scholarly journals Helping hospital professionals to implement Advance Care Planning in daily practice: a European Delphi study from field experts

2018 ◽  
Vol 24 (6) ◽  
pp. 433-443 ◽  
Author(s):  
Birgit Vanderhaeghen ◽  
Inge Bossuyt ◽  
Johan Menten ◽  
Peter Rober
Keyword(s):  
Advance Care Planning ◽  
Delphi Study ◽  
Emotional Processing ◽  
Daily Practice ◽  
Patient Characteristics ◽  
Descriptive Statistics ◽  
Care Planning ◽  
Implementation Barriers ◽  
Multidisciplinary Cooperation ◽  
Advance Care

Background Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience implementation barriers in practice. Aims The aim of this study was to investigate what is valued in having ACP conversations by hospital professionals (physicians, nurses, psychologists and social workers) and what they experience as barriers and facilitating factors for having ACP conversations with patients. Methods A Delphi study consisting of two rounds with respectively 21 and 19 multidisciplinary experts from seven European countries was organised. Data were analysed using content analysis and descriptive statistics. Results Participants agreed that ACP is valued mostly because it is seen to improve transmural continuation of care, emotional processing of the loss of a patient, and serenity at the end of life. Reported barriers are patient characteristics blocking patient-centred communication and a lack of knowledge to have these conversations. An important facilitator is multidisciplinary cooperation. Conclusions There is consensus by experts from different settings and countries suggesting that these results can theoretically be applied to hospital settings in Europe. This study reveals that hospital professionals value ACP in hospital practice, but that they encounter several barriers to its implementation.

scholarly journals An e-Delphi Study to Identify Priority Areas for Education on Advance Care Planning in COPD Management

2019 ◽  
Vol 65 (3) ◽  
pp. 347-354
Author(s):  
Art Burgess Kelleher ◽  
Catherine Sweeney ◽  
Tony Foley ◽  
Ruth M Hally ◽  
Elaine Meehan ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Delphi Study ◽  
Care Planning ◽  
Priority Areas ◽  
Advance Care

scholarly journals Preventing unwanted situations and gaining trust: a qualitative study of older people and families’ experiences with advance care planning in the daily practice of primary care

2019 ◽  
Vol 37 (4) ◽  
pp. 519-524
Author(s):  
Jolien J Glaudemans ◽  
Dick L Willems ◽  
Jan Wind ◽  
Bregje D Onwuteaka Philipsen
Keyword(s):  
Primary Care ◽  
Older People ◽  
Advance Care Planning ◽  
Daily Practice ◽  
Care Planning ◽  
Theory Approach ◽  
Face To Face ◽  
Future Care ◽  
Advance Care

Abstract Background Using advance care planning (ACP) to anticipate future decisions can increase compliance with people’s end-of-life wishes, decrease inappropriate life-sustaining treatment and reduce stress, anxiety and depression. Despite this, only a minority of older people engage in ACP, partly because care professionals lack knowledge of approaches towards ACP with older people and their families. Objective To explore older people’s and their families’ experiences with ACP in primary care. Methods We conducted qualitative, semi-structured, face-to-face interviews with 22 older people (aged >70 years, v/m: 11/11), with experience in ACP, and eight of their family members (aged 40–79 years, f/m: 7/1). Transcripts were inductively analysed using a grounded theory approach. Results We distinguished three main themes. (i) Openness and trust: Respondents were more open to ACP if they wanted to prevent specific future situations and less open if they lacked trust or had negative thoughts regarding general practitioners’ (GPs’) time for and interest in ACP. Engaging in ACP appeared to increase trust. (ii) Timing and topics: ACP was not initiated too early. Quality of ACP seemed to improve if respondents’ views on their current life and future, a few specific future care scenarios and expectations and responsibilities regarding ACP were discussed. (iii) Roles of family: Quality of ACP appeared to improve if family was involved in ACP. Conclusions Quality and accessibility of ACP may improve if GPs and nurses involve family, explain GPs’ interest in ACP and discuss future situations older people may want to prevent, and views on their current life and future.

Identification and operationalisation of indicators to monitor successful uptake of advance care planning policies: a modified Delphi study

2021 ◽  
pp. bmjspcare-2020-002780
Author(s):  
Konrad Fassbender ◽  
Patricia Biondo ◽  
Jayna Holroyd-Leduc ◽  
Alexei Potapov ◽  
Tracy Lynn Wityk Martin ◽  
...  
Keyword(s):  
Healthcare System ◽  
Advance Care Planning ◽  
Delphi Study ◽  
Online Survey ◽  
Practice Change ◽  
Public Healthcare ◽  
Care Planning ◽  
Face To Face ◽  
Modified Delphi ◽  
Advance Care

BackgroundIn 2014, the province of Alberta, Canada implemented a province-wide policy and procedures for advance care planning (ACP) and goals of care designation (GCD) across its complex, integrated public healthcare system. This study was conducted to identify and operationalise performance indicators for ACP/GCD to monitor policy implementation success and sustainment of ACP/GCD practice change.MethodsA systematic review and environmental scan was conducted to identify potential indicators of ACP/GCD uptake (n=132). A purposive sample of ACP/GCD stakeholders was invited to participate in a modified Delphi study to evaluate, reduce and refine these indicators through a combination of face-to-face meetings and online surveys.ResultsAn evidence-informed Donabedian by Institute of Medicine (IOM) framework was adopted as an organising matrix for the indicators in an initial face-to-face meeting. Three online survey rounds reduced and refined the 132 indicators to 18. A final face-to-face meeting operationalised the indicators into a measurable format. Nine indicators, covering 11 of the 18 Donabedian×IOM domains, were operationalised.ConclusionsNine ACP/GCD evidence-informed indicators mapping to 11 of 18 Donabedian×IOM domains were endorsed, and have been operationalised into an online ACP/GCD dashboard. The indicators provide a characterisation of ACP/GCD uptake that could be generalised to other healthcare settings, measuring aspects related to ACP/GCD documentation, patient satisfaction and agreement between medical orders and care received. The final nine indicators reflect the stakeholders’ expressed intent to strike a balance between comprehensiveness and feasibility within a large provincial healthcare system.

scholarly journals What do hospitalists experience as barriers and helpful factors for having ACP conversations? A systematic qualitative evidence synthesis

2018 ◽  
Vol 139 (2) ◽  
pp. 97-105 ◽  
Author(s):  
Birgit Vanderhaeghen ◽  
Karen Van Beek ◽  
Mieke De Pril ◽  
Inge Bossuyt ◽  
Johan Menten ◽  
...  
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Evidence Synthesis ◽  
Patient Characteristics ◽  
Qualitative Evidence Synthesis ◽  
Care Planning ◽  
Bibliographic Search ◽  
Advance Care ◽  
Personal Physician ◽  
Helpful Factors

Background: Hospitalists seem to struggle with advance care planning implementation. One strategy to help them is to understand which barriers and helpful factors they may encounter. Aims: This review aims to give an overview on what hospitalists experience as barriers and helpful factors for having advance care planning conversations. Method: A systematic synthesis of the qualitative literature was conducted. Data sources: A bibliographic search of English peer-reviewed publications in PubMed, Embase, CINAHL, Central, PsycINFO, and Web of Science was undertaken. Results: Hospitalists report lacking communication skills which lead to difficulties with exploring values and wishes of patients, dealing with emotions of patients and families and approaching the conversation about letting a patient die. Other barriers are related to different interpretations of the concept advance care planning, cultural factors, like being lost in translation, and medicolegal factors, like fearing prosecution. Furthermore, hospitalists report that decision-making is often based on irrational convictions, and it is highly personal. Physician and patient characteristics, like moral convictions, experience, and personality play a role in the decision-making process. Hospitalists report that experience and learning from more experienced colleagues is helpful. Furthermore, efficient multidisciplinary co-operation is helping. Conclusion: This systematic review shows that barriers are often related to communication issues and the convictions of the involved hospitalist. However, they seem to be preventable by creating a culture where experienced professionals can be consulted, where convictions can be questioned, and where co-operation within and between organizations is encouraged. This knowledge can serve as a basis for implementation.

scholarly journals Experiences with approaches to advance care planning with older people: a qualitative study among Dutch general practitioners

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024762 ◽  
Author(s):  
Jolien Jeltje Glaudemans ◽  
Eric Moll van Charante ◽  
Jan Wind ◽  
John Jacob Oosterink ◽  
Dick Ludolf Willems
Keyword(s):  
Qualitative Study ◽  
Older People ◽  
General Practitioners ◽  
Advance Care Planning ◽  
Older Patients ◽  
Ad Hoc ◽  
Daily Practice ◽  
Community Dwelling ◽  
Care Planning ◽  
Advance Care

ObjectivesAdvance care planning (ACP) with older people needs to be approached differently than ACP with patients with a terminal illness. ACP is still used with only a minority of older patients due to a lack of knowledge regarding appropriate approaches to ACP with older people. General practitioners (GPs) may play a key role in ACP with older people. Therefore, we explored their experiences with and views on approaches to ACP with older patients in daily practice.Design, setting and participantsA qualitative study among a purposive sample of 19 Dutch GPs based on semistructured interviews.ResultsApproaches to ACP with older patients can be divided into two categories: systematic and ad hoc. Systematic approaches consisted of discussing a fixed combination of topics with community-dwelling older patients who are frail, cognitively impaired or are aged >75 years, and with older patients living in residential care homes during group information meetings, intakes, comprehensive geriatric assessments and periodic assessments. Meetings were aimed at making agreements in anticipation of future care, at providing information and encouraging older people to take further steps in ACP. With ad hoc approaches, respondents discussed only one or two topics related to the near future. Ad hoc ACP was mainly done with deteriorating patients or when patients or family initiated ACP. Systematic and ad hoc approaches were used simultaneously or sequentially and were both used for initiating and following up on ACP. Due to a lack of time and knowledge of other occasions and topics than the ones respondents used, respondents seemed to underuse many occasions and topics.ConclusionsAwareness of appropriate systematic and ad hoc approaches for ACP, and the focus on providing information and encouraging older people to take further steps in ACP reported in this study can support GPs and improve older patients’ access to ACP.

Advance care planning for patients with cancer in the palliative phase in Dutch general practices

2018 ◽  
Vol 36 (5) ◽  
pp. 587-593 ◽  
Author(s):  
Daisy J M Ermers ◽  
Karin J H van Bussel ◽  
Marieke Perry ◽  
Yvonne Engels ◽  
Henk J Schers
Keyword(s):  
Advance Care Planning ◽  
Daily Practice ◽  
Health Care Use ◽  
Care Planning ◽  
Electronic Patient Records ◽  
Medical Interventions ◽  
Patients With Cancer ◽  
Advance Care ◽  
General Practices ◽  
Palliative Phase

Abstract Background Advance care planning (ACP) is a crucial element of palliative care. It improves the quality of end-of-life care and reduces aggressive and needless life-prolonging medical interventions. However, little is known about its application in daily practice. This study aims to examine the application of ACP for patients with cancer in general practice. Methods We performed a retrospective cohort study in 11 general practices in the Netherlands. Electronic patient records (EPRs) of deceased patients with colorectal or lung cancer were analysed. Data on ACP documentation, correspondence between medical specialist and GP, and health care use in the last year of life were extracted. Results Records of 163 deceased patients were analysed. In 74% of the records, one or more ACP items were registered. GPs especially documented patients’ preferences for euthanasia (58%), palliative sedation (46%) and preferred place of death (26%). Per patient, GPs received on average six letters from medical specialists. These letters mainly contained information regarding medical treatment and rarely ACP items. In the last year of life, patients contacted the GP over 30 times, and 51% visited the emergency department at least once, of whom 54% in the last month. Conclusions Registration of ACP items in GPs’ EPRs appeared to be limited. ACP elements were rarely subject of communication between primary and secondary care, which may impact the continuity of patient care during the last year of life. More emphasis on registration of ACP items and better exchange of information regarding patients’ preferences are needed.

scholarly journals A11-C Identification of Indicators to Monitor Successful Implementation of Advance Care Planning Policies in Alberta: A Delphi Study

2016 ◽  
Vol 52 (6) ◽  
pp. e13-e14
Author(s):  
Konrad Fassbender ◽  
Jayna Holroyd-Leduc ◽  
Patricia Biondo ◽  
Malcena Stalker ◽  
Alex Potapov ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Delphi Study ◽  
Successful Implementation ◽  
Care Planning ◽  
Advance Care ◽  
Planning Policies

scholarly journals Disparities in Video and Telephone Visits Among Older Adults During the COVID-19 Pandemic: Cross-Sectional Analysis

JMIR Aging ◽  
10.2196/23176 ◽  
2020 ◽  
Vol 3 (2) ◽  
pp. e23176 ◽  
Author(s):  
Christopher H Schifeling ◽  
Prajakta Shanbhag ◽  
Angene Johnson ◽  
Riannon C Atwater ◽  
Claire Koljack ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Advance Care Planning ◽  
Patient Characteristics ◽  
Care Planning ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Advance Care ◽  
Sectional Analysis ◽  
White Patients

Background Telephone and video telemedicine appointments have been a crucial service delivery method during the COVID-19 pandemic for maintaining access to health care without increasing the risk of exposure. Although studies conducted prior to the pandemic have suggested that telemedicine is an acceptable format for older adults, there is a paucity of data on the practical implementation of telemedicine visits. Due to prior lack of reimbursement for telemedicine visits involving nonrural patients, no studies have compared telephone visits to video visits in geriatric primary care. Objective This study aimed to determine (1) whether video visits had longer durations, more visit diagnoses, and more advance care planning discussions than telephone visits during the rapid implementation of telemedicine in the COVID-19 pandemic, and (2) whether disparities in visit type existed based on patient characteristics. Methods We conducted a retrospective, cross-sectional analysis of patients seen at two geriatric clinics from April 23 to May 22, 2020. Approximately 25% of patients who had telephone and video appointments during this time underwent chart review. We analyzed patient characteristics, visit characteristics, duration of visits, number of visit diagnoses, and the presence of advance care planning discussion in clinical documentation. Results Of the 190 appointments reviewed, 47.4% (n=90) were video visits. Compared to telephone appointments, videoconferencing was, on average, 7 minutes longer (mean 37.3 minutes, SD 10 minutes; P<.001) and had, on average, 1.2 more visit diagnoses (mean 5.7, SD 3; P=.001). Video and telephone visits had similar rates of advance care planning. Furthermore, hearing, vision, and cognitive impairment did not result in different rates of video or telephone appointments. Non-White patients, patients who needed interpreter services, and patients who received Medicaid were less likely to have video visits than White patients, patients who did not need an interpreter, and patients who did not receive Medicaid, respectively (P=.003, P=.01, P<.001, respectively). Conclusions Although clinicians spent more time on video visits than telephone visits, more than half of this study’s older patients did not use video visits, especially if they were from racial or ethnic minority backgrounds or Medicaid beneficiaries. This potential health care disparity merits greater attention.

scholarly journals Advance Care Planning in Primary Care. A Retrospective Medical Record Study Among Patients With Different Illness Trajectories.

2021 ◽  
Author(s):  
Yvonne A.C. Bekker ◽  
A. Suntjens ◽  
Y. Engels ◽  
H. Schers ◽  
Gert P. Westert ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Organ Failure ◽  
Medical Record ◽  
Advance Care Planning ◽  
Medical Records ◽  
Daily Practice ◽  
Care Planning ◽  
Patients With Cancer ◽  
Advance Care

Abstract BackgroundAdvance Care Planning (ACP) enables physicians to align healthcare with patients wishes, reduces burdensome life-prolonging medical interventions, and potentially improves the quality of life of patients in the last phase of life. However, little objective information is available about the extent to which structured ACP conversations are held in general practice. Our aim was to examine the documentation of ACP for patients with cancer, organ failure and multimorbidity in medical records (as a proxy for ACP application) in Dutch general practice. MethodsWe chose a retrospective medical record study design in seven primary care facilities. Medical records of 119 patients who died non-suddenly (55 cancer, 28 organ failure and 36 multimorbidity) were analysed. Other variables were: general characteristics, data on ACP documentation, correspondence between medical specialist and GP, and healthcare utilization in the last two years of life. ResultsIn 65% of the records, one or more ACP items was registered. Most often documented were aspects regarding euthanasia (35%), the preferred place of care and death (29%) and concerns and hopes towards the future (29%). Median timing of the first ACP conversation was 126 days before death. ACP was more often documented in patients with cancer (84%) than in those with organ failure (57%) or multimorbidity (42%) (p = 0,000). Patients with cancer had the most frequent (median 3 times, inter-quartile range (IQR) 2-5), and extensive (median 5 items, IQR 2-7) ACP consultations. ConclusionDocumentation of ACP items in medical records by GPs is present, but incomplete, especially in patients with multimorbidity or organ failure. We recommend more attention for, and documentation of ACP in daily practice in order to start anticipatory conversations in time, and to address the needs of all people living with advanced conditions in primary care.

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