Care Planning ◽  
Advance Care ◽  
Care Practices ◽  
Embodied Agent ◽  
Do So

Ethical issues in older patients often arise in the context of physical and mental frailty. Professionals should be alert to the possibility that, on the grounds of frailty, the older patient’s personhood is undermined. It can often seem as if physical or mental dependence makes this inevitable and stigma results. But there are ways in which the person’s autonomy can be enhanced by those who provide care. Advance care planning is intended to preserve the person’s autonomy, but may not do so if care practices are poor. When it comes to consent, the issue of capacity is crucial. But evaluative judgements are required in assessments of capacity, as indeed they are when it comes to diagnoses of dementia or even of mild cognitive impairment. What we really need are broad judgements of best interests, which should be predicated on broad conceptions of the person as a situated embodied agent.

scholarly journals A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia

2011 ◽  
Vol 41 (2) ◽  
pp. 263-269 ◽  
Author(s):  
Louise Robinson ◽  
Claire Dickinson ◽  
Nicolette Rousseau ◽  
Fiona Beyer ◽  
Alexa Clark ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care
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