scholarly journals Efficacy of Normalisation of Advance Care Planning (NACP) for people with chronic diseases in hospital and community settings: a quasi-experimental study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Jeong ◽  
Peter Cleasby ◽  
Se Ok Ohr ◽  
Tomiko Barrett ◽  
Ryan Davey ◽  
...  
Keyword(s):  
Experimental Study ◽  
Chronic Diseases ◽  
Advance Care Planning ◽  
Fixed Effects ◽  
Care Planning ◽  
Community Settings ◽  
Link Type ◽  
Quasi Experimental ◽  
Advance Care ◽  
And Control

Abstract Background Advance Care Planning (ACP) has emerged to improve end-of-life processes and experiences. However, the available evidence presents the gloomy picture of increasing number of older people living with chronic diseases and the mismatch between their preferences for and the actual place of death. The study aimed to investigate the efficacy of normalisation of an Advance Care Planning (NACP) service delivered by specially trained Registered Nurses (RNs) in hospital and community settings. Methods A quasi-experimental study was conducted involving 16 sites (eight hospital and eight community sites) in Australia. Patients who were aged ≥18 years, who had at least one of nine chronic conditions, and who did not have an Advance Care Directive (ACD) were offered the NACP service. ACP was normalised as part of routine service on admission. The intervention, NACP, was a series of facilitated conversations about the components of ACP. The primary outcomes which included the completion of ACDs, and/or appointment of an Enduring Guardian (EG), were assessed in both intervention and control sites at pre and post intervention stages. Numbers of patients who completed an ACD or appointed an EG were described by count (percentage). ACD completion was compared between intervention and control sites using a logistic mixed effects regression model. The model includes fixed effects for treatment group, period, and their interaction, as well as random site level intercepts. Secondary model included potentially confounding variables as covariates, including age, sex and chronic diseases. Results The prevalence of legally binding ACDs in intervention sites has increased from five to 85 (from 0.85% in pre to 17.6% in post), whereas it has slightly decreased from five to 2 (from 1.2% in pre and to 0.49% in post) in control sites (the difference in these changes being statistically significant p < 0.001). ACD completion rate was 3.6% (n = 4) in LHD1 and 1.2% (n = 3) in LHD2 in hospital whereas it was 53% (n = 26) in LHD1 and 80% (n = 52) in LHD2 in community. Conclusions The study demonstrated that NACP service delivered by ACP RNs was effective in increasing completion of ACDs (interaction odds ratio = 50) and was more effective in community than hospital settings. Involvement of various healthcare professionals are warranted to ensure concordance of care. Trial registration The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246) on 03/10/2018. The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx

scholarly journals Prevalence of advance care planning practices among people with chronic diseases in hospital and community settings: a retrospective medical record audit

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Jeong ◽  
Tomiko Barrett ◽  
Se Ok Ohr ◽  
Peter Cleasby ◽  
Ryan Davey ◽  
...  
Keyword(s):  
Health Care ◽  
Medical Record ◽  
Chronic Diseases ◽  
Advance Care Planning ◽  
Healthcare Professionals ◽  
Care Planning ◽  
Community Settings ◽  
Link Type ◽  
Advance Care ◽  
Medical Record Audit

Abstract Background Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community settings is rarely reported. Methods The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites in eight hospital and eight community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan. Results The overall prevalence of ACD was 2.8% (n = 28) out of 1006 audited records, and only 10 (1%) of them were legally binding. The number of EGs appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n = 144) of the resuscitation plans indicated ‘Not-for-resuscitation’. Conclusions The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or Enduring Guardian in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals’ education. 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 http://www.anzctr.org.au/trial/MyTrial.aspx

scholarly journals Prevalence of Advance Care Planning Practices Among People with Chronic Diseases in Hospital and Community Settings: A Quasi-Experimental Design

2020 ◽  
Author(s):  
Sarah Yeun-Sim Jeong ◽  
Tomiko Barrett ◽  
Se Ok Ohr ◽  
Peter Cleasby ◽  
Ryan Davey
Keyword(s):  
Health Care ◽  
Chronic Diseases ◽  
Advance Care Planning ◽  
Healthcare Professionals ◽  
Community Setting ◽  
Care Planning ◽  
Community Settings ◽  
Future Health ◽  
Number Of Patients ◽  
Advance Care

Abstract Background: Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community setting is rarely reported.Methods: The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites (eight intervention and eight control) in hospital and community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan. Results: The overall prevalence of ACD was 2.8% (n=28) out of 1006 audited records, and only 10 of them were legally binding. The number of EGs legally appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n=144) of the resuscitation plans advised ‘Not-for-resuscitation’. Conclusions: The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or EG in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals’ education. 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 http://www.anzctr.org.au/trial/MyTrial.aspx

scholarly journals Evaluating if an Advance Care Planning Intervention Promotes Do-Not-Resuscitate Orders by Facilitating Accurate Prognostic Awareness

2020 ◽  
Vol 18 (12) ◽  
pp. 1658-1666
Author(s):  
Fur-Hsing Wen ◽  
Chen Hsiu Chen ◽  
Wen-Chi Chou ◽  
Jen-Shi Chen ◽  
Wen-Cheng Chang ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Hierarchical Linear Modeling ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Care Planning ◽  
Do Not Resuscitate ◽  
Link Type ◽  
Advance Care ◽  
And Control ◽  
Dnr Orders

Background: Issuing do-not-resuscitate (DNR) orders has seldom been an outcome in randomized clinical trials of advance care planning (ACP) interventions. The aim of this study was to examine whether an ACP intervention facilitating accurate prognostic awareness (PA) for patients with advanced cancer was associated with earlier use of DNR orders. Patients and Methods: Participants (n=460) were randomly assigned 1:1 to the experimental and control arms, with 392 deceased participants constituting the final sample of this secondary analysis study. Participants in the intervention and control arms had each received an intervention tailored to their readiness for ACP/prognostic information and symptom-management education, respectively. Effectiveness in promoting a DNR order by facilitating accurate PA was determined by intention-to-treat analysis using multivariate logistic regression with hierarchical linear modeling. Results: At enrollment in the ACP intervention and before death, 9 (4.6%) and 8 (4.1%) participants and 168 (85.7%) and 164 (83.7%) participants in the experimental and control arms, respectively, had issued a DNR order, without significant between-arm differences. However, participants in the experimental arm with accurate PA were significantly more likely than participants in the control arm without accurate PA to have issued a DNR order before death (adjusted odds ratio, 2.264; 95% CI, 1.036–4.951; P=.041). Specifically, participants in the experimental arm who first reported accurate PA 31 to 90 days before death were significantly more likely than their counterparts in the control arm who reported accurate PA to have issued a DNR order in the next wave of assessment (adjusted odds ratio, 13.365; 95% CI, 1.989–89.786; P=.008). Both arms issued DNR orders close to death (median, 5–6 days before death). Conclusions: Our ACP intervention did not promote the overall presence of a DNR order. However, our intervention facilitated the issuance of NDR orders before death among patients with accurate PA, especially those who reported accurate PA 31 to 90 days before death, but it did not facilitate the issuance of DNR orders earlier than their counterparts in the control arm.ClinicalTrial.gov Identification: NCT01912846

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.

scholarly journals Effect of advance care planning discussions with trained nurses in older adults with chronic diseases in Japan

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Hiroko Okada ◽  
Takahiro Kiuchi ◽  
Tsuyoshi Okuhara ◽  
Yoshiyuki Kizawa
Keyword(s):  
Older Adults ◽  
Chronic Diseases ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

scholarly journals Advance Care Planning in Neurodegenerative Disorders: A Scoping Review

2022 ◽  
Vol 19 (2) ◽  
pp. 803
Author(s):  
Andrea Giordano ◽  
Ludovica De Panfilis ◽  
Marta Perin ◽  
Laura Servidio ◽  
Marta Cascioli ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Scoping Review ◽  
Neurodegenerative Disorders ◽  
Health Professionals ◽  
Care Planning ◽  
Randomized Controlled ◽  
Quasi Experimental ◽  
Advance Care ◽  
Almost All ◽  
Lateral Sclerosis

Advance care planning (ACP) is increasingly acknowledged as a key step to enable patients to define their goals/preferences for future medical care, together with their carers and health professionals. We aimed to map the evidence on ACP in neurodegenerative disorders. We conducted a scoping review by searching PubMed (inception-December 28, 2020) in addition to trial, review, and dissertation registers. From 9367 records, we included 53 studies, mostly conducted in Europe (45%) and US-Canada (41%), within the last five years. Twenty-six percent of studies were qualitative, followed by observational (21%), reviews (19%), randomized controlled trials (RCTs, 19%), quasi-experimental (11%), and mixed-methods (4%). Two-thirds of studies addressed dementia, followed by amyotrophic lateral sclerosis (13%), and brain tumors (9%). The RCT interventions (all in dementia) consisted of educational programs, facilitated discussions, or videos for patients and/or carers. In conclusion, more research is needed to investigate barriers and facilitators of ACP uptake, as well as to develop/test interventions in almost all the neurodegenerative disorders. A common set of outcome measures targeting each discrete ACP behavior, and validated across the different diseases and cultures is also needed.

scholarly journals The Role of Regional and State Initiatives in Nursing Home Advance Care Planning Policies

2020 ◽  
pp. 104990912097011
Author(s):  
Caroline J. Fu ◽  
Mansi Agarwal ◽  
Leah V. Estrada ◽  
Komal P. Murali ◽  
Denise D. Quigley ◽  
...  
Keyword(s):  
Nursing Home ◽  
Advance Care Planning ◽  
Fixed Effects ◽  
Antibiotic Use ◽  
National Sample ◽  
Care Planning ◽  
Advance Care ◽  
Multivariable Regression Models ◽  
Representative National Sample ◽  
Seriously Ill

Objective: Antibiotic use at the end of life (EoL) may introduce physiological as well as psychological stress and be incongruent with patients’ goals of care. Advance care planning (ACP) related to antibiotic use at the EoL helps improve goal-concordant care. Many nursing home (NH) residents are seriously ill. Therefore, we aimed to examine whether state and regional ACP initiatives play a role in the presence of “do not administer antibiotics” orders for NH residents at the EoL. Methods: We surveyed a random, representative national sample of 810 U.S. NHs (weighted n = 13,983). The NH survey included items on “do not administer antibiotics” orders in place and participation in infection prevention collaboratives. The survey was linked to state Physician Orders for Life-Sustaining Treatment (POLST) adoption status and resident, facility, and county characteristics data. We conducted multivariable regression models with state fixed effects, stratified by state POLST designation. Results: NHs in mature POLST states reported higher rates of “do not administer antibiotics” orders compared to developing POLST states (10.1% vs. 4.6%, respectively, p = 0.004). In mature POLST states, participation in regional collaboratives and smaller NH facilities (<100 beds) were associated with having “do not administer antibiotics” orders for seriously ill residents (β = 0.11, p = 0.006 and β = 0.12, p = 0.003, respectively). Discussion: NHs in states with mature POLST adoption that participated in infection control collaboratives were more likely to have “do not administer antibiotics” orders. State ACP initiatives combined with regional antibiotic stewardship initiatives may improve inappropriate antibiotic use at the EoL for NH residents.

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