Advance Care Planning in Chronically Ill Patients With an Episodic Disease Trajectory in the Acute Care Setting: A Quality Improvement Project

2021 ◽  
pp. 104990912110367
Author(s):  
Molly T. Williams ◽  
Mohana Karlekar ◽  
Anne Coogan ◽  
Megan Shifrin ◽  
Judy Ascenzi
Keyword(s):  
Quality Improvement ◽  
Acute Care ◽  
Advance Care Planning ◽  
Care Setting ◽  
Comparison Group ◽  
Chronically Ill ◽  
Care Planning ◽  
Acute Care Setting ◽  
Disease Trajectory ◽  
Advance Care

Introduction: Advance care planning (ACP) is a fluid discussion between patients and providers to define preferences for future medical care. In the acute care setting, ACP is limited due to lack of structured process for identifying persons who may benefit from ACP. This quality improvement (QI) project aimed to increase the frequency of ACP discussions and documentation of preferences by targeting geriatric patients with an episodic disease trajectory for ACP. Methods: This project used an intervention and comparison group design to target English-speaking, geriatric adults at a large academic medical center with a diagnosis of NYHA class III/IV HF and/or GOLD criteria III/IV COPD for ACP discussions. The intervention group was compared to a group with a range of diagnoses who were approached in a non-systematic way. Results: Thirteen (n = 13) participants completed all aspects of the QI project. Results showed a non-significant increase in the number of patients with a diagnosis of HF and/or COPD who participated in an ACP discussion when compared to the comparison group (n = 20, p = 0.131), as well as a non-significant increase in the number of ACP tools documented in the HER (53.8% compared to 30%) (x = 1.877, p = 0.171). Conclusion: While this project demonstrated non-significant statistical results in the incidence and documentation of an ACP tool, this project increased the number of ACP discussions had, which is clinically significant.

Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting

2020 ◽  
Vol 23 (1) ◽  
pp. 59-68
Author(s):  
Monica Fliedner ◽  
Ruud J. G. Halfens ◽  
Cynthia R. King ◽  
Steffen Eychmueller ◽  
Christa Lohrmann ◽  
...  
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Advance Care Planning ◽  
Care Setting ◽  
Care Planning ◽  
Acute Care Setting ◽  
Roles And Responsibilities ◽  
Advance Care

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.

Advance care planning for patients with COVID-19: a communication guide

2021 ◽  
pp. 1-6
Author(s):  
Natasha Palipane ◽  
Abi Ponnampalampillai ◽  
Srirupa Gupta
Keyword(s):  
Advance Care Planning ◽  
Symptom Control ◽  
Patient Choice ◽  
High Morbidity ◽  
Care Planning ◽  
Goals Of Care ◽  
Disease Trajectory ◽  
Improve Symptom ◽  
Inappropriate Admissions ◽  
Advance Care

In view of the high morbidity and mortality associated with COVID-19, early and honest conversations with patients about goals of care are vital. Advance care planning in its traditional manner may be difficult to achieve given the unpredictability of the disease trajectory. Despite this, it is crucial that patients' care wishes are explored as this will help prevent inappropriate admissions to hospital and to critical care, improve symptom control and advocate for patient choice. This article provides practical tips on how to translate decisions around treatment escalation plans into conversations, both face-to-face and over the phone, in a sensitive and compassionate manner. Care planning conversations for patients with COVID-19 should be individualised and actively involve the patient. Focusing on goals of care rather than ceilings of treatment can help to alleviate anxiety around these conversations and will remind patients that their care will never cease. Using a framework such as the ‘SPIKES’ mnemonic can help to structure this conversation. Verbally conveying empathy will be key, particularly when wearing personal protective equipment or speaking to relatives over the phone. It is also important to make time to recognise your own emotions during and/or after these conversations.

scholarly journals Information needs of patients with chronic diseases and their relatives for web-based advance care planning: a qualitative interview study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Doris van der Smissen ◽  
Judith A. C. Rietjens ◽  
Lisette van Gemert-Pijnen ◽  
Sandra van Dulmen ◽  
Agnes van der Heide ◽  
...  
Keyword(s):  
Chronic Diseases ◽  
Advance Care Planning ◽  
Information Needs ◽  
Care Planning ◽  
Web Based ◽  
Disease Trajectory ◽  
Search Terms ◽  
Practical Support ◽  
Advance Care ◽  
Search For Information

Abstract Background Advance care planning (ACP) enables persons to identify preferences for future treatment and care, and to discuss, record and review these preferences. However, the uptake of ACP among patients with chronic diseases is relatively low. Web-based ACP programs can support patients and their relatives in ACP. However, information needs of patients and their relatives for ACP are unknown. The aim of this study is to explore information needs of patients with chronic disease and their relatives for web-based ACP. Methods We conducted semi-structured interviews with patients with chronic diseases and relatives at their home or at the study center. In three cases, the patient and relative were paired since they preferred to be interviewed together. We asked about information they would search for when to start with ACP, where they would search for information, what search terms they would use on the Internet, and what content and information they would consider important on an ACP website. The interviewer asked participants to clarify their responses during the interview. We used thematic analysis to analyze the interviewees’ responses. Results We interviewed nine patients with different chronic diseases including amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), chronic obstructive pulmonary disease (COPD) and kidney diseases, and seven relatives, namely partners or (adult) children. The interviewees were aged 24 to 80 years, nine were female and seven were male. Both patients with a chronic disease and relatives mentioned comparable information needs. Many interviewees indicated they would use the Internet to search for information about ACP. Mentioned search terms were “advance care planning”, “treatment plan”, “disease trajectory” and names of patient associations. Information needs concerned their disease trajectory and quality of life, medical treatment decisions, practical support in arranging care, the concept of ACP and guidance in ACP, communication of treatment and care preferences, peer support of others with chronic diseases, and information for relatives. Many appreciated encouragement of their healthcare providers to take a pro-active role in ACP. Conclusions We conclude that information needs for ACP included guidance in ACP, support in making decisions about medical treatment, and practical support in arranging care. We recommend adapting web-based ACP information to the information needs of patients and their relatives to increase its findability, uptake and usefulness.

Understanding how advance care planning is approached in the residential aged care setting: A continuum model of practice as an explanatory device

2009 ◽  
Vol 28 (4) ◽  
pp. 211-215 ◽  
Author(s):  
Christopher Shanley ◽  
Elizabeth Whitmore ◽  
Angela Khoo ◽  
Colleen Cartwright ◽  
Amanda Walker ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Continuum Model ◽  
Care Setting ◽  
Aged Care ◽  
Residential Aged Care ◽  
Care Planning ◽  
Advance Care ◽  
Model Of Practice

Quality Improvement Initiatives to Reduce Mortality: An Opportunity to Engage Palliative Care and Improve Advance Care Planning

2018 ◽  
Vol 36 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Signe Peterson Flieger ◽  
Erica Spatz ◽  
Emily J. Cherlin ◽  
Leslie A. Curry
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
End Of Life ◽  
Advance Care Planning ◽  
Secondary Analysis ◽  
Care Quality ◽  
Care Planning ◽  
Goals Of Care ◽  
Patient Goals ◽  
Advance Care

Background: Despite substantial efforts to integrate palliative care and improve advance care planning, both are underutilized. Quality improvement initiatives focused on reducing mortality may offer an opportunity for facilitating engagement with palliative care and advance care planning. Objective: In the context of an initiative to reduce acute myocardial infarction (AMI) mortality, we examined challenges and opportunities for engaging palliative care and improving advance care planning. Methods: We performed a secondary analysis of qualitative data collected through the Leadership Saves Lives initiative between 2014 and 2016. Data included in-depth interviews with hospital executives, clinicians, administrators, and quality improvement staff (n = 28) from 5 hospitals participating in the Mayo Clinic Care Network. Focused analysis examined emergent themes related to end-of-life experiences, including palliative care and advance care planning. Results: Participants described challenges related to palliative care and advance care planning in the AMI context, including intervention decisions during an acute event, delivering care aligned with patient and family preferences, and the culture around palliative care and hospice. Participants proposed strategies for addressing such challenges in the context of improving AMI quality outcomes. Conclusions: Clinicians who participated in an initiative to reduce AMI mortality highlighted the challenges associated with decision-making regarding interventions, systems for documenting patient goals of care, and broader engagement with palliative care. Quality improvement initiatives focused on mortality may offer a meaningful and feasible opportunity for engaging palliative care. Primary palliative care training is needed to improve discussions about patient and family goals of care near the end of life.

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