scholarly journals Advance care directive prevalence among older Australians and associations with person‐level predictors and quality indicators

2021 ◽  
Author(s):  
Kimberly Buck ◽  
Linda Nolte ◽  
Marcus Sellars ◽  
Craig Sinclair ◽  
Ben P. White ◽  
...  
Keyword(s):  
Quality Indicators ◽  
Advance Care ◽  
Advance Care Directive

scholarly journals Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria

2015 ◽  
Vol 39 (5) ◽  
pp. 552 ◽  
Author(s):  
Tim Luckett ◽  
Priyanka Bhattarai ◽  
Jane Phillips ◽  
Meera Agar ◽  
David Currow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medical Treatment ◽  
Advance Care Planning ◽  
Consumer Choice ◽  
Population Level ◽  
Care Planning ◽  
Advance Care ◽  
Advance Care Directive ◽  
Online Availability ◽  
National Framework

Objectives A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. Methods A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Framework for Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Results Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment – the Dying with Dignity Victoria Advance Healthcare Directive. Conclusions More research is needed to understand how online resources can optimally elicit and record consumers’ individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement. What is known about the topic? Online availability of ACD templates provides consumers with an opportunity for advance care planning outside of formal healthcare settings. While online availability has advantages, there is a risk that templates may be biased either for or against medical treatment and may not elicit directives that are appropriately informed by reflection on personal values and discussion with family and health professionals. What does this paper add? This is the first attempt at monitoring the quality and bias of online ACD templates designed for use in Australia. What are the implications for practitioners? The results of this review provide a description and quality index to assist consumers and clinicians in deciding which online ACD template to use or recommend.

Prevalence, perceived barriers and sociodemographic correlates of advance care planning in a sample of outpatients

2020 ◽  
Vol 26 (1) ◽  
pp. 76
Author(s):  
Elise Mansfield ◽  
Sarah Jeong ◽  
Amy Waller ◽  
Sally Chan
Keyword(s):  
Advance Care Planning ◽  
Healthcare Providers ◽  
Perceived Barriers ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
South Wales ◽  
Sociodemographic Correlates ◽  
Advance Care ◽  
Advance Care Directive

This study aimed to examine the prevalence and perceived barriers to uptake of advance care planning (ACP), including appointment of an enduring guardian (EG) and completion of an advance care directive (ACD) among Australian adults attending hospital outpatient clinics. Sociodemographic correlates of not completing ACP were also assessed. A cross-sectional survey exploring the uptake of ACP was conducted with outpatients and their accompanying persons aged >18 years (n=191) at one regional hospital in New South Wales, Australia. Rates of completion of an ACD and appointment of an EG were 20% (n=37) and 35% (n=67) respectively. The most common reason for non-completion of an ACD and not appointing an EG was: ‘didn’t think I needed this’. Younger age was associated with not having appointed an EG (OR 3.8, 95% CI 1.2–12.1, P=0.02). No sociodemographic characteristics were significantly associated with non-completion of ACDs. Uptake of ACP is suboptimal among outpatients. Community-based healthcare providers are well positioned to promote ACP with outpatients.

Cardiopulmonary resuscitation and endotracheal intubation decisions for adults with advance care directive and resuscitation plans in the emergency department

2020 ◽  
Vol 23 (4) ◽  
pp. 247-251
Author(s):  
Abdi D. Osman ◽  
Muhammad Aziz Rahman ◽  
Louisa Lam ◽  
Chien-Che Lin ◽  
Michael Yeoh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiopulmonary Resuscitation ◽  
Endotracheal Intubation ◽  
Advance Care ◽  
Advance Care Directive

Ethnicity and Advance Care Directives

1996 ◽  
Vol 24 (2) ◽  
pp. 108-117 ◽  
Author(s):  
Sheila T. Murphy ◽  
Joycelynne M. Palmer ◽  
Stanley Azen ◽  
Gelya Frank ◽  
Vicki Michel ◽  
...  
Keyword(s):  
Health Care ◽  
Living Will ◽  
Power Of Attorney ◽  
Major Barrier ◽  
Positive Attitudes ◽  
Advance Care Directives ◽  
Advance Care ◽  
Advance Care Directive ◽  
End Of Life Decision ◽  
And Behavior

Advance care directives for health care have been promoted as a way to improve end-of-life decision making. These documents allow a patient to state, in advance of incapacity, the types of medical treatments they would like to receive (a living will), to name a surrogate to make those decisions (a durable power of attorney for health care), or to do both. Although studies have shown that both physicians and patients generally have positive attitudes about the use of these documents, relatively few individuals have actually completed one.What underlies this discrepancy between attitudes and behavior with regard to advance care directives? One obvious explanation is lack of access. Emanuel et al. estimated that approximately 90 percent of the population desire an advance care directive, and they pointed to access as the major barrier. Yet interventions that increase accessibility have typically failed to yield more than a 20 percent completion rate. Thus, it appears that access is not the sole determinant of advance care directive completion.

scholarly journals Knowledge of End-of-life Wishes by Physicians and Caregivers in Cancer Patients

2021 ◽  
Author(s):  
Jose A Calvache ◽  
Socorro Moreno ◽  
Gillian Prue ◽  
Joanne Reid ◽  
Sam Ahmedzai ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Communication Strategies ◽  
Teaching Hospitals ◽  
Medical Team ◽  
Online Questionnaire ◽  
Advance Care ◽  
Absolute Agreement ◽  
Advance Care Directive ◽  
Eol Care

Abstract Objectives: To describe communication regarding cancer patient’s end-of-life (EoL) wishes by physicians and caregivers.Methods: An online questionnaire and telephone-based surveys were performed with physicians and caregivers respectively in three teaching hospitals in Colombia who had been involved in the EoL care of cancer patients. Results: For 138 deceased patients we obtained responses from physicians and caregivers. In 32% physicians reported they spoke to the caregiver and in 17% with the patient regarding EoL decisions. In most cases with absence of a conversation, physicians indicated the treatment option was “clearly the best for the patient” or that it was “not necessary to discuss treatment with the patient”.Twenty-six percent of the caregivers indicated that someone from the medical team spoke with the patient about treatment, and in 67% who had a conversation, caregivers felt that the provided information was unclear or incomplete. Physicians and caregivers were unaware if the patient had any advance care directive (ACD) in 65% and 51% of cases, respectively, with a very low absolute agreement (34%).Conclusion: There is a lack of open conversations regarding EoL in patients with advanced cancer with their physicians and caregivers in Colombia. Communication strategies are urgently needed.

Barriers to Completion of Advance Care Directives among African Americans Ages 25–84: A Cross-Generational Study

2012 ◽  
Vol 65 (2) ◽  
pp. 125-137 ◽  
Author(s):  
Sharon Kelly West ◽  
Marianne Hollis
Keyword(s):  
African Americans ◽  
The Elderly ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Multiple Focus ◽  
Advance Care Directives ◽  
Advance Care ◽  
Surrogate Decision ◽  
Advance Care Directive ◽  
Common Barriers

Prior studies conducted in the area of Advance Care Directive document completion in African Americans have primarily targeted the elderly who are either institutionalized in skilled nursing facilities or are members of faith communities. Few studies have been done concerning barriers to Advance Care Directive document completion that include non-elderly African Americans. The purpose of this study was to identify the common barriers to advance care directive document completion across generations of African Americans ages 25–84. Using convenience sampling among various Baptist denominations of the African-American faith community of Buncombe County, North Carolina, 40 individuals ranging in age from 25–84 participated in multiple focus group sessions. Findings revealed participants shared three common barriers: 1) surrogate decision-making, 2) lack of education concerning advance care directive discussions and completion and 3) fear and denial. Also revealed were barriers that varied across generations: 1) fatalism, 2) mistrust of the health care system, 3) spirituality, and 4) economics.

Narrative medicine: A useful approach for difficult conversations.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 6-6
Author(s):  
Leslie J. Hinyard ◽  
Cara L. Wallace ◽  
April Trees ◽  
Jennifer E. Ohs
Keyword(s):  
End Of Life ◽  
Health Care Professionals ◽  
Self Efficacy ◽  
Death And Dying ◽  
Narrative Medicine ◽  
Personal Story ◽  
Difficult Conversations ◽  
Advance Care ◽  
Advance Care Directive ◽  
Practice Methods

6 Background: Narrative medicine (NM) is acknowledged as an effective approach for valuing patient and provider experiences. The NM approach requires developing narrative competence to “recognize, absorb, interpret, and honor” the stories of self and other (Charon, 2010). Given the difficulties providers face engaging in end-of-life (EOL) and advance care planning (ACP) conversations, this study reports the results of a NM workshop to 1) develop skills in attending and responding to the stories of others as part of ACP conversations and 2) reflect on their own stories of loss in relation to their professional practice. Methods: 80 health care professionals participated in a workshop on NM principles for end-of-life care and completed both pre- and post-workshop surveys. Workshop activities included a close reading on a professional’s story of personal loss and a reflective writing exercise sharing one’s own personal story of loss. Small groups debriefed after each exercise. 2 participants were current students and were dropped from analysis, for a final analytic sample of 78. Participants completed surveys at baseline and at the conclusion of the workshop. Surveys included questions on participant demographics, confidence for EOL conversations, and the ACP Self Efficacy scale. Descriptive statistics were calculated for sample demographics and post-workshop evaluation questions. A paired sample t-test was used to compare ACP Self Efficacy scores pre- and post-workshop. Confidence for EOL conversations was compared pre- and post-workshop using Kendall’s tau-b. Results: The mean age of the sample was 46.6 years (SD 13.1), 94% were female, and 82% were White. Social workers represented 84.6% of the sample. 53% of the sample reported having some type of advance care directive for themselves. Self-efficacy for engaging in ACP conversations increased from pre- to post-workshop (p < 0.0001) and there was a statistically significant improvement in confidence discussing death and dying from pre- to post-workshop (p = 0.004). Conclusions: NM competencies improve self-efficacy and confidence for engaging in ACP and EOL conversations. Providers find the NM approach to be a useful framework for engaging in difficult conversations about end-of-life.

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