Prior Advance Care Planning Is Associated with Less Decisional Conflict among Surrogates for Critically Ill Patients

Abstract Background: Training has been found effective in improving healthcare professionals’ knowledge, confidence, and skills in conducting advance care planning (ACP). However, its association with their attitudes toward ACP, which is crucial to its implementation, remained unclear. To fill this gap, this paper examines the association between their attitudes toward ACP and relevant training experiences.Methods: An online survey about attitudes toward ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted.Results: Of 250 respondents, approximately half (51.6%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001–0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience.Conclusions: This paper revealed the association between training and positive attitudes toward ACP among healthcare professionals. The findings showed that training is a predictor of their preparedness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.

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Advance care planning in critically ill haematology patients

Critical Care ◽

10.1186/cc13220 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P30

Author(s):

V Metaxa ◽

J Lambert ◽

A Barrow ◽

J De Vos

Keyword(s):

Critically Ill ◽

Advance Care Planning ◽

Care Planning ◽

Advance Care ◽

Haematology Patients

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Evaluation of a Video Decision Aid to Reduce Decisional Conflict in Physician Orders for Life-Sustaining Treatment (POLST) Decision-Making

Journal of Palliative Care ◽

10.1177/0825859720923437 ◽

2020 ◽

Vol 35 (4) ◽

pp. 243-247

Author(s):

Jarred V. Gallegos ◽

Barry Edelstein ◽

Alvin H. Moss

Keyword(s):

Decision Making ◽

Advance Care Planning ◽

Decision Aid ◽

Decision Aids ◽

Decisional Conflict ◽

Community Dwelling ◽

Care Planning ◽

Life Sustaining Treatment ◽

Advance Care ◽

Decisional Satisfaction

Background/Objectives: Physician Orders for Life-Sustaining Treatment (POLST) is recommended as a preferred practice for advance care planning with seriously ill patients. Decision aids can assist patients in advance care planning, but there are limited studies on their use for POLST decisions. We hypothesized that after viewing a POLST video, decision aid participants would demonstrate increased knowledge and satisfaction and decreased decisional conflict. Design: Pre-and postintervention with no control group. Setting/Participants: Fifty community-dwelling adults aged 65 and older asked to complete a POLST based on a hypothetical condition. Interventions: Video decision aid for Sections A and B of the POLST form. Measurements: Pre- and postintervention participant knowledge, decisional satisfaction, decisional conflict, and acceptability of video decision aid. Results: Use of the video decision aid increased knowledge scores from 11.24 ± 2.77 to 14.32 ± 2.89, P < .001, improved decisional satisfaction 10.14 ± 3.73 to 8.70 ± 3.00, P = .001, and decreased decisional conflict 12 ± 9.42 to 8.15 ± 9.13, P < .001. All participants reported that they were comfortable using the video decision aid, that they would recommend it to others, and that it clarified POLST decisions. Conclusions: Participants endorsed the use of a POLST video decision aid, which increased their knowledge of POLST form options and satisfaction with their decisions, and decreased their decisional conflict in POLST completion. This pilot study provides preliminary support for the use of video decision aids for POLST decision-making. Future research should evaluate a decision aid for the entire POLST form and identify patient preferences for implementing POLST decision aids into clinical practice.

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Association between training experience and readiness for advance care planning among healthcare professionals: a cross-sectional study

10.21203/rs.3.rs-29070/v2 ◽

2020 ◽

Author(s):

Helen Yue-lai Chan ◽

Annie Oi-ling Kwok ◽

Kwok-keung Yuen ◽

Derrick Kit-sing Au ◽

Jacqueline Kwan-yuk Yuen

Keyword(s):

Advance Care Planning ◽

Online Survey ◽

Healthcare Professionals ◽

Clinical Work ◽

Decisional Conflict ◽

Cross Sectional Study ◽

Care Planning ◽

Training Experience ◽

Cross Sectional ◽

Advance Care

Abstract Background: Training has been found effective in improving healthcare professionals’ knowledge, confidence, and skills in conducting advance care planning (ACP). However, the association between training and its actual practice in the clinical setting has not been well demonstrated. To fill this gap, this paper examines the association between their readiness for ACP, in terms of perceived relevancy of ACP with their clinical work, attitudes toward and confidence and willingness to perform it, based on the Theory Planned Behavior and relevant training experiences.Methods: An online survey about experiences about ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted. Results: Of 250 respondents, approximately half (51.6%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and different levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001–0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience.Conclusions: This paper revealed the association between training and higher level of readiness toward ACP among healthcare professionals. The findings showed that training is a predictor of their readiness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.

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CAN PERSONS WITH DEMENTIA MEANINGFULLY PARTICIPATE IN ADVANCE CARE PLANNING CONVERSATIONS? A MIXED-METHODS STUDY

Innovation in Aging ◽

10.1093/geroni/igz038.209 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S53-S54

Author(s):

Mi-Kyung Song ◽

Sandra Ward ◽

Ken Hepburn ◽

Sudeshna Paul ◽

Hyejin Kim ◽

...

Keyword(s):

Decision Making ◽

End Of Life ◽

Advance Care Planning ◽

Intervention Development ◽

Decisional Conflict ◽

Structured Interview ◽

Care Patient ◽

Care Planning ◽

Advance Care ◽

Panel Review

Abstract Studies of advance care planning (ACP) in persons living with dementia (PLWDs) are rare. We conducted an intervention development study to adapt an efficacious ACP intervention, SPIRIT (Sharing Patient’s Illness Representations to Increase Trust), for PLWDs in early stages and their surrogates and assessed the feasibility/acceptability of the adapted SPIRIT. SPIRIT was adapted by the investigators and underwent expert panel review. The refined SPIRIT was then evaluated in a randomized trial with 23 dyads of PLWDs and their surrogates. Dyads were randomized to SPIRIT in-person (in a private room in a memory clinic) or SPIRIT remote (via videoconferencing from home). Participants completed preparedness outcome measures (dyad congruence on goals of care, patient decisional conflict, surrogate decision-making confidence) 2-3 days postintervention along with a semi-structured interview. PLWDs’ levels of articulation of end-of-life wishes during SPIRIT sessions were rated (3 = expressed wishes very coherently, 2 = somewhat coherently, 1 = unable to express wishes coherently). Fourteen PLWDs had moderate dementia, but all 23 were able to articulate their end-of-life wishes very or somewhat coherently during the SPIRIT session. While decision-making capacity was higher in PLWDs who articulated their wishes very coherently, global cognitive function did not differ by articulation levels. PLWDs and surrogates perceived SPIRIT as beneficial, but the preparedness outcomes did not change from baseline to postintervention in either group. SPIRIT for PLWDs and surrogates engaged them in meaningful ACP discussions. Further research is warranted to test its efficacy and long-term outcomes with a larger and diverse sample.

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Association between training experience and readiness for advance care planning among healthcare professionals: a cross-sectional study

BMC Medical Education ◽

10.1186/s12909-020-02347-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Helen Yue-lai Chan ◽

Annie Oi-ling Kwok ◽

Kwok-keung Yuen ◽

Derrick Kit-sing Au ◽

Jacqueline Kwan-yuk Yuen

Keyword(s):

Advance Care Planning ◽

Online Survey ◽

Healthcare Professionals ◽

Clinical Work ◽

Decisional Conflict ◽

Cross Sectional Study ◽

Care Planning ◽

Training Experience ◽

Cross Sectional ◽

Advance Care

Abstract Background Training has been found effective in improving healthcare professionals’ knowledge, confidence, and skills in conducting advance care planning (ACP). However, the association between training and its actual practice in the clinical setting has not been well demonstrated. To fill this gap, this paper examines the association between their readiness for ACP, in terms of perceived relevancy of ACP with their clinical work, attitudes toward and confidence and willingness to perform it, based on the Theory Planned Behavior and relevant training experiences. Methods An online survey about experiences about ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted. Results Of 250 respondents, approximately half (52.0%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and different levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001–0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience. Conclusions This paper revealed the association between training and higher level of readiness toward ACP among healthcare professionals. The findings showed that training is a predictor of their readiness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.

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Implementing advance care planning in dementia care: results and insights from a pilot interventional trial

10.21203/rs.3.rs-383522/v1 ◽

2021 ◽

Author(s):

Francesca Bosisio ◽

Anca Sterie ◽

Eve Rubli Truchard ◽

Ralf J. Jox

Keyword(s):

Advance Care Planning ◽

Perceived Control ◽

Controlled Trial ◽

Qualitative Interviews ◽

Healthcare Providers ◽

Depression Scale ◽

Decisional Conflict ◽

Dementia Care ◽

Care Planning ◽

Advance Care

Abstract Background: Advance care planning (ACP) is particularly appropriate for persons with dementia (PWD) since it fosters conversation about dementia-specific illness scenarios, addresses inconsistencies between advance directives and patients’ observed behaviour, emphasises prospective and relational autonomy, and may be generally consistent to elderly’s decision-making needs. However, despite the evidence of its benefits, ACP is yet to become widely used among PWD. In this paper, we present results regarding the feasibility and acceptability of a pilot intervention designed to foster ACP among PWD and their relative and explore future outcome measures in prevision of a randomized controlled trial. Methods: In order to assess pre-post variations, we used qualitative interviews and four psychometric scales: Hospital Anxiety and Depression Scale, Questionnaire of Psychological Autonomy, Decisional conflict scale, and Zarit burden scale. We added two visual analog scales for perceived control over and perceived involvement in healthcare decisions, as well as two hypothetic scenarios to test concordance between PWD’s and surrogate’s decisions.Results: Five main challenges in terms of feasibility were 1) to locate eligible patients, 2) to tailor recruitment procedures to recruitment locations, 3) to adapt inclusion criteria to meet clinical routines, 4) to engage PWD and their relatives in ACP, and 5) to choose outcome criteria that do not burden PWD. Alongside with those expected challenges, we discuss substantial unanticipated gatekeeping by the research ethics committee and healthcare professionals. Despite the setbacks, the intervention was well received by PWD and their relatives that expressed satisfaction with the procedure, especially in regard to the opportunity to discuss a sensitive topic with the help of a facilitator. Relatives’ perceived control over healthcare decisions increased, as well as concordance between PWD’s preferences and relatives’ decision. Conclusion: Misconceptions about dementia and ACP, both in the patient, relatives, and healthcare providers, combined with structural institutional challenges, have the power to impede research and implementation of ACP in dementia care. For this reason, we advocate for a systemic approach of ACP and for the use of ACP tools and research adapted to PWD cognitive capacities.Trial registration: This trial was registered in the database clinicaltrial.gov with the number NCT03615027

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O-85 Advance care planning and decisional conflict in adolescents with HIV

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2015-000978.84 ◽

2015 ◽

Vol 5 (Suppl 2) ◽

pp. A27.1-A27

Author(s):

Allison L Kimmel ◽

YI Cheng ◽

J Wang ◽

ME Lyon

Keyword(s):

Advance Care Planning ◽

Decisional Conflict ◽

Care Planning ◽

Advance Care

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Feasibility of Educating Stem Cell Transplant Patients on Advance Care Planning: A Pilot Study

Blood ◽

10.1182/blood-2018-99-119431 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4798-4798

Author(s):

Kuldeep N Yadav ◽

Lon T Ogunduyile ◽

Brain Bayes ◽

Elizabeth Cooney ◽

Alison W. Loren ◽

...

Keyword(s):

Quality Of Life ◽

End Of Life ◽

Advance Care Planning ◽

Educational Intervention ◽

Hematologic Malignancies ◽

Decisional Conflict ◽

Care Planning ◽

Advance Care ◽

To Receive

Abstract Introduction Patients with hematologic malignancies undergoing hematopoietic cell transplants (HCT) experience a high symptom burden, suffer from diminished quality of life, and often receive aggressive care at the end of life. Low completion rates of advance directives (ADs) regarding preferences for end-of-life care in this population are also common. Our study aims to examine the feasibility of a timely educational intervention about an online AD (i.e., OurCareWishes.org; OCW) for patients with hematologic malignancies undergoing autologous or allogeneic stem cell transplantation. We also seek to ascertain whether this educational intervention impacts patients' decisional conflict regarding transplant and quality of life. Methods Patients scheduled for HCT were recruited and randomized to receive either in-person guided education about OCW (i.e., intervention) or standard AD information (i.e., usual care) 3-4 weeks prior to hospital admission for transplantation. Patients receiving the educational intervention were offered the opportunity to specify their preferences for life-sustaining or comfort-oriented care using vignettes and ultimately complete two components of online AD (e.g., health care proxy and living will). All patients received in-person follow-ups during their transplant and 2 months post-transplant appointments, during which patients who had received the educational intervention were re-approached about completing the online AD. Patients indicating a previously completed AD were offered the opportunity to review. At all three time points, patients were surveyed on their (1) decisional conflict regarding transplant using Decision Conflict Scale (DCS, 16-item, Range 0-60) and their (2) overall quality of life using McGill Quality of Life (MQoL) scale (16-item, Range 1-7). Greater DCS and MQoL scores represent greater decision conflict and better quality of life, respectively. We conducted a one-way repeated measures ANOVA to examine the effect of the educational AD intervention on decisional outcomes and quality of life. Results A total of 96 patients (98% Recruitment Rate) consented to participate and were randomized to receive either OCW (n=47) or standard AD information (n=49). They underwent either autologous (n=29), allogeneic reduced intensity (n=29), or allogeneic myeloablative (n=38) HCT. Most patients were male (n=57; 61%) and White (n=85; 89%). The median age was 59 (IQR=49.5-65.5) years (Table 1). There were no differences between intervention and usual care groups in their rating for overall quality of life and decisional conflict at all three timepoints (all p>0.05). 48% of patients (n=49) self-reported to have completed an AD prior this study, but only 43% (n=21) had a current AD uploaded to the EHR. Moreover, less than 6% of patients who received the OCW intervention fully completed the online AD. Conclusions This pilot study demonstrated the feasibility of administering a brief educational intervention on advance care planning (ACP) in patients with hematologic malignancies preparing for HCT. Participants in this study were generally receptive to discussions about advance care planning, even when presented by non-clinical staff. Education about advance directives does not appear to negatively affect decisional outcomes or quality of life. Nonetheless, further research should focus on how to increase AD completion rates, possibly through multidisciplinary team engagement in serious illness conversations and coordinated physician/patient incentives. Future studies should examine the impact of education of AD on aggressiveness of care and end-of-life outcomes in patients undergoing HCT. Disclosures No relevant conflicts of interest to declare.

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Perspectives of Persons With Dementia, Family, and Healthcare Providers on an Advance Care Planning Decision Aid

Innovation in Aging ◽

10.1093/geroni/igaa057.2849 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 787-787

Author(s):

Lisa Geshell ◽

Jung Kwak

Keyword(s):

Advance Care Planning ◽

Decision Aid ◽

Descriptive Analysis ◽

Healthcare Providers ◽

Decisional Conflict ◽

Care Planning ◽

Dementia Caregiver ◽

Planning Decision ◽

Advance Care

Abstract Few evidence-based interventions to engage persons living with dementia in advance care planning (ACP) exist. We developed and explored the acceptability and appropriateness of an ACP decision aid for PLWD/family caregiver dyads living in the U.S. We conducted a mixed-methods study with 10 persons with dementia-caregiver dyads, and 4 healthcare providers. Content analysis and descriptive analysis were conducted. Major and subthemes included: (1) the role of caregivers during ACP discussion: clarifier, guide, and proxy; (2) decisional needs of persons with dementia for ACP: lack of knowledge and decisional conflict; and (3) perceptions of the decision aid: lack of clarity between advance directive types, a need to remove any questions that may be conceptually different, but appear similar to users, and need to include summary of decision-support needs. Findings provide implications for how healthcare providers can use a decision aid to facilitate ACP conversations with persons with dementia and caregivers.

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