Making the Informal Formal: Discussing and Completing Advance Care Plans in Care Dyads with Cognitive Impairment

2021 ◽  
pp. 082585972110630
Author(s):  
Megan Shepherd-Banigan ◽  
Cassie B. Ford ◽  
Nicole DePasquale ◽  
Valerie A. Smith ◽  
Emmanuelle Belanger ◽  
...  
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Health Care Providers ◽  
Living Will ◽  
Care Providers ◽  
Positive Role ◽  
Cross Sectional ◽  
Care Plans ◽  
Care Partners ◽  
Advance Care

Background Discussing advance care planning (ACP) with care partners may be a steppingstone to the completion of advance directives (ADs) for persons with cognitive impairment (PwCIs). Objectives To examine whether PwCI-reported occurrence of and PwCI-care partner agreement about ACP discussions are associated with completion of ADs. Design and Subjects We conducted a secondary, cross-sectional analysis of data from 1672 PwCI-care partner dyads in the BLINDED study. PwCIs were Medicare beneficiaries in the US, aged >65 years, and diagnosed with mild cognitive impairment or dementia. Care partners were identified by PwCIs as being most involved in their health care. Measurements PwCIs’ completion of ADs was determined by 1 or more affirmative responses to dichotomous indicators for formalizing a living will, medical directive, or durable power of attorney for health care. Discussion occurrence was based on PwCI reports and agreement between PwCI and care partner reports of prior conversations about PwCIs’ ACP preferences between PwCIs and care partners. Results In logistic regression models adjusted for PwCI and care partner characteristics, PwCIs who had (vs. had not) discussed ACP were 10% more likely to complete ADs. PwCIs from dyads agreeing (vs. disagreeing) a discussion occurred were 7% more likely to complete ADs. PwCIs from care dyads in agreement (vs. disagreement) about non-discussion were 11% less likely to formalize ADs. Conclusions Discussing ACP with care partners plays a direct, positive role in completing ADs among PwCIs. Health care providers who approach ACP as a dyadic, communicative decision-making process from the outset may facilitate PwCIs’ uptake of ADs.

Health-Care Provider Personal Religious Preferences and Their Perspectives on Advance Care Planning With Patients

2018 ◽  
Vol 35 (12) ◽  
pp. 1565-1571
Author(s):  
Marjorie Bowman ◽  
Sarah St. Cyr ◽  
Adrienne Stolf i
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Religious Affiliation ◽  
Living Will ◽  
Care Planning ◽  
Care Providers ◽  
Power Of Attorney ◽  
Religious Preference ◽  
Advance Care

Objective: To understand how health-care providers’ (HCPs) religious preferences influence their willingness to undertake advance care planning (ACP) with patients and their acceptance of other HCP’s involvement. Methods: Online anonymous survey distributed to HCPs in hospital, ambulatory offices, and hospice settings in Dayton, Ohio. We evaluated the associations of HCP religion with their personal ACP, willingness to facilitate ACP, and acceptance of other HCPs’ ACP participation. Results: 704 respondents: nurses (66.2%), physicians (18.8%), other HCPs (15.0%), white (88.9%), and primarily Catholic (23.3%) or Protestant (32.0%). “No religion” was marked by 13.9%. Respondents were favorable to ACP with patients. Religious respondents were more likely to have a living will ( P = .035) and health-care power of attorney ( P = .007) and more accepting of clergy as ACP decision coaches ( P = .030). HCP’s religion was not associated with willingness to facilitate ACP discussions. There were minor differences between Catholics and Protestants. Conclusions: Personal religious preference is associated with HCP’s own ACP but had little relationship with their willingness to facilitate ACP conversations with patients or acceptance of other professional types of HCPs involvement in ACP conversations. Regardless of religious affiliation, HCPs have interest in undertaking ACP and endorse other HCPs ACP involvement. As results of this study suggest that personal religious affiliation is not a barrier for HCPs engaging in ACP with patients, attempts to overcome barriers to increasing ACP should be directed to other factors.

scholarly journals INCOMPLETE ADVANCE CARE PLANNING? CORRELATES OF PLANNING WITHOUT PERSONAL CONVERSATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S425-S426
Author(s):  
Kathrin Boerner ◽  
Deborah Carr ◽  
Katherine M Ornstein ◽  
Sara Moorman
Keyword(s):  
Health Care ◽  
Social Isolation ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Living Will ◽  
Community Dwelling ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Abstract In the course of advance care planning (ACP), people may elect any of the following: a living will, a durable power of attorney for health care, and discussions with family members and health care providers. A small proportion of planners complete legal documents without discussing them with others (formal planning only, FPO). If people who have done FPO become incapacitated, their family and health care professionals may lack guidance on how to direct their care. To better understand this group, we drew on four large surveys of community-dwelling adults. Social isolation, measured by living alone and lack of a confidante, increased the odds of FPO across all studies. We also found some evidence that economic disadvantage and depressive symptoms were linked with FPO. We discuss implications for policy and practice, underscoring that ACP is yet another important domain affected by the crisis of social isolation in old age.

Advance Care Planning for Mechanical Ventilation: A Qualitative Study on Health-Care Providers’ Approaches to Cross-Cultural Care

2017 ◽  
Vol 80 (2) ◽  
pp. 305-330 ◽  
Author(s):  
Ayah Nayfeh ◽  
Isabelle Marcoux ◽  
Jeffrey Jutai
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
End Of Life ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Care Planning ◽  
Care Providers ◽  
Care Plans ◽  
Beliefs And Values ◽  
Advance Care

Advance care planning (ACP) is a method used for patients to express in advance their preferences for life-sustaining treatments at the end of life. With growing ethnocultural diversity in Canada, health-care providers are managing an increasing number of diverse beliefs and values that are commonly associated with preferences for intensive mechanical ventilation (MV) treatment at the end of life. This study aimed to identify and describe the approaches used by health-care providers to set advance care plans for MV with seriously ill patients from diverse ethnocultural backgrounds. Semistructured interviews were conducted with health-care providers from acute-care settings. Using a value-based approach in ACP was deemed an effective method of practice for managing and interpreting diverse beliefs and values that impact decisions for MV. However, personnel, organizational, and systemic barriers that exist continue to hinder the provision of ACP across cultures.

Insufficient Advance Care Planning? Correlates of Planning Without Personal Conversations

2020 ◽  
Vol 76 (1) ◽  
pp. 104-108
Author(s):  
Kathrin Boerner ◽  
Sara M Moorman ◽  
Deborah Carr ◽  
Katherine A Ornstein
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Multinomial Logistic Regression ◽  
Living Will ◽  
Care Planning ◽  
Care Providers ◽  
Advance Care

Abstract Objectives Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointed decision makers may lack guidance on how to interpret or enact their formal wishes. We document the prevalence and correlates of this partial approach to ACP. Method Using multinomial logistic regression models and data from a U.S. sample of 4,836 older adults in the 2018 wave of the National Health and Aging Trends Study (NHATS), this brief report evaluated associations between social integration indicators and the odds of completing (a) both discussions and formal plans (two-pronged ACP), (b) discussions only, (c) no ACP, and (d) formal ACP only (reference category). We adjust for demographic and health characteristics established as correlates of ACP. Results A minority (15%) of NHATS participants reported formal plans without having discussed them. Indicators of social isolation (e.g., smaller social networks and fewer social activities) increased the odds of engaging in formal planning only compared to two-pronged ACP. Socioeconomic disadvantage and probable dementia reduced the odds of having end-of-life conversations, whether as one’s only preparation or in tandem with formal preparations. Discussion Socially isolated persons are especially likely to do formal planning only, which is considered less effective than two-pronged ACP. Health care professionals should recognize that older adults with few kin may require additional support and guidance when doing ACP.

scholarly journals Barriers in Advance Care Planning and Goals of Care Discussion With Oncology Patients: The Perspective of Brazilian Medical Residents

2021 ◽  
Author(s):  
Laiane Moraes Dias ◽  
Mayra Almeida Frutig ◽  
Mirella Rebello Bezerra ◽  
Williams Fernandes Barra ◽  
Luísa Castro ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Advance Care Planning ◽  
Medical Residents ◽  
Care Planning ◽  
Care Providers ◽  
Cross Sectional ◽  
Goals Of Care ◽  
Early Palliative Care ◽  
Advance Care

Abstract Background. Advance care planning (ACP) and goals of care discussions involve the exploration of what is most important to a person to prepare for health-care decision-making. Despite their well-established benefits, they are still not frequently performed in clinical oncology practice. The awareness of physicians’ barriers enables the development of tailored interventions to improve professional practice. Considering the scarcity of studies about the difficulties of medical residents in discussing goals of care, this study aims to determine, from the perspective of medical residents, the barriers to the discussion goals of care and ACP with patients with cancer. Methods. A previously published survey (Decide-Oncology) to assess barriers to goals of care discussion among health care providers was adapted to Portuguese language and distributed to Brazilian medical residents from three hospitals in Brazil in a cross-sectional pilot study. Residents were asked to rank the importance of various barriers to discuss goals of care (ranging from 1-extremely unimportant to 7-extremely important). Results: Twenty-nine residents answered the questionnaire (30.9%). The most reported barriers were related to patients and their families' difficulty in understanding and accepting the diagnostic and the prognosis, patients’ desire to receive full active treatment and the lack of an advance directive. Furthermore, the physician and external factors such as lack of training and lack of time to have these conversations were also very important barriers. The identification of the key barriers that limit the discussion of ACP and early palliative care referrals can certainly help to prioritize the next steps for future studies aimed at improving ACP and goals of care discussions.

A survey of Cambodian health-care providers' HIV knowledge, attitudes and intentions to take a sexual history

2009 ◽  
Vol 20 (5) ◽  
pp. 346-350 ◽  
Author(s):  
G Webber ◽  
N Edwards ◽  
I D Graham ◽  
C Amaratunga ◽  
I Gaboury ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Theory Of Planned Behaviour ◽  
Sexual History ◽  
People Living With Hiv ◽  
Care Providers ◽  
Hiv Knowledge ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Planned Behaviour

Cambodia has one of the highest prevalence rates of HIV in Asia and is scaling up HIV testing. We conducted a cross-sectional survey with 358 health care providers in Phnom Penh, Cambodia to assess readiness for voluntary testing and counselling for HIV. We measured HIV knowledge and attitudes, and predictors of intentions to take a sexual history using the Theory of Planned Behaviour. Over 90% of health care providers correctly answered knowledge questions about HIV transmission, but their attitudes were often not positive towards people living with HIV. The Theory of Planned Behaviour constructs explained 56% of the variance in intention to take a sexual history: the control providers perceive they have over taking a sexual history was the strongest contributor (51%), while social pressure explained a further 3%. Attitudes about taking a sexual history did not contribute to intention. Interventions with Cambodian health care providers should focus on improving skills in sexual history-taking.

scholarly journals Assessing Knowledge on Clubfoot Among Parents Having Children with Clubfoot Deformity

2015 ◽  
Vol 14 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Zobaer Alam ◽  
Md Monoarul Haque ◽  
Md Rijwan Bhuiyan ◽  
Md Shahinoor Islam ◽  
Monirul Haque ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Public Health Problem ◽  
Educational Status ◽  
Cross Sectional Study ◽  
Childhood Disability ◽  
Care Providers ◽  
Cross Sectional ◽  
Middle Income ◽  
Level Of Knowledge

Background: The burden of childhood disability as a public health problem in developing countries remains relatively unrecognized. One out of 750 children born in the world suffer from club foot among them 80% are in low and middle income countries. Most of these babies have limited access to receive effective treatment for their clubfoot due to lack o knowledge, awareness and some barriers. We actually don’t know the level of knowledge of parents who have child with clubfoot deformity. The purpose of this study was to assess the level of knowledge of parents who have children with clubfoot during clubfoot treatment. Materials and Methods: This cross sectional study was conducted among 102 parents who have children with clubfoot deformity during its treatment in a selected clinic. The samples were selected purposively from the clinics where clubfoot treatment was given and face to face interview was done by using semi-structured questionnaire. Results: The mean (±SD) age of the respondents were 24.7 (±6.0) years where 87.3% (n=89) respondents ware female and 59.8 %(n=61) respondent’s educational status ware up to primary level. About 44.1% respondents started treatment of their child within 6 months of birth and 33% within 6 to 12 months where 57% (n=58) respondents are referred by health care professional to this clinics. About 93.1% of parents (n=95) said that they knew nothing about clubfoot deformity before their child was diagnosed where 97% are aware after diagnosis of their child. About 93.1% respondents knew the best time for treatment initiation where 59.8% respondents know the correct follow up time of clubfoot management. In case of knowledge of parents’ roles in the treatment of clubfoot about 91.2%, parents have knowledge weekly visit for treatment and 86.3% know the plaster care where 52.9% (n=54) parents have lack of knowledge about how to use the brace Conclusion: There is need to improve the communication skills of clinicians/health care providers offering treatment to children with clubfoot at the Clinics. Need to share information with the parents about the condition. Finally, there is need to emphasize of educating parents about plaster care and how to use brace. DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22882 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 42-46

scholarly journals SERVICES AND PRACTICES OF HEALTH CARE PROVIDERS IN A RURAL AREA OF FAISALABAD.

2011 ◽  
Vol 18 (03) ◽  
pp. 518-524
Author(s):  
GHULAM SARWAR ◽  
FARIDA MANZUR ◽  
IMTIAZ HAMID
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Cross Sectional ◽  
Medical Assistants ◽  
The Public ◽  
Union Council ◽  
Proper Training ◽  
Socio Demographic Factors

Objectives: (1) To determine the mode of services being rendered and practices done by the health care providers of the study area. (2) To identify various socio-demographic factors about the health care providers. A health care provider provides preventive, curative, rehabilitative and spiritual health services to the community. Health care is being provided by not only the registered and qualified doctors, but also by non-qualified non-registered and inexperienced persons in Pakistan. Methodology: A total of 57 health care providers from the union council 42 area in district Faisalabad were included. A pre-tested questionnaire to know about the services and practices of the individuals was served upon them to collect the relevant data. Design: Cross-sectional study. Setting: Union council 42 area in district Faisalabad. Period: 2008. Results: Out of 57, 30 (52.63%) were males and 27 (47.37%) were females. Most of them, 18 (31.6%) were above 49 years of age. 51 (89.47%) were practicing in the private; whereas, only 2(3.51%) in the public sector. Most of the individuals, 21 (36.8%) were LHW and only 2(3.5%) were doctors or medical assistants; 3(5.3%) were dispensers, 9(15.8%) were hakeems and 7 (12.3%) homeopaths. Most of them, 40(70.2%) were matriculates and 14(24.6%) graduates. Only 20 (35.1%) were having certificates and 11(19.3%) were diploma holders. Further, only 2(11.76%) out of 57 were registered with PM&DC and Punjab Medical Faculty. 30 (52.6%) individuals were rendering curative and only 5 (8.8%) preventive services. None of the health care providers was rendering laboratory, x-ray or ultrasound services. Most of the individuals, 36 (63.2%) were practicing allopathy and 7(12.3%) homeopathy way of treatment. Further, most of the professionals, 45 (78.95%) were not doing any surgery. As regards sterilization, the most 8(66.7%) were practicing boiling of instruments. Most of them 47 (82.45%) were giving injections to the patients, however, using disposable syringes, and 27(57.4%) were disposing of the syringes by cutting the needles to dump. 20 (42.55%) were referring their patients to DHQ Hospital and 47 (82.46%) were keeping the record. Conclusions: Qualified medical professionals were scarce in the locality. However, allopathic system of medicine was being widely practiced. Only LHWs were providing curative services with proper training to deliver first aid services.

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