ADVANCE CARE PLANNING CONVERSATIONS BY MD OR NP/PA YIELD SIMILAR LIFE-SUSTAINING TREATMENT CHOICES

Background: The Western individualistic understanding of autonomy for advance care planning is considered not to reflect the Asian family-centered approach in medical decision-making. The study aim is to compare preferences on timing for advance care planning initiatives and life-sustaining treatment withdrawal between terminally-ill cancer patients and their family caregivers in Taiwan. Methods: A prospective study using questionnaire survey was conducted with both terminally-ill cancer patient and their family caregiver dyads independently in inpatient and outpatient palliative care settings in a tertiary hospital in Northern Taiwan. Self-reported questionnaire using clinical scenario of incurable lung cancer was employed. Descriptive analysis was used for data analysis. Results: Fifty-four patients and family dyads were recruited from 1 August 2019 to 15 January 2020. Nearly 80% of patients and caregivers agreed that advance care planning should be conducted when the patient was at a non-frail stage of disease. Patients’ frail stage of disease was considered the indicator for life-sustaining treatments withdrawal except for nutrition and fluid supplements, antibiotics or blood transfusions. Patient dyads considered that advance care planning discussions were meaningful without arousing emotional distress. Conclusion: Patient dyads’ preferences on the timing of initiating advance care planning and life-sustaining treatments withdrawal were found to be consistent. Taiwanese people’s medical decision-making is heavily influenced by cultural characteristics including relational autonomy and filial piety. The findings could inform the clinical practice and policy in the wider Asia–Pacific region.

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Validation of Preferences for Life-Sustaining Treatment: Implications for Advance Care Planning

Annals of Internal Medicine ◽

10.7326/0003-4819-127-7-199710010-00002 ◽

1997 ◽

Vol 127 (7) ◽

pp. 509 ◽

Cited By ~ 76

Author(s):

Donald L. Patrick

Keyword(s):

Advance Care Planning ◽

Care Planning ◽

Life Sustaining Treatment ◽

Advance Care

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Virtual Reality Video Promotes Advance Care Planning Effectiveness

10.21203/rs.2.13780/v1 ◽

2019 ◽

Author(s):

Wan-Ting Hsieh

Keyword(s):

Advance Care Planning ◽

Patient Autonomy ◽

Care Planning ◽

Good Decision ◽

Legal Effect ◽

Before And After ◽

Post Test ◽

Accurate Perception ◽

Life Sustaining Treatment ◽

Advance Care

Abstract Introduction: In 2019, the Patient Autonomy Act has gone into effect, allowing Taiwanese citizens to establish an advance decision(AD) with legal effect. In an effort to secure more realistic and accurate perception of patients as the basis for them to explore their values, a VR video was developed to supplement the traditional way of decision making before advance care planning(ACP). Methods: Participants were asked to complete pre-test questionnaires and were then asked to read a handout with information about life-sustaining treatment and the legal process of making an effective AD. Participants then viewed a six-minute 360-degree VR video on a portable VR headset with a smartphone inside to play it and then completed the post-test questionnaire followed by feedback on the help of the VR. Results: Of the 120 participants, 71.1% had heard about of AD. The increased percentage of the certainty of their preferences for the five kinds of life-sustaining treatments before and after participants read the handout and viewed the VR video was noted. Conclusion and Discussion: The decrease in the number of participants who couldn’t make decision indicates indicate that VR video may be helpful for users to make decision and clarify users’ preference. According to feedback of VR video, highly agreement also lied in its help of equipping users with better understanding of medical scenarios and it is a good decision aid tool for preparing our users before ACP.

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Extent and Determinants of Terminally Ill Cancer Patients' Concordance Between Preferred and Received Life-Sustaining Treatment States: An Advance Care Planning Randomized Trial in Taiwan

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2019.04.010 ◽

2019 ◽

Vol 58 (1) ◽

pp. 1-10.e10 ◽

Cited By ~ 2

Author(s):

Fur-Hsing Wen ◽

Jen-Shi Chen ◽

Wen-Chi Chou ◽

Wen-Cheng Chang ◽

Chia-Hsun Hsieh ◽

...

Keyword(s):

Randomized Trial ◽

Cancer Patients ◽

Advance Care Planning ◽

Terminally Ill ◽

Care Planning ◽

Terminally Ill Cancer Patients ◽

Life Sustaining Treatment ◽

Advance Care

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Provider Perspectives on Advance Care Planning Documentation in the Electronic Health Record: The Experience of Primary Care Providers and Specialists Using Advance Health-Care Directives and Physician Orders for Life-Sustaining Treatment

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909117693578 ◽

2017 ◽

Vol 34 (10) ◽

pp. 918-924 ◽

Cited By ~ 12

Author(s):

Ellis Dillon ◽

Judith Chuang ◽

Atul Gupta ◽

Sharon Tapper ◽

Steve Lai ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Advance Care Planning ◽

Primary Care Providers ◽

Health Record ◽

Care Planning ◽

Care Providers ◽

Life Sustaining Treatment ◽

Advance Care ◽

Advance Health Care Directives

Context: Advance care planning (ACP) is valued by patients and clinicians, yet documenting ACP in an accessible manner is problematic. Objectives: In order to understand how providers incorporate electronic health record (EHR) ACP documentation into clinical practice, we interviewed providers in primary care and specialty departments about ACP practices (n = 13) and analyzed EHR data on 358 primary care providers (PCPs) and 79 specialists at a large multispecialty group practice. Methods: Structured interviews were conducted with 13 providers with high and low rates of ACP documentation in primary care, oncology, pulmonology, and cardiology departments. The EHR problem list data on Advance Health Care Directives (AHCDs) and Physician Orders for Life-Sustaining Treatment (POLST) were used to calculate ACP documentation rates. Results: Examining seriously ill patients ≥65 years with no preexisting ACP documentation seen by providers during 2013 to 2014, 88.6% (AHCD) and 91.1% (POLST) of 79 specialists had zero ACP documentations. Of 358 PCPs, 29.1% (AHCD) and 62.3% (POLST) had zero ACP documentations. Interviewed PCPs often believed ACP documentation was beneficial and accessible, while specialists more often did not. Specialists expressed more confusion about documenting ACP, whereas PCPs reported standard clinic workflows. Problems with interoperability between outpatient and inpatient EHR systems and lack of consensus about who should document ACP were sources of variations in practices. Conclusion: Results suggest that providers desire standardized workflows for ACP discussion and documentation. New Medicare reimbursement for ACP and an increasing number of quality metrics for ACP are incentives for health-care systems to address barriers to ACP documentation.

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Evaluation of a Video Decision Aid to Reduce Decisional Conflict in Physician Orders for Life-Sustaining Treatment (POLST) Decision-Making

Journal of Palliative Care ◽

10.1177/0825859720923437 ◽

2020 ◽

Vol 35 (4) ◽

pp. 243-247

Author(s):

Jarred V. Gallegos ◽

Barry Edelstein ◽

Alvin H. Moss

Keyword(s):

Decision Making ◽

Advance Care Planning ◽

Decision Aid ◽

Decision Aids ◽

Decisional Conflict ◽

Community Dwelling ◽

Care Planning ◽

Life Sustaining Treatment ◽

Advance Care ◽

Decisional Satisfaction

Background/Objectives: Physician Orders for Life-Sustaining Treatment (POLST) is recommended as a preferred practice for advance care planning with seriously ill patients. Decision aids can assist patients in advance care planning, but there are limited studies on their use for POLST decisions. We hypothesized that after viewing a POLST video, decision aid participants would demonstrate increased knowledge and satisfaction and decreased decisional conflict. Design: Pre-and postintervention with no control group. Setting/Participants: Fifty community-dwelling adults aged 65 and older asked to complete a POLST based on a hypothetical condition. Interventions: Video decision aid for Sections A and B of the POLST form. Measurements: Pre- and postintervention participant knowledge, decisional satisfaction, decisional conflict, and acceptability of video decision aid. Results: Use of the video decision aid increased knowledge scores from 11.24 ± 2.77 to 14.32 ± 2.89, P < .001, improved decisional satisfaction 10.14 ± 3.73 to 8.70 ± 3.00, P = .001, and decreased decisional conflict 12 ± 9.42 to 8.15 ± 9.13, P < .001. All participants reported that they were comfortable using the video decision aid, that they would recommend it to others, and that it clarified POLST decisions. Conclusions: Participants endorsed the use of a POLST video decision aid, which increased their knowledge of POLST form options and satisfaction with their decisions, and decreased their decisional conflict in POLST completion. This pilot study provides preliminary support for the use of video decision aids for POLST decision-making. Future research should evaluate a decision aid for the entire POLST form and identify patient preferences for implementing POLST decision aids into clinical practice.

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A Practice Improvement Project to Increase Advance Care Planning in a Dementia Specialty Practice

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119841544 ◽

2019 ◽

Vol 36 (9) ◽

pp. 831-835 ◽

Cited By ~ 1

Author(s):

Valerie T. Cotter ◽

Maryam M. Hasan ◽

Jheesoo Ahn ◽

Chakra Budhathoki ◽

Esther Oh

Keyword(s):

Advance Care Planning ◽

Educational Interventions ◽

Care Planning ◽

Improvement Project ◽

Future Care ◽

Life Sustaining Treatment ◽

Advance Care ◽

Specialty Practice ◽

Medical Order ◽

Paired Design

This study was conducted to enhance the rate of advance care planning (ACP) conversations and documentation in a dementia specialty practice by increasing physician knowledge, attitudes, and skills. We used a pre- and postintervention paired design for physicians and 2 independent groups for patients. The ACP dementia educational program encompassed 3 objectives: (1) to understand the relevance of ACP to the dementia specialty practice, (2) to provide a framework to discuss ACP with patients and caregivers, and (3) to discuss ways to improve ACP documentation and billing in the electronic medical record. A 10-item survey was utilized pre- and posteducational intervention to assess knowledge, attitudes, and skill. The prevalence of ACP documentation was assessed through chart review 3 months pre- and postintervention. The educational intervention was associated with increased confidence in ability to discuss ACP ( P = .033), belief that ACP improves outcomes in dementia ( P = .035), knowledge about ACP Medicare billing codes and requirements ( P = .002), and belief that they have support from other personnel to implement ACP ( P = .017). In 2 independent groups of patients with dementia, documentation rates of an advance directive increased from 13.6% to 19.7% ( P = .045) and the Medical Order for Life-Sustaining Treatment (MOLST) increased from 11.0% to 19.0% ( P = .006). The MOLST documentation in 2 independent groups of patients with nondementia increased from 7.3% to 10.7% ( P = .046). Continuing efforts to initiate educational interventions are warranted to increase the effectiveness ACP documentation and future care of persons with dementia.

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