Mindfulness training to support advance care planning: Qualitative findings from a randomized pilot.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 4-4
Author(s):  
Shelley A. Johns ◽  
Ann H. Cottingham ◽  
Tayler Gowan ◽  
Tasneem L. Talib ◽  
Patrick V. Stutz ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Emotional Regulation ◽  
Standard Care ◽  
Mindfulness Meditation ◽  
Qualitative Interviews ◽  
Mindfulness Training ◽  
Care Planning ◽  
Post Intervention ◽  
Mindfulness Intervention ◽  
Advance Care

4 Background: Emotional discomfort talking about end of life (EOL) often inhibits advance care planning (ACP). Mindfulness meditation facilitates emotional regulation through present-centered awareness and non-reactive coping and may help adults with cancer and their family caregivers (CGs) approach ACP with greater ease. As part of a randomized pilot study of a mindfulness intervention, we conducted qualitative interviews with cancer patients and their CGs to explore participants’ perceptions of the effects of mindfulness on EOL discussions and ACP. Methods: Adults with advanced solid malignancies and an estimated prognosis of < 12 months were randomized with their CG (N = 55 dyads) to receive standard care alone or standard care plus a 6-session mindfulness intervention that included guided mindfulness meditation, mindful communication practices, and ACP information. A subset of mindfulness patients (n = 20) and CGs (n = 15) completed semi-structured qualitative interviews post-intervention that were recorded, transcribed, and coded using a deductive approach. Results: Researchers identified three primary themes. For patients and CGs, the mindfulness intervention: (1) enhanced awareness and discussion of ACP; (2) increased acceptance of poor prognosis; and (3) fostered supportive communication. Consistent with these themes, patients noted that the intervention enabled them to begin to accept that cure may not be possible, helped them “get over the hurdle” of talking about EOL, and provided an opportunity to reflect on their life priorities, including goals of care. CGs reported that the intervention fostered ACP conversations that had been previously avoided, enhanced understanding of patient preferences that often differed from their own, and increased ability to accept realities of the patient’s illness. Patients and CGs both reported improved understanding of the need to plan for EOL, greater openness to discussing sensitive issues, and an enhanced ability to listen more deeply and communicate with greater kindness. Conclusions: Findings support the use of mindfulness training to equip patients and CGs for timely EOL discussions and ACP. Clinical trial information: NCT03257007.

Cultural Differences in Advance Care Planning and Implications for Practice

2021 ◽  
pp. 003022282110295
Author(s):  
Jung-Hwa Ha ◽  
Changsook Lee ◽  
Jennifer Yoo
Keyword(s):  
Social Workers ◽  
Cultural Differences ◽  
Advance Care Planning ◽  
Qualitative Interviews ◽  
Relationship Building ◽  
Cultural Norms ◽  
Care Planning ◽  
The Us ◽  
Health Related ◽  
Advance Care

This study examined cultural differences in advance care planning (ACP) and various strategies that social workers use to initiate conversations on ACP. We conducted qualitative interviews with 12 social workers in South Korea and the US and a thematic content analysis of the transcribed data. Our findings show that different cultural norms and generational viewpoints surrounding death and health-related decision-making influence how people prepare for end-of-life care (EOLC). Whereas principles of self-determination and autonomy guide ACP practices in the US, decisions regarding EOLC are more often made in consultation with family members in Korean and Korean-American communities. Nevertheless, social workers in both countries identified relationship-building, empowerment, and individualized approaches as common strategies in initiating discussions on ACP.

Impact of mindfulness training on avoidant coping and advance care planning.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 86-86
Author(s):  
Shelley A. Johns ◽  
Kathleen Beck-Coon ◽  
Karen Schmidt ◽  
Timothy E. Stump ◽  
Jennifer Kim Bernat ◽  
...  
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
Avoidant Coping ◽  
Present Moment ◽  
Care Planning ◽  
Cognitive Avoidance ◽  
Post Intervention ◽  
Psychiatric Disturbance ◽  
Goals Of Care ◽  
Advance Care

86 Background: Timely end-of-life (EOL) discussions and advance care planning (ACP) are crucial to quality cancer care; however, patients, family caregivers (CGs), and oncologists often avoid these tender conversations. When EOL discussions are avoided, patients are more likely to receive non-beneficial treatment near death and CGs are more likely to experience psychiatric disturbance. Mindfulness meditation facilitates emotional regulation and may enhance adaptive coping necessary for EOL discussions and ACP. Methods: Mindfully Optimizing Delivery of End-of-Life (MODEL) Care is a within-group pilot study developed to train patients with advanced-stage solid malignancies and their CGs (n=13 dyads) in present-moment awareness and non-reactive coping through a variety of mindfulness practices. Eligible patients met a threshold for avoidant coping and had not completed a Physician Orders for Scope of Treatment (POST) form documenting care preferences. Cognitive avoidance and quality of life (QoL) for patients and CGs were assessed from baseline (T1) to post-intervention (T2) and 1-month follow-up (T3) with standardized response mean (SRM) effect sizes. ACP from T1 to T3 was assessed descriptively. Results: Moderate decreases in cancer-related avoidance were found for patients (SRM=-0.47) and CGs (SRM=-0.59) T1 to T2, while T1 to T3 effects were small for patients (SRM=-0.31) and large for CGs (SRM=-1.12). At T1, no patient had completed a POST form; by T3, 50% reported completing one and 40% were preparing to do so soon. At T1, 23% of patients reported having had a ‘goals of care’ discussion with their oncologist, with 82% doing so by T3. At T1, 46% of patients reported having discussed ‘goals of care’ with their CGs, with 100% doing so by T3. Large improvements in QoL were found at both time points for patients and CGs (SRMs ranging from 0.85 to 1.21). Conclusions: Mindfulness was associated with mostly moderate reductions in avoidant coping and large improvements in QoL for patients and caregivers, with notable ACP progress for patients.

Engaging the cancer care team in advance care planning.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 14-14
Author(s):  
Tallat Mahmood ◽  
Jane Alcyne Severson ◽  
Laura Thompson
Keyword(s):  
Advance Directives ◽  
Advance Care Planning ◽  
Metastatic Cancer ◽  
Care Team ◽  
Care Planning ◽  
Power Of Attorney ◽  
Post Intervention ◽  
Improvement Program ◽  
Advanced Directives ◽  
Advance Care

14 Background: Engagement of oncologists and their care team is essential to ensure advance care planning (ACP) occurs for cancer patients. However, numerous barriers to ACP exists, including the availability of trained staff with competence and confidence to have discussions with patients as well as resources to ensure ACP is effectively and efficiently integrated into the oncology practice. Methods: A baseline audit to determine the presence of documented ACP discussions for patients with metastatic cancer was conducted, followed by a quality improvement program with subsequent reassessment. The baseline audit identified only 20% (10/50) compliance with documentation of such discussions. Subsequently, we joined the Michigan Oncology Quality Consortium’s (MOQC) ACP Collaborative where the care team (MA, RN, PA, MD) were taught how to request and complete a durable power of attorney, conduct ACP conversations, and document pertinent information in a standard EHR location. Results: A one-year post-intervention audit found that 80% (40/50) of patients with metastatic cancer had an ACP documented in their record - a four fold improvement. A post-implementation staff survey noted that the team improved their understanding of both the legal issues and importance of asking about advance directives as well as using the designated chart location to document. 100% of staff agreed or strongly agreed with the statement “I understand the importance of asking patients about advanced directives”. Staff gained confidence in how to talk to patients about advance directives again with 100% of staff agreeing or strongly agreeing with the statement,” I feel more confident now in how to talk to a patient about advanced directives”. Conclusions: It is critical that all members of the oncology care team understand the importance of ACP and that staff feel confident in how to have discussions with patients. While physician/patient discussion is both necessary and expected, patients often discuss their wishes and fears with others in the practice. It is critical that all members of the team understand the importance of and opportunities where they can both support patients’ wishes and direct patients to their oncologist if necessary for further discussion.

scholarly journals Can a patient-directed video improve inpatient advance care planning? A prospective pre-post cohort study

2019 ◽  
Vol 28 (11) ◽  
pp. 887-893 ◽  
Author(s):  
Rajesh Nair ◽  
Samuel Abuaf Kohen
Keyword(s):  
Decision Making ◽  
Patient Satisfaction ◽  
Hospital Admission ◽  
Advance Care Planning ◽  
Therapeutic Interventions ◽  
Care Planning ◽  
Post Intervention ◽  
Patient Understanding ◽  
Hospitalised Patients ◽  
Advance Care

BackgroundPatients and their families often have an inadequate understanding of the risks and benefits of their advance care planning (ACP) options. Improving patients’ knowledge of therapeutic interventions allows them to better select treatments they believe are most appropriate for their condition.ObjectivesTo determine if a video aimed at educating and engaging hospitalised patients on a standardised ACP order set can improve (1) inpatient understanding of key ACP concepts, (2) ACP documentation within 48 hours of hospital admission, (3) concordance between a patient’s expressed and chart-documented care preferences, (4) patient satisfaction with decision-making, and (5) patient’s decisional confidence.MethodsA prospective, non-randomised, pre-post intervention study of 252 inpatients in a 215-bed community-based hospital in Comox, British Columbia, Canada.ResultsOur video decision support tool was associated with significant improvements in (1) patient understanding of key ACP concepts (70%–100%; p<0.0001), (2) ACP documentation within 48 hours of hospital admission (81%–92%; p=0.01), (3) concordance between patients’ expressed wishes and chart documentation (69%–89%; p<0.0001), (4) patient satisfaction with decision-making (Canadian Health Care Evaluation Project Lite score: 4.3–4.5, p=0.001), and (5) patient’s decisional confidence (patients with no decisional conflict, increased from 72% to 93%; p<0.0001).ConclusionA 13 min video aimed at educating and engaging inpatients on ACP concepts improved patient understanding of key ACP concepts, rates of ACP documentation and patient satisfaction with decision-making.

Effect of a communication skills intervention on resident comfort and knowledge of discussing goals of care and advance care planning.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 50-50 ◽  
Author(s):  
Rushil Virendra Patel ◽  
Elizabeth Golding ◽  
Aaron Lampkin ◽  
Mary Walker Larach ◽  
Lawrence Klima
Keyword(s):  
Communication Skills ◽  
Advance Care Planning ◽  
Comfort Level ◽  
Clinical Psychologist ◽  
Care Planning ◽  
Post Intervention ◽  
Goals Of Care ◽  
Online Curriculum ◽  
Planning Methods ◽  
Advance Care

50 Background: Inpatient providers are sometimes challenged with advanced care planning for their patients. At a teaching hospital, resident physicians find themselves tasked with this responsibility for inpatients they may have only just met, as well as in their assigned outpatient panel. Education on communication skills though has been shown to improve resident comfort level and knowledge of discussing goals of care and advance care planning. Methods: Internal medicine categorical residents (n = 15) and preliminary (n = 3) residents at a university-affiliated, community hospital learned the fundamentals of discussing goals of care and advance care planning using selected modules from the Center for Advancing Palliative Care’s (CAPC) online curriculum in communication skills during their outpatient clinic rotation from February through June 2016. Residents then discussed a patient encounter from their experience with their colleagues along with a member from the inpatient palliative care team and a clinical psychologist in weekly 1-hour afternoon sessions. A pre- and post-intervention survey was administered and recoded by a numerical identifier to assess the change in each resident's comfort level and knowledge level with conducting these discussions with their patients. Sessions were also audiorecorded to identify recurrent themes and insights for future follow-up projects. Results: Preliminary analysis (n = 11) demonstrates a statistically significant improvement in the median difference between overall resident comfort level (p = 0.007) and knowledge (p = 0.027) of discussing goals of care and advance care planning. Several participants also expressed desires for additional opportunities to practice these skills under supervision by experienced providers. Conclusions: Residents value developing skills requisite to facilitate goals of care discussions and advance care planning. Further opportunities for practice and feedback should be identified.

A qualitative investigation of mindfulness practice to support advance care planning (ACP).

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 15-15
Author(s):  
Shelley A. Johns ◽  
Ann H. Cottingham ◽  
Kathleen A. Beck-Coon ◽  
Paul R. Helft
Keyword(s):  
End Of Life ◽  
Emotional Regulation ◽  
Emotional Reactivity ◽  
Qualitative Interviews ◽  
Living Will ◽  
Mindfulness Training ◽  
Mindfulness Practice ◽  
Post Intervention ◽  
Patients With Cancer ◽  
Care Intervention

15 Background: Despite ongoing attempts to increase ACP in the U.S, a national longitudinal study of patients with cancer found no significant change in participation in end-of-life (EOL) discussions or living will completion between 2000-2012. A key barrier to ACP includes emotional discomfort talking about EOL care preferences. Mindfulness practices facilitate emotional regulation through present-centered awareness and non-reactive coping. In this pilot, an intervention combining mindfulness training, mindful communication skill development, and information about ACP was hypothesized to increase ACP in patients with cancer. Methods: The Mindfully Optimizing Delivery of End-of-Life Care (MODEL Care) intervention provided 12 hours of training to 13 patients with advanced-stage cancer and their family CGs (n = 13 dyads). Training included breath awareness, sitting meditation, mindful movement (yoga), mindful communication, and ACP information. Patients reported on participation in ACP behaviors at baseline and 4 weeks post intervention. Patients and CGs participated in semi-structured qualitative interviews after MODEL Care that were recorded, transcribed, and coded for key themes. Results: Compared to baseline, patients made notable improvement in ACP behaviors, including having goals of care conversations with their oncologist (p = .03) and family CG (p = .06). Qualitatively, patients and CGs reported an improved ability to “pause” and effectively manage tender emotions, coupled with improved communication and connection between patient and caregiver: “It kind of reminded us both that we need to make a conscious effort to ensure communication occurs on important things”; “We’ve been more in sync than we ever have been.” Moreover, MODEL Care reportedly facilitated thinking about the future to “do what we need to do” and “get things prepared." Conclusions: The MODEL care intervention improved patient and CG ability in areas foundational to ACP engagement: reduced emotional reactivity, communicating about difficult issues, and understanding relevance of ACP. Findings support the potential use of mindfulness training to support ACP for adults with cancer and their family CGs. Clinical trial information: NCT02367508.

scholarly journals Advance care planning with people with dementia: a process evaluation of an educational intervention for general practitioners

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Bram Tilburgs ◽  
Raymond Koopmans ◽  
Henk Schers ◽  
Carolien Smits ◽  
Myrra Vernooij-Dassen ◽  
...  
Keyword(s):  
Process Evaluation ◽  
General Practitioners ◽  
Advance Care Planning ◽  
Educational Intervention ◽  
Contextual Factors ◽  
Heterogeneous Group ◽  
Care Planning ◽  
Post Intervention ◽  
People With Dementia ◽  
Advance Care

Abstract Background General practitioners (GPs) are advised to offer advance care planning (ACP) to people with dementia (PWD). In a randomized controlled trial, an educational intervention for GPs aimed at initiating and optimizing ACP proved to be effective. During the intervention most GPs were accompanied by their practice nurse (PN). To provide insights into the intervention’s successful components and what could be improved, we conducted a process evaluation and explored implementation, mechanisms of impact and contextual factors. Methods We used the Medical Research Council guidance for process evaluations. Implementation was explored identifying reach and acceptability. We performed descriptive analyses of participants’ characteristics; selection, inclusion and intervention attendance; a GP post-intervention survey on initiating ACP; a post intervention focus group with trainers of the intervention. Mechanisms of impact were explored identifying adoption and appropriateness. We used: participants’ intervention ratings; a GP post-intervention survey on conducting ACP; ACP documentation in PWD’s medical files; post-intervention interviews with PWD/FC dyads. All data was used to identify contextual factors. Results The intervention was implemented by a small percentage of the total Dutch GP population invited, who mostly included motivated PWD/FC dyads with relatively little burden, and PWD with limited cognitive decline. The mechanisms of impact for GPs were: interactively learning to initiate ACP with training actors with a heterogeneous group of GPs and PNs. For PWD/FCs dyads, discussing non-medical preferences was most essential regarding their SDM experience and QoL. Some dyads however found ACP stressful and not feasible. Younger female GPs more often initiated ACP. Male PWD and those with mild dementia more often had had ACP. These characteristics and the safe and intimate training setting, were important contextual facilitators. Conclusion We recommend Interventions aimed at improving ACP initiation with PWD by GPs to include interactive components and discussion of non-medical preferences. A safe environment and a heterogeneous group of participants facilitates such interventions. However, in practice not all FC/PWD dyads will be ready to start. Therefore, it is necessary to check their willingness when ACP is offered.

scholarly journals CHANGING THE CULTURE OF ADVANCE CARE PLANNING, DEATH, DYING, AND BEREAVEMENT CARE IN NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S181-S181
Author(s):  
Toni Miles ◽  
Amanda Brown ◽  
Pamela O’Rouke
Keyword(s):  
Nursing Homes ◽  
Advance Care Planning ◽  
Cultural Change ◽  
Best Practice ◽  
Qualitative Interviews ◽  
Interview Data ◽  
Care Planning ◽  
Eden Alternative ◽  
Advance Care ◽  
Bereavement Care

Abstract Cultural change, using an Eden Alternative metaphor, means that palliative care becomes ‘the servant of genuine human caring, not its master’. This project, funded through the Georgia Civil Monetary Penalty Fund Reinvestment Program (CMPRP), aimed to gather information from multiple stakeholders to promote changes in the culture of advance care planning, death, dying, and bereavement care in nursing homes. Staff, residents and families from nine nursing homes provided perspectives through qualitative interviews (n=70). Participants were drawn from both small facilities and corporate entities with multiple sites, and included residents in both short and long-stay beds. Qualitative analysis of interview data resulted in the publication and dissemination of Best Practice in Bereavement Care Guides, with separate versions for residents, families, and staff. This presentation will describe this project in terms of the process of consensuses building and obtaining funding, as well as development of the guides through qualitative interview data.

scholarly journals Advance care planning for adolescents with cancer and their parents: study protocol of the BOOST pACP multi-centre randomised controlled trial and process evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne van Driessche ◽  
Aline De Vleminck ◽  
Joni Gilissen ◽  
Marijke C. Kars ◽  
Jutte van der Werff ten Bosch ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Advance Care Planning ◽  
Controlled Trial ◽  
Intervention Group ◽  
Paediatric Oncology ◽  
Care Planning ◽  
University Hospitals ◽  
Post Intervention ◽  
Advance Care ◽  
Randomised Controlled

Abstract Background Research has highlighted the need for evidence-based interventions to improve paediatric advance care planning (pACP) in adolescents with cancer. Although adolescents express the desire and ability to share their values, beliefs and preferences for treatment, there is a lack of structured multicomponent interventions to improve parent-adolescent communication on different ACP themes including those not limited to end-of-life care. The aim of this study is to evaluate the effectiveness and implementation, context and mechanisms of impact of a novel ACP program in paediatric oncology. Methods We will conduct a multi-centre parallel-group randomised controlled superiority trial with embedded mixed-methods process evaluation in Flanders, Belgium. Adolescents aged 10–18 who have cancer, and their parent(s) will be recruited via all four university hospitals in Flanders, Belgium, and support groups. Families will be randomised to receive care as usual or the multicomponent BOOST pACP program, consisting of three conversation sessions between an external facilitator and the adolescent and parent(s). The primary endpoint is improved parent-adolescent communication from the perspective of the adolescent. Secondary endpoints are adolescents’ and parents’ attitudes, self-efficacy, intention and behaviour regarding talking about ACP themes with each other, parents’ perspective of shared decision making in the last clinical encounter, and the paediatric oncologist’s intention and behaviour regarding talking about ACP themes with the family. Measurements will be performed at baseline, at 3 months and at 7 months using structured self-reported questionnaires. We will perform a process evaluation in the intervention group, with measurement throughout and post-intervention, using structured diaries filled out by the facilitators, interviews with facilitators, interviews with involved paediatric oncology teams, and audio-recordings of the BOOST pACP conversations. Discussion The BOOST pACP program has been developed to stimulate conversations on ACP themes between parent(s) and the adolescents, simultaneously lowering the threshold to discuss similar themes with healthcare professionals, initiating a process of normalization and integration of ACP in standard care. This combined outcome and process evaluation aims to contribute to building the necessary evidence to improve ACP in paediatric oncology. Trial registration The study is registered at ISRCTN, ISRCTN33228289. Registration date: January 22, 2021.

Improving communication about prognosis on an academic inpatient solid tumor oncology consult service.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 46-46
Author(s):  
Chrystal Ann Landry ◽  
Alaina J Kessler ◽  
Aarti Sonia Bhardwaj ◽  
Cardinale B. Smith
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Solid Tumor ◽  
Hospital Death ◽  
Care Planning ◽  
Post Intervention ◽  
Number Of Patients ◽  
Advance Care ◽  
The Impact

46 Background: As the number of patients living with cancer increases, a growing proportion of hospital inpatients will have an advanced cancer diagnosis. Data suggests that an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of less than 6 months. As hospitalists more frequently become the primary team taking care of admitted cancer patients, communication between a patient's oncologic care team and inpatient primary providers is crucial. We sought to implement and assess the impact of improved oncology consult documentation of patient prognosis on outcomes of advanced cancer patients admitted to our hospitalist medicine teaching services. Methods: We implemented an EMR-based oncology consult note template which required documentation of prognosis, potential future treatment options (if available), and advance care planning. We reviewed all patients with stage IV solid tumors admitted to the hospitalist teaching service for 8 weeks prior and 8 weeks post-template implementation for comparison. We utilized descriptive statistics and chi-squared testing as appropriate for analysis. Results: We evaluated 51 patients in the pre- and 36 patients in the post-intervention groups. Post-intervention, there was an improvement in documentation of prognosis (29.4% vs. 52.8%, p = 0.03), advanced care planning (37.2% vs. 83.3%, p < 0.0001), and in number of palliative care consults (58.8% vs. 83.3%, p = 0.02). On average, goals of care conversations occurred 2 days earlier in the post-intervention group (11 vs 9 days). Similarly, there was a decrease in inpatient chemotherapy administration (3 cases vs. 0), unit codes (2 vs. 0) and in-hospital death (23.5% vs. 11.1%). Conclusions: Creation of an oncology consult note template which incorporates current oncologic prognostic information improved documentation of prognosis and advance care planning as well as outcomes for advanced solid tumor oncology patients and enhanced inter-service communication. Based on these results, continued and targeted interventions are planned to further improve interservice communication.

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