Advance Care Planning—Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT

2021 ◽  
pp. 104990912199180
Author(s):  
Maureen E. Lyon ◽  
Sarah Caceres ◽  
Rachel K. Scott ◽  
Debra Benator ◽  
Linda Briggs ◽  
...  
Keyword(s):  
African American ◽  
End Of Life ◽  
Advance Care Planning ◽  
Latent Class ◽  
Congruence Class ◽  
Care Planning ◽  
Post Intervention ◽  
Persons Living With Hiv ◽  
Advance Care ◽  
End Of Life Treatment

Context: The effect of advance care planning (ACP) interventions on the trajectory of end-of-life treatment preference congruence between patients and surrogate decision-makers is unstudied. Objective: To identify unobserved distinctive patterns of congruence trajectories and examine how the typology of outcome development differed between ACP and controls. Methods: Multisite, assessor-blinded, intent-to-treat, randomized clinical trial enrolled participants between October 2013 to March 2017 from 5 hospital-based HIV clinics. Persons living with HIV(PLWH)/surrogate dyads were randomized to 2 weekly 60-minute sessions: ACP (1) ACP facilitated conversation, (2) advance directive completion; or Control (1) Developmental/relationship history, (2) Nutrition/Exercise. Growth Mixed Modeling was used for 18-month post-intervention analysis. Findings: 223 dyads (N = 449 participants) were enrolled. PLWH were 56% male, aged 22 to 77 years, and 86% African American. Surrogates were 56% female, aged 18 to 82 years, and 84% African American. Two latent classes (High vs. Low) of congruence growth trajectory were identified. ACP influenced the trajectory of outcome growth (congruence in all 5 AIDS related situations) by latent class. ACP dyads had a significantly higher probability of being in the High Congruence latent class compared to controls (52%, 75/144 dyads versus 27%, 17/62 dyads, p = 0.001). The probabilities of perfect congruence diminished at 3-months post-intervention but was then sustained. ACP had a significant effect (β = 1.92, p = 0.006, OR = 7.10, 95%C.I.: 1.729, 26.897) on the odds of being in the High Congruence class. Conclusion: ACP had a significant effect on the trajectory of congruence growth over time. ACP dyads had 7 times the odds of congruence, compared to controls. Three-months post-intervention is optimal for booster sessions.

Impact of mindfulness training on avoidant coping and advance care planning.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 86-86
Author(s):  
Shelley A. Johns ◽  
Kathleen Beck-Coon ◽  
Karen Schmidt ◽  
Timothy E. Stump ◽  
Jennifer Kim Bernat ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Avoidant Coping ◽  
Present Moment ◽  
Care Planning ◽  
Cognitive Avoidance ◽  
Post Intervention ◽  
Psychiatric Disturbance ◽  
Goals Of Care ◽  
Advance Care

86 Background: Timely end-of-life (EOL) discussions and advance care planning (ACP) are crucial to quality cancer care; however, patients, family caregivers (CGs), and oncologists often avoid these tender conversations. When EOL discussions are avoided, patients are more likely to receive non-beneficial treatment near death and CGs are more likely to experience psychiatric disturbance. Mindfulness meditation facilitates emotional regulation and may enhance adaptive coping necessary for EOL discussions and ACP. Methods: Mindfully Optimizing Delivery of End-of-Life (MODEL) Care is a within-group pilot study developed to train patients with advanced-stage solid malignancies and their CGs (n=13 dyads) in present-moment awareness and non-reactive coping through a variety of mindfulness practices. Eligible patients met a threshold for avoidant coping and had not completed a Physician Orders for Scope of Treatment (POST) form documenting care preferences. Cognitive avoidance and quality of life (QoL) for patients and CGs were assessed from baseline (T1) to post-intervention (T2) and 1-month follow-up (T3) with standardized response mean (SRM) effect sizes. ACP from T1 to T3 was assessed descriptively. Results: Moderate decreases in cancer-related avoidance were found for patients (SRM=-0.47) and CGs (SRM=-0.59) T1 to T2, while T1 to T3 effects were small for patients (SRM=-0.31) and large for CGs (SRM=-1.12). At T1, no patient had completed a POST form; by T3, 50% reported completing one and 40% were preparing to do so soon. At T1, 23% of patients reported having had a ‘goals of care’ discussion with their oncologist, with 82% doing so by T3. At T1, 46% of patients reported having discussed ‘goals of care’ with their CGs, with 100% doing so by T3. Large improvements in QoL were found at both time points for patients and CGs (SRMs ranging from 0.85 to 1.21). Conclusions: Mindfulness was associated with mostly moderate reductions in avoidant coping and large improvements in QoL for patients and caregivers, with notable ACP progress for patients.

scholarly journals PROJECT SOAR PARTNERSHIPS: EXPLORING ADVANCE CARE PLANNING AMONG RURAL AFRICAN AMERICANS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S404-S405
Author(s):  
Rebecca S Allen ◽  
Pamela Payne-Foster ◽  
JoAnn S Oliver ◽  
Christopher H Spencer ◽  
Deanne M Dragan
Keyword(s):  
African American ◽  
African Americans ◽  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Preferences ◽  
Care Planning ◽  
Research Project ◽  
Community Partners ◽  
African American Adults ◽  
Advance Care

Abstract Sharing Opinions and Advice about Research (Project SOAR), funded by PCORI, trained individuals living in under-resourced and underserved communities how to evaluate and provide advice to scientists about recruitment procedures, survey items, and intervention components for implementation in their communities. In partnership with the HELLO Project (Van Scoy, Green, & Volpe, 2019), Project SOAR community partners recruited 50 rural African American adults to consider their values, plans, and treatment preferences near the end of life while playing the HELLO game. Community and research partners along with a HELLO Project representative facilitated questionnaire completion and the process of the HELLO game to promote advance care planning. Tables of 10 participants held facilitated discussions for each HELLO game item and recorded their individual wishes and plans in HELLO booklets. Community participants had difficulty completing questionnaires without assistance; however, all were engaged and accepting of game-like discussions regarding advance care planning.

Church leaders and parishioners speak out about the role of the church in advance care planning and end-of-life care

2020 ◽  
pp. 1-7 ◽  
Author(s):  
Danetta Hendricks Sloan ◽  
Tamryn F. Gray ◽  
Darriel Harris ◽  
Theodora Peters ◽  
Anne Belcher ◽  
...  
Keyword(s):  
African American ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Well Being ◽  
Care Planning ◽  
Life Care ◽  
Advance Care ◽  
The Church

Abstract Objective Despite the increased focus on improving advance care planning (ACP) in African Americans through community partnerships, little published research focused on the role of the African American church in this effort. This study examines parishioner perceptions and beliefs about the role of the church in ACP and end-of-life care (EOLC). Method Qualitative interviews were completed with 25 church members (parishioners n = 15, church leader n = 10). The coding of data entailed a direct content analysis approach incorporating team experts for final themes. Results Seven themes emerged: (1) church role on end-of-life, (2) advocacy for health and well-being, (3) health literacy in EOLC, (4) lay health training on ACP and EOLC, (5) church recognized as a trusted source, (6) use of church ministries to sustain programs related to ACP and EOLC, and (7) community resources for EOLC needs. Significance of results The church has a central role in the African American Community. These findings suggest that involving African American churches in ACP and EOLC training can have a positive effect on facilitating planning and care during illness, dying, and death for their congregants.

scholarly journals Association of Participation in an End-of-Life Conversation Game With Advance Care Planning Behavior and Perspectives Among African American Individuals

2020 ◽  
Vol 3 (5) ◽  
pp. e204315 ◽  
Author(s):  
Lauren Jodi Van Scoy ◽  
Benjamin H. Levi ◽  
Pamela Witt ◽  
Cindy Bramble ◽  
Christopher Richardson ◽  
...  
Keyword(s):  
African American ◽  
End Of Life ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

scholarly journals LIGHT: A Church-Based Curriculum for Training African American Lay Health Workers to Support Advance Care Planning and End-of-Life Decision-Making

Health Equity ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. 533-541
Author(s):  
Jerry C. Johnson ◽  
Tara Hayden ◽  
Lynne Allen Taylor ◽  
Arthur Gilbert ◽  
Marshall Paul Hughes Mitchell
Keyword(s):  
Decision Making ◽  
African American ◽  
End Of Life ◽  
Advance Care Planning ◽  
Health Workers ◽  
Care Planning ◽  
Lay Health Workers ◽  
Advance Care ◽  
End Of Life Decision ◽  
Life Decision
Sign in / Sign up

Export Citation Format

Share Document