scholarly journals Advance care planning among older Canadians amid the COVID-19 pandemic: a focus on sexual orientation

2021 ◽  
Vol 15 ◽  
pp. 263235242110190
Author(s):  
Brian de Vries ◽  
Gloria Gutman ◽  
Robert Beringer ◽  
Paneet Gill ◽  
Helena Daudt
Keyword(s):  
Sexual Orientation ◽  
Advance Care Planning ◽  
Online Survey ◽  
Educational Interventions ◽  
Care Planning ◽  
Final Sample ◽  
Women And Education ◽  
Advance Care ◽  
And Bisexual ◽  
Facebook Advertising

Objectives: The COVID-19 pandemic has led to death and hardship around the world, and increased popular discourse about end-of-life circumstances and conditions. The extent to which this discourse and related pandemic experiences have precipitated advance care planning (ACP) activities was the focus of this study with a particular emphasis on sexual orientation. Methods: A large, national online survey was conducted between 10 August and 10 October 2020 in Canada. The final sample of 3923 persons aged 55 and older was recruited using social media, direct email, and Facebook advertising and in conjunction with community groups. Women comprised almost 78% of the sample; just more than 7% of the sample identified as lesbian, gay, and bisexual (LGB). Measures included demographic variables and a series of questions on ACP, including documents and discussions undertaken prior to the pandemic and since its onset. Results: Descriptive analyses revealed few gender or sexual orientation differences on documents and discussions prior to the pandemic; since its onset, LGB persons have completed or initiated wills, powers of attorney, advance directives, representation agreements, and have engaged in ACP discussions in greater proportion than heterosexuals. Logistic regressions reveal the increased likelihood of pre-pandemic ACP engagement by age, gender (women), and education; since the pandemic onset, gender, education, and sexual orientation were predictive of greater ACP engagement. Care discussions were more likely undertaken by women and LGB persons since the pandemic most often with spouses, family, and friends, especially among LGB persons. Discussion: Gender roles and previous pandemic experiences (HIV/AIDS, in particular) are implicated in this pattern of results; opportunities for educational interventions are considered.

scholarly journals The role of sexual orientation, age, living arrangements and self-rated health in planning for end-of-life care for lesbian, gay and bisexual (LGB) older people in the UK

Sexualities ◽  
2020 ◽  
pp. 136346072093238
Author(s):  
Meiko Makita ◽  
Alejandro Bahena ◽  
Kathryn Almack
Keyword(s):  
Sexual Orientation ◽  
End Of Life ◽  
Advance Care Planning ◽  
Living Arrangements ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Self Rated Health ◽  
Advance Care ◽  
And Bisexual

This article reports on findings from the quantitative phase of a two-year research project designed to explore end-of-life care experiences and needs of lesbian, gay, bisexual and transgender people. We draw on a subset of the sample (N  = 180/237) to analyse the relationship between advance care planning, sexual orientation, living arrangements and self-rated health. The results contribute to a growing body of evidence on how sexual minorities approach and make decisions on advance care planning. A greater understanding of such patterns could help inform the way healthcare professionals engage in conversations about end-of-life care planning with older LGB people.

Enabling Advance Care Planning in Dementia Care: A Primary Care Approach

2020 ◽  
pp. 082585972097393
Author(s):  
Linda Lee ◽  
Loretta M. Hillier ◽  
Stephanie K. Lu ◽  
Donna Ward
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Health Professionals ◽  
Online Survey ◽  
Ease Of Use ◽  
Depth Information ◽  
Care Planning ◽  
Care Approach ◽  
Memory Clinics ◽  
Advance Care

Background: Lack of tools to support advance care planning (ACP) has been identified as a significant barrier to implementing these discussions. Aim: We pilot tested an ACP framework tool for use with persons living with dementia (PLWD) in primary care-based memory clinics and an Adult Day Program; this study describes user and recipient experiences with this framework. Methods: We used a mixed methods approach. Health professionals completed an online survey following pilot testing and PLWD and substitute decision makers (SDM) completed survey immediately following the ACP discussion assessing their satisfaction (5-point scale) with the framework and exploring potential outcomes. Interviews with health professionals, PLWD, and SDM were conducted to gather more in-depth information on their perceptions of the ACP framework/ discussion. Results: Surveys were completed by 12 health professionals, 13 PLWD, and 16 SDM. While PLWD and SDM were satisfied with the ACP discussion (M = 4.0/5), health professionals were minimally satisfied with the ease of use of the framework (M = 2.0/5), acceptability for patients (M = 2.4/5) and feasibility in practice (M = 1.9/5). Sixteen interviews were completed with 8 health professionals, 1 PLWD, and 7 SDM. While health professionals valued ACP, lack of time and training were identified barriers to framework use. SDM felt better prepared for future decisions and PLWD were put at ease, knowing that their wishes for care were understood. Conclusion: PLWD and SDM value the opportunity for ACP, and although health professionals identified some concerns with framework administration, they acknowledge the value and importance of ACP. Continuing efforts to refine ACP processes are justified.

scholarly journals Association Between Training Experience and Attitudes Toward Advance Care Planning Among Healthcare Professionals: A Cross-Sectional Study

2020 ◽  
Author(s):  
Helen Yue-lai Chan ◽  
Annie Oi-ling Kwok ◽  
Kwok-keung Yuen ◽  
Derrick Kit-sing Au ◽  
Jacqueline Kwan-yuk Yuen
Keyword(s):  
Advance Care Planning ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Decisional Conflict ◽  
Cross Sectional Study ◽  
Care Planning ◽  
Training Experience ◽  
Cross Sectional ◽  
Cultural Taboos ◽  
Advance Care

Abstract Background: Training has been found effective in improving healthcare professionals’ knowledge, confidence, and skills in conducting advance care planning (ACP). However, its association with their attitudes toward ACP, which is crucial to its implementation, remained unclear. To fill this gap, this paper examines the association between their attitudes toward ACP and relevant training experiences.Methods: An online survey about attitudes toward ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted.Results: Of 250 respondents, approximately half (51.6%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001–0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience.Conclusions: This paper revealed the association between training and positive attitudes toward ACP among healthcare professionals. The findings showed that training is a predictor of their preparedness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.

Variability of physician perspectives toward advance care planning for patients with incurable cancer and congestive heart failure.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 12-12
Author(s):  
Manisha Chandar ◽  
Bruce Brockstein ◽  
Alan Zunamon ◽  
Irwin Silverman ◽  
Sarah Dlouhy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Congestive Heart Failure ◽  
Cancer Patients ◽  
Advance Care Planning ◽  
Primary Care Physicians ◽  
Online Survey ◽  
Care Planning ◽  
Incurable Cancer ◽  
Advance Care

12 Background: Advance Care Planning (ACP) discussions afford patients and physicians a chance to better understand patients’ values and wishes regarding end-of-life care; however these conversations typically take place late in the course of a disease, or not at all. The goal of this study was to understand attitudes of oncologists, cardiologists, and primary care physicians (PCPs) towards ACP. We also aimed to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system aimed at improving ACP completion rate. Methods: A 23-question cross-sectional online survey was created and distributed to cardiologists, oncologists, primary care physicians and cardiology and oncology support staff at the NorthShore University Health System (NorthShore) from February-March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool. Results: Only 15% of cardiologists felt it was their responsibility to conduct ACP with their congestive heart failure (CHF) patients. In contrast, 68% of oncologists accepted responsibility for ACP in incurable cancer patients. Sixty-eight percent of PCPs felt personally responsible for conducting ACP discussions with CHF patients, while only 34% felt the same about cancer patients. Documentation of ACP in the electronic health record (EHR) was inconsistent among specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient’s family towards these discussions were also significant reported barriers. Conclusions: Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study feeling more personal responsibility for carrying out these discussions with cancer patients than cardiologists with their heart failure patients. Robust implementation of ACP across the spectrum of medical illnesses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and ambulatory settings.

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.

Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure

2016 ◽  
Vol 34 (5) ◽  
pp. 423-429 ◽  
Author(s):  
Manisha Chandar ◽  
Bruce Brockstein ◽  
Alan Zunamon ◽  
Irwin Silverman ◽  
Sarah Dlouhy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Advance Care Planning ◽  
Online Survey ◽  
Analysis Tool ◽  
Care Planning ◽  
Care Providers ◽  
Major Barrier ◽  
Medical Diagnoses ◽  
Advance Care

Background: Advance care planning (ACP) discussions afford patients and physicians a chance to better understand patients’ values and wishes regarding end-of-life care; however, these conversations typically take place late in the course of a disease. The goal of this study was to clarify attitudes of oncologists, cardiologists, and primary care physicians (PCPs) toward ACP and to identify persistent barriers to timely ACP discussion following a quality improvement initiative at our health system geared at improvement in ACP implementation. Methods: A 20-question, cross-sectional online survey was created and distributed to cardiologists, oncologists, PCPs, and cardiology and oncology support staff at the NorthShore University HealthSystem (NorthShore) from February to March 2015. A total of 117 individuals (46% of distributed) completed the surveys. The results were compiled using an online survey analysis tool (SurveyMonkey, Inc., Palo Alto, California, USA). Results: Only 15% of cardiologists felt it was their responsibility to conduct ACP discussions with their patients having congestive heart failure (CHF). In contrast, 68% of oncologists accepted this discussion as their responsibility in patients with terminal cancer ( P < .01). These views were mirrored by PCPs, as 68% of PCPs felt personally responsible for ACP discussion with patients having CHF, while only 34% felt the same about patients with cancer. Reported documentation of these discussions in the electronic health record was inconsistent between specialties. Among all surveyed specialties, lack of time was the major barrier limiting ACP discussion. Perceived patient discomfort and discomfort of the patient’s family toward these discussions were also significant reported barriers. Conclusion: Attitudes toward ACP implementation vary considerably by medical specialty and medical condition, with oncologists in this study tending to feel more personal responsibility for these discussions with patients having cancer than cardiologists with their patients having heart failure. Robust implementation of ACP across the spectrum of medical diagnoses is likely to require a true collaboration between office-based PCPs and specialists in both the inpatient and the ambulatory settings.

Midlevel provider utilization within a large community oncology network.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 282-282
Author(s):  
Sabrina Q. Mikan ◽  
Melinda Madison Cody ◽  
Lori Lindsey ◽  
Patricia Carter ◽  
J. Russell Hoverman ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Online Survey ◽  
Care Delivery ◽  
Signs And Symptoms ◽  
Physician Assistants ◽  
Care Planning ◽  
Large Network ◽  
Genetic Risk Assessment ◽  
Community Oncology ◽  
Advance Care

282 Background: The Association of American Medical Colleges (AAMC) reports that 56% of Oncologists work with midlevel providers (MLPs). MLPs include physician assistants (PAs) and advanced practice nurses (APNs). Within our large network of community oncology practices,there are 241 MLPs (88 PAs and 153 APNs). The MLP role encompasses the continuum of care beginning with genetic risk assessment throughout treatment, health promotion teaching, survivorship management and advance care planning (ACP) services. Methods: We used an online survey to elicit self-reported proficiency in eight core health care delivery roles. A 52 item, 5-point Likert scale (novice, advanced beginner, competent, proficient, expert) survey was sent in March 2013 to all MLPs. Results: Of all MLPs (n=241) invited to participate, 103 (43.5%) responded anonymously. Over half of all MLPs reported feeling proficient in the areas of collaborating with multi-disciplinary teams to formulate a plan of care (50.4%), facilitating patient and family decision-making in treatments, symptom management and end-of-life care (53.3%), and providing information to patients and families to facilitate adherence to cancer treatments and supportive care (54.2%). Secondly, the MLPs were confident in their ability to provide proficient care in health assessment through physical exam (46.6%), disease progression signs and symptoms (44.7%), and incorporating resources that meet diverse needs of the patients into the planning and delivery of care (52.3%) areas. Finally, the areas where MLPs reported feeling less than proficient were in specialty areas such as survivorship (34.2%) and genetics (34.2%). Also noted, for 45.7% of respondents, ACP was performed only 1-20% of their time. Conclusions: Self-assessment is one form of measurement that allows the individual provider to identify their strengths and weaknesses. It is important so that educational resources can be created, tested, and shared amongst providers to continue to improve their confidence and care delivery. Ongoing work in developing strong tools for survivorship visits, advance care planning, and genetic counseling within our network, is recognized as an imperative part of advancing PA and APN skills and quality patient care.

scholarly journals Development of a Japanese version of the Advance Care Planning Engagement Survey: Examination of its reliability and validity

2020 ◽  
pp. 1-7
Author(s):  
Hiroko Okada ◽  
Sayaka Takenouchi ◽  
Tsuyoshi Okuhara ◽  
Haruka Ueno ◽  
Takahiro Kiuchi
Keyword(s):  
Factor Structure ◽  
Internal Consistency ◽  
Advance Care Planning ◽  
Online Survey ◽  
Japanese Version ◽  
Original Version ◽  
Care Planning ◽  
Validity And Reliability ◽  
Floor Effect ◽  
Advance Care

Abstract Objectives The importance of supporting advance care planning (ACP) by healthcare professionals is recognized worldwide, and assessing the outcomes, such as people's understanding and readiness for ACP, using an appropriate instrument is essential. We, therefore, developed a Japanese version of the Advance Care Planning Engagement Survey (ACP Engagement Survey; 15 items, 9 items, and 4 items), an international scale for assessing the progress of the ACP, and examined its validity and reliability. Methods The ACP Engagement Survey was translated into Japanese, back-translated, and culturally adapted, and the final version was reviewed by the author of the original version. Data on basic demographic information and ACP-related experiences were simultaneously collected as external criteria in an online survey of older adults with chronic diseases. The Cronbach's alpha was calculated to assess its internal consistency, and a retest was performed three days later to calculate the intra-class correlation coefficients (ICCs). Results A total of 200 respondents (mean age 70; 9.5% female) were included in the analysis. None of the items showed a ceiling effect, but several items did exhibit a floor effect. The factor structure was the same 2-factor structure as the original version, and both factors exhibited a high cumulative contribution rate. The Cronbach's alphas were 0.94 (15-item version), 0.91 (9-item version), and 0.95 (4-item version), and ICCs were of 0.88 (15-item version), 0.9 (9-item version), and 0.84 (4-item version). Significance of results The Japanese version of the ACP Engagement Survey was confirmed to have very good reliability regarding both internal consistency and test-retest reliability. Together with the result of the item analysis, we can conclude that the Japanese version of the ACP Engagement Survey is sufficiently reliable to be utilized in interventional studies, and it has acceptable content validity, construct validity, and criterion-related validity.

scholarly journals Educational Interventions to Improve Advance Care Planning Discussions, Documentation and Billing

2020 ◽  
pp. 104990912095108
Author(s):  
Cristine B. Henage ◽  
J. Marvin McBride ◽  
Joseph Pino ◽  
Jessica Williams ◽  
Jill Vedovi ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Advance Care Planning ◽  
Primary Care Providers ◽  
Educational Interventions ◽  
Care Planning ◽  
Interprofessional Team ◽  
Advance Care

Background/Objectives: To determine the impact of educational interventions, clinic workflow redesign, and quality improvement coaching on the frequency of advance care planning (ACP) activities for patients over the age of 65. Design: Nonrandomized before-and-after study. Setting: 13 ambulatory care clinics with 81 primary care providers in eastern and central North Carolina. Participants: Patients across 13 primary care clinics staffed by 66 physicians, 8 physician assistants and 7 family nurse practitioners. Interventions: Interprofessional, interactive ACP training for the entire interprofessional team and quality improvement project management with an emphasis on workflow redesign. Measurements: From July 2017 through June 2018—number of ACP discussions, number of written ACP documents incorporated into the electronic medical record (EMR), number of ACP encounters billed. Results: Following the interventions, healthcare providers were more than twice as likely to conduct ACP discussions with their patients. Patients were 1.4 times more likely to have an ACP document included in their electronic medical record. Providers were significantly ( p < 0.05) more likely to bill for an ACP encounter in only one clinic. Conclusions: Implementing ACP education for all clinic staff, planning for workflow changes to involve the entire interprofessional team and supporting ACP activities with quality improvement coaching leads to statistically significant improvements in the frequency of ACP discussions, the number of ACP documents included in the electronic medical record and number of ACP encounters billed.

scholarly journals Association between training experience and readiness for advance care planning among healthcare professionals: a cross-sectional study 

2020 ◽  
Author(s):  
Helen Yue-lai Chan ◽  
Annie Oi-ling Kwok ◽  
Kwok-keung Yuen ◽  
Derrick Kit-sing Au ◽  
Jacqueline Kwan-yuk Yuen
Keyword(s):  
Advance Care Planning ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Clinical Work ◽  
Decisional Conflict ◽  
Cross Sectional Study ◽  
Care Planning ◽  
Training Experience ◽  
Cross Sectional ◽  
Advance Care

Abstract Background: Training has been found effective in improving healthcare professionals’ knowledge, confidence, and skills in conducting advance care planning (ACP). However, the association between training and its actual practice in the clinical setting has not been well demonstrated. To fill this gap, this paper examines the association between their readiness for ACP, in terms of perceived relevancy of ACP with their clinical work, attitudes toward and confidence and willingness to perform it, based on the Theory Planned Behavior and relevant training experiences.Methods: An online survey about experiences about ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted. Results: Of 250 respondents, approximately half (51.6%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and different levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001–0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience.Conclusions: This paper revealed the association between training and higher level of readiness toward ACP among healthcare professionals. The findings showed that training is a predictor of their readiness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.

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