Narrative Medicine for Healthcare Providers: Improving Practices of Advance Care Planning

2021 ◽  
pp. 003022282110155
Author(s):  
Cara L. Wallace ◽  
April Trees ◽  
Jennifer Ohs ◽  
Leslie Hinyard
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Narrative Medicine ◽  
Treatment Preferences ◽  
Active Listening ◽  
Care Planning ◽  
Personal Experiences ◽  
Advance Care ◽  
The Relationship

Advance care planning (ACP) conversations about treatment preferences and end-of-life goals relate to positive outcomes for patients and families, though ongoing barriers exist. Additionally, providers personal discomfort and personal experiences may influence how they engage (or avoid) ACP conversations. Narrative medicine (NM) offers one approach to help practitioners develop ability to hear and understand the story of others in ways that may overcome barriers to quality conversations. This study investigated the effectiveness of a 3-hour NM workshop to develop communication skills around ACP and facilitate reflection on the relationship between personal experiences and professional practices in ACP and end-of-life care. Twenty-five participants completed post-assessments of the workshop. Key themes included increased awareness, improved skills for active listening and eliciting stories, and improved understanding of how personal experiences shape professional practice. Results indicate practitioners value the NM approach to ACP suggesting this approach may provide impactful change in practice.

Treatment preferences and advance care planning at end of life: The role of ethnicity and spiritual coping in cancer patients

2005 ◽  
Vol 30 (2) ◽  
pp. 174-179 ◽  
Author(s):  
Gala True ◽  
Etienne J. Phipps ◽  
Leonard E. Braitman ◽  
Tina Harralson ◽  
Diana Harris ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Advance Care Planning ◽  
Spiritual Coping ◽  
Treatment Preferences ◽  
Care Planning ◽  
Advance Care

How is advance care planning conceptualised in Australia? Findings from key informant interviews

2011 ◽  
Vol 35 (2) ◽  
pp. 197 ◽  
Author(s):  
Joel J. Rhee ◽  
Nicholas A. Zwar
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Health Professionals ◽  
End Of Life Care ◽  
Aged Care ◽  
Treatment Preferences ◽  
Successful Implementation ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Objective. Advance Care Planning (ACP) has been gaining prominence as an important component of good end-of-life care. This study explored how ACP is conceptualised by stakeholder organisations and clinicians involved in aged care and end-of-life care in Australia, in particular their views on the aim, appropriate context and settings for ACP, and how ACP should be facilitated. Participants. Twenty-three participants including expert clinicians and representatives of government organisations, professional societies, consumer groups and other organisations involved in aged care and end-of-life care. Design. Qualitative descriptive analysis of semi-structured telephone interviews. Results. Most participants viewed ACP as an ongoing process aimed at enhancing an individual’s autonomy and ensuring good end-of-life care. However, there were significant differences in how this process was conceptualised. Some viewed ACP as a process undertaken by patients to define and communicate their treatment preferences. Others viewed ACP as discussions undertaken by health professionals to gain a better understanding of the patient’s values and goals in order to provide good care. Implications. Our findings highlight significant differences in how ACP is conceptualised in Australia. A shared conceptualisation and agreement on purpose is needed to ensure a successful implementation of ACP in Australia. What is known about the topic? Advance care planning (ACP) has been gaining increasing prominence both internationally and in Australia and is seen as an important component of good end-of-life care. Originally conceptualised as a document outlining a patient’s specific treatment preferences about life-sustaining treatments, ACP has been increasingly recognised in the literature as an ongoing process of discussion, communication and documentation of the patient’s wishes and values regarding end-of-life care. What does this paper add? This paper shows that most expert clinicians and representatives of key stakeholder organisations view ACP as a process that aims to enhance individual autonomy and ensure good end-of-life care. However, our findings show that they often hold contrasting views on ACP – ranging from a consumer-orientated view that sees ACP as undertaken to define and communicate their care preferences; to a care-orientated view that sees ACP as discussions led by health professionals in order to gain an understanding of patients’ values and wishes in order to provide better care. What are the implications for practitioners? Our findings highlight significant differences in how ACP is conceptualised in Australia. This can cause confusion and conflict, leading to reduced effectiveness of ACP. A shared conceptualisation and agreement on purpose is needed to ensure a successful implementation of ACP in Australia.

Readiness to participate in advance care planning: A qualitative study of renal failure patients, families and healthcare providers

2017 ◽  
Vol 13 (3) ◽  
pp. 171-187 ◽  
Author(s):  
Lauren A Hutchison ◽  
Donna S Raffin-Bouchal ◽  
Charlotte A Syme ◽  
Patricia D Biondo ◽  
Jessica E Simon
Keyword(s):  
Renal Failure ◽  
End Of Life ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Care Planning ◽  
Structured Interviews ◽  
Individual Values ◽  
Advance Care ◽  
The Moment ◽  
End Of Life Decision

Objectives Advance care planning is the process by which people reflect upon their wishes and values for healthcare, discuss their choices with family and friends and document their wishes. Readiness represents a key predictor of advance care planning participation; however, the evidence for addressing readiness is scarce within the renal failure context. Our objectives were to assess readiness for advance care planning and barriers and facilitators to advance care planning uptake in a renal context. Methods Twenty-five participants (nine patients, nine clinicians and seven family members) were recruited from the Southern Alberta Renal Program. Semi-structured interviews were recorded, transcribed and then analyzed using interpretive description. Results Readiness for advance care planning was driven by individual values perceived by a collaborative encounter between clinicians and patients/families. If advance care planning is not valued, then patients/families and clinicians are not ready to initiate the process. Patients and clinicians are delaying conversations until “illness burden necessitates,” so there is little “advance” care planning, only care planning in-the-moment closer to the end of life. Discussion The value of advance care planning in collaboration with clinicians, patients and their surrogates needs reframing as an ongoing process early in the patient’s illness trajectory, distinguished from end-of-life decision making.

Connecting Personal Experiences of Loss and Professional Practices in Advance Care Planning and End-of-Life Care: A Survey of Providers

2018 ◽  
Vol 35 (11) ◽  
pp. 1369-1376
Author(s):  
Cara L. Wallace ◽  
Dulce M. Cruz-Oliver ◽  
Jennifer E. Ohs ◽  
Leslie Hinyard
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Advance Care Planning ◽  
Professional Practices ◽  
Care Planning ◽  
Personal Experiences ◽  
Advance Care ◽  
Hospice And Palliative Care ◽  
Eol Care

Background: Although practitioners overwhelmingly agree on the importance of advance care planning (ACP) and preparing for the end of life (EOL), the process is fraught with barriers. Objective: The goal of this research was to explore potential connections between providers’ own personal experiences and current professional practices in ACP and EOL care. Design: A cross-sectional survey design, gathering voluntary, anonymous responses from participants between August and December 2016. The survey sought information from providers in 3 distinct areas: (1) personal experiences of loss, (2) personal ACP, and (3) professional practices related to ACP and EOL care. Setting/Participants: One hundred and ninety health-care professionals (primarily physicians, nurses, and social workers) participated in the survey across a greater, Metropolitan area in the Midwest. Measurements: Questions for professional practices were subscales from the End-of-Life Professional Caregiver Survey: Patient- and Family-Centered Communication (PFCC) and Effective Care Delivery (ECD). Questions developed by the research team were evaluated by judges chosen for clinical and/or research expertise. Results: Numerous connections were found between professionals’ histories of loss, personal ACP, and professional practices. For example, both clinicians with personal experience caring for someone who is dying and clinicians who had completed their own ACP scored higher in both PFCC and ECD and were more likely to refer patients to hospice and palliative care. Conclusions: Results support educational interventions involving opportunities for reflection and completion and communication about ACP. Additionally, educational opportunities for students in health care should focus on incorporating both ACP and greater exposure to hospice and palliative care.

Engaging death: Narrative and constructed dialogue in Advance Care Planning discussions

2015 ◽  
Vol 11 (2) ◽  
pp. 153-165 ◽  
Author(s):  
Gabriella Modan ◽  
Seuli Bose Brill
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Cultural Barriers ◽  
Care Planning ◽  
Constructed Dialogue ◽  
Life Issues ◽  
Advance Care ◽  
End Of Life Issues ◽  
Death Narrative

Advance Care Planning (ACP) remains extremely low in the US, due to numerous institutional and cultural barriers and discomfort in discussing death. There is a need for guidance about how patient and healthcare providers can effectively engage in ACP discussion. Here we analyze the linguistic strategies that focus-group participants use when discussing ACP in detailed ways. Prevalent linguistic structures in effective ACP discussions were loved ones’ end-of-life narratives, hypothetical narratives, and constructed dialogue. In elucidating spontaneous, unprompted approaches to effective discussion of end-of-life issues, such research can help to dislodge communicative barriers to ACP so that more people are prepared to engage the process.

scholarly journals PROJECT SOAR PARTNERSHIPS: EXPLORING ADVANCE CARE PLANNING AMONG RURAL AFRICAN AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S404-S405
Author(s):  
Rebecca S Allen ◽  
Pamela Payne-Foster ◽  
JoAnn S Oliver ◽  
Christopher H Spencer ◽  
Deanne M Dragan
Keyword(s):  
African American ◽  
African Americans ◽  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Preferences ◽  
Care Planning ◽  
Research Project ◽  
Community Partners ◽  
African American Adults ◽  
Advance Care

Abstract Sharing Opinions and Advice about Research (Project SOAR), funded by PCORI, trained individuals living in under-resourced and underserved communities how to evaluate and provide advice to scientists about recruitment procedures, survey items, and intervention components for implementation in their communities. In partnership with the HELLO Project (Van Scoy, Green, & Volpe, 2019), Project SOAR community partners recruited 50 rural African American adults to consider their values, plans, and treatment preferences near the end of life while playing the HELLO game. Community and research partners along with a HELLO Project representative facilitated questionnaire completion and the process of the HELLO game to promote advance care planning. Tables of 10 participants held facilitated discussions for each HELLO game item and recorded their individual wishes and plans in HELLO booklets. Community participants had difficulty completing questionnaires without assistance; however, all were engaged and accepting of game-like discussions regarding advance care planning.

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