7 Exploring healthcare professionals’ attitudes to future care planning with older adults in hospital: qualitative research co-design through multi-professional patient and carer involvement

2018 ◽  
Vol 8 (3) ◽  
pp. 362.2-362
Author(s):  
Anna-Maria Bielinska ◽  
Stephanie Archer ◽  
Catherine Urch ◽  
Ara Darzi
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
End Of Life Care ◽  
Healthcare Professionals ◽  
List Type ◽  
Care Planning ◽  
Life Care ◽  
Topic Guide ◽  
Future Care ◽  
Advance Care

IntroductionDespite evidence that advance care planning in older hospital inpatients improves the quality of end-of-life care (Detering 2010) future care planning (FCP) with older adults remains to be normalised in hospital culture. It is therefore crucial to understand the attitudes of healthcare professionals to FCP in older patients in the hospital setting. Co-design with patients carers and healthcare professionals can generate more detailed meaningful data through better conversations.AimsTo co-design a semi-structured interview (SSI) topic guide to explore healthcare professionals’ attitudes to FCP with older adults in hospital.MethodsA multi-professional research group including a panel of patient and carer representatives co-designed an in-depth topic guide for a SSI exploring healthcare professionals’ attitudes to FCP with older adults in hospital.ResultsThe co-designed topic guide encourages participants to explore personal and system-level factors that may influence attitudes to FCP and practice in hospital amongst healthcare staff. Co-designed topics for inclusion in the SSI schedule include:Potential differences between specialist and generalist approaches to FCPThe influence of perceived hierarchy and emergency–decision making ability in professionals on FCP discussionsThe relevance to transitions of careAttitudes to FCP beyond the biomedical paradigm including perceived well–being and psychosocial aspects of careDigital FCP tools including patient–led FCP.ConclusionCo-designing qualitative research with older people and multi-disciplinary professionals may narrow translational gaps in implementing FCP by setting joint research priorities. Data generated from a co-designed study may expand understanding of hospital-based anticipatory decision-making with older adults.Reference. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ23 March 2010;340:c1345.

scholarly journals FUTURE CARE PLANNING AND END-OF-LIFE CARE DECISION MAKING: INDIVIDUAL AND SOCIAL INFLUENCES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S425-S425
Author(s):  
Jeong Eun Lee ◽  
Silvia Sörensen
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
End Of Life ◽  
Racial Differences ◽  
End Of Life Care ◽  
Current Evidence ◽  
Care Planning ◽  
Life Care ◽  
Future Care ◽  
Care Decision

Abstract As a growing number of older adults reach very old age, future care planning and end-of-life care decision making becomes increasingly important. Previous studies have shown that concrete future care planning steps are related to improved ability to manage illness and to better mental and physical health outcomes among older adults. Yet, relatively few older adults sufficiently plan for their future care. The purpose of this symposium is to highlight a collection of studies that each brings a unique perspective to the issue, reporting on individual and social factors that influence future care planning, end-of-life care decision making, and strategies to enhance future care planning among older adults. First, Chen and Siconolfi address common barriers and facilitators across diverse domains of age-related planning using content analysis. Second, Boerner and colleagues focus on the completion of formal planning without discussing the contents and factors associated with formal planning completion. Third, Strum investigates the complexities of navigating “fair” later life decisions involving family resources. Fourth, Moorman examines the racial differences in decisions of euthanasia and physician assisted suicide. Finally, Lee and colleagues report the findings from a future care planning intervention with older adults in rural area. The discussion by Sörensen will integrate the five papers with the goal of connecting the current evidence for meaningful steps in research and practice related to future care planning in older populations.

IMPROVING END-OF-LIFE CARE AND ADVANCE CARE PLANNING FOR FRAIL OLDER ADULTS IN CANADA

2018 ◽  
pp. 1-7
Author(s):  
J. Downar ◽  
P. Moorhouse ◽  
R. Goldman ◽  
D. Grossman ◽  
S. Sinha ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Frail Older Adults ◽  
Key Concepts ◽  
Advance Care

We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.

scholarly journals Costs and outcomes of advance care planning and end-of-life care for older adults with end-stage kidney disease: A person-centred decision analysis

PLoS ONE ◽  
2019 ◽  
Vol 14 (5) ◽  
pp. e0217787 ◽  
Author(s):  
Marcus Sellars ◽  
Josephine M. Clayton ◽  
Karen M. Detering ◽  
Allison Tong ◽  
David Power ◽  
...  
Keyword(s):  
Older Adults ◽  
Kidney Disease ◽  
Decision Analysis ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
End Stage Kidney Disease ◽  
Advance Care ◽  
End Stage

Factors Influencing Advance Care Planning Among Older Adults in Two Socioeconomically Diverse Living Communities

2016 ◽  
Vol 35 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Jennifer L. Tripken ◽  
Cathy Elrod ◽  
Susan Bills
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Retirement Community ◽  
Continuing Care ◽  
Care Planning ◽  
Attitudes And Beliefs ◽  
Life Care ◽  
Advance Care

Background/Objectives: Advance care planning (ACP) is an iterative, complex, and dynamic process of discussion, decision-making, and documentation about end-of-life care. The extent to which this process takes place in older adults in diverse socioeconomic settings is not well documented. The aim of this study was to assess the knowledge, attitudes, and beliefs about ACP among older adults in two socioeconomically diverse settings to identify the individual and contextual factors that influence behaviors regarding end-of-life care. Design: A cross-sectional survey design was used. Setting: An affordable independent continuing care retirement community and a high-income eligible (HIE) independent continuing care retirement community. Participants: Individuals aged 55 years and older who resided in independent living. Measurements: A 61-item survey was administered. Simple descriptive statistics were used to examine the responses, and inferential statistics were used to evaluate which items were associated with key outcomes between the 2 settings. Results: Seventy-seven older adults completed the survey. Significant differences in familiarity of terminology and knowledge of ACP, as well as significant differences in completion of advance directives and communication, were found between the 2 communities. No differences were found in attitudes and beliefs about end-of-life issues. Conclusion: Higher levels of knowledge and engagement in ACP were reported at the HIE community as compared to the affordable housing community. These findings provide insight into the influence of the contextual forces that encourage and support ACP.

scholarly journals Barriers and Facilitators of Advance Care Planning for Older Adults with Sickle Cell Disease

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 58-59
Author(s):  
Charity I Oyedeji ◽  
Tolulpe Oyesanya ◽  
Nathan Gray ◽  
John J. Strouse
Keyword(s):  
Older Adults ◽  
Sickle Cell Disease ◽  
Life Expectancy ◽  
End Of Life ◽  
Advance Directives ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Cell Disease ◽  
Advance Care

Background Life expectancy for individuals with sickle cell disease (SCD) has improved significantly in the last 50 years, creating a new population of older adults with SCD; however, life expectancy of adults with SCD is still up to 30 years shorter than African Americans in the general population and much lower than whites. SCD complications cause significant morbidity, requiring patients to make complex decisions about end of life care. Yet, there is a paucity of literature on SCD advance care planning (ACP), to guide providers on how to address ACP in this population. Thus, the purpose of this study was to assess barriers and facilitators to ACP for older adults with SCD. Methods We recruited 19 older adults with SCD (age > 50) from a comprehensive SCD center in the Southeastern United States. We conducted semi-structured interviews by phone or in person. Interview questions addressed aging with SCD, living beyond SCD life expectancy, experience with health care, experience with end of life care, comfort discussing death and end of life care, presence and nature of prior ACP discussions, and preferences for future ACP discussions. Audio-recorded interviews were transcribed verbatim. The data were analyzed using conventional content analysis. Results The mean age of participants was 57 years (range 50-71) and 47% (n = 9) were female. Most participants were diagnosed with SCD several years after birth and were told that they were not expected to live past age 18. Four of 19 participants had written advanced directives. Most participants were comfortable and willing to discuss ACP and thought that SCD ACP discussions should ideally start in early adulthood. Barriers to ACP included lack of communication, inappropriate contexts for ACP discussions, lack of trust, difficulty navigating ACP documents, and spirituality (Figure 1). Lack of communication included limited to no communication from trusted healthcare providers about ACP preferences. Inappropriate contexts for ACP discussions included being approached at difficult times by unfamiliar providers, such as being asked to complete advance directives while sick in the hospital by a provider who did not know the patient well. Trust was a barrier, as several participants were concerned that being asked about ACP while sick meant providers were giving up on them; others were unsure if they could trust providers or family members to carry out their end of life wishes as written. They reported difficulty navigating ACP documents and several participants incorrectly assumed a lawyer was required to finalize ACP documents. Finally, spirituality was a barrier as some participants reported that end of life planning was inconsistent with their religious beliefs. Facilitators of ACP included discussion at the right time, provider familiarity and knowledge, presence of family, and assistance in completing ACP documents. Participants expressed a desire to have an opportunity to openly communicate their end of life wishes with their provider when they were not sick in the hospital. They preferred discussing ACP with a provider whom they had a good relationship with, was familiar with their history, and they perceived was knowledgeable about SCD. Participants identified their SCD provider, PCP, or pulmonologist as suitable providers to talk to about ACP. Most preferred their family to be present during the ACP discussion. Those that had already completed advance directives at the time of the study received assistance from someone outside the health system to do so, such as help from their church, a lawyer, or their family. Conclusion Older adults with SCD expressed a desire for communication about ACP from trusted providers who are knowledgeable about SCD and want to have ACP conversations when they are feeling well. In addition, having the patient's family present and giving them assistance may increase the patient's comfort in completing their advance directives. The lack of communication from trusted providers or communication from unfamiliar providers about ACP during hospitalizations for acute complications are major barriers to creating advance directives for older adults with SCD. Future research is needed to obtain providers' perspectives on barriers to initiating conversations about ACP with adults with SCD. We will use these results to inform development of patient-centered and culturally-sensitive interventions to improve ACP in adults with SCD. Disclosures Strouse: Takeda: Research Funding.

scholarly journals Health Care Professionals’ Views Associated with the Barriers and Facilitators of Advance Care Planning (ACP) for Community Dwelling Older Adults with Palliative and End-of-Life Care Needs Towards Achieving a ‘Good’ Death: Findings from a Qualitative, Exploratory Pilot Study

2018 ◽  
Author(s):  
Gary Bellamy ◽  
Jennifer Stock ◽  
Patricia Schofield
Keyword(s):  
Older Adults ◽  
Health Care ◽  
End Of Life ◽  
Health Care Professionals ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Face To Face ◽  
Telephone Interviews ◽  
Advance Care

This paper reports the findings from a pilot study designed to explore the barriers, facilitators and similarities with the delivery and implementation of two distinct models of Advance Care Planning (ACP) documentation for older adults in their last year of life used by health care professionals in their clinical practice. PACe (Proactive Anticipatory Care Plan): a GP led model and PEACE (Proactive Elderly Persons’ Advisory CarE): a nurse led model with community geriatrician oversight were used by participants in their clinical practice. Telephone interviews were conducted with general practitioners (GPs) to explore their views of using the PACe tool. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. GPs and admission avoidance matrons were employed by Clinical Commissioning Groups (CCGs) and all study participants were recruited from the South East of England where data collection took place in 2015. Nine telephone interviews and two face-to-face interviews (one joint and one individual) were conducted with twelve participants. The data was analysed thematically. Participants highlighted the similarity of both tools in providing focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme-established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable conversations of this nature. Using both tools enabled participants to think critically and reflect on their own practice was another theme identified. Notwithstanding participants’ views to improve the layout of both tools, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a barrier which focused on the problems with access to paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpin ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care was put forward as the solution.

scholarly journals Advance care planning in Asian culture

2020 ◽  
Vol 50 (9) ◽  
pp. 976-989 ◽  
Author(s):  
Shao-Yi Cheng ◽  
Cheng-Pei Lin ◽  
Helen Yue-lai Chan ◽  
Diah Martina ◽  
Masanori Mori ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Patient Autonomy ◽  
Care Planning ◽  
Life Care ◽  
Asian Countries ◽  
Advance Care

Abstract Ageing has been recognized as one of the most critically important health-care issues worldwide. It is relevant to Asia, where the increasing number of older populations has drawn attention to the paramount need for health-care investment, particularly in end-of-life care. The advocacy of advance care planning is a mean to honor patient autonomy. Since most East Asian countries are influenced by Confucianism and the concept of ‘filial piety,’ patient autonomy is consequently subordinate to family values and physician authority. The dominance from family members and physicians during a patient’s end-of-life decision-making is recognized as a cultural feature in Asia. Physicians often disclose the patient’s poor prognosis and corresponding treatment options to the male, family member rather to the patient him/herself. In order to address this ethical and practical dilemma, the concept of ‘relational autonomy’ and the collectivism paradigm might be ideally used to assist Asian people, especially older adults, to share their preferences on future care and decision-making on certain clinical situations with their families and important others. In this review article, we invited experts in end-of-life care from Hong Kong, Indonesia, Japan, South Korea, Singapore and Taiwan to briefly report the current status of advance care planning in each country from policy, legal and clinical perspectives. According to the Asian experiences, we have seen different models of advance care planning implementation. The Asian Delphi Taskforce for advance care planning is currently undertaken by six Asian countries and a more detailed, culturally sensitive whitepaper will be published in the near future.

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