Costs and outcomes of advance care planning and end-of-life care for older adults with end-stage kidney disease: A person-centred decision analysis

We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.

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Case-control study of end-of-life treatment preferences and costs following advance care planning for adults with end-stage kidney disease

Nephrology ◽

10.1111/nep.13230 ◽

2019 ◽

Vol 24 (2) ◽

pp. 148-154 ◽

Cited By ~ 4

Author(s):

Marcus Sellars ◽

Rachael L Morton ◽

Josephine M Clayton ◽

Allison Tong ◽

Daveena Mawren ◽

...

Keyword(s):

Kidney Disease ◽

Advance Care Planning ◽

Case Control Study ◽

Case Control ◽

Treatment Preferences ◽

Care Planning ◽

End Stage Kidney Disease ◽

Advance Care ◽

End Stage ◽

Control Study

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Factors Influencing Advance Care Planning Among Older Adults in Two Socioeconomically Diverse Living Communities

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116679140 ◽

2016 ◽

Vol 35 (1) ◽

pp. 69-74 ◽

Cited By ~ 9

Author(s):

Jennifer L. Tripken ◽

Cathy Elrod ◽

Susan Bills

Keyword(s):

Older Adults ◽

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Retirement Community ◽

Continuing Care ◽

Care Planning ◽

Attitudes And Beliefs ◽

Life Care ◽

Advance Care

Background/Objectives: Advance care planning (ACP) is an iterative, complex, and dynamic process of discussion, decision-making, and documentation about end-of-life care. The extent to which this process takes place in older adults in diverse socioeconomic settings is not well documented. The aim of this study was to assess the knowledge, attitudes, and beliefs about ACP among older adults in two socioeconomically diverse settings to identify the individual and contextual factors that influence behaviors regarding end-of-life care. Design: A cross-sectional survey design was used. Setting: An affordable independent continuing care retirement community and a high-income eligible (HIE) independent continuing care retirement community. Participants: Individuals aged 55 years and older who resided in independent living. Measurements: A 61-item survey was administered. Simple descriptive statistics were used to examine the responses, and inferential statistics were used to evaluate which items were associated with key outcomes between the 2 settings. Results: Seventy-seven older adults completed the survey. Significant differences in familiarity of terminology and knowledge of ACP, as well as significant differences in completion of advance directives and communication, were found between the 2 communities. No differences were found in attitudes and beliefs about end-of-life issues. Conclusion: Higher levels of knowledge and engagement in ACP were reported at the HIE community as compared to the affordable housing community. These findings provide insight into the influence of the contextual forces that encourage and support ACP.

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Acceptability of Paper-Based Advance Care Planning (ACP) to Inform End-of-Life Care Provision for Community Dwelling Older Adults: A Qualitative Interview Study

Geriatrics ◽

10.3390/geriatrics3040088 ◽

2018 ◽

Vol 3 (4) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Gary Bellamy ◽

Jennifer Stock ◽

Patricia Schofield

Keyword(s):

Older Adults ◽

End Of Life ◽

Advance Care Planning ◽

End Of Life Care ◽

Community Dwelling ◽

Care Planning ◽

Care Provision ◽

Life Care ◽

Telephone Interviews ◽

Advance Care

This paper reports the findings from a study to investigate health care professionals’ views regarding the use and acceptability of two similar paper-based advance care planning (ACP) documents designed for older adults in their last year of life to inform end-of-life care provision. Participants’ views of using PEACE (Proactive Elderly Persons Advisory Care), a nurse led model with community geriatrician oversight, and PACe (proactive anticipatory care plan), a general practitioner (GP) led model implemented by two clinical commissioning groups (CCGs) as part of a wider pilot to determine their ability to improve end-of-life care provision, were explored. Hospital admission avoidance matrons took part in face to face interviews and care staff employed in private residential care homes took part in individual telephone interviews to explore their views of using the PEACE tool. Telephone interviews were conducted with GPs to explore their views of PACe. GPs and admission avoidance matrons were employed by CCGs and all study participants were recruited from the South East of England, where data collection took place in 2015. The data were analysed thematically. Findings from the study demonstrate how both tools provide a focus to ACP discussions to inform individual end-of-life care preferences. The importance of relationships was a pivotal theme established, trusting inter-professional relationships to enable multidisciplinary teamwork and a prior relationship with the older person (or their proxy in the case of cognitive impairment) to enable such conversations in the first place. Both tools enabled participants to think critically and reflect on their own practice. Notwithstanding participants’ views to improve their layout, using a paper-based approach to deliver streamlined ACP and end-of-life care was a theme to emerge as a potential barrier, and highlighted problems with accessing paper-based documentation, accuracy and care co-ordination in the context of multidisciplinary team working. The value of technology in overcoming this barrier and underpinning ACP as a means to help simplify service provision, promote integrated professional practice and provide seamless care, was put forward as a way forward.

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Advance care planning for end-stage kidney disease

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd010687.pub2 ◽

2016 ◽

Author(s):

Andem Effiong ◽

Laura Shinn ◽

Thaddeus M Pope ◽

Joseph A Raho

Keyword(s):

Kidney Disease ◽

Advance Care Planning ◽

Care Planning ◽

End Stage Kidney Disease ◽

Advance Care ◽

End Stage

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Advance Care Planning for Patients Approaching End-Stage Kidney Disease

Seminars in Nephrology ◽

10.1016/j.semnephrol.2016.12.007 ◽

2017 ◽

Vol 37 (2) ◽

pp. 173-180 ◽

Cited By ~ 2

Author(s):

Rebecca J. Schmidt

Keyword(s):

Kidney Disease ◽

Advance Care Planning ◽

Care Planning ◽

End Stage Kidney Disease ◽

Advance Care ◽

End Stage

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Advance Care Planning to Elicit and Respect Patient Values and Preferences

Palliative Care in Nephrology ◽

10.1093/med/9780190945527.003.0010 ◽

2020 ◽

pp. 98-107

Author(s):

Jean L. Holley ◽

J. April Yasunaga

Keyword(s):

Kidney Disease ◽

Advance Directives ◽

Advance Care Planning ◽

Care Planning ◽

Power Of Attorney ◽

End Stage Kidney Disease ◽

Health States ◽

Advance Care ◽

Patient Values ◽

End Stage

Advance care planning (ACP) is a patient-centered process to elicit patient and family goals and values that shape medical decision-making and form the basis for completing written advance directives. Advance directives such as healthcare power of attorney, surrogate decision-maker identification, and living wills are executed by the patient. These may be supplemented by provider orders such as resuscitation status (do not resuscitate/do not attempt resuscitation) and provider orders for life-sustaining treatment. Provider input into ACP is required as patients and families need information on prognosis and risks and benefits of interventions to make informed decisions. Because health states influence decisions for ongoing care, ACP is a process that requires revisiting wishes and goals via discussions at stages throughout a patient’s life. All healthcare systems through which a patient passes will need to be involved and cognizant of advance directives to ensure a patient’s wishes are honored. Dialysis units are an integral part of the healthcare system for end-stage kidney disease patients and need to be engaged in the ACP process. Consensus statements, guidelines, and tools exist to facilitate ACP in end-stage kidney disease and chronic kidney disease patients.

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