THE IMPACT OF PERSONAL AND WORK-RELATED DEATH EXPOSURE ON EARLY ADVANCE CARE PLANNING

Abstract The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.

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Discussion and documentation of future care: a before-and-after study examining the impact of an alternative approach to recording treatment decisions on advance care planning in an acute hospital

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2016-001101 ◽

2017 ◽

Vol 10 (2) ◽

pp. e12-e12 ◽

Cited By ~ 2

Author(s):

Alexandra C Malyon ◽

Julia R Forman ◽

Jonathan P Fuld ◽

Zoë Fritz

Keyword(s):

End Of Life ◽

Advance Care Planning ◽

Treatment Decisions ◽

Care Planning ◽

New Approach ◽

Significance Level ◽

Oncology Ward ◽

Future Care ◽

Advance Care ◽

The Impact

ObjectiveTo determine whether discussion and documentation of decisions about future care was improved following the introduction of a new approach to recording treatment decisions: the Universal Form of Treatment Options (UFTO).MethodsRetrospective review of the medical records of patients who died within 90 days of admission to oncology or respiratory medicine wards over two 3-month periods, preimplementation and postimplementation of the UFTO. A sample size of 70 per group was required to provide 80% power to observe a change from 15% to 35% in discussion or documentation of advance care planning (ACP), using a two-sided test at the 5% significance level.ResultsOn the oncology ward, introduction of the UFTO was associated with a statistically significant increase in cardiopulmonary resuscitation decisions documented for patients (pre-UFTO 52% to post-UFTO 77%, p=0.01) and an increase in discussions regarding ACP (pre-UFTO 27%, post-UFTO 49%, p=0.03). There were no demonstrable changes in practice on the respiratory ward. Only one patient came into hospital with a formal ACP document.ConclusionsDespite patients’ proximity to the end-of-life, there was limited documentation of ACP and almost no evidence of formalised ACP. The introduction of the UFTO was associated with a change in practice on the oncology ward but this was not observed for respiratory patients. A new approach to recording treatment decisions may contribute to improving discussion and documentation about future care but further work is needed to ensure that all patients’ preferences for treatment and care at the end-of-life are known.

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The Impact of Advance Care Planning for Care Home Residents with Dementia on Hospital Admission and Death in Preferred Place of Care

Journal of Palliative Care & Medicine ◽

10.4172/2165-7386.1000261 ◽

2016 ◽

Vol 06 (03) ◽

Author(s):

Garden G

Keyword(s):

Hospital Admission ◽

Advance Care Planning ◽

Care Home ◽

Care Planning ◽

Advance Care ◽

The Impact

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The Impact of Personal and Professional Loss on Advance Care Planning and Effective Care Delivery for Healthcare Social Workers

Families in Society The Journal of Contemporary Social Services ◽

10.1177/1044389418803450 ◽

2018 ◽

Vol 99 (4) ◽

pp. 358-368

Author(s):

Cara L. Wallace ◽

Yit Mui Khoo ◽

Leslie Hinyard ◽

Jennifer E. Ohs ◽

Dulce M. Cruz-Oliver

Keyword(s):

Social Workers ◽

Advance Care Planning ◽

Care Delivery ◽

Death And Dying ◽

Care Planning ◽

Professional Experiences ◽

Effective Care ◽

Advance Care ◽

Past Experiences ◽

The Impact

Personal experiences can influence the practice of social work. However, the connection between past experiences with death and social workers’ practice has been underexplored. As such, this study surveyed social workers ( N = 74) about their personal and professional experiences of loss, personal advance care planning, and professional practices. Results demonstrated that social workers that experienced prior loss were more likely to complete an advance directive and communicate their end-of-life wishes. Additionally, those who had experienced personal and professional loss showed greater effectiveness on measures of patient- and family-centered communication and care delivery. Findings suggest positive outcomes for encouraging social workers to connect their personal and professional experiences surrounding death and dying to effectively serve in their professional capacity.

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