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.

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.

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.

scholarly journals Power Dynamics in a Triad Relationship: Advance Care Planning for Older Adults with Dementia in China

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 903-903
Author(s):  
Yifan Lou ◽  
Jinyu Liu ◽  
Bei Wu
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Decision Maker ◽  
Advance Care Planning ◽  
Medical Decision ◽  
Power Dynamics ◽  
Care Planning ◽  
Grounded Theory Method ◽  
Advance Care ◽  
Actual Decision

Abstract Objective: Primary family caregiver (CG), other family members (FM), and medical professionals (MP) play important roles in medical decision-making for older adults with dementia, who often have lost the capacity to make decisions on their own. Power dynamics within the CG-FM-MP triad relationship determine the process and outcome of the decision-making. Guided by Rahl’s relational power model, this study is among the first to understand the experiences of advance care planning among Chinese. Method: This study includes a total of 25 primary CGs or FMs and 5 MPs from 3 neurology departments. Hybrid grounded theory method was used to analyze the preliminary data we had so far. Based on the dimensions of power, we analyzed the power base, means, and scope of each agent in each interview to determine the power comparability. Results: Three types of triadic power relations were categorized: 1) shared-power with shared-decision, in which three agents shared the power of decision-making and CG as the lawful decision-maker makes the final decisions; 2) balanced-power with reversed-patriarchal decisions, in which FM’s power is over both CG and MP and become the actual decision-maker; and 3) unbalanced power with conflicting decisions, in which neither CG and FM has absolute power over each other and MP becomes the actual decision-maker implicitly. Conclusion: The study provides a framework for researchers and practitioners to understand the ACP process for Chinese older adults, which helps develop intervention strategies to improve surrogates’ ACP knowledge and reduce potential conflicts during the stressful process for the population.

What Surrogates Understand (and Don’t Understand) About Patients’ Wishes After Engaging Advance Care Planning: A Qualitative Analysis

2021 ◽  
pp. 104990912110266
Author(s):  
David B. Simmons ◽  
Benjamin H. Levi ◽  
Michael J. Green ◽  
In Seo La ◽  
Daniella Lipnick ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
Tertiary Care ◽  
Medical Decision ◽  
Care Planning ◽  
Prognostic Information ◽  
Informational Uncertainty ◽  
Advance Care ◽  
Patients Wishes

Background: The goal of advance care planning (ACP) is to improve end-of-life decision-making for patients and their spokespersons, but multiple studies have failed to show substantial or consistent benefit from ACP. Understanding how and why ACP under-performs in the setting of complex medical decision-making is key to optimizing current, or designing new, ACP interventions. Aim: To explore how ACP did or did not contribute to a spokespersons’ understanding of patient wishes after engaging in ACP. Design: Thematic analysis of 200 purposively sampled interviews from a randomized control trial of an ACP decision aid. Setting/Participants: 200 dyads consisting of patients 18 years or older with advanced serious illness and their spokesperson at 2 tertiary care centers in Hershey, PA and Boston, MA. Participants were interviewed 1 month after completing ACP. Results: ACP helped participants: 1) express clear end-of-life wishes, 2) clarify values, and 3) recognize challenges associated with applying those wishes in complex situations. Shortcomings of ACP included 1) unknown prognostic information or quality-of-life outcomes to inform decision-making, 2) skepticism about patients’ wishes, and 3) complicated emotions impacting end-of-life discussions. Conclusions: Helping patients and their spokespersons better anticipate decision-making in the face of prognostic and informational uncertainty as well as the emotional complexities of making medical decisions may improve the efficacy of ACP interventions.

Qualitative themes underlying potentially avoidable terminal oncology ICU hospitalizations.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 101-101
Author(s):  
Robert Michael Daly ◽  
Andrew Hantel ◽  
Blase N. Polite
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Clinical Management ◽  
Medical Decision Making ◽  
Outpatient Setting ◽  
Medical Decision ◽  
Care Planning ◽  
Theory Approach ◽  
Acute Hospitalization ◽  
Advance Care

101 Background: ICU admissions in the last 30 days of life is a quality measure endorsed by the National Quality Forum. Our prior research has demonstrated that nearly half of terminal oncology ICU hospitalizations are potentially avoidable. Methods: This was a retrospective care series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. Using a standardized assessment tool, an oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months prior to hospitalization until death and made a clinical determination of avoidability. Two investigators, blinded to the specialty of the reviewer, used a grounded theory approach to extract clinical themes associated with avoidability from the reviewers’ assessments. Results: The primary themes for avoidability identified and percent by specialty were as follows: failure to initiate appropriate advance care planning in the outpatient setting (68% oncologists, 55% intensivists, 65% hospitalists), failure to integrate understanding of limited prognosis from underlying cancer within the context of acute hospitalization (23% oncologists, 24% intensivists, 26% hospitalists), failure of clinical management (6% oncologists, 21% intensivists, 6% hospitalists), failure to recognize futility of outside hospital transfer (3% oncologists, 0% intensivists, 0% hospitalists), and failure of care coordination (0% oncologists, 0% intensivists, 3% hospitalists). A failure to educate and integrate surrogates into timely medical decision making was a prominent secondary theme for oncologists (22%), intensivists (18%), and hospitalists (29%). Conclusions: The themes identified suggest potential interventions to prevent avoidable terminal oncology ICU hospitalizations, including improved advance care planning in the outpatient setting, inpatient multidisciplinary communication to gain a better understanding of the patient’s underlying malignancy within the context of the acute hospitalization and prevent failures in clinical management, and better education and integration of surrogates in medical decision making.

Advance care planning: what do patients want?

2019 ◽  
Vol 80 (5) ◽  
pp. 263-267 ◽  
Author(s):  
Lucy Owen ◽  
Anna Steel
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Care Planning ◽  
Care Planning ◽  
Shared Decision ◽  
Future Health ◽  
Final Study ◽  
Future Health Care ◽  
Advance Care

Introduction: Advance care planning is the process by which patients can make decisions about their future health care should they lose capacity. Such conversations are shown to improve quality of life and reduce institutionalization. This article explores the preferences and wishes of patients in terms of advance care planning. Methods: CINAHL, Medline, Embase and Pubmed were searched. Key words included ‘elderly’, ‘advance care planning’, ‘advance directive’, ‘views’ and ‘opinions’. Results: A total of 64 abstracts were screened and 20 full text articles read; 11 articles were included in the final study. Individual and cultural differences influence the level of decision making that patients want. Most studies agreed that conversations should be carried out opportunistically by a trained health-care professional. Patients value honest and open conversations, without which they may make misinformed decisions. Conclusions: The level of shared decision making that individuals personally want should be established. Open and honest conversations should be initiated at the earliest opportunity.

73 Using the Gold Standards Framework to Identify Opportunities for Advance Care Planning

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
R Harwood ◽  
H Enguell ◽  
K Sakuda ◽  
E Lunt ◽  
A Ali
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Medical Decision Making ◽  
Medical Condition ◽  
Medical Decision ◽  
Care Planning ◽  
Data Set ◽  
Discharge Data ◽  
Advance Care ◽  
Gold Standards

Abstract Introduction Departmental discharge data (January 2017–January 2018) suggested a high number of “Day 1 Deaths” i.e. an individual who was readmitted 24 hours after discharge, and subsequently died during their readmission. We wondered if this was due to a lack of Advance Care Planning (ACP). Methods We undertook a retrospective case note audit of 50 cases from the “readmissions who died” (total 176/7421) subgroup, to understand whether or not they were predictably within the last days, weeks or months of life and whether there was ACP in place. We reviewed all Day 1 Deaths (16/50), and a random selection of cases across the Day 2–30 (34/50) data set. We used the Gold Standards Framework (GSF) as a prognostic tool, by use of the intuitive “surprise question” (“would you be surprised if this person died within the next days, weeks, months?”) and the disease-specific Prognostic Indictors (PI). Results Using the GSF we (retrospectively) predicted death in 94% of the Day 1 deaths and 63% of the Day 2–30 deaths. There was evidence of ACP in 32/50 patients (64%), predominantly in the form of a DNAR CPR (61%). There was very little evidence of other forms of ACP. Readmissions were justified on the basis of a medical condition in 100% of cases; this was infective in 60% (30/50). There were few interactions with secondary care in the 12 months prior to death (mode was 2 admissions in the month prior to death, 4 in the 12 months prior to death). Conclusions We must consider our discharge processes and medical decision making at the front door. A Prognostic indicator Tool would be useful to focus medical decision making. We must recognise infections as end stage disease in advanced ill health, including advanced frailty. We need to consider how we facilitate meaningful involvement of older people in their medical care towards the end of life.

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