General practitioners’ evaluations of optimal timing to initiate advance care planning for patients with cancer, organ failure, or multimorbidity: A health records survey study

Background: Appropriate timing to initiate advance care planning is difficult, especially for individuals with non-malignant disease in community settings. Aim: To identify the optimal moment for, and reasons to initiate advance care planning in different illness trajectories. Design and methods: A health records survey study; health records were presented to 83 GPs with request to indicate and substantiate what they considered optimal advance care planning timing within the 2 years before death. We used quantitative and qualitative analyses. Setting and patients: We selected and anonymized 90 health records of patients who died with cancer, organ failure or multimorbidity, from a regional primary care registration database in the Netherlands. Results: The median optimal advance care planning timing according to the GPs was 228 days before death (interquartile range 392). This moment was closer to death for cancer (87.5 days before death, IQR 302) than for organ failure (266 days before death, IQR 401) and multimorbidity (290 days before death, IQR 389) ( p < 0.001). The most frequently mentioned reason for cancer was “receiving a diagnosis” (21.5%), for organ failure it was “after a period of illness” (14.7%), and for multimorbidity it was “age” and “patients” expressed wishes or reflections’ (both 12.0%). Conclusion: The optimal advance care planning timing and reasons to initiate advance care planning indicated by GPs differ between patients with cancer and other illnesses, and they also differ between GPs. This suggests that “the” optimal timing for ACP should be seen as a “window of opportunity” for the different disease trajectories.

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Advance Care Planning in Primary Care. A Retrospective Medical Record Study Among Patients With Different Illness Trajectories.

10.21203/rs.3.rs-600560/v1 ◽

2021 ◽

Author(s):

Yvonne A.C. Bekker ◽

A. Suntjens ◽

Y. Engels ◽

H. Schers ◽

Gert P. Westert ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Organ Failure ◽

Medical Record ◽

Advance Care Planning ◽

Medical Records ◽

Daily Practice ◽

Care Planning ◽

Patients With Cancer ◽

Advance Care

Abstract BackgroundAdvance Care Planning (ACP) enables physicians to align healthcare with patients wishes, reduces burdensome life-prolonging medical interventions, and potentially improves the quality of life of patients in the last phase of life. However, little objective information is available about the extent to which structured ACP conversations are held in general practice. Our aim was to examine the documentation of ACP for patients with cancer, organ failure and multimorbidity in medical records (as a proxy for ACP application) in Dutch general practice. MethodsWe chose a retrospective medical record study design in seven primary care facilities. Medical records of 119 patients who died non-suddenly (55 cancer, 28 organ failure and 36 multimorbidity) were analysed. Other variables were: general characteristics, data on ACP documentation, correspondence between medical specialist and GP, and healthcare utilization in the last two years of life. ResultsIn 65% of the records, one or more ACP items was registered. Most often documented were aspects regarding euthanasia (35%), the preferred place of care and death (29%) and concerns and hopes towards the future (29%). Median timing of the first ACP conversation was 126 days before death. ACP was more often documented in patients with cancer (84%) than in those with organ failure (57%) or multimorbidity (42%) (p = 0,000). Patients with cancer had the most frequent (median 3 times, inter-quartile range (IQR) 2-5), and extensive (median 5 items, IQR 2-7) ACP consultations. ConclusionDocumentation of ACP items in medical records by GPs is present, but incomplete, especially in patients with multimorbidity or organ failure. We recommend more attention for, and documentation of ACP in daily practice in order to start anticipatory conversations in time, and to address the needs of all people living with advanced conditions in primary care.

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Efficacy of Normalisation of Advance Care Planning (NACP) for people with chronic diseases in hospital and community settings: a quasi-experimental study

BMC Health Services Research ◽

10.1186/s12913-021-06928-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sarah Jeong ◽

Peter Cleasby ◽

Se Ok Ohr ◽

Tomiko Barrett ◽

Ryan Davey ◽

...

Keyword(s):

Experimental Study ◽

Chronic Diseases ◽

Advance Care Planning ◽

Fixed Effects ◽

Care Planning ◽

Community Settings ◽

Link Type ◽

Quasi Experimental ◽

Advance Care ◽

And Control

Abstract Background Advance Care Planning (ACP) has emerged to improve end-of-life processes and experiences. However, the available evidence presents the gloomy picture of increasing number of older people living with chronic diseases and the mismatch between their preferences for and the actual place of death. The study aimed to investigate the efficacy of normalisation of an Advance Care Planning (NACP) service delivered by specially trained Registered Nurses (RNs) in hospital and community settings. Methods A quasi-experimental study was conducted involving 16 sites (eight hospital and eight community sites) in Australia. Patients who were aged ≥18 years, who had at least one of nine chronic conditions, and who did not have an Advance Care Directive (ACD) were offered the NACP service. ACP was normalised as part of routine service on admission. The intervention, NACP, was a series of facilitated conversations about the components of ACP. The primary outcomes which included the completion of ACDs, and/or appointment of an Enduring Guardian (EG), were assessed in both intervention and control sites at pre and post intervention stages. Numbers of patients who completed an ACD or appointed an EG were described by count (percentage). ACD completion was compared between intervention and control sites using a logistic mixed effects regression model. The model includes fixed effects for treatment group, period, and their interaction, as well as random site level intercepts. Secondary model included potentially confounding variables as covariates, including age, sex and chronic diseases. Results The prevalence of legally binding ACDs in intervention sites has increased from five to 85 (from 0.85% in pre to 17.6% in post), whereas it has slightly decreased from five to 2 (from 1.2% in pre and to 0.49% in post) in control sites (the difference in these changes being statistically significant p < 0.001). ACD completion rate was 3.6% (n = 4) in LHD1 and 1.2% (n = 3) in LHD2 in hospital whereas it was 53% (n = 26) in LHD1 and 80% (n = 52) in LHD2 in community. Conclusions The study demonstrated that NACP service delivered by ACP RNs was effective in increasing completion of ACDs (interaction odds ratio = 50) and was more effective in community than hospital settings. Involvement of various healthcare professionals are warranted to ensure concordance of care. Trial registration The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246) on 03/10/2018. The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx

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Prevalence of Advance Care Planning Practices Among People with Chronic Diseases in Hospital and Community Settings: A Quasi-Experimental Design

10.21203/rs.3.rs-97446/v1 ◽

2020 ◽

Author(s):

Sarah Yeun-Sim Jeong ◽

Tomiko Barrett ◽

Se Ok Ohr ◽

Peter Cleasby ◽

Ryan Davey

Keyword(s):

Health Care ◽

Chronic Diseases ◽

Advance Care Planning ◽

Healthcare Professionals ◽

Community Setting ◽

Care Planning ◽

Community Settings ◽

Future Health ◽

Number Of Patients ◽

Advance Care

Abstract Background: Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community setting is rarely reported.Methods: The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites (eight intervention and eight control) in hospital and community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan. Results: The overall prevalence of ACD was 2.8% (n=28) out of 1006 audited records, and only 10 of them were legally binding. The number of EGs legally appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n=144) of the resuscitation plans advised ‘Not-for-resuscitation’. Conclusions: The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or EG in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals’ education. Trial registration: The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx

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O-77 Effects of advance care planning in patients with cancer. results from a systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2015-000978.76 ◽

2015 ◽

Vol 5 (Suppl 2) ◽

pp. A24.3-A24

Author(s):

Jan Schildmann ◽

C Bausewein ◽

Tanja Krones ◽

A Simon ◽

ST Simon ◽

...

Keyword(s):

Systematic Review ◽

Advance Care Planning ◽

Care Planning ◽

Patients With Cancer ◽

Advance Care

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Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective

Journal of Clinical Nursing ◽

10.1111/jocn.15216 ◽

2020 ◽

Vol 29 (13-14) ◽

pp. 2069-2082

Author(s):

Anne Kuusisto ◽

Jenni Santavirta ◽

Kaija Saranto ◽

Päivi Korhonen ◽

Elina Haavisto

Keyword(s):

Palliative Care ◽

Advance Care Planning ◽

Scoping Review ◽

Care Planning ◽

Patients With Cancer ◽

Professional Perspective ◽

Advance Care

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Lay Health Workers’ Perspectives on Delivery of Advance Care Planning and Symptom Screening Among Adults With Cancer: A Qualitative Study

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120977841 ◽

2020 ◽

pp. 104990912097784

Author(s):

Manali I. Patel ◽

Sana Khateeb ◽

Tumaini Coker

Keyword(s):

Advance Care Planning ◽

Health Workers ◽

Comparative Method ◽

Well Being ◽

The United States ◽

Care Planning ◽

Lay Health Workers ◽

Patients With Cancer ◽

Symptom Screening ◽

Advance Care

Introduction: Advance care planning and symptom screening among patients with cancer require team-based approaches to ensure that these services are equitably and appropriately delivered. In several organizations across the United States, we trained and employed lay health workers (LHWs) to assist with delivering these services for patients with cancer. The aim of this study was to understand LHWs’ views on delivering these services. Methods: We conducted semi-structured interviews with 22 LHWs in 6 US-based clinical cancer care settings in 4 large cities. We recorded, transcribed, and analyzed interviews using the constant comparative method of qualitative analysis. Results: Participants noted the importance of their role in assisting with the delivery of advance care planning (ACP) and symptom screening services. Participants noted the importance of developing relationships with patients to engage openly in ACP and symptom screening discussions. Participants reported that ongoing training provided skills and empowered them to discuss sensitive issues with patients and their caregivers. Participants described challenges in their roles including communication with oncology providers and their own emotional well-being. Participants identified solutions to these challenges including formal opportunities for introduction with oncology clinicians and staff and grievance sessions with LHWs and other team members. Discussion: LHWs from several organizations endorsed the importance of their roles in ensuring the delivery of ACP and proactive symptom screening. LHWs noted challenges and specific solutions to improve their effectiveness in delivering these important services to patients after their diagnosis of cancer.

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