A Retrospective Study Reviewing Interprofessional Advance Care Planning Group Discussions in Pulmonary Rehabilitation: A Proof-of-Concept and Feasibility Study

2019 ◽  
pp. 082585971989642
Author(s):  
Daphna Grossman ◽  
Amanda Katz ◽  
Karen Lock ◽  
Valerie B. Caraiscos
Keyword(s):  
Advance Care Planning ◽  
Pulmonary Rehabilitation ◽  
Family Satisfaction ◽  
Treatment Preferences ◽  
Care Planning ◽  
Personal Care ◽  
Trade Offs ◽  
Advance Care ◽  
Eol Care ◽  
The Impact

Background: Advance care planning (ACP) is a process of reflection and discussion wherein a patient, in consultation with a health-care provider, family, and/or loved ones, clarifies values and treatment preferences and establishes goals, including a plan for end-of-life (EOL) care. Advance care planning encompasses appreciating and understanding illness and treatment options, elucidating patient values and beliefs, and identifying a substitute decision maker (SDM) or designating a power of attorney (POA) for personal care. These discussions have proven to be effective in improving patient–family satisfaction, reducing anxiety regarding EOL care in patients and family members, and improving patient-centered care by empowering patients to direct their care at EOL. However, ACP conversations are often difficult to have due to the sensitive nature of such discussions. Objective: The aim of this study was to determine whether group facilitation for teaching and discussing ACP enhances participants’ understanding of ACP and allows them to feel comfortable and supported when discussing these sensitive issues. Methods: Patients who were registered in North York General Hospital’s (NYGH) pulmonary rehabilitation program from June 2016 until August 2017 were given the opportunity to attend two 1-hour sessions related to ACP. The first session was dedicated to educating patients on ACP, explaining the hierarchy of the SDM and the role of the POA for personal care. The second session, provided a short time later, was devoted to discussions of values, wishes, fears, and trade-offs for future medical and EOL care. These discussions led by the supportive care nurse practitioner and a physician who are members of the NYGH Freeman Palliative Care Team were held in a group-facilitated format. Anonymous feedback forms, including both qualitative and quantitative feedback, were completed by the participants and analyzed. Participants: Analysis of a sample of 30 participants who attended 1 or 2 of the ACP sessions revealed that 21 identified as female and 9 identified as male. The average age of the participants was 76 years. Findings: Participants felt the content was relevant to their needs and were comfortable asking questions with all feedback averages ranging from good to very good. Participants appreciated the opportunity to share their thoughts in an open and interactive format. Conclusion: Discussing issues relevant to ACP, including providing information about ACP, sharing fears, wishes, and tradeoffs, were well-received in a group-support environment. Future studies should assess the impact of ACP group discussion on the individual, such as identifying a POA, having discussions regarding wishes and values with the SDM/POA, and examining the clinical impact of such sessions.

Advance care planning among seniors of a diverse city.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 117-117
Author(s):  
Randi Belisomo ◽  
Daniel M. Gaitan ◽  
Amy R. Eisenstein ◽  
Mary Frances Mulcahy
Keyword(s):  
Medical Care ◽  
Advance Care Planning ◽  
Family Satisfaction ◽  
Care Patient ◽  
Healthcare Team ◽  
Care Planning ◽  
Racial Groups ◽  
Information Awareness ◽  
Advance Care ◽  
Eol Care

117 Background: Advance care planning (ACP) is a system of education, reflection and documentation of health care wishes. Respecting Choices has been successful in implementing ACP throughout Lacrosse County, WI (J Am Geriatr Soc 2010;58:1249–1255)..A single center study in Melbourne, AU, showed that ACP improves end of life (EOL) care, patient and family satisfaction, and reduces stress, anxiety, and depression in surviving relatives (BMJ 2010;340:c1345).We aim to quantify knowledge about ACP, interest in engaging in ACP, and barriers to effective ACP among the older adults of Chicago. The results will provide actionable items to implement an ACP program in a diverse city. Methods: 17 of the 22 City of Chicago senior centers participated in a survey and education forum “Starting the Conversation”. Participants provided demographic information, awareness and knowledge of EOL wishes and advance directives (AD). Data was tabulated and analyzed using descriptive statistics in IBM SPSS Statistics 22 Software. Results: 375 people completed the survey, the average age was 70+8, (range 41 to 93), 93.3% in English, and 6.7% in Spanish. Respondents live alone (44.5%), with a spouse (29.9%) or child (14.4%). 71% have thought about the medical care they would want at the EOL, 60% have discussed their EOL wishes with their loved ones, and 4% with their doctor. 60.5% do not know what an AD is, 25% have an AD, 76% know who would speak for them if they were unable, 58% have discussed their wishes with that person. Using neighborhood demographics, there was no difference in having an AD for predominately African American neighborhoods compared to others (33% and 27%). Respondents from lower income neighborhoods were less likely to think about medical care at the EOL (65% and 77%), less likely to have discussed EOL care (41% and 30% have not discussed EOL care) and less likely to have an AD (19% and 31%). Conclusions: ACP is underutilized in Chicago. The frequency of AD completion among Chicago seniors mirrors that of the US (Am J Public Health. 2013;103(6):e8-e10). Unlike other population studies, no difference was found among racial groups. Participants are aware of EOL wishes, are interested in engaging in these conversations, but lack the knowledge and collaboration of their healthcare team.

scholarly journals The Association Between Hearing Loss and Completion of Advance Care Planning Among Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 332-332
Author(s):  
Junghee Han ◽  
Junghyun Park
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Chronic Disease ◽  
Advance Care Planning ◽  
Living Wills ◽  
Health Concern ◽  
Care Planning ◽  
Advance Care ◽  
Eol Care ◽  
The Impact

Abstract Background: Ensuring access to quality end-of-life (EOL) care for all older adults is emerging public health concern. Hearing loss (HL) is the third most common chronic disease affecting older adults and a major impediment to access healthcare services. However, little is known about the impact of HL on advance care planning for older adults. Method: A sample of 1,862 older adults (≥65 years) was drawn from the National Health and Aging Trends Study (NHATS). HL was determined by self-report and advance care planning was measured by asking if an individual completed living wills or the Durable Power of Attorney for Health Care (DPAHC). Covariates included age, gender, race, marital status, education, religion, nativity, depression, region, facility status, regular doctor availability, Medicaid, hospitalization, cognition, perceived health status and a presence of chronic disease. Results: Descriptive statistics revealed that nearly 67% of older adults with HL completed the DPAHC, and the majority of them (71%) also had living wills. Multivariable logistic regression analyses showed that HL was significantly associated with completion of DPAHC and living wills, after controlling for a list of covariates (OR=0.50, p<0.05). Conclusions: The findings show HL is a significant predictor of completion of any type of advance directives. Facilitating effective communication in advance care planning for older adults with HL is needed. Healthcare provider should make health information accessible to them to get quality EOL care.

scholarly journals The Impact of Prior Advance Care Planning Documentation on End-of-Life Care Provision in Long-Term Care

2020 ◽  
Vol 23 (2) ◽  
pp. 172-183
Author(s):  
Henry Y.H. Siu ◽  
Dawn Elston ◽  
Neha Arora ◽  
Amie Vahrmeyer ◽  
Sharon Kaasalainen ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Long Term Care ◽  
Illness Management ◽  
Care Planning ◽  
Care Provision ◽  
Term Care ◽  
Advance Care ◽  
Eol Care ◽  
The Impact

Background The impact of prior advance care planning (ACP) documentation on substitute decision-makers’ (SDMs) knowledge of values for end-of-life (EOL) care, and its correlation with SDM satisfaction with EOL care provision, have not been assessed in long-term care (LTC). Methods A cross-sectional survey of 2,595 SDMs from 27 LTC homes assessed: 1) knowledge of pre-existing ACP documentation and values for EOL care, and 2) the importance and satisfaction of EOL care provision in LTC. Knowledge of values for EOL care was compared to administrative documentation. Importance and satisfaction were plotted on a performance-importance grid. Multiple linear regression assessed whether knowledge of pre-existing ACP documentation correlated with satisfaction. Results The response rate was 25% (658/2,595); 69% of LTC residents had pre-existing ACP documentation. Discordance was noted between SDMs’ knowledge of values for EOL care and administrative documentation. Pre-existing knowledge of ACP documentation was not correlated with EOL care provision satisfaction. Priority areas for increasing satisfaction include illness management, SDM communication, and relationships with LTC clinicians. Conclusions The discordance between SDMs’ knowledge of values for EOL care and formal documentation needs to be addressed. Although pre-existing ACP documentation does not impact satisfaction, EOL care provision could be improved by targeting illness management, SDM communication, and relationships with LTC clinicians.

scholarly journals Assisted Living Administrators’ Approaches to Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 66-66
Author(s):  
Elise Abken ◽  
Alexis Bender ◽  
Ann Vandenberg ◽  
Candace Kemp ◽  
Molly Perkins
Keyword(s):  
Advance Care Planning ◽  
Assisted Living ◽  
Staff Training ◽  
Chronically Ill ◽  
External Support ◽  
Care Plan ◽  
Care Planning ◽  
Term Care ◽  
Advance Care ◽  
Eol Care

Abstract Assisted living (AL) communities are increasingly home to frail, chronically ill older adults who remain until death. State laws mandate that AL facilities request copies of any advance care planning documents residents have and make forms available upon request. Using secondary data from a larger study funded by the National Institute on Aging (R01AG047408) that focuses on end-of-life (EOL) care in AL, this project investigated barriers and facilitators to conducting advance care planning in AL. Data included in-depth interviews (of 86 minute average length) with 20 administrators from 7 facilities around the Atlanta metropolitan area and aggregate data collected from each facility regarding facility, staff, and resident characteristics. Findings from thematic analysis of qualitative data showed that key barriers to planning in AL included lack of staff training and reluctance among administrators and families to discuss advance care planning and EOL care. Important facilitators included periodic follow-up discussions of residents’ wishes, often during care plan meetings, educating families about the importance of planning, and external support for staff training and family education from agencies such as hospice and home health. Three study facilities exceeded state requirements to request and store documents by systematically encouraging residents to complete documentation. These facilities, whose administrators discuss advance care planning and residents’ EOL wishes with residents and families during regular care plan meetings, were more likely to have planning documents on file, demonstrating the potential of long-term care communities, such as AL, to successfully promote advance care planning among residents and their family members.

scholarly journals Racial Differences in the Impact of Subjective Life Expectancy on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 903-903
Author(s):  
Yifan Lou ◽  
Deborah Carr
Keyword(s):  
Life Expectancy ◽  
Racial Differences ◽  
Advance Care Planning ◽  
Living Will ◽  
Care Planning ◽  
Power Of Attorney ◽  
Risk Of Death ◽  
Advance Care ◽  
Survival Expectations ◽  
The Impact

Abstract The need for advance care planning (ACP) is heightened during the COVID-19 pandemic, especially for older Blacks and Latinx persons who are at a disproportionate risk of death from both infectious and chronic disease. A potentially important yet underexplored explanation for well-documented racial disparities in ACP is subjective life expectancy (SLE), which may impel or impede ACP. Using Health and Retirement Study data (n=7484), we examined the extent to which perceived chances of living another 10 years (100, 51-99, 50, 1-49, or 0 percent) predict three aspects of ACP (living will (LW), durable power of attorney for health care designations (DPAHC), and discussions). We use logistic regression models to predict the odds of each ACP behavior, adjusted for sociodemographic, health, and depressive symptoms. We found modest evidence that SLE predicts ACP behaviors. Persons who are 100% certain they will be alive in ten years are less likely (OR = .68 and .71, respectively) whereas those with pessimistic survival prospects are more likely (OR = 1.23 and 1.15, respectively) to have a LW and a DPAHC, relative to those with modest perceived survival. However, upon closer inspection, these patterns hold only for those whose LW specify aggressive measures versus no LW. We found no race differences for formal aspects of planning (LW, DPAHC) although we did detect differences for informal discussions. Blacks with pessimistic survival expectations are more likely to have discussions, whereas Latinos are less likely relative to whites. We discuss implications for policies and practices to increase ACP rates.

Association of advance care planning with place of death and utilisation of life-sustaining treatments in deceased patients at Taipei City Hospital in Taiwan

2020 ◽  
pp. bmjspcare-2020-002520
Author(s):  
Yung-Feng Yen ◽  
Ya-Ling Lee ◽  
Hsiao-Yun Hu ◽  
Wen-Jung Sun ◽  
Ming-Chung Ko ◽  
...  
Keyword(s):  
Cohort Study ◽  
Advance Care Planning ◽  
Place Of Death ◽  
Care Planning ◽  
City Hospital ◽  
Taipei City ◽  
Advance Care ◽  
Eol Care ◽  
To Receive ◽  
At Home

ObjectiveEvidence is mixed regarding the impact of advance care planning (ACP) on place of death. This cohort study investigated the effect of ACP programmes on place of death and utilisation of life-sustaining treatments for patients during end-of-life (EOL) care.MethodsThis prospective cohort study identified deceased patients between 2015 and 2016 at Taipei City Hospital. ACP was determined by patients’ medical records and defined as a process to discuss patients’ preferences with respect to EOL treatments and place of death. Place of death included hospital or home death. Stepwise logistic regression determined the association of ACP with place of death and utilisation of life-sustaining treatments during EOL care.ResultsOf the 3196 deceased patients, the overall mean age was 78.6 years, and 46.5% of the subjects had an ACP communication with healthcare providers before death. During the study follow-up period, 166 individuals died at home, including 98 (6.59%) patients with ACP and 68 (3.98%) patients without ACP. After adjusting for sociodemographic factors and comorbidities, patients with ACP were more likely to die at home during EOL care (adjusted OR (AOR)=1.71, 95% CI 1.24 to 2.35). Moreover, patients with ACP were less likely to receive cardiopulmonary resuscitation (AOR 0.36, 95% CI 0.25 to 0.51) as well as intubation and mechanical ventilation support (AOR 0.54, 95% CI 0.44 to 0.67) during the last 3 months of life.ConclusionPatients with ACP were more likely to die at home and less likely to receive life-sustaining treatments during EOL care.

Discussion and documentation of future care: a before-and-after study examining the impact of an alternative approach to recording treatment decisions on advance care planning in an acute hospital

2017 ◽  
Vol 10 (2) ◽  
pp. e12-e12 ◽  
Author(s):  
Alexandra C Malyon ◽  
Julia R Forman ◽  
Jonathan P Fuld ◽  
Zoë Fritz
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Decisions ◽  
Care Planning ◽  
New Approach ◽  
Significance Level ◽  
Oncology Ward ◽  
Future Care ◽  
Advance Care ◽  
The Impact

ObjectiveTo determine whether discussion and documentation of decisions about future care was improved following the introduction of a new approach to recording treatment decisions: the Universal Form of Treatment Options (UFTO).MethodsRetrospective review of the medical records of patients who died within 90 days of admission to oncology or respiratory medicine wards over two 3-month periods, preimplementation and postimplementation of the UFTO. A sample size of 70 per group was required to provide 80% power to observe a change from 15% to 35% in discussion or documentation of advance care planning (ACP), using a two-sided test at the 5% significance level.ResultsOn the oncology ward, introduction of the UFTO was associated with a statistically significant increase in cardiopulmonary resuscitation decisions documented for patients (pre-UFTO 52% to post-UFTO 77%, p=0.01) and an increase in discussions regarding ACP (pre-UFTO 27%, post-UFTO 49%, p=0.03). There were no demonstrable changes in practice on the respiratory ward. Only one patient came into hospital with a formal ACP document.ConclusionsDespite patients’ proximity to the end-of-life, there was limited documentation of ACP and almost no evidence of formalised ACP. The introduction of the UFTO was associated with a change in practice on the oncology ward but this was not observed for respiratory patients. A new approach to recording treatment decisions may contribute to improving discussion and documentation about future care but further work is needed to ensure that all patients’ preferences for treatment and care at the end-of-life are known.

The Impact of Personal and Professional Loss on Advance Care Planning and Effective Care Delivery for Healthcare Social Workers

2018 ◽  
Vol 99 (4) ◽  
pp. 358-368
Author(s):  
Cara L. Wallace ◽  
Yit Mui Khoo ◽  
Leslie Hinyard ◽  
Jennifer E. Ohs ◽  
Dulce M. Cruz-Oliver
Keyword(s):  
Social Workers ◽  
Advance Care Planning ◽  
Care Delivery ◽  
Death And Dying ◽  
Care Planning ◽  
Professional Experiences ◽  
Effective Care ◽  
Advance Care ◽  
Past Experiences ◽  
The Impact

Personal experiences can influence the practice of social work. However, the connection between past experiences with death and social workers’ practice has been underexplored. As such, this study surveyed social workers ( N = 74) about their personal and professional experiences of loss, personal advance care planning, and professional practices. Results demonstrated that social workers that experienced prior loss were more likely to complete an advance directive and communicate their end-of-life wishes. Additionally, those who had experienced personal and professional loss showed greater effectiveness on measures of patient- and family-centered communication and care delivery. Findings suggest positive outcomes for encouraging social workers to connect their personal and professional experiences surrounding death and dying to effectively serve in their professional capacity.

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