Decision-Making Toolkit

2021 ◽  
pp. 60-76
Author(s):  
Jeffrey D. Myers
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Physician Assistant ◽  
Healthcare Providers ◽  
Terminally Ill ◽  
Decision Makers ◽  
Care Planning ◽  
Collaborative Partnership ◽  
Advance Care

Physician assistant (PA) training is rooted in treating the whole patient and developing a trusting and collaborative partnership with patients and their families. This foundation is critical in the advance care planning (ACP) process for patients who are seriously or terminally ill. Understanding the ACP process, the components and reasons behind them, and the tools for successful discussions and decision-making is a key skill set for all healthcare providers, including PAs. This chapter examines the components of ACP, including advance directives, the POLST paradigm, decision-makers, prognostication, documentation, and legacy planning. ACP is key in capturing what is most important to our patients in terms of their health, their life, and their goals related to both.

scholarly journals Advance care planning and palliative care in ACHD: the healthcare providers’ perspective

2020 ◽  
Vol 30 (3) ◽  
pp. 402-408
Author(s):  
Jill M. Steiner ◽  
Erwin N. Oechslin ◽  
Gruschen Veldtman ◽  
Craig S. Broberg ◽  
Karen Stout ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Physical Symptoms ◽  
Care Planning ◽  
Psychosocial Needs ◽  
Cross Sectional ◽  
Advance Care

ABSTRACTBackground:Advance care planning and palliative care are gaining recognition as critical care components for adults with CHD, yet these often do not occur. Study objectives were to evaluate ACHD providers’ 1) comfort managing patients’ physical symptoms and psychosocial needs and 2) perspectives on the decision/timing of advance care planning initiation and palliative care referral.Methods:Cross-sectional study of ACHD providers. Six hypothetical patients were described in case format, followed by questions regarding provider comfort managing symptoms, initiating advance care planning, and palliative care referral.Results:Fifty providers (72% physicians) completed surveys. Participants reported low levels of personal palliative care knowledge, without variation by gender, years in practice, or prior palliative care training. Providers appeared more comfortable managing physical symptoms and discussing prognosis than addressing psychosocial needs. Providers recognised advance directives as important, although the percentage who would initiate advance care planning ranged from 18 to 67% and referral to palliative care from 14 to 32%. Barriers and facilitators to discussing advance care planning with patients were identified. Over 20% indicated that advance care planning and end-of-life discussions are best initiated with the development of at least one life-threatening complication/hospitalisation.Conclusions:Providers noted high value in advance directives yet were themselves less likely to initiate advance care planning or refer to palliative care. This raises the critical questions of when, how, and by whom discussion of these important matters should be initiated and how best to support ACHD providers in these endeavours.

Evidence of increasing public participation in advance care planning: a comparison of polls in Alberta between 2007 and 2013

2016 ◽  
Vol 9 (2) ◽  
pp. 189-196 ◽  
Author(s):  
J E Simon ◽  
S Ghosh ◽  
D Heyland ◽  
T Cooke ◽  
S Davison ◽  
...  
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Healthcare Systems ◽  
Medical Decision ◽  
Care Planning ◽  
Future Health ◽  
Advance Care ◽  
Definition Of ◽  
Over Time

BackgroundAdvance care planning (ACP) encompasses both verbal and written communications expressing preferences for future health and personal care and helps prepare people for healthcare decision-making in times of medical crisis. Healthcare systems are increasingly promoting ACP as a way to inform medical decision-making, but it is not clear how public engagement in ACP activities is changing over time.MethodsRaw data from 3 independently conducted public polls on ACP engagement, in the same Canadian province, were analysed to assess whether participation in ACP activities changed over 6 years.ResultsStatistically significant increases were observed between 2007 and 2013 in: recognising the definition of ACP (54.8% to 80.3%, OR 3.37 (95% CI 2.68 to 4.24)), discussions about healthcare preferences with family (48.4% to 59.8%, OR 1.41 (95% CI 1.17 to 1.69)) and with healthcare providers (9.1% to 17.4%, OR 1.98 (95% CI 1.51 to 2.59)), written ACP plans (21% to 34.6%, OR 1.77 (95% CI 1.45 to 2.17)) and legal documentation (23.4% to 42.7%, OR 2.13 (95% CI 1.75 to 2.59)). These remained significant after adjusting for age, education and self-rated health status.ConclusionsACP engagement increased over time, although the overall frequency remains low in certain elements such as discussing ACP with healthcare providers. We discuss factors that may be responsible for the increase and provide suggestions for healthcare systems or other public bodies seeking to stimulate engagement in ACP.

scholarly journals Implementing advance care planning in early dementia care: results and insights from a pilot interventional trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesca Bosisio ◽  
Anca-Cristina Sterie ◽  
Eve Rubli Truchard ◽  
Ralf J. Jox
Keyword(s):  
Advance Directives ◽  
Advance Care Planning ◽  
Study Protocol ◽  
Large Scale ◽  
Pilot Trial ◽  
Healthcare Providers ◽  
Dementia Care ◽  
Care Planning ◽  
Early Dementia ◽  
Advance Care

Abstract Background Advance care planning (ACP) is particularly appropriate for persons with early dementia (PWED) since it promotes conversations about dementia-specific illness scenarios, addresses inconsistencies between advance directives and patients’ observed behavior, emphasizes prospective and relational autonomy, and may be generally consistent with older persons’ decision-making needs. However, despite evidence of its benefits, ACP is yet to become widely used among PWED. In this paper, we present a dementia-specific tool developed in Western Switzerland, discuss results of a pilot trial designed to promote ACP among PWED and their relatives, and discuss the feasibility and acceptability of the intervention and the study protocol in prevision of a large scale trial. Methods This one-arm pre-post pilot trial consisted of four visits, with visits 2 and 3 being the ACP intervention. Quantitative outcome measures during visit 1 and 4 assessed the aptitude of the intervention to support PWED autonomy and relatives’ knowledge of PWED’s preferences. Feasibility was explored according to how the recruitment procedure unfurled and based on the necessary revisions to the study protocol and healthcare providers’ reason for excluding a PWED from the study. Acceptability was assessed according to pre-post evaluations, difficulties regarding the intervention or trial participation, and pre-post qualitative interviews regarding participants’ reasons to participate to the study, satisfaction with the tool and difficulties perceived. Results The ACP intervention itself was well received by PWED and their relatives that expressed satisfaction with the procedure, especially regarding the opportunity to discuss a sensitive topic with the help of a facilitator. Five main challenges in terms of feasibility were 1) to locate eligible patients, 2) to tailor recruitment procedures to recruitment locations, 3) to adapt inclusion criteria to clinical routines, 4) to engage PWED and their relatives in ACP, and 5) to design a trial that does not burden PWED. Despite these challenges, the intervention increased the number of advance directives, the concordance between PWED’s preferences and relatives’ decision on their behalf, and relatives’ perceived control over healthcare decisions. Conclusion Misconceptions about dementia and ACP, in the patient, relatives, and healthcare providers, combined with structural and institutional challenges, have the power to impede research and implementation of ACP in dementia care. For this reason, we conclude that a large scale trial to test a dementia-specific tool of ACP is currently not feasible in Western Switzerland and should be endorsed in a systemic approach of ACP. Trial registration This trial was registered in the database clinicaltrial.gov with the number NCT03615027.

scholarly journals Identifying key elements for paediatric advance care planning with parents, healthcare providers and stakeholders: A qualitative study

2020 ◽  
Vol 34 (3) ◽  
pp. 300-308 ◽  
Author(s):  
Kerstin Hein ◽  
Kathrin Knochel ◽  
Vedrana Zaimovic ◽  
Daniel Reimann ◽  
Anna Monz ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Advance Directives ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Emergency Services ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Background: Although international guidelines recommend discussions about goals of care and treatment options for children with severe and life-limiting conditions, there are still few structured models of paediatric advance care planning. Aim: The study aimed at identifying key components of paediatric advance care planning through direct discussions with all involved parties. Design: The study had a qualitative design with a participatory approach. Participants constituted an advisory board and took part in two transdisciplinary workshops. Data were collected in discussion and dialogue groups and analysed using content analysis. Setting/participants: We included bereaved parents, health care providers and stakeholders of care networks. Results: Key elements were discussions, documentation, implementation, timing and participation of children and adolescents. Parents engage in discussions with facilitators and persons of trust to reach a decision. Documentation constitutes the focus of professionals, who endorse brief recommendations for procedures in case of emergencies, supplemented by larger advance directives. Implementation hindrances include emotional barriers of stakeholders, disagreements between parents and professionals and difficulties with emergency services. Discussion timing should take into account parental readiness. The intervention should be repeated at regular intervals, considering emerging needs and increasing awareness of families over time. Involving children and adolescents in advance care planning remains a challenge. Conclusion: A paediatric advance care planning intervention should take into account potential pitfalls and barriers including issues related to timing, potential conflicts between parents and professionals, ambiguity towards written advance directives, the role of non-medical carers for paediatric advance care planning implementation, the need to involve the child and the necessity of an iterative process.

Advance Care Planning—A Primer

2014 ◽  
Vol 5 (1) ◽  
Author(s):  
Karishma Taneja ◽  
Puneet Sayal
Keyword(s):  
Advance Care Planning ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Decision Makers ◽  
Care Plan ◽  
Care Planning ◽  
Advance Care Plan ◽  
Advance Care ◽  
Substitute Decision Makers ◽  
Eol Care

Advance Care Planning (ACP) is the process by which individuals make decisions that can guide their future healthcare if they become incompetent. Creation of an Advance Care Plan should involve discussions with healthcare providers and substitute decision makers (SDM). ACP can assist individuals, their families, and healthcare professionals in planning for future and end-of-life (EOL) care. Recent research suggests that ACP can increase discussions about EOL preferences and improve the concordance between patient preferences and their EOL care. More than 50% of Canadians have not completed an Advanced Care Plan. This may be due to a variety of reasons, however it is possible that the community does not have enough knowledge about healthcare options that can be provided in the hospitals. Current research is focused on identifying barriers and facilitators to ACP, as well as implementing methods for incorporating it during standard medical care. Various stakeholders have identified ACP as a priority, and in order to raise awareness, April 16th has been designated as National Advance Care Planning Day in Canada

The implications of the Mental Capacity Act (MCA) 2005 for advance care planning and decision making

2018 ◽  
Author(s):  
Simon Chapman ◽  
Ben Lobo
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Best Interest ◽  
Policy And Practice ◽  
Advance Care ◽  
Current Context ◽  
Mental Capacity Act ◽  
End Of Life Decision

This chapter provides an overview of the MCA’s impact on end-of-life care. It situates the MCA in the current context of policy and practice. It describes how the MCA can be used to improve care, enable people to express and protect choices, and empower and enable the professional and/or the proxy decision maker. It also presents an introduction and explanation of the role of the IMCA and how it might apply to advance care planning (ACP) and end of life decision making, and an explanation of the legal and ethical process involved in reaching best interest decisions, especially for potentially vulnerable people in care homes and other settings.

An introduction to advance care planning: practice at the frontline

2018 ◽  
Author(s):  
Anjali Mullick ◽  
Jonathan Martin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Communication Skills ◽  
Advance Care Planning ◽  
Use Case ◽  
Care Planning ◽  
Practical Advice ◽  
Future Care ◽  
Case Vignettes ◽  
Advance Care

Advance care planning (ACP) is a process of formal decision-making that aims to help patients establish decisions about future care that take effect when they lose capacity. In our experience, guidance for clinicians rarely provides detailed practical advice on how it can be successfully carried out in a clinical setting. This may create a barrier to ACP discussions which might otherwise benefit patients, families and professionals. The focus of this paper is on sharing our experience of ACP as clinicians and offering practical tips on elements of ACP, such as triggers for conversations, communication skills, and highlighting the formal aspects that are potentially involved. We use case vignettes to better illustrate the application of ACP in clinical practice.

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