scholarly journals OP19 Content analysis of advance directives completed by patients as part of advance care planning: insights gained from the ACTION trial

2019 ◽  
Author(s):  
M Zwakman ◽  
JJM van Delden ◽  
G Caswell ◽  
CA Christensen ◽  
L Deliens ◽  
...  
Keyword(s):  
Content Analysis ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

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.

scholarly journals ‘We need a physician who is a human being too’: exploration of barriers and facilitators for hospitalised palliative patients and their families to discuss advance care planning

2019 ◽  
Vol 25 (12) ◽  
pp. 603-609
Author(s):  
Birgit Vanderhaeghen ◽  
Inge Bossuyt ◽  
Katelijne De Nys ◽  
Johan Menten ◽  
Peter Rober
Keyword(s):  
Content Analysis ◽  
Grounded Theory ◽  
Advance Care Planning ◽  
Disease Process ◽  
Care Planning ◽  
Human Being ◽  
Hospitalised Patients ◽  
Recall Procedure ◽  
Advance Care ◽  
Palliative Patients

Background: Advance care planning (ACP) is not well implemented in hospital. Implementation theory stresses the importance of knowing what hospitalised palliative patients and their families experience as barriers or as facilitators in the uptake of ACP with their treating physician. Aims: This study aimed to gain an in-depth understanding of what hospitalised palliative patients and their families experienced as barriers or facilitators for having ACP conversations. Methods: We used a tape-assisted recall procedure to conduct 29 videotaped interviews with hospitalised patients and their families. We used content analysis based on grounded theory principles. Results: Four major fields of tension were discovered: not knowing what to expect from the treating physician; not being sure the treating physician can be a trusted partner; daring to speak about ACP; and staying loyal to one's own wishes. Conclusions: Patients and families need physicians who are accessible and can be trusted ACP partners throughout the disease process.

scholarly journals Advance care planning and palliative care in ACHD: the healthcare providers’ perspective

2020 ◽  
Vol 30 (3) ◽  
pp. 402-408
Author(s):  
Jill M. Steiner ◽  
Erwin N. Oechslin ◽  
Gruschen Veldtman ◽  
Craig S. Broberg ◽  
Karen Stout ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Physical Symptoms ◽  
Care Planning ◽  
Psychosocial Needs ◽  
Cross Sectional ◽  
Advance Care

ABSTRACTBackground:Advance care planning and palliative care are gaining recognition as critical care components for adults with CHD, yet these often do not occur. Study objectives were to evaluate ACHD providers’ 1) comfort managing patients’ physical symptoms and psychosocial needs and 2) perspectives on the decision/timing of advance care planning initiation and palliative care referral.Methods:Cross-sectional study of ACHD providers. Six hypothetical patients were described in case format, followed by questions regarding provider comfort managing symptoms, initiating advance care planning, and palliative care referral.Results:Fifty providers (72% physicians) completed surveys. Participants reported low levels of personal palliative care knowledge, without variation by gender, years in practice, or prior palliative care training. Providers appeared more comfortable managing physical symptoms and discussing prognosis than addressing psychosocial needs. Providers recognised advance directives as important, although the percentage who would initiate advance care planning ranged from 18 to 67% and referral to palliative care from 14 to 32%. Barriers and facilitators to discussing advance care planning with patients were identified. Over 20% indicated that advance care planning and end-of-life discussions are best initiated with the development of at least one life-threatening complication/hospitalisation.Conclusions:Providers noted high value in advance directives yet were themselves less likely to initiate advance care planning or refer to palliative care. This raises the critical questions of when, how, and by whom discussion of these important matters should be initiated and how best to support ACHD providers in these endeavours.

Engaging the cancer care team in advance care planning.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 14-14
Author(s):  
Tallat Mahmood ◽  
Jane Alcyne Severson ◽  
Laura Thompson
Keyword(s):  
Advance Directives ◽  
Advance Care Planning ◽  
Metastatic Cancer ◽  
Care Team ◽  
Care Planning ◽  
Power Of Attorney ◽  
Post Intervention ◽  
Improvement Program ◽  
Advanced Directives ◽  
Advance Care

14 Background: Engagement of oncologists and their care team is essential to ensure advance care planning (ACP) occurs for cancer patients. However, numerous barriers to ACP exists, including the availability of trained staff with competence and confidence to have discussions with patients as well as resources to ensure ACP is effectively and efficiently integrated into the oncology practice. Methods: A baseline audit to determine the presence of documented ACP discussions for patients with metastatic cancer was conducted, followed by a quality improvement program with subsequent reassessment. The baseline audit identified only 20% (10/50) compliance with documentation of such discussions. Subsequently, we joined the Michigan Oncology Quality Consortium’s (MOQC) ACP Collaborative where the care team (MA, RN, PA, MD) were taught how to request and complete a durable power of attorney, conduct ACP conversations, and document pertinent information in a standard EHR location. Results: A one-year post-intervention audit found that 80% (40/50) of patients with metastatic cancer had an ACP documented in their record - a four fold improvement. A post-implementation staff survey noted that the team improved their understanding of both the legal issues and importance of asking about advance directives as well as using the designated chart location to document. 100% of staff agreed or strongly agreed with the statement “I understand the importance of asking patients about advanced directives”. Staff gained confidence in how to talk to patients about advance directives again with 100% of staff agreeing or strongly agreeing with the statement,” I feel more confident now in how to talk to a patient about advanced directives”. Conclusions: It is critical that all members of the oncology care team understand the importance of ACP and that staff feel confident in how to have discussions with patients. While physician/patient discussion is both necessary and expected, patients often discuss their wishes and fears with others in the practice. It is critical that all members of the team understand the importance of and opportunities where they can both support patients’ wishes and direct patients to their oncologist if necessary for further discussion.

The effects of global and targeted advance care planning efforts at a national comprehensive cancer center.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 79-79 ◽  
Author(s):  
Finly Zachariah ◽  
Lindsay Emanuel ◽  
Gayle Ito-Hammerling ◽  
Judy Wong-Toh ◽  
Denise Morse ◽  
...  
Keyword(s):  
Advance Directives ◽  
Advance Care Planning ◽  
Capture Rate ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Central Component ◽  
Care Planning ◽  
Advance Care ◽  
Patient Centric ◽  
Capture Rates

79 Background: Advance Care Planning is a central component of patient centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. Various studies demonstrate advance care planning decreases stress and anxiety, increases satisfaction, improves awareness and implementation of a patient’s end of life wishes, and reduces costs in select populations. At City of Hope (COH) National Medical Center, we made concerted efforts over the last four years to improve the overall number of advance directives(ADs), and have additionally focused on improving AD capture rates in clinically relevant populations (patients undergoing surgery, those with metastatic disease, and those undergoing hematologic transplant). Methods: The Department of Supportive Care Medicine with executive team endorsement and in collaboration with medical oncology, hematology, anesthesia, surgery, nursing, marketing, and informatics created a patient-centric advance care planning program. We developed disease specific workflows, created multi-lingual AD workshops in the Sheri & Les Biller Patient and Family Resource Center, changed policy to provide complimentary patient/caregiver and staff notarizations for ADs, leveraged the electronic medical record (assured providers were able to document discussions, know when ADs were absent, and easily retrieve ADs when present), deploy AD specific screening questions, and most recently created a culturally sensitive branding campaign coined “Plan Today for Tomorrow.” Results: The rate of advance directive capture for all patients new to COH has continuously improved from 12% in 2012 to 22% in 2016. In transplant patients, AD capture rate increased to 63%. In a pilot for bladder cancer patients undergoing cystectomy, ADs were increased to 68%, and in the pre-anesthesia testing clinic, ADs were increased to 35%. Conclusions: We have made significant strides in the capture of advance directives at City of Hope with markedly higher capture rates in selectively targeted, clinically relevant populations. We anticipate improved patient centric care as a result, with the unintended consequence of cost savings and decreased resource utilization.

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