Advance care planning

2021 ◽  
pp. 286-292
Author(s):  
Judith Rietjens ◽  
Ida Korfage ◽  
Jane Seymour
Keyword(s):  
Advance Care Planning ◽  
Hospital Admissions ◽  
Healthcare Providers ◽  
Care Planning ◽  
Delphi Consensus ◽  
Raising Awareness ◽  
Advance Care Directives ◽  
Advance Care ◽  
Definition Of

Advance care planning (ACP) enables individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and healthcare providers, and to record and review these preferences if appropriate. ACP interventions have potentially beneficial outcomes for patients and healthcare systems, including increased completion of advance care directives, alignment of care to expressed preferences, better quality of communication and improved quality of life, reduction of unwanted hospital admissions, and increased use of palliative care. Aspects of ACP have been adopted in national and international healthcare policy. However, due to barriers to ACP, the occurrence in practice remains low. For instance, some people find ACP challenging: they may neither wish to ‘foresee’ the future nor to discuss the implications of their illness. Some may find it difficult to express their wishes or find the emphasis on autonomy to be countercultural. This chapter examines evidence about the effectiveness of ACP, describes the current practices, analyses its barriers and facilitators, and formulates best practices. It also explores the challenges of raising awareness of ACP among the general public, which is a necessary precursor to ACP. It draws on an international Delphi consensus study that was charged with developing a definition of ACP and recommendations for its application.

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.

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 Perceptions of involvement in advance care planning and emotional functioning in patients with advanced cancer

2021 ◽  
Author(s):  
Lente L. Kroon ◽  
◽  
Janneke van Roij ◽  
Ida J. Korfage ◽  
An K. L. Reyners ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Medical Treatment ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Emotional Functioning ◽  
Solid Cancer ◽  
Care Planning ◽  
Advance Care ◽  
Prospective Longitudinal

Abstract Purpose Advance Care Planning (ACP) is positively associated with the quality of care, but its impact on emotional functioning is ambiguous. This study investigated the association between perceptions of ACP involvement and emotional functioning in patients with advanced cancer. Methods This study analyzed baseline data of 1,001 patients of the eQuiPe study, a prospective, longitudinal, multicenter, observational study on quality of care and quality of life in patients with advanced cancer in the Netherlands. Patients with metastatic solid cancer were asked to participate between November 2017 and January 2020. Patients’ perceptions of ACP involvement were measured by three self-administered statements. Emotional functioning was measured by the EORTC-QLQ-C30. A linear multivariable regression analysis was performed while taking gender, age, migrant background, education, marital status, and symptom burden into account. Results The majority of patients (87%) reported that they were as much involved as they wanted to be in decisions about their future medical treatment and care. Most patients felt that their relatives (81%) and physicians (75%) were familiar with their preferences for future medical treatment and care. A positive association was found between patients’ perceptions of ACP involvement and their emotional functioning (b=0.162, p<0.001, 95%CI[0.095;0.229]) while controlling for relevant confounders. Conclusions Perceptions of involvement in ACP are positively associated with emotional functioning in patients with advanced cancer. Future studies are needed to further investigate the effect of ACP on emotional functioning. Trial registration number NTR6584 Date of registration: 30 June 2017 Implications for Cancer Survivors Patients’ emotional functioning might improve from routine discussions regarding goals of future care. Therefore, integration of ACP into palliative might be promising.

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.

Attitudes of Patients With Incurable Cancer Toward Medical Treatment in the Last Phase of Life

2005 ◽  
Vol 23 (9) ◽  
pp. 2012-2019 ◽  
Author(s):  
Elsbeth Voogt ◽  
Agnes van der Heide ◽  
Judith A.C. Rietjens ◽  
Anna F. van Leeuwen ◽  
Adriaan P. Visser ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Incurable Cancer ◽  
History Of ◽  
Advance Care ◽  
Positive Feelings ◽  
End Of Life Decision ◽  
History Of Cancer

Purpose When cancer has advanced to a stage in which cure becomes unlikely, patients may have to consider the aim of further treatment. We studied the relationship of patients' attitudes toward treatment with advance care planning and the development of these attitudes after diagnosis of incurable cancer. Patients and Methods Patients with incurable cancer were interviewed and asked to fill out a written questionnaire about their attitudes concerning life-prolonging treatment and end-of-life decision making. These questions were repeated after 6 and 12 months. Results One hundred twenty-two patients (mean age, 64 years; standard deviation, 10.5 years; 53% women) participated in the study. Patients' attitudes toward treatment could be categorized into the following three different profiles: striving for quality of life, striving for length of life, and no clear preference. Patients who were older, more tired, or had less positive feelings and patients who had more often taken initiatives to engage in advance care planning were more inclined to strive for quality of life than others. Patients with a history of cancer of less than 6 months were more inclined to prefer life prolongation than patients with a longer history of cancer. During follow-up, no changes in attitudes toward treatment were found, except for patients with a short history of cancer in whom the inclination to strive for length decreased. Conclusion Patients who appreciate advance care planning were more inclined to strive for quality of life than other patients. Shortly after the diagnosis of cancer, patients typically seem to prefer life-prolonging treatment, whereas quality of life becomes more important when death is nearing.

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