scholarly journals Does physician remuneration improve advance care planning and end of life discussions in primary care?

2012 ◽  
Vol 2 (2) ◽  
pp. 200.2-200
Author(s):  
Andrew Gill ◽  
Jan Waugh ◽  
Jessica Simon
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care ◽  
Physician Remuneration

Integrative Palliative Care

2018 ◽  
Author(s):  
Angela Lee ◽  
Stephanie Cheng ◽  
Dale Lupu
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
End Of Life ◽  
Integrative Medicine ◽  
Advance Care Planning ◽  
Palliative Medicine ◽  
Geriatric Patients ◽  
Care Planning ◽  
Patient Goals ◽  
Advance Care

Integrative medicine and palliative medicine share many tenets. This chapter reviews integrative approaches to the most common symptoms needing palliation among geriatric patients at the end of life, including pain, nausea and vomiting, constipation, dyspnea, and fatigue. Several palliative care approaches to communication about patient goals and advance care planning for a time when the patient is unable to make decisions are described. Resources to support advance care planning are provided. Finally, issues that need to be addressed by either primary care geriatrics or in consultation with palliative care in the last weeks, days, and hours of life are described.

scholarly journals COVID-19 Pandemic Response: Development of Outpatient Palliative Care Toolkit Based on Narrative Communication

2020 ◽  
Vol 37 (11) ◽  
pp. 985-987
Author(s):  
Benjamin Roberts ◽  
Scott M. Wright ◽  
Colleen Christmas ◽  
Mariah Robertson ◽  
David Shih Wu
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Curriculum Development ◽  
End Of Life ◽  
Advance Care Planning ◽  
Symptom Management ◽  
Care Planning ◽  
Palliative Care Education ◽  
Advance Care ◽  
Primary Care Clinicians

Context: The coronavirus disease 2019 (COVID-19) pandemic laid bare the immediate need for primary palliative care education for many clinicians. Primary care clinicians in our health system reported an urgent need for support in advance care planning and end-of-life symptom management for their vulnerable patients. This article describes the design and dissemination of palliative care education for primary care clinicians using an established curriculum development method. Objectives: To develop a succinct and practical palliative care toolkit for use by primary care clinicians during the COVID-19 pandemic, focused on 2 key elements: (i) advance care planning communication skills based on the narrative 3-Act Model and (ii) comfort care symptom management at the end of life. Results: The toolkit was finalized through an iterative process involving a team of end-users and experts in palliative care and primary care, including social work, pharmacy, nursing, and medicine. The modules were formatted into an easily navigable, smartphone-friendly document to be used at point of care. The toolkit was disseminated to our institution’s primary care network with practices spanning our state. Early feedback has been positive. Conclusion: While we had been focused primarily on the inpatient setting, our palliative care team at Johns Hopkins Bayview Medical Center pivoted existing infrastructure and curriculum development expertise to meet the expressed needs of our primary care colleagues during the COVID-19 pandemic. Through collaboration with an interprofessional team including end-users, we designed and disseminated a concise palliative care toolkit within 6 weeks.

Advance care planning in the community

2018 ◽  
Author(s):  
Peter Nightingale ◽  
Scott Murray ◽  
Chris Absolon
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Educational Opportunities ◽  
Care Planning ◽  
Personalized Care ◽  
Policy Initiatives ◽  
Professional Quality ◽  
Recent Developments ◽  
Advance Care ◽  
Community Movement

Advance care planning (ACP) is becoming more widely used as part of a drive to improve personalized care planning, but there is still more work to be done. Electronic Palliative Care Co-ordination systems (EPaCCs) have proved to be very effective in some areas but there are many barriers to be overcome before they are universally available. This chapter covers recent developments leading to the wider integration of ACP into primary care. These include policy initiatives, educational opportunities, information technology (IT), professional quality control and regulation, financial and business incentives, and the Compassionate Community movement. The chapter includes an overview of issues surrounding ACP in primary care and in the community.

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.

Lessons Learned From a Pilot Project on Telemedicine Advance Care Planning in an Urban Geriatric Primary Care Office

2021 ◽  
pp. 104990912110369
Author(s):  
Olivia M. Seecof ◽  
Molly Allanoff ◽  
John Liantonio ◽  
Susan Parks
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Medical Record ◽  
Advance Care Planning ◽  
Pilot Project ◽  
Lessons Learned ◽  
Care Planning ◽  
Geriatric Population ◽  
Advance Care ◽  
Primary Care Office

Purpose: There is a dearth of literature regarding the documentation of advance care planning (ACP) in the geriatric population, despite the controversial, yet well-studied need for ACP. The purpose of this pilot study was to provide an update to a prior study from our institution that outlined the need for increased documentation of advance care planning (ACP) in an urban geriatric population. Methods: Our study involved using telemedicine to conduct dedicated ACP visits and an electronic medical record (EMR) note-template specifically designed for these visits in an attempt to increase the amount of documented ACP in the EMR in this population. Results: The study did not yield significant results due to the inability to schedule enough patients for these dedicated visits. Discussion: While our study was ultimately unsuccessful, 3 crucial lessons were identified that will inform and fuel future interventions by the authors to further the study of documentation of ACP.

scholarly journals Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 417-418
Author(s):  
Hyo Jung Lee ◽  
Giyeon Kim
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Relative Risk ◽  
End Of Life ◽  
Advance Care Planning ◽  
Multinomial Logistic Regression ◽  
Quality Care ◽  
Care Planning ◽  
Advance Care ◽  
Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

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