Identification and operationalisation of indicators to monitor successful uptake of advance care planning policies: a modified Delphi study

2021 ◽  
pp. bmjspcare-2020-002780
Author(s):  
Konrad Fassbender ◽  
Patricia Biondo ◽  
Jayna Holroyd-Leduc ◽  
Alexei Potapov ◽  
Tracy Lynn Wityk Martin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Advance Care Planning ◽  
Delphi Study ◽  
Online Survey ◽  
Practice Change ◽  
Public Healthcare ◽  
Care Planning ◽  
Face To Face ◽  
Modified Delphi ◽  
Advance Care

BackgroundIn 2014, the province of Alberta, Canada implemented a province-wide policy and procedures for advance care planning (ACP) and goals of care designation (GCD) across its complex, integrated public healthcare system. This study was conducted to identify and operationalise performance indicators for ACP/GCD to monitor policy implementation success and sustainment of ACP/GCD practice change.MethodsA systematic review and environmental scan was conducted to identify potential indicators of ACP/GCD uptake (n=132). A purposive sample of ACP/GCD stakeholders was invited to participate in a modified Delphi study to evaluate, reduce and refine these indicators through a combination of face-to-face meetings and online surveys.ResultsAn evidence-informed Donabedian by Institute of Medicine (IOM) framework was adopted as an organising matrix for the indicators in an initial face-to-face meeting. Three online survey rounds reduced and refined the 132 indicators to 18. A final face-to-face meeting operationalised the indicators into a measurable format. Nine indicators, covering 11 of the 18 Donabedian×IOM domains, were operationalised.ConclusionsNine ACP/GCD evidence-informed indicators mapping to 11 of 18 Donabedian×IOM domains were endorsed, and have been operationalised into an online ACP/GCD dashboard. The indicators provide a characterisation of ACP/GCD uptake that could be generalised to other healthcare settings, measuring aspects related to ACP/GCD documentation, patient satisfaction and agreement between medical orders and care received. The final nine indicators reflect the stakeholders’ expressed intent to strike a balance between comprehensiveness and feasibility within a large provincial healthcare system.

scholarly journals Advance Care Planning Among Healthcare Professionals During COVID-19

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 1031-1031
Author(s):  
Jessica Hahne ◽  
Brian Carpenter
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Healthcare Providers ◽  
Rapid Decline ◽  
Care Planning ◽  
Face To Face ◽  
Heavy Sedation ◽  
Advance Care

Abstract The COVID-19 pandemic is bringing healthcare professionals face to face with gravely ill patients in complex clinical situations. Caring for patients experiencing lengthy intubation, heavy sedation, rapid decline, and significant distress at the end of life has the potential to shift the perspectives of healthcare professionals regarding their own end-of-life care. This study explored advance care planning (ACP) among medical professionals and whether COVID-19 experiences altered their healthcare preferences and planning. Ninety-eight professionals (mean age = 45.6, 75% female) completed an online survey about ACP conversations, behavioral intentions to pursue ACP, openness to life-prolonging interventions, and ACP resource needs. ACP conversations were most extensive with spouse/partner (89% had talked about care preferences “some” or “a lot”) and to a lesser extent with parents (64%) and other healthcare providers (69%). Two-thirds (67%) of respondents had an ACP conversation since the start of COVID. Among respondents who had not completed ACP documents, 64% had taken some step toward ACP. When asked whether their preferences for life-prolonging medical interventions had changed, 70% reported no change, 16% reported being less open, and 14% reported being more open. A majority (60%) requested resources to help them pursue ACP on their own, although many (42%) were interested in assistance at their workplace. Given that only 37% of our sample had themselves completed an advance directive, our results suggest now may be a critical moment to engage professionals in ACP, considering how their experience during the pandemic has motivated ACP conversations and a reconsideration of preferences.

Enabling Advance Care Planning in Dementia Care: A Primary Care Approach

2020 ◽  
pp. 082585972097393
Author(s):  
Linda Lee ◽  
Loretta M. Hillier ◽  
Stephanie K. Lu ◽  
Donna Ward
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Health Professionals ◽  
Online Survey ◽  
Ease Of Use ◽  
Depth Information ◽  
Care Planning ◽  
Care Approach ◽  
Memory Clinics ◽  
Advance Care

Background: Lack of tools to support advance care planning (ACP) has been identified as a significant barrier to implementing these discussions. Aim: We pilot tested an ACP framework tool for use with persons living with dementia (PLWD) in primary care-based memory clinics and an Adult Day Program; this study describes user and recipient experiences with this framework. Methods: We used a mixed methods approach. Health professionals completed an online survey following pilot testing and PLWD and substitute decision makers (SDM) completed survey immediately following the ACP discussion assessing their satisfaction (5-point scale) with the framework and exploring potential outcomes. Interviews with health professionals, PLWD, and SDM were conducted to gather more in-depth information on their perceptions of the ACP framework/ discussion. Results: Surveys were completed by 12 health professionals, 13 PLWD, and 16 SDM. While PLWD and SDM were satisfied with the ACP discussion (M = 4.0/5), health professionals were minimally satisfied with the ease of use of the framework (M = 2.0/5), acceptability for patients (M = 2.4/5) and feasibility in practice (M = 1.9/5). Sixteen interviews were completed with 8 health professionals, 1 PLWD, and 7 SDM. While health professionals valued ACP, lack of time and training were identified barriers to framework use. SDM felt better prepared for future decisions and PLWD were put at ease, knowing that their wishes for care were understood. Conclusion: PLWD and SDM value the opportunity for ACP, and although health professionals identified some concerns with framework administration, they acknowledge the value and importance of ACP. Continuing efforts to refine ACP processes are justified.

scholarly journals An e-Delphi Study to Identify Priority Areas for Education on Advance Care Planning in COPD Management

2019 ◽  
Vol 65 (3) ◽  
pp. 347-354
Author(s):  
Art Burgess Kelleher ◽  
Catherine Sweeney ◽  
Tony Foley ◽  
Ruth M Hally ◽  
Elaine Meehan ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Delphi Study ◽  
Care Planning ◽  
Priority Areas ◽  
Advance Care

scholarly journals Preventing unwanted situations and gaining trust: a qualitative study of older people and families’ experiences with advance care planning in the daily practice of primary care

2019 ◽  
Vol 37 (4) ◽  
pp. 519-524
Author(s):  
Jolien J Glaudemans ◽  
Dick L Willems ◽  
Jan Wind ◽  
Bregje D Onwuteaka Philipsen
Keyword(s):  
Primary Care ◽  
Older People ◽  
Advance Care Planning ◽  
Daily Practice ◽  
Care Planning ◽  
Theory Approach ◽  
Face To Face ◽  
Future Care ◽  
Advance Care

Abstract Background Using advance care planning (ACP) to anticipate future decisions can increase compliance with people’s end-of-life wishes, decrease inappropriate life-sustaining treatment and reduce stress, anxiety and depression. Despite this, only a minority of older people engage in ACP, partly because care professionals lack knowledge of approaches towards ACP with older people and their families. Objective To explore older people’s and their families’ experiences with ACP in primary care. Methods We conducted qualitative, semi-structured, face-to-face interviews with 22 older people (aged >70 years, v/m: 11/11), with experience in ACP, and eight of their family members (aged 40–79 years, f/m: 7/1). Transcripts were inductively analysed using a grounded theory approach. Results We distinguished three main themes. (i) Openness and trust: Respondents were more open to ACP if they wanted to prevent specific future situations and less open if they lacked trust or had negative thoughts regarding general practitioners’ (GPs’) time for and interest in ACP. Engaging in ACP appeared to increase trust. (ii) Timing and topics: ACP was not initiated too early. Quality of ACP seemed to improve if respondents’ views on their current life and future, a few specific future care scenarios and expectations and responsibilities regarding ACP were discussed. (iii) Roles of family: Quality of ACP appeared to improve if family was involved in ACP. Conclusions Quality and accessibility of ACP may improve if GPs and nurses involve family, explain GPs’ interest in ACP and discuss future situations older people may want to prevent, and views on their current life and future.

scholarly journals Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries

2017 ◽  
Vol 35 (3) ◽  
pp. 307-311 ◽  
Author(s):  
Alex Sable-Smith ◽  
Kelly R Arnett ◽  
Molly A Nowels ◽  
Kathryn Colborn ◽  
Hillary D Lum ◽  
...  
Keyword(s):  
Healthcare System ◽  
Advance Care Planning ◽  
Developed Countries ◽  
Care Planning ◽  
Representative Survey ◽  
Advance Care

scholarly journals Association Between Training Experience and Attitudes Toward Advance Care Planning Among Healthcare Professionals: A Cross-Sectional Study

2020 ◽  
Author(s):  
Helen Yue-lai Chan ◽  
Annie Oi-ling Kwok ◽  
Kwok-keung Yuen ◽  
Derrick Kit-sing Au ◽  
Jacqueline Kwan-yuk Yuen
Keyword(s):  
Advance Care Planning ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Decisional Conflict ◽  
Cross Sectional Study ◽  
Care Planning ◽  
Training Experience ◽  
Cross Sectional ◽  
Cultural Taboos ◽  
Advance Care

Abstract Background: Training has been found effective in improving healthcare professionals’ knowledge, confidence, and skills in conducting advance care planning (ACP). However, its association with their attitudes toward ACP, which is crucial to its implementation, remained unclear. To fill this gap, this paper examines the association between their attitudes toward ACP and relevant training experiences.Methods: An online survey about attitudes toward ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted.Results: Of 250 respondents, approximately half (51.6%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001–0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience.Conclusions: This paper revealed the association between training and positive attitudes toward ACP among healthcare professionals. The findings showed that training is a predictor of their preparedness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.

scholarly journals Helping hospital professionals to implement Advance Care Planning in daily practice: a European Delphi study from field experts

2018 ◽  
Vol 24 (6) ◽  
pp. 433-443 ◽  
Author(s):  
Birgit Vanderhaeghen ◽  
Inge Bossuyt ◽  
Johan Menten ◽  
Peter Rober
Keyword(s):  
Advance Care Planning ◽  
Delphi Study ◽  
Emotional Processing ◽  
Daily Practice ◽  
Patient Characteristics ◽  
Descriptive Statistics ◽  
Care Planning ◽  
Implementation Barriers ◽  
Multidisciplinary Cooperation ◽  
Advance Care

Background Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience implementation barriers in practice. Aims The aim of this study was to investigate what is valued in having ACP conversations by hospital professionals (physicians, nurses, psychologists and social workers) and what they experience as barriers and facilitating factors for having ACP conversations with patients. Methods A Delphi study consisting of two rounds with respectively 21 and 19 multidisciplinary experts from seven European countries was organised. Data were analysed using content analysis and descriptive statistics. Results Participants agreed that ACP is valued mostly because it is seen to improve transmural continuation of care, emotional processing of the loss of a patient, and serenity at the end of life. Reported barriers are patient characteristics blocking patient-centred communication and a lack of knowledge to have these conversations. An important facilitator is multidisciplinary cooperation. Conclusions There is consensus by experts from different settings and countries suggesting that these results can theoretically be applied to hospital settings in Europe. This study reveals that hospital professionals value ACP in hospital practice, but that they encounter several barriers to its implementation.

Variability of physician perspectives toward advance care planning for patients with incurable cancer and congestive heart failure.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 12-12
Author(s):  
Manisha Chandar ◽  
Bruce Brockstein ◽  
Alan Zunamon ◽  
Irwin Silverman ◽  
Sarah Dlouhy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Congestive Heart Failure ◽  
Cancer Patients ◽  
Advance Care Planning ◽  
Primary Care Physicians ◽  
Online Survey ◽  
Care Planning ◽  
Incurable Cancer ◽  
Advance Care

12 Background: Advance Care Planning (ACP) discussions afford patients and physicians a chance to better understand patients’ values and wishes regarding end-of-life care; however these conversations typically take place late in the course of a disease, or not at all. The goal of this study was to understand attitudes of oncologists, cardiologists, and primary care physicians (PCPs) towards ACP. We also aimed to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system aimed at improving ACP completion rate. Methods: A 23-question cross-sectional online survey was created and distributed to cardiologists, oncologists, primary care physicians and cardiology and oncology support staff at the NorthShore University Health System (NorthShore) from February-March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool. Results: Only 15% of cardiologists felt it was their responsibility to conduct ACP with their congestive heart failure (CHF) patients. In contrast, 68% of oncologists accepted responsibility for ACP in incurable cancer patients. Sixty-eight percent of PCPs felt personally responsible for conducting ACP discussions with CHF patients, while only 34% felt the same about cancer patients. Documentation of ACP in the electronic health record (EHR) was inconsistent among specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient’s family towards these discussions were also significant reported barriers. Conclusions: Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study feeling more personal responsibility for carrying out these discussions with cancer patients than cardiologists with their heart failure patients. Robust implementation of ACP across the spectrum of medical illnesses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and ambulatory settings.

Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure

2016 ◽  
Vol 34 (5) ◽  
pp. 423-429 ◽  
Author(s):  
Manisha Chandar ◽  
Bruce Brockstein ◽  
Alan Zunamon ◽  
Irwin Silverman ◽  
Sarah Dlouhy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Advance Care Planning ◽  
Online Survey ◽  
Analysis Tool ◽  
Care Planning ◽  
Care Providers ◽  
Major Barrier ◽  
Medical Diagnoses ◽  
Advance Care

Background: Advance care planning (ACP) discussions afford patients and physicians a chance to better understand patients’ values and wishes regarding end-of-life care; however, these conversations typically take place late in the course of a disease. The goal of this study was to clarify attitudes of oncologists, cardiologists, and primary care physicians (PCPs) toward ACP and to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system geared at improvement in ACP implementation. Methods: A 20-question, cross-sectional online survey was created and distributed to cardiologists, oncologists, PCPs, and cardiology and oncology support staff at the NorthShore University HealthSystem (NorthShore) from February to March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool (SurveyMonkey, Inc., Palo Alto, California, USA). Results: Only 15% of cardiologists felt it was their responsibility to conduct ACP discussions with their patients having congestive heart failure (CHF). In contrast, 68% of oncologists accepted this discussion as their responsibility in patients with terminal cancer ( P < .01). These views were mirrored by PCPs, as 68% of PCPs felt personally responsible for ACP discussion with patients having CHF, while only 34% felt the same about patients with cancer. Reported documentation of these discussions in the electronic health record was inconsistent between specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient’s family toward these discussions were also significant reported barriers. Conclusion: Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study tending to feel more personal responsibility for these discussions with patients having cancer than cardiologists with their patients having heart failure. Robust implementation of ACP across the spectrum of medical diagnoses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and the ambulatory settings.

Midlevel provider utilization within a large community oncology network.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 282-282
Author(s):  
Sabrina Q. Mikan ◽  
Melinda Madison Cody ◽  
Lori Lindsey ◽  
Patricia Carter ◽  
J. Russell Hoverman ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Online Survey ◽  
Care Delivery ◽  
Signs And Symptoms ◽  
Physician Assistants ◽  
Care Planning ◽  
Large Network ◽  
Genetic Risk Assessment ◽  
Community Oncology ◽  
Advance Care

282 Background: The Association of American Medical Colleges (AAMC) reports that 56% of Oncologists work with midlevel providers (MLPs). MLPs include physician assistants (PAs) and advanced practice nurses (APNs). Within our large network of community oncology practices,there are 241 MLPs (88 PAs and 153 APNs). The MLP role encompasses the continuum of care beginning with genetic risk assessment throughout treatment, health promotion teaching, survivorship management and advance care planning (ACP) services. Methods: We used an online survey to elicit self-reported proficiency in eight core health care delivery roles. A 52 item, 5-point Likert scale (novice, advanced beginner, competent, proficient, expert) survey was sent in March 2013 to all MLPs. Results: Of all MLPs (n=241) invited to participate, 103 (43.5%) responded anonymously. Over half of all MLPs reported feeling proficient in the areas of collaborating with multi-disciplinary teams to formulate a plan of care (50.4%), facilitating patient and family decision-making in treatments, symptom management and end-of-life care (53.3%), and providing information to patients and families to facilitate adherence to cancer treatments and supportive care (54.2%). Secondly, the MLPs were confident in their ability to provide proficient care in health assessment through physical exam (46.6%), disease progression signs and symptoms (44.7%), and incorporating resources that meet diverse needs of the patients into the planning and delivery of care (52.3%) areas. Finally, the areas where MLPs reported feeling less than proficient were in specialty areas such as survivorship (34.2%) and genetics (34.2%). Also noted, for 45.7% of respondents, ACP was performed only 1-20% of their time. Conclusions: Self-assessment is one form of measurement that allows the individual provider to identify their strengths and weaknesses. It is important so that educational resources can be created, tested, and shared amongst providers to continue to improve their confidence and care delivery. Ongoing work in developing strong tools for survivorship visits, advance care planning, and genetic counseling within our network, is recognized as an imperative part of advancing PA and APN skills and quality patient care.

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