scholarly journals Nurse-led normalised advance care planning service in hospital and community health settings: a qualitative study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Se Ok Ohr ◽  
Peter Cleasby ◽  
Sarah Yeun-Sim Jeong ◽  
Tomiko Barrett
Keyword(s):  
Community Health ◽  
Advance Care Planning ◽  
Structured Interview ◽  
Normalisation Process Theory ◽  
Care Planning ◽  
South Wales ◽  
Qualitative Descriptive ◽  
Advance Care ◽  
Clinical Trials Registry ◽  
Clinical Systems

Abstract Background Advance Care Planning (ACP) by Registered Nurses (RNs) has been emerging. However, there is limited understanding about what RNs experience as they incorporate ACP into their practice. This study aimed to elicit the experiences of ACP RNs with the implementation of a normalised ACP (NACP) service in hospital and community care settings. Methods A qualitative descriptive study invited four ACP RNs who delivered a nurse-led NACP for a 6 months duration at two hospital and two community health care settings in New South Wales (NSW), Australia. The experiences of the ACP RNs were captured through a semi-structured interview and weekly debriefing meetings. The interview recordings were transcribed verbatim and the minutes of weekly debriefing meetings were utilized. Data were analysed by two independent researchers using thematic analysis with the Normalisation Process Theory (NPT) as a methodological framework. Findings The ACP RNs were females with a mean age of 43 years old. Their nursing experiences ranged 2 to 25 years but they had minimal experiences with ACP and had not attended any education about ACP previously. The following four themes were identified in the experiences of the ACP RNs; 1) Embracing NACP service; 2) Enablers and barriers related to patients and health professionals; 3) Enablers and barriers related to ACP RNs; and 4) What it means to be an ACP RN. Conclusion The introduction of a NACP service into existing clinical systems is complex. The study demonstrated the capacity of RNs to engage in ACP processes, and their willingness to deliver an NACP service with a raft of locally specific enablers and barriers. Trial registration The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record

scholarly journals Qualitative assessment of the intention of Chinese community health workers to implement advance care planning using theory of planned behavior

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Bingyu Xing ◽  
Guanmian Liang ◽  
Jing Zhang ◽  
Jinsheng Zhang ◽  
Zhizhi Jiang ◽  
...  
Keyword(s):  
Theory Of Planned Behavior ◽  
Human Resources ◽  
Community Health ◽  
Community Health Workers ◽  
Planned Behavior ◽  
Advance Care Planning ◽  
Health Workers ◽  
Care Planning ◽  
Medical Environment ◽  
Advance Care

Abstract Background The aging population coupled with progressive medical technology has increased the demand for improved quality of end-of-life in China. However, implementation of an advance care planning (ACP) program in mainland China is still in its infancy owing to the significant influence of filial piety in Chinese culture. Research on implementation of ACP program among community health workers (CHWs) is limited. The current study sought to explore the willingness of CHWs to implement ACP based on the theory of planned behavior (TPB) and provide a reference for promotion of ACP in Chinese communities. Methods Phenomenological qualitative study using semi-structured face-to-face interviews. Interviews were audio-recorded. Colaizzi’s method was used for data analysis. The study received ethical approval and all participants provided written consent. Results Thirteen CHWs from 3 community health service centers (CHSCs) in Hangzhou, Zhejiang Province, China were interviewed. Through the analysis of the interview content, we determined that most CHWs have a supportive attitude towards the implementation of ACP, the reasons for which are as follows: relieve suffering of patients and respect their medical autonomy; relieve economic and psychological burden on family members; promote development of community palliative care. However, some CHWs believe that the implementation of ACP will lead to doctor-patient disputes and medical risks. CHWs reported that the support of patients and their families, community lawyers, psychosocial professionals, and CHSCs senior managers helped them to implement ACP. In addition, they indicated that the improvement of doctor-patient communication ability, the improvement of community medical environment, the support of government policy, and the training of CHWs were the promoting factors influencing their implementation of ACP. The hindrance factors include insufficient allocation of community health human resources, imperfect ACP legislation in China, and deep-rooted traditional culture. Conclusion Findings demonstrated that Chinese CHWs tend to support the implementation of ACP, but their willingness to implement is affected by different factors. CHSCs should actively organize standardized ACP training and comprehensively consider community medical environment, organizational norms, and human resources in implementation of ACP.

scholarly journals MO200COVID-19 PANDEMIC INCREASED ADVANCE CARE PLANNING DEMAND

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Alessandro Toccafondi ◽  
Giuseppina Simone ◽  
Marco Lombardi ◽  
Pietro Claudio Dattolo
Keyword(s):  
Advance Care Planning ◽  
Advance Directive ◽  
Planning Process ◽  
Structured Interview ◽  
Care Planning ◽  
Dialysis Patients ◽  
Clinical Routine ◽  
Number Of Patients ◽  
Advance Care ◽  
Future Treatments

Abstract Background and Aims Advance care planning (ACP) enables competent patients to define goals and preferences for future treatments and care, to discuss these goals and preferences with relatives, and if appropriate to record these preferences. After many years of political and social debates, in December 2017 the first advance directive and care planning legislation was approved in Italy. Nevertheless, citizens’ awareness of these issues is scarce as well as the integration of the advance care planning process into clinical routine. The latest data reported to the Italian Parliament by the Ministry of Health indicated that advance directives have been completed by 62030 people, approximately 1.1% of Italian adult population. However, during the last months, the COVID-19 pandemic solicited taking steps towards promoting an advance care planning culture. Indeed, the need of proposing ACP to patients have been recently stressed both by medical associations and national and local institutional documents. Method Since November 2020, our nephrology unit adopted a protocol approved by Ethical committee by Physician Order of Florence, aimed to conduct ACP interventions with dialysis patients. Firstly, all patients were informed about the possibility to taking part in one or more advance care planning conversations with their nephrologist. Secondly, a semi-structured guide to the conversation was created in order to support physicians in conducting the ACP intervention. Finally, patients along with nephrologist and their relatives, could documented their preferences for future treatments and care. Results From November to March only one patient asked to receive an ACP intervention. However, since COVID-19 spread in Italy last March, the number of patients who demanded ACP raised up. In the period from April to July, 15 out of 110 hemodialysis patients treated in our center asked for an ACP intervention and filled-in an advance directive. Specifically, no patients required an immediate discontinuation of dialysis, nevertheless 80% of them stated that would not like to continue with dialysis in case he/she was no longer able to self-determine (e.g. permanent loss of capacity to communicate with others). All patients except one have appointed a personal representative (usually their partner). In the eventuality of cardiac arrest, 60% of patients asked for cardiopulmonary resuscitation. Finally, all patients expressed the wish to spend the last days of life at home. Conclusion The COVID-19 pandemic raised up the number of dialysis patients who required to taking part in a advance care planning intervention. In this sense, the pandemic can be an opportunity for consolidate advance care planning in Italy as well as in other countries, where these interventions are not well known by people and not yet regularly offered in the clinical routine. Using a semi-structured interview for the ACP interview can help the nephrologist to discuss future care and end-of-life topics with their patients.

Prevalence, perceived barriers and sociodemographic correlates of advance care planning in a sample of outpatients

2020 ◽  
Vol 26 (1) ◽  
pp. 76
Author(s):  
Elise Mansfield ◽  
Sarah Jeong ◽  
Amy Waller ◽  
Sally Chan
Keyword(s):  
Advance Care Planning ◽  
Healthcare Providers ◽  
Perceived Barriers ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
South Wales ◽  
Sociodemographic Correlates ◽  
Advance Care ◽  
Advance Care Directive

This study aimed to examine the prevalence and perceived barriers to uptake of advance care planning (ACP), including appointment of an enduring guardian (EG) and completion of an advance care directive (ACD) among Australian adults attending hospital outpatient clinics. Sociodemographic correlates of not completing ACP were also assessed. A cross-sectional survey exploring the uptake of ACP was conducted with outpatients and their accompanying persons aged >18 years (n=191) at one regional hospital in New South Wales, Australia. Rates of completion of an ACD and appointment of an EG were 20% (n=37) and 35% (n=67) respectively. The most common reason for non-completion of an ACD and not appointing an EG was: ‘didn’t think I needed this’. Younger age was associated with not having appointed an EG (OR 3.8, 95% CI 1.2–12.1, P=0.02). No sociodemographic characteristics were significantly associated with non-completion of ACDs. Uptake of ACP is suboptimal among outpatients. Community-based healthcare providers are well positioned to promote ACP with outpatients.

scholarly journals Impact of Community Health Workers on Elderly Patients’ Advance Care Planning and Health Care Utilization

Medical Care ◽  
2017 ◽  
Vol 55 (4) ◽  
pp. 319-326 ◽  
Author(s):  
Debra K. Litzelman ◽  
Thomas S. Inui ◽  
Wilma J. Griffin ◽  
Anthony Perkins ◽  
Ann H. Cottingham ◽  
...  
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Utilization ◽  
Community Health ◽  
Community Health Workers ◽  
Advance Care Planning ◽  
Health Workers ◽  
Care Utilization ◽  
Care Planning ◽  
Advance Care

scholarly journals CAN PERSONS WITH DEMENTIA MEANINGFULLY PARTICIPATE IN ADVANCE CARE PLANNING CONVERSATIONS? A MIXED-METHODS STUDY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S53-S54
Author(s):  
Mi-Kyung Song ◽  
Sandra Ward ◽  
Ken Hepburn ◽  
Sudeshna Paul ◽  
Hyejin Kim ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Advance Care Planning ◽  
Intervention Development ◽  
Decisional Conflict ◽  
Structured Interview ◽  
Care Patient ◽  
Care Planning ◽  
Advance Care ◽  
Panel Review

Abstract Studies of advance care planning (ACP) in persons living with dementia (PLWDs) are rare. We conducted an intervention development study to adapt an efficacious ACP intervention, SPIRIT (Sharing Patient’s Illness Representations to Increase Trust), for PLWDs in early stages and their surrogates and assessed the feasibility/acceptability of the adapted SPIRIT. SPIRIT was adapted by the investigators and underwent expert panel review. The refined SPIRIT was then evaluated in a randomized trial with 23 dyads of PLWDs and their surrogates. Dyads were randomized to SPIRIT in-person (in a private room in a memory clinic) or SPIRIT remote (via videoconferencing from home). Participants completed preparedness outcome measures (dyad congruence on goals of care, patient decisional conflict, surrogate decision-making confidence) 2-3 days postintervention along with a semi-structured interview. PLWDs’ levels of articulation of end-of-life wishes during SPIRIT sessions were rated (3 = expressed wishes very coherently, 2 = somewhat coherently, 1 = unable to express wishes coherently). Fourteen PLWDs had moderate dementia, but all 23 were able to articulate their end-of-life wishes very or somewhat coherently during the SPIRIT session. While decision-making capacity was higher in PLWDs who articulated their wishes very coherently, global cognitive function did not differ by articulation levels. PLWDs and surrogates perceived SPIRIT as beneficial, but the preparedness outcomes did not change from baseline to postintervention in either group. SPIRIT for PLWDs and surrogates engaged them in meaningful ACP discussions. Further research is warranted to test its efficacy and long-term outcomes with a larger and diverse sample.

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