Advance care planning among seniors of a diverse city.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 117-117
Author(s):  
Randi Belisomo ◽  
Daniel M. Gaitan ◽  
Amy R. Eisenstein ◽  
Mary Frances Mulcahy
Keyword(s):  
Medical Care ◽  
Advance Care Planning ◽  
Family Satisfaction ◽  
Care Patient ◽  
Healthcare Team ◽  
Care Planning ◽  
Racial Groups ◽  
Information Awareness ◽  
Advance Care ◽  
Eol Care

117 Background: Advance care planning (ACP) is a system of education, reflection and documentation of health care wishes. Respecting Choices has been successful in implementing ACP throughout Lacrosse County, WI (J Am Geriatr Soc 2010;58:1249–1255)..A single center study in Melbourne, AU, showed that ACP improves end of life (EOL) care, patient and family satisfaction, and reduces stress, anxiety, and depression in surviving relatives (BMJ 2010;340:c1345).We aim to quantify knowledge about ACP, interest in engaging in ACP, and barriers to effective ACP among the older adults of Chicago. The results will provide actionable items to implement an ACP program in a diverse city. Methods: 17 of the 22 City of Chicago senior centers participated in a survey and education forum “Starting the Conversation”. Participants provided demographic information, awareness and knowledge of EOL wishes and advance directives (AD). Data was tabulated and analyzed using descriptive statistics in IBM SPSS Statistics 22 Software. Results: 375 people completed the survey, the average age was 70+8, (range 41 to 93), 93.3% in English, and 6.7% in Spanish. Respondents live alone (44.5%), with a spouse (29.9%) or child (14.4%). 71% have thought about the medical care they would want at the EOL, 60% have discussed their EOL wishes with their loved ones, and 4% with their doctor. 60.5% do not know what an AD is, 25% have an AD, 76% know who would speak for them if they were unable, 58% have discussed their wishes with that person. Using neighborhood demographics, there was no difference in having an AD for predominately African American neighborhoods compared to others (33% and 27%). Respondents from lower income neighborhoods were less likely to think about medical care at the EOL (65% and 77%), less likely to have discussed EOL care (41% and 30% have not discussed EOL care) and less likely to have an AD (19% and 31%). Conclusions: ACP is underutilized in Chicago. The frequency of AD completion among Chicago seniors mirrors that of the US (Am J Public Health. 2013;103(6):e8-e10). Unlike other population studies, no difference was found among racial groups. Participants are aware of EOL wishes, are interested in engaging in these conversations, but lack the knowledge and collaboration of their healthcare team.

scholarly journals Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

2020 ◽  
Vol 17 (5) ◽  
pp. 1594
Author(s):  
Fu-Ming Chiang ◽  
Jyh-Gang Hsieh ◽  
Sheng-Yu Fan ◽  
Ying-Wei Wang ◽  
Shu-Chen Wang
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
Advance Care Planning ◽  
Qualitative Content Analysis ◽  
Care Planning ◽  
Medical Decisions ◽  
Self Blame ◽  
Advance Care ◽  
Past Experiences ◽  
Eol Care

The aging of the Taiwanese population has become a major issue. Previous research has focused on the burden and stress faced by caregivers, but has not explored how the experience of these caregivers influences decisions of advance care planning (ACP). Semi-structured and in-depth interviews were conducted. Qualitative content analysis was used to identify important themes. Five themes and fourteen sub-themes were identified: (1) Past experiences: patient wishes, professional recommendations, and expectation about disease progress; (2) Impact of care on family members: positive affirmation, open-minded life, social isolation and health effects, and financial and life planning effects; (3) Attitude toward life: not forcing to stay, and not becoming a burden, (4) Expected proxy dilemmas: torment between doing or not, seeing the extension of suffering and toil, and remorse and self-blame; (5) Expectation of end of life (EOL) care: caregiver’s experience and EOL care decisions, and practicality of EOL decision making. After making multiple medical decisions for their disabled relatives, caregivers are able to calmly face their own medical decisions, and “not becoming a burden” is their primary consideration. It’s suggested that implementation of shared decision-making on medical care for patients with chronic disability will not only improve the quality of their medical care but also reduce the development of remorse and guilty feelings of caregivers after making medical decisions.

A Retrospective Study Reviewing Interprofessional Advance Care Planning Group Discussions in Pulmonary Rehabilitation: A Proof-of-Concept and Feasibility Study

2019 ◽  
pp. 082585971989642
Author(s):  
Daphna Grossman ◽  
Amanda Katz ◽  
Karen Lock ◽  
Valerie B. Caraiscos
Keyword(s):  
Advance Care Planning ◽  
Pulmonary Rehabilitation ◽  
Family Satisfaction ◽  
Treatment Preferences ◽  
Care Planning ◽  
Personal Care ◽  
Trade Offs ◽  
Advance Care ◽  
Eol Care ◽  
The Impact

Background: Advance care planning (ACP) is a process of reflection and discussion wherein a patient, in consultation with a health-care provider, family, and/or loved ones, clarifies values and treatment preferences and establishes goals, including a plan for end-of-life (EOL) care. Advance care planning encompasses appreciating and understanding illness and treatment options, elucidating patient values and beliefs, and identifying a substitute decision maker (SDM) or designating a power of attorney (POA) for personal care. These discussions have proven to be effective in improving patient–family satisfaction, reducing anxiety regarding EOL care in patients and family members, and improving patient-centered care by empowering patients to direct their care at EOL. However, ACP conversations are often difficult to have due to the sensitive nature of such discussions. Objective: The aim of this study was to determine whether group facilitation for teaching and discussing ACP enhances participants’ understanding of ACP and allows them to feel comfortable and supported when discussing these sensitive issues. Methods: Patients who were registered in North York General Hospital’s (NYGH) pulmonary rehabilitation program from June 2016 until August 2017 were given the opportunity to attend two 1-hour sessions related to ACP. The first session was dedicated to educating patients on ACP, explaining the hierarchy of the SDM and the role of the POA for personal care. The second session, provided a short time later, was devoted to discussions of values, wishes, fears, and trade-offs for future medical and EOL care. These discussions led by the supportive care nurse practitioner and a physician who are members of the NYGH Freeman Palliative Care Team were held in a group-facilitated format. Anonymous feedback forms, including both qualitative and quantitative feedback, were completed by the participants and analyzed. Participants: Analysis of a sample of 30 participants who attended 1 or 2 of the ACP sessions revealed that 21 identified as female and 9 identified as male. The average age of the participants was 76 years. Findings: Participants felt the content was relevant to their needs and were comfortable asking questions with all feedback averages ranging from good to very good. Participants appreciated the opportunity to share their thoughts in an open and interactive format. Conclusion: Discussing issues relevant to ACP, including providing information about ACP, sharing fears, wishes, and tradeoffs, were well-received in a group-support environment. Future studies should assess the impact of ACP group discussion on the individual, such as identifying a POA, having discussions regarding wishes and values with the SDM/POA, and examining the clinical impact of such sessions.

scholarly journals Assisted Living Administrators’ Approaches to Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 66-66
Author(s):  
Elise Abken ◽  
Alexis Bender ◽  
Ann Vandenberg ◽  
Candace Kemp ◽  
Molly Perkins
Keyword(s):  
Advance Care Planning ◽  
Assisted Living ◽  
Staff Training ◽  
Chronically Ill ◽  
External Support ◽  
Care Plan ◽  
Care Planning ◽  
Term Care ◽  
Advance Care ◽  
Eol Care

Abstract Assisted living (AL) communities are increasingly home to frail, chronically ill older adults who remain until death. State laws mandate that AL facilities request copies of any advance care planning documents residents have and make forms available upon request. Using secondary data from a larger study funded by the National Institute on Aging (R01AG047408) that focuses on end-of-life (EOL) care in AL, this project investigated barriers and facilitators to conducting advance care planning in AL. Data included in-depth interviews (of 86 minute average length) with 20 administrators from 7 facilities around the Atlanta metropolitan area and aggregate data collected from each facility regarding facility, staff, and resident characteristics. Findings from thematic analysis of qualitative data showed that key barriers to planning in AL included lack of staff training and reluctance among administrators and families to discuss advance care planning and EOL care. Important facilitators included periodic follow-up discussions of residents’ wishes, often during care plan meetings, educating families about the importance of planning, and external support for staff training and family education from agencies such as hospice and home health. Three study facilities exceeded state requirements to request and store documents by systematically encouraging residents to complete documentation. These facilities, whose administrators discuss advance care planning and residents’ EOL wishes with residents and families during regular care plan meetings, were more likely to have planning documents on file, demonstrating the potential of long-term care communities, such as AL, to successfully promote advance care planning among residents and their family members.

The Role and Activities of Board-Certified Chaplains in Advance Care Planning

2021 ◽  
pp. 104990912198999
Author(s):  
Jung Kwak ◽  
Soyeon Cho ◽  
George Handzo ◽  
Brian P. Hughes ◽  
Sami S. Hasan ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Self Report ◽  
Healthcare Team ◽  
Care Planning ◽  
Cross Sectional ◽  
Team Members ◽  
Roles And Responsibilities ◽  
Healthcare Settings ◽  
Academic Medical ◽  
Advance Care

Background: Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. Objectives: To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. Methods: A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains’ organizations in the U.S. The survey data included chaplains’ demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. Results: More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. Conclusion: Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

Association of advance care planning with place of death and utilisation of life-sustaining treatments in deceased patients at Taipei City Hospital in Taiwan

2020 ◽  
pp. bmjspcare-2020-002520
Author(s):  
Yung-Feng Yen ◽  
Ya-Ling Lee ◽  
Hsiao-Yun Hu ◽  
Wen-Jung Sun ◽  
Ming-Chung Ko ◽  
...  
Keyword(s):  
Cohort Study ◽  
Advance Care Planning ◽  
Place Of Death ◽  
Care Planning ◽  
City Hospital ◽  
Taipei City ◽  
Advance Care ◽  
Eol Care ◽  
To Receive ◽  
At Home

ObjectiveEvidence is mixed regarding the impact of advance care planning (ACP) on place of death. This cohort study investigated the effect of ACP programmes on place of death and utilisation of life-sustaining treatments for patients during end-of-life (EOL) care.MethodsThis prospective cohort study identified deceased patients between 2015 and 2016 at Taipei City Hospital. ACP was determined by patients’ medical records and defined as a process to discuss patients’ preferences with respect to EOL treatments and place of death. Place of death included hospital or home death. Stepwise logistic regression determined the association of ACP with place of death and utilisation of life-sustaining treatments during EOL care.ResultsOf the 3196 deceased patients, the overall mean age was 78.6 years, and 46.5% of the subjects had an ACP communication with healthcare providers before death. During the study follow-up period, 166 individuals died at home, including 98 (6.59%) patients with ACP and 68 (3.98%) patients without ACP. After adjusting for sociodemographic factors and comorbidities, patients with ACP were more likely to die at home during EOL care (adjusted OR (AOR)=1.71, 95% CI 1.24 to 2.35). Moreover, patients with ACP were less likely to receive cardiopulmonary resuscitation (AOR 0.36, 95% CI 0.25 to 0.51) as well as intubation and mechanical ventilation support (AOR 0.54, 95% CI 0.44 to 0.67) during the last 3 months of life.ConclusionPatients with ACP were more likely to die at home and less likely to receive life-sustaining treatments during EOL care.

scholarly journals 2439 Depression, anxiety, and planning for the future: Associations with advance care planning

2018 ◽  
Vol 2 (S1) ◽  
pp. 39-39
Author(s):  
Ryan McMahan ◽  
Evan Walker ◽  
Rebecca Sudore
Keyword(s):  
Medical Care ◽  
San Francisco ◽  
Advance Care Planning ◽  
Life Extension ◽  
Worth Living ◽  
Care Planning ◽  
Depression And Anxiety ◽  
Spanish Speaking ◽  
Advance Care ◽  
Item Scale

OBJECTIVES/SPECIFIC AIMS: Millions of diverse, older adults live with serious and chronic illness for which they will face complex, ongoing medical decisions. Advance care planning (ACP) has been conceptualized as a health behavior that supports adults in understanding and sharing their values, goals, and preferences for future medical care. Depression and anxiety are known barriers to participation in health behaviors. It is unknown whether depression and anxiety are associated with ACP participation or with patients’ values for future medical care. Understanding whether depression and anxiety are associated with ACP would be important to tailor ACP interventions. METHODS/STUDY POPULATION: In total, 908 English-speaking and Spanish-speaking participants ≥55 years of age were recruited from a San Francisco county hospital. We measured depression (Patient Health Questionnaire 8-item scale) and anxiety (Generalized Anxiety Disorder 7-item scale), dichotomized into none-to-mild Versus moderate-to-severe. We measured ACP engagement using a validated survey of Behavior Change Processes (e.g., knowledge, self-efficacy, readiness; 5-point Likert) and Action Measures (e.g., ask, discuss, and document one’s wishes; yes/no). We elicited values concerning life extension categorized as “life is always worth living no matter the health situation” Versus “some health situations would make life not worth living.” To explore associations, we usedχ2, Mann-Whitney tests, linear and logistic regressions. RESULTS/ANTICIPATED RESULTS: Mean participant age was 64 years±6, 80% were non-White, 40% had limited literacy, 45% were Spanish-speaking, and the prevalence of depression and anxiety was 12% and 10%, respectively. Depression and anxiety were not associated with ACP Engagement, p>0.05. However, participants with depression had an increased odds of reporting “some health situations would make life not worth living” than those not depressed, p=0.02. In multivariate linear and logistic regression, controlling for age, gender, literacy, and health status, having depression increased the odds of not valuing life extension OR 2.9 (CI: 1.7–4.9). Anxiety was not associated with values concerning life extension, p>0.05. DISCUSSION/SIGNIFICANCE OF IMPACT: Depression and anxiety were not associated with prior ACP engagement suggesting engaging patients in ACP does not increase these conditions. However, depression was associated with an increased odds of not valuing life extension and, therefore, may influence treatment choices. Longitudinal randomized controlled trials of an ACP intervention are currently underway to investigate these associations further.

Advance-care planning quality improvement plan: A Cancer Care Ontario toolkit to support primary care teams to implement advance care plans in practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 76-76
Author(s):  
Jeff Myers ◽  
Suzanne Strasberg ◽  
Kathi Carroll ◽  
Zabin Dhanji ◽  
Ingrid Harle ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Advance Care Planning ◽  
Cancer Care ◽  
Care Planning ◽  
Advance Care ◽  
Care Practices ◽  
Primary Care Practices ◽  
Eol Care

76 Background: In Ontario, the Ministry of Health and Long Term Care’s (MOHLTC) uses Quality Improvement Plans (QIPs) to drive system improvement aimed at providing high value, high quality care for all. To support the introduction of QIPs into the primary care sector, Cancer Care Ontario has developed an Advance Care Planning (ACP) toolkit for practices that include ACP as part of their annual QIP. ACP is an ongoing and dynamic process that involves a capable individual reflecting on their current values and beliefs for their health care, communicating their personal wishes for future health care and identifying an individual who will make decisions on their behalf in the event that they are unable to provide informed consent. The process is iterative and wishes may change over time with changes in health status. Methods: The ACP QIP was developed based on the Plan, Do, Study, Act cycle of continuous quality improvement. The ACP QIP provides primary care practices with detailed instructions on how to implement, monitor and report on an ACP Quality Improvement initiative. Importantly, the ACP QIP provides guidance and practical tools for developing objectives, establishing targets, and identifying measures and baselines for performance. CCO is actively promoting the ACP QIP in an effort to encourage uptake and broad adoption across Ontario. Results: There is now evidence that with ACP there is a greater likelihood EOL wishes will be both known and followed resulting in improved EOL care. ACP is also associated with decreased distress among the family members. Conclusions: Creating an ACP QIP supports primary care’s focus on advancing quality patient care. Importantly, implementing the ACP QIP into primary care practices has the potential to improve EOL care and secondarily reduce health care costs ultimately working towards achieving the triple aim of “better care, better health, and lower costs”.

Advance care planning in hospitals

2018 ◽  
Author(s):  
Clare Marlow ◽  
Karen Groves ◽  
Premila Fade
Keyword(s):  
Advance Care Planning ◽  
Hospital Setting ◽  
Well Being ◽  
Family Satisfaction ◽  
Hospital Environment ◽  
Care Planning ◽  
Good Communication ◽  
Challenges And Opportunities ◽  
Future Care ◽  
Advance Care

This chapter outlines the challenges and opportunities surrounding advance care planning (ACP) within the hospital setting. Although the hospital environment may not seem the obvious place for future care planning, the triggers to these conversations may occur during a hospital admission. Around a third of all patients in general hospitals are likely to be in the last year of life and nearly 90% of people who die are hospitalized in the last year of life. ACP can help improve end-of-life care in hospital, with the potential to improve communication, increase quality of life and well-being of patients and those important to them, reduce use of futile and often unwanted treatments and unnecessary hospitalizations, and improve patient and family satisfaction with hospital care. Recognition that someone is in the last year of life, good communication skills, and a clear process for documentation and dissemination are key to successful ACP in hospitals.

scholarly journals Advance care planning in patients referred to hospital for acute medical care: Results of a national day of care survey

2020 ◽  
Vol 19 ◽  
pp. 100235 ◽  
Author(s):  
Thomas Knight ◽  
Alexandra Malyon ◽  
Zoe Fritz ◽  
Chris Subbe ◽  
Tim Cooksley ◽  
...  
Keyword(s):  
Medical Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Care Survey ◽  
Advance Care ◽  
Acute Medical Care

Exploring Motivational Interviewing to Engage Latinos in Advance Care Planning: A Community-Based Social Work Intervention

2018 ◽  
Vol 35 (8) ◽  
pp. 1091-1098 ◽  
Author(s):  
Frances R. Nedjat-Haiem ◽  
Iraida V. Carrion ◽  
Krystyna Gonzalez ◽  
Elizabeth D. Bennett ◽  
Kathleen Ell ◽  
...  
Keyword(s):  
United States ◽  
Motivational Interviewing ◽  
Advance Care Planning ◽  
Stages Of Change ◽  
Comparative Method ◽  
The United States ◽  
Care Planning ◽  
Community Based ◽  
Advance Care ◽  
Eol Care

Advance care planning (ACP) does not readily occur in medical settings and often gets missed. Older Latinos need ACP information to encourage advance directive (AD) completion indicating preferences for end-of-life (EOL) care. Objective: To explore the experiences with counseling using motivational interviewing (MI) techniques and social workers to encourage ACP communication among older Latinos with advance chronic diseases. This study describes stages of readiness to plan for EOL care. Design: We conducted a qualitative study with older Latinos who participated in a community-based intervention in Southern New Mexico. Methods: Participants in the intervention were selected because they received ACP education plus counseling involving MI to address resistance to ACP. Motivational interviewing counseling involved the following: (1) engaging in structured dialogue about ACP, (2) using and completing AD documentation, (3) encouraging ACP communication with providers and families, and (4) applying AD information into actionable behavior. We utilized a constant comparative method and thematic analysis to explore the meaning of older Latinos’ experiences with MI counseling and stages of change. Results: Participants (n = 32) were mostly women (74.3%), half born in the United States and half from Mexico in the United States on average for 31.75 (standard deviation 16.22) years. Many had less than sixth grade education (31.3%) or had not completed high school (21.9%). Key themes indicate the following stages of change: (1) precontemplation, (2) contemplation, (3) preparation, (4) ACP action, and (5) maintenance. Conclusion: This study contributes to the literature by identifying areas for adaption to enhance understanding and increase information to ultimately achieve the completion of ACP among Latinos.

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