Toward Hospital Implementation of Advance Care Planning: Should Hospital Professionals Be Involved?

2017 ◽  
Vol 28 (3) ◽  
pp. 456-465 ◽  
Author(s):  
Birgit Vanderhaeghen ◽  
Inge Bossuyt ◽  
Sybille Opdebeeck ◽  
Johan Menten ◽  
Peter Rober
Keyword(s):  
Content Analysis ◽  
Grounded Theory ◽  
Social Workers ◽  
Advance Care Planning ◽  
Implementation Process ◽  
Successful Implementation ◽  
Care Planning ◽  
Hospital Practice ◽  
External Auditors ◽  
Advance Care

In Belgium, Advance Care Planning (ACP) is not well implemented in hospital practice. One of the premises for successful implementation is involving the adopters in the implementation process. In hospital, important adopters of ACP are physicians, nurses, social workers, and psychologists. First, this study wants to understand what the characteristics are of ACP in hospital, according to professionals. Second, this study aims to give an insight in the experienced value of ACP. Third, the experienced barriers to have ACP conversations are explored. Twenty-four interviews were taken and analyzed with Content Analysis based on Grounded Theory. Three independent external auditors surveilled the analysis. ACP in hospital exists by the grace of the initiative of the actors involved in the case. Professionals perceive fields of tension between one another; barriers to ACP communication. ACP is mainly considered valuable because it is a process that creates time for exploration and reflection.

scholarly journals What Is Good Advance Care Planning According to Hospitalized Palliative Patients and Their Families? An Explorative Study

2020 ◽  
Vol 35 (4) ◽  
pp. 236-242
Author(s):  
Birgit Vanderhaeghen ◽  
Inge Bossuyt ◽  
Johan Menten ◽  
Peter Rober
Keyword(s):  
Advance Care Planning ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Relevant Information ◽  
Successful Implementation ◽  
Care Planning ◽  
Hospital Practice ◽  
Recall Procedure ◽  
Advance Care ◽  
Palliative Patients

Background: Advance care planning is not well implemented in Belgian hospital practice. In order to obtain successful implementation, implementation theory states that the adopters should be involved in the implementation process. This information can serve as a basis for creating better implementation strategies. Aim: For this study, we asked hospitalized palliative patients and their families what they experienced as good advance care planning. Methods: Twenty-nine interviews were taken from patients and families, following the Tape Assisted Recall procedure of Elliot. These interviews were analyzed using content analysis based on grounded theory. To improve reliability, 3 independent external auditors audited the analysis. Results: Results show that hospitalized palliative patients and families want to have advance care planning communication about treatment and care throughout their disease and about different aspects: social, psychological, physical, practical, and medical. They prefer to have these conversations with their supervising physician. They report 4 important goals of advance care planning communication: establishing a trustful relationship with the physician, in which they feel the involvement of the physician; giving and receiving relevant information for the decision process, making a personal decision about which treatment and care are preferred; and finding consensus between the preferred decision of the physician, the patient and the family concerning the treatment and care policy. Conclusion: This study can contribute to advance care planning implementation in hospital practice because it gives in insight into which elements in advance care planning patients and families experience as necessary and when advance care planning is necessary to them.

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.

Cultural Differences in Advance Care Planning and Implications for Practice

2021 ◽  
pp. 003022282110295
Author(s):  
Jung-Hwa Ha ◽  
Changsook Lee ◽  
Jennifer Yoo
Keyword(s):  
Social Workers ◽  
Cultural Differences ◽  
Advance Care Planning ◽  
Qualitative Interviews ◽  
Relationship Building ◽  
Cultural Norms ◽  
Care Planning ◽  
The Us ◽  
Health Related ◽  
Advance Care

This study examined cultural differences in advance care planning (ACP) and various strategies that social workers use to initiate conversations on ACP. We conducted qualitative interviews with 12 social workers in South Korea and the US and a thematic content analysis of the transcribed data. Our findings show that different cultural norms and generational viewpoints surrounding death and health-related decision-making influence how people prepare for end-of-life care (EOLC). Whereas principles of self-determination and autonomy guide ACP practices in the US, decisions regarding EOLC are more often made in consultation with family members in Korean and Korean-American communities. Nevertheless, social workers in both countries identified relationship-building, empowerment, and individualized approaches as common strategies in initiating discussions on ACP.

scholarly journals Couples affected by dementia and their experiences of advance care planning: a grounded theory study

2018 ◽  
Vol 40 (2) ◽  
pp. 439-460 ◽  
Author(s):  
Tony Ryan ◽  
Jane McKeown
Keyword(s):  
Grounded Theory ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Policy And Practice ◽  
Global Policy ◽  
Formal Service ◽  
People With Dementia ◽  
Advance Care ◽  
End Of Life Issues

AbstractGlobal policy places emphasis on the implementation and usage of advance care planning (ACP) to inform decision making at the end of life. For people with dementia, where its use is encouraged at the point of diagnosis, utilisation of ACP is relatively poor, particularly in parts of Europe. Using a constructivist grounded theory methodology, this study explores the ways in which co-residing couples considered ACP. Specifically, it seeks to understand the ways in which people with dementia and their long-term co-residing partners consider and plan, or do not plan, for future medical and social care. Sixteen participants were interviewed. They identified the importance of relationships in the process of planning alongside an absence of formal service support and as a result few engaged in ACP. The study recognises the fundamental challenges for couples in being obliged to consider end-of-life issues whilst making efforts to ‘live well’. Importantly, the paper identifies features of the ACP experience of a relational and biographical nature. The paper challenges the relevance of current global policy and practice, concluding that what is evident is a process of ‘emergent planning’ through which couples build upon their knowledge of dementia, their networks and relationships, and a number of ‘tipping points’ leading them to ACP. The relational and collective nature of future planning is also emphasised.

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.

scholarly journals Advance Care Planning for Older People with Cancer and Its Implications in Asia: Highlighting the Mental Capacity and Relational Autonomy

Geriatrics ◽  
2018 ◽  
Vol 3 (3) ◽  
pp. 43 ◽  
Author(s):  
Cheng-Pei Lin ◽  
Shao-Yi Cheng ◽  
Ping-Jen Chen
Keyword(s):  
Older People ◽  
Advance Care Planning ◽  
Positive Impact ◽  
Mental Capacity ◽  
Capacity Assessment ◽  
Successful Implementation ◽  
Care Planning ◽  
Relational Autonomy ◽  
Healthcare Outcomes ◽  
Advance Care

With dramatically increasing proportions of older people, global ageing has remarkably influenced healthcare services and policy making worldwide. Older people represent the majority of patients with cancer, leading to the increasing demand of healthcare due to more comorbidities and inherent frailty. The preference of older people with cancer are often ignored, and they are considered incapable of making choices for themselves, particularly medical decisions. This might impede the provision of their preferred care and lead to poor healthcare outcomes. Advance care planning (ACP) is considered an effective intervention to assist older people to think ahead and make a choice in accordance with their wishes when they possess capacity to do so. The implementation of ACP can potentially lead to positive impact for patients and families. However, the assessment of mental capacity among older adults with cancer might be a crucial concern when implementing ACP, as loss of mental capacity occurs frequently during disease deterioration and functional decline. This article aims to answer the following questions by exploring the existing evidence. How does ACP develop for older people with cancer? How can we measure mental capacity and what kind of principles for assessment we should apply? What are the facilitators and barriers when implementing an ACP in this population? Furthermore, a discussion about cultural adaptation and relevant legislation in Asia is elucidated for better understanding about its cultural appropriateness and the implications. Finally, recommendations in relation to early intervention with routine monitoring and examination of capacity assessment in clinical practice when delivering ACP, reconciling patient autonomy and family values by applying the concept of relational autonomy, and a corresponding legislation and public education should be in place in Asia. More research on ACP and capacity assessment in different cultural contexts and policy frameworks is highlighted as crucial factors for successful implementation of ACP.

Involvement of Japanese Care Managers and Social Workers in Advance Care Planning

2018 ◽  
Vol 14 (4) ◽  
pp. 315-327 ◽  
Author(s):  
Yoshihisa Hirakawa ◽  
Chifa Chiang ◽  
Mayu Yasuda Uemura ◽  
Atsuko Aoyama
Keyword(s):  
Social Workers ◽  
Advance Care Planning ◽  
Care Planning ◽  
Care Managers ◽  
Advance Care
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