What gives your life meaning (WGYLM)? Strategies to encourage advanced care planning.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 8-8
Author(s):  
Catherina Anne Madani ◽  
Cassia Yi ◽  
Kyle Edmonds ◽  
Sharon Hamill
Keyword(s):  
Front Page ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Social Experiment ◽  
State University ◽  
Care Providers ◽  
Life Meaning ◽  
Loved One ◽  
San Marcos ◽  
Centered Care

8 Background: Conversations regarding healthcare decisions are central to patient-and-family-centered care. Early and regular advanced care planning (ACP) conversations benefit the patient, family, multidisciplinary team, and healthcare system. Initiatives targeting employee’s participation in their own ACP may extend to improvement in patients’ ACP utilization. Methods: A social experiment entitled, “What gives your life meaning” (WGYLM?) initially developed at California State University, San Marcos to increase student’s awareness of ACP was adapted to focus health system’s employees’ attention on ACP over the course of a 3-month campaign that culminated during National Healthcare Decisions week. Results: 55 volunteers were involved in the campaign. Over 10,000 workstation screensavers displayed campaign slogans. A system-wide newsletter with 12,500 subscribers included a campaign write-up. The local newspaper featured a front-page color article. Almost 1,700 post-its with comments of what gives their life meaning were collected. More than 1500 ACP packets with ACP resources were distributed with over 1200 people signing a pledge to have an ACP discussion with a loved one within 30 days. Of the 664-successful follow-up email sent to pledge participants: 77 (12%) of respondents responded to the survey; 44% were nurses, and 12% were physicians; 41% reported already having an AD in place, while 21% did not currently have a designated person to make healthcare decisions on their behalf; 66 (85%) reported talking with someone about what gives their own life meaning. Of these, 51% reported it was their spouse they spoke with and 34% reported it was a coworker; 5% created an AD, and 8% edited an AD since the campaign; 73% agreed it helped them think about ACP in a less scary way; 83% agreed it increased their interest in thinking about future healthcare preferences; and 79% agreed it motivated them to talk about healthcare they would want to receive at EOL with a loved one. Conclusions: ACP conversations can be used to prepare anyone regardless of age, sex, culture, or disease. Asking heath care providers, “What gives your life meaning” may familiarize them with the process of ACP and emboldened them to encourage patients to have these same crucial conversations.

scholarly journals Advance Care Planning in Healthy Older Adults

2011 ◽  
Vol 9 (2) ◽  
pp. 6-14 ◽  
Author(s):  
Karen Van Leuven
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Advance Directives ◽  
Health Care Providers ◽  
Successful Aging ◽  
Care Planning ◽  
Advanced Care Planning ◽  
Care Providers ◽  
Healthy Older Adults ◽  
Medical Diagnoses

This article reports the secondary analysis of a qualitative study that examined the beliefs, values, lifestyles and health status of adults at least 75 years old (N=18). An unanticipated finding was that all participants who self-identified as healthy (N=14) had in place advance directives which dictated their end-of-life wishes. In contrast, participants who self-identified as fair or poor health (N=4) did not have advance directives (N=4). These "healthy" older adults also differed substantially from their counterparts in the degree in which they were socially engaged in their community and family, but varied little related to their actual medical diagnoses or health problems. The self-described healthy group approached advanced care planning as part of health promotion; they simultaneously planned for end-of-life while engaging in activities to maintain optimum health. In contrast, those who evaluated their health as fair or poor perceived advanced care planning as something to be avoided. Planning for end-of-life may be a form of ongoing engagement as it requires dialogue with health care providers, and thoughtful consideration of experiences and wishes. It may also be a manifestation of successful aging in that death is recognized as the culmination of a good life rather than something to be feared.

scholarly journals Development of a person-centered interdisciplinary plan-of-care program for dialysis

2020 ◽  
Vol 35 (8) ◽  
pp. 1426-1435
Author(s):  
Adeline Dorough ◽  
Derek Forfang ◽  
Shannon L Murphy ◽  
James W Mold ◽  
Abhijit V Kshirsagar ◽  
...  
Keyword(s):  
Qualitative Interviews ◽  
Care Program ◽  
Care Planning ◽  
Care Providers ◽  
Planning Program ◽  
Concept Elicitation ◽  
Care Partners ◽  
Centered Care ◽  
Program Content ◽  
The Individual

Abstract Background Dialysis care often focuses on outcomes that are of lesser importance to patients than to clinicians. There is growing international interest in individualizing care based on patient priorities, but evidence-based approaches are lacking. The objective of this study was to develop a person-centered dialysis care planning program. To achieve this objective we performed qualitative interviews, responsively developed a novel care planning program and then assessed program content and burden. Methods We conducted 25 concept elicitation interviews with US hemodialysis patients, care partners and care providers, using thematic analysis to analyze transcripts. Interview findings and interdisciplinary stakeholder panel input informed the development of a new care planning program, My Dialysis Plan. We then conducted 19 cognitive debriefing interviews with patients, care partners and care providers to assess the program’s content and face validities, comprehensibility and burden. Results We identified five themes in concept elicitation interviews: feeling boxed in by the system, navigating dual lives, acknowledging an evolving identity, respecting the individual as a whole person and increasing individualization to enhance care. We then developed a person-centered care planning program and supporting materials that underwent 32 stakeholder-informed iterations. Data from subsequent cognitive interviews led to program revisions intended to improve contextualization and understanding, decrease burden and facilitate implementation. Conclusions My Dialysis Plan is a content-valid, person-centered dialysis care planning program that aims to promote care individualization. Investigation of the program’s capacity to improve patient experiences and outcomes is needed.

Association between religious beliefs and discussions regarding advance care planning: A nationwide survey

2021 ◽  
pp. 026921632110295
Author(s):  
Jun Miyashita ◽  
Sayaka Shimizu ◽  
Shunichi Fukuhara ◽  
Yosuke Yamamoto
Keyword(s):  
Health Care Providers ◽  
Advance Care Planning ◽  
Religious Beliefs ◽  
Nationwide Survey ◽  
Care Planning ◽  
Care Providers ◽  
Logistic Regression Models ◽  
Japanese Buddhism ◽  
Advance Care ◽  
Quota Sampling

Background: The relationship between advance care planning and religious beliefs, which are important for palliative care, is controversial in Western countries and has not been verified in Asian countries. Aim: To investigate the association between advance care planning discussions and religious beliefs in Japan. Design: A nationwide survey conducted in 2016 using a quota sampling method to obtain a representative sample of Japan’s general population. Setting/participants: We analyzed responses from 3167 adults aged 20–84 years (mean age ± standard deviation, 50.9 ± 16.8 years). The outcome was measured by asking whether the respondents had ever discussed advance care planning, and the main exposure by whether they had any religious beliefs or affiliations, and if so, their degree of devoutness. We analyzed religious beliefs, affiliations, and devoutness in relation to the occurrence of discussions using multivariable logistic regression models adjusted for possible sociodemographic covariates. Results: Compared with respondents without, those with religious beliefs had significantly higher odds of having had discussions (adjusted odds ratio: 1.45, 95% confidence interval: 1.22–1.73). The devoutness of religious belief was proportional to the propensity of the occurrence of discussions ( p for trend < 0.001). In addition, Buddhists and Christians had higher odds of having had discussions than did nonbelievers. Conclusion: The results suggest that holding religious beliefs, especially in Japanese Buddhism and Christianity, facilitates advance care planning discussions among Japanese adults, and thus, may help health-care providers identify those prioritized for facilitating engagement in advance care planning, especially in palliative and spiritual care settings.

Home Health Nurses’ Journey Toward Culture-Sensitive/Patient-Centered Skills: A Grounded Theory Study

2021 ◽  
pp. 108482232110278
Author(s):  
Mary Curry Narayan ◽  
Robert Kevin Mallinson
Keyword(s):  
Grounded Theory ◽  
Patient Centered Care ◽  
Home Health ◽  
Care Planning ◽  
Culturally Competent ◽  
Patient Centered ◽  
High Quality ◽  
Culturally Competent Care ◽  
Home Health Nurses ◽  
Centered Care

Introduction. Home health patients, who are members of minority and vulnerable groups, suffer disparate outcomes. Patient-centered care (PCC) and culturally-competent care (CCC) aim to facilitate high-quality, equitable care. How home health nurses incorporate PCC and CCC principles into their assessment and care-planning practices has not been -investigated. This study answers the question, “ What is the process by which home health nurses develop their culture-sensitive/patient-centered assessment and care planning skills?” Methods. Home health nurses (n= 20) were recruited into this grounded theory study from agencies around the United States via flyers, websites, and contacts. We conducted in-depth recorded interviews using a semi-structured interview guide to ask questions about nurses’ assessment and care-planning practices, their understanding of CCC and PCC principles, and facilitators/barriers to CCC and PCC practice. Results. Participants primarily gained their CCC and PCC assessment and care-planning skills through a “seat of your pants,” trial-and-error process, with little educational or agency assistance. They combined caring, diverse patient experiences, and critical, creative self-reflection on their experiences to gradually learn helpful, though not optimal, CCC and PCC strategies. However, they reported numerous barriers that discouraged or distressed them in their quest to deliver culturally-competent and patient-centered care. Only a few nurses demonstrated the resilience to overcome these challenges creatively and happily. Conclusion. If we accept that patient-centered care and culturally competent care are key elements of high-quality, equitable care, this grounded theory may help home healthcare clinicians, administrators, educators, and policy-makers identify impact points for enhancing CS/PC practices.

Reclaiming and Reshaping Life: Patterns of Reconstruction After the Suicide of a Loved One

2016 ◽  
Vol 27 (7) ◽  
pp. 994-1005 ◽  
Author(s):  
Dolores Angela Castelli Dransart
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Providers ◽  
Suicide Survivors ◽  
Loved One ◽  
Life Patterns ◽  
Survivors Of Suicide ◽  
And Coping ◽  
The Impact ◽  
Depth Interviews

The objective of this study is to identify patterns (components and processes) of reconstruction of suicide survivors. In-depth interviews were conducted with 50 survivors of suicide in Switzerland. Data were analyzed using ATLAS.ti and according to the Grounded Theory principles. Survivors of suicide face four major challenges: dealing with the impact of suicide, searching for meaning, clarifying responsibility, and finding a personal style of reaction and coping. The various ways in which survivors fare through the specific processes of the challenges result in various patterns of reconstruction: the vulnerability, transformation, commitment, and hard blow. The unique characteristics and dynamics of each of them are highlighted. Health care providers would benefit from an approach based on the dynamics of the various patterns of reconstruction in providing appropriate support to survivors of suicide.

scholarly journals Caregiver-Centered Care Health Workforce Competencies: Developing Consistent Support for Family Caregivers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 15-15
Author(s):  
Jasneet Parmar ◽  
Sharon Anderson ◽  
Lisa Poole ◽  
Wendy Duggleby ◽  
Jayna Holyroyd-Leduc ◽  
...  
Keyword(s):  
Health System ◽  
Family Caregivers ◽  
Health Providers ◽  
Care Providers ◽  
Modified Delphi ◽  
Healthcare Settings ◽  
Delphi Approach ◽  
People With Dementia ◽  
Health And Social Care ◽  
Centered Care

Abstract Family caregivers [FCGs] are the backbone of the health system. They provide over 80% of the care for people with dementia, chronic illnesses and impairments. Despite evidence of their contributions and consequences of caregiving, support for FCGs has not been a health system priority. Education to prepare health providers to effectively identify, engage, assess, and support FCGs throughout the care trajectory is an innovative approach in addressing inconsistent system of supports for FCGs. We report on development and validation of the Caregiver-Centered Care Competency Framework to help with curricular design and subsequent evaluation of effectiveness of care providers working within healthcare settings to engage and support FCGs. We used a three round modified Delphi approach. An expert panel of 42 international, national, and provincial stakeholders agreed to participate. In the first 2 rounds, multi-level, interdisciplinary participants, rated the indicators in terms of importance and relevance. In the 3rd round consensus meeting, participants validated the six competency domains, including indicators in small group sessions. Thirty-four experts (81%) participated in the round 1, 36 (85.7%) in round 2, and 42 people (100%) in round 3. There was stable consensus across all three rounds, 96.07% of participants rated the indicators as essential or important (Round 1, 95.81%; Round 2, 94.15; Round 3, 98.23%). FCG research has been primarily focussed on educating FCGs to provide care. These competencies will shape the design of educational curricula and interdisciplinary training programs aimed at supporting the health and social care workforce to provide caregiver-centered care.

A letter to your care providers: implementation and analysis of a letter-based advance care planning initiative for gynecologic oncology patients

2021 ◽  
Vol 162 ◽  
pp. S76
Author(s):  
Catherine Zivanov ◽  
Anne Coogan ◽  
Robin Lane ◽  
Marc Robinson ◽  
Molly Williams ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Gynecologic Oncology ◽  
Care Planning ◽  
Care Providers ◽  
Oncology Patients ◽  
Advance Care

Verlieservaringen bij kinderen: een leidraad voor hulpverleners

2021 ◽  
Author(s):  
L. KEIRSE ◽  
S. WILLEMS ◽  
E. NELIS ◽  
H. GEERTS ◽  
E. HOLVOET ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Stressful Life Events ◽  
Professional Support ◽  
Significant Other ◽  
Care Providers ◽  
Loved One ◽  
Loss Experience ◽  
Current Article ◽  
Developmental Phases ◽  
Support Family

Loss experience in children: a guideline for primary care Everyone gets confronted with severe loss experiences during life, such as bereavement of a significant other, loss of a loved one after a divorce or loss of one’s own capabilities due to illness. Health care providers need to be equipped with substantial knowledge about children’s experiences of grief and distress in order to support family members properly. Moreover, this can influence the next generation’s capabilities to cope with stressful life events. The current article describes the characteristics of loss experiences in children up to 11 years. Developmental phases, as well as the need to explain to children the 4 fundamental characteristics of death will be discussed (i.e. finality, irreversibility, universality and causality). While grief and distress in children can generally be managed by the immediate surrounding of the child, sometimes professional support is necessary, which is also discussed in this article. Finally, the authors present 4 key principles and concrete recommendations on how adults can respond to children who lost someone so that they can regain pleasure in life.

The timing and the dose of advanced care planning in patients with resectable pancreatic cancer: Who makes the call?

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 397-397 ◽  
Author(s):  
Lyudmyla Demyan ◽  
Grace Wu ◽  
Dina Moumin ◽  
Gary B Deutsch ◽  
William Nealon ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Median Number ◽  
Ductal Adenocarcinoma ◽  
Care Planning ◽  
Theory Approach ◽  
Advanced Care Planning ◽  
Curative Intent ◽  
Convenience Sample ◽  
Potential Benefits ◽  
Preoperative Counseling

397 Background:The timing and the extent of Advanced Care Planning (ACP) in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing curative-intent resection are generally dictated by the surgeon performing the operation. The aim of this study is to evaluate surgeons’ insights, perceptions, and biases regarding preoperative ACP. We hypothesize that many surgeons harbor significant reservations about extensive preoperative ACP. Methods:A qualitative investigation using 1:1 interviews with 40 open-ended questions were conducted with convenience sample. Data accrual continued until theme saturation was achieved. Grounded theory approach was used for data coding and analysis. Results:A total of 10 interviews were conducted with expert pancreatic surgeons from 6 medical centers—6 males and 4 females. The median number of years in practice was 15 (IQR 13-30) and the median number of pancreatic cancer cases performed per year was 52 (IQR 39-75). During preoperative counseling all surgeons discuss the possibility of recurrence and postoperative complications but attempt to motivate patients by emphasizing hope, optimism, and fact that surgery offers the only opportunity for cure. 90% of surgeons report no formal training in ACP. All surgeons report comfort with end of life conversations when death is imminent, but most lack experience with in-depth preoperative ACP. All surgeons emphasized that ACP should be led by a physician that both knows the patient well and understands the complexity of PDAC management. All surgeons recognized potential benefits of ACP, including delivery of goal-concordant care (60%), increased prognostic awareness (40%), and better life planning (40%). 50% report discussing in-depth ACP related to perioperative complications, but not long-term oncologic outcome. 80% of surgeons report that they actively steer away from in-depth ACP during preoperative counseling. Barriers to in-depth ACP reported by surgeons include taking away hope (70%), lack of time (50%) and concern for sending “mixed messages” (50%). Further, 50% of surgeons perceived that extensive preoperative ACP is not appropriate for patients with PDAC undergoing curative-intent resection. Most surgeons (60%) believe that ACP should occur as a process throughout the disease and in-depth discussions were more appropriate during postoperative visits (30%) and/or recurrence (60%). Conclusions:Despite recognizing potential benefits, most pancreatic surgeons report actively avoiding in-depth ACP conversations prior to curative-intent surgery. Surgeons had difficulty articulating the best time for ACP and felt that ACP should occur as a continuum throughout the course of treatment, with the depth of the discussion echoing the disease progression and patients’ readiness for such conversation. Future studies could evaluate patients’ perspective on the timing and the dose of ACP.

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