scholarly journals Crucial Conversations for High Risk Populations Before Surgery: Advance Care Planning in a Preoperative Setting

2020 ◽  
Author(s):  
Roma Gautam Patel ◽  
Alexia Torke ◽  
Barb Nation ◽  
Ann Cottingham ◽  
Jennifer Hur ◽  
...  
Keyword(s):  
High Risk ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Elective Surgery ◽  
Total Mortality ◽  
Major Surgery ◽  
Care Planning ◽  
Advance Care ◽  
One Year

Abstract Background: High-risk patients undergoing elective surgery may experience life-threatening complications. Preoperative assessment clinics provide an opportunity to conduct Advance Care Planning but it is unknown how often this is accomplished or subsequently needed for goals of care discussions. Objective: 1) assess the relationship between advance directives with readmissions and mortality at one year 2) qualitatively examine clinical events that occurred for patients who died during follow-up.Design: This was an observational cohort study conducted via chart review. Patients were followed for one year.Participants: Four hundred patients who were undergoing preoperative evaluation for elective surgery at two academic hospitals. Main measures: The prevalence of advance directives at the time of surgery, prevalence of advance directives in the electronic medical record during the one year follow-up period, readmissions and mortality at one year. Key Results: Three hundred and ninety patients were included. There were 102 (26.4%) patients were readmitted, which was not associated with having an AD on file. Seventeen (4.4%) filed an AD during follow-up. Twelve of 19 (63%) patients who died had an AD on file at the time of death. There was a significant association between having an AD at any time with mortality (chi-square p-value <0.001). Total mortality for the cohort was 4.9%. Of the 19 patients who died, seven (37%) underwent resuscitation, four of whom had an AD on file. Conclusions: A minority of patients who die within a year after major surgery have an AD, highlighting the missed opportunity to conduct advance care planning in a preoperative clinic.

Improving advance care planning in high‐risk hospitalised patients: a knowledge translation pilot study

2021 ◽  
Vol 51 (4) ◽  
pp. 623-624
Author(s):  
Arvind Rajamani ◽  
Karen Fernandez ◽  
Hailey Carpen ◽  
Upul Liyanage ◽  
Jeffery Zijian Wang ◽  
...  
Keyword(s):  
Pilot Study ◽  
High Risk ◽  
Knowledge Translation ◽  
Advance Care Planning ◽  
Care Planning ◽  
Hospitalised Patients ◽  
Advance Care

Decision-Making Toolkit

2021 ◽  
pp. 60-76
Author(s):  
Jeffrey D. Myers
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Physician Assistant ◽  
Healthcare Providers ◽  
Terminally Ill ◽  
Decision Makers ◽  
Care Planning ◽  
Collaborative Partnership ◽  
Advance Care

Physician assistant (PA) training is rooted in treating the whole patient and developing a trusting and collaborative partnership with patients and their families. This foundation is critical in the advance care planning (ACP) process for patients who are seriously or terminally ill. Understanding the ACP process, the components and reasons behind them, and the tools for successful discussions and decision-making is a key skill set for all healthcare providers, including PAs. This chapter examines the components of ACP, including advance directives, the POLST paradigm, decision-makers, prognostication, documentation, and legacy planning. ACP is key in capturing what is most important to our patients in terms of their health, their life, and their goals related to both.

scholarly journals Advance care planning and palliative care in ACHD: the healthcare providers’ perspective

2020 ◽  
Vol 30 (3) ◽  
pp. 402-408
Author(s):  
Jill M. Steiner ◽  
Erwin N. Oechslin ◽  
Gruschen Veldtman ◽  
Craig S. Broberg ◽  
Karen Stout ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Directives ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Physical Symptoms ◽  
Care Planning ◽  
Psychosocial Needs ◽  
Cross Sectional ◽  
Advance Care

ABSTRACTBackground:Advance care planning and palliative care are gaining recognition as critical care components for adults with CHD, yet these often do not occur. Study objectives were to evaluate ACHD providers’ 1) comfort managing patients’ physical symptoms and psychosocial needs and 2) perspectives on the decision/timing of advance care planning initiation and palliative care referral.Methods:Cross-sectional study of ACHD providers. Six hypothetical patients were described in case format, followed by questions regarding provider comfort managing symptoms, initiating advance care planning, and palliative care referral.Results:Fifty providers (72% physicians) completed surveys. Participants reported low levels of personal palliative care knowledge, without variation by gender, years in practice, or prior palliative care training. Providers appeared more comfortable managing physical symptoms and discussing prognosis than addressing psychosocial needs. Providers recognised advance directives as important, although the percentage who would initiate advance care planning ranged from 18 to 67% and referral to palliative care from 14 to 32%. Barriers and facilitators to discussing advance care planning with patients were identified. Over 20% indicated that advance care planning and end-of-life discussions are best initiated with the development of at least one life-threatening complication/hospitalisation.Conclusions:Providers noted high value in advance directives yet were themselves less likely to initiate advance care planning or refer to palliative care. This raises the critical questions of when, how, and by whom discussion of these important matters should be initiated and how best to support ACHD providers in these endeavours.

scholarly journals The Effect of Advance Care Planning on Heart Failure: a Systematic Review and Meta-analysis

2019 ◽  
Vol 35 (3) ◽  
pp. 874-884 ◽  
Author(s):  
Markus Schichtel ◽  
Bee Wee ◽  
Rafael Perera ◽  
Igho Onakpoya
Keyword(s):  
Heart Failure ◽  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Meta Analysis ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Abstract Background Advance care planning is widely advocated to improve outcomes in end-of-life care for patients suffering from heart failure. But until now, there has been no systematic evaluation of the impact of advance care planning (ACP) on clinical outcomes. Our aim was to determine the effect of ACP in heart failure through a meta-analysis of randomized controlled trials (RCTs). Methods We searched CINAHL, Cochrane Central Register of Controlled Trials, Database of Systematic Reviews, Embase, ERIC, Ovid MEDLINE, Science Citation Index and PsycINFO (inception to July 2018). We selected RCTs including adult patients with heart failure treated in a hospital, hospice or community setting. Three reviewers independently screened studies, extracted data, assessed the risk of bias (Cochrane risk of bias tool) and evaluated the quality of evidence (GRADE tool) and analysed interventions according to the Template for Intervention Description and Replication (TIDieR). We calculated standardized mean differences (SMD) in random effects models for pooled effects using the generic inverse variance method. Results Fourteen RCTs including 2924 participants met all of the inclusion criteria. There was a moderate effect in favour of ACP for quality of life (SMD, 0.38; 95% CI [0.09 to 0.68]), patients’ satisfaction with end-of-life care (SMD, 0.39; 95% CI [0.14 to 0.64]) and the quality of end-of-life communication (SMD, 0.29; 95% CI [0.17 to 0.42]) for patients suffering from heart failure. ACP seemed most effective if it was introduced at significant milestones in a patient’s disease trajectory, included family members, involved follow-up appointments and considered ethnic preferences. Several sensitivity analyses confirmed the statistically significant direction of effect. Heterogeneity was mainly due to different study settings, length of follow-up periods and compositions of ACP. Conclusions ACP improved quality of life, patient satisfaction with end-of-life care and the quality of end-of-life communication for patients suffering from heart failure and could be most effective when the right timing, follow-up and involvement of important others was considered.

scholarly journals Incorporating an advance care planning screening tool into routine health assessments with older people

2020 ◽  
Vol 26 (3) ◽  
pp. 240
Author(s):  
Abigail E. Franklin ◽  
Joel Rhee ◽  
Bronwyn Raymond ◽  
Josephine M. Clayton
Keyword(s):  
General Practice ◽  
Advance Care Planning ◽  
Screening Tool ◽  
Care Planning ◽  
Practice Nurses ◽  
Substitute Decision Maker ◽  
Health Assessments ◽  
Advance Care ◽  
Screening Interview

General practice is arguably the ideal setting to initiate advance care planning (ACP), but there are many barriers. This pilot study was designed to assess the feasibility, acceptability and perceived utility of a nurse-facilitated screening interview to initiate ACP with older patients in general practice. Patients were recruited from four general practices in Sydney, Australia. General practice nurses administered the ACP screening interview during routine health assessments. Patients and nurses completed a follow-up questionnaire consisting of questions with Likert responses, as well as open-ended questions. Descriptive statistics and content analysis were used to analyse the data. Twenty-four patients participated; 17 completed the follow-up questionnaire. All patients found the ACP screening interview useful and most felt it would encourage them to discuss their wishes further with their family and general practitioner. Several patients were prompted to consider legally appointing their preferred substitute decision-maker. All six participating nurses found the screening interview tool useful for initiating discussions about ACP and substitute decision-making. This nurse facilitated screening tool provides a simple, acceptable and feasible approach to introducing ACP to older general practice patients during routine health assessments.

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