How to Measure Goal Concordant Care in Order to Evaluate Advance Care Planning with Integrity: A Literature Review

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 80-80
Author(s):  
Sophie Gloeeckler ◽  
◽  
Manuel Trachsel ◽  
Keyword(s):  
Literature Review ◽  
Medical Record ◽  
Advance Care Planning ◽  
Best Practice ◽  
Evidence Base ◽  
Medical Record Review ◽  
Care Planning ◽  
Advance Care ◽  
The Many ◽  
Record Review

"Advance care planning is an effort to consider and communicate one’s values, goals, and preferences as they relate to future healthcare decisions to guide clinicians and loved ones when one is incapable of consenting, refusing, or requesting care. While generally accepted as valuable, advance care planning has proven challenging to evaluate. Goal concordant care is increasingly recognized as the target outcome, but there is no agreed-on methodology for assessment and some question if it can be meaningfully captured. It is ethically necessary to have a strong evidence base to guide practice. The current study is a literature review designed to support best practice for measuring goal concordant care. A database search of Pubmed, Embase, PsycINFO, CINAHL, and Cochrane was conducted in September 2020; articles were included that measured whether advance care planning, defined broadly to consider advance directives, use of proxies, POLSTs, etc., led to goal concordant care. 132 included articles were reviewed according to aim, methodology, and integrity. Common approaches included medical record review 51% (n = 36); questionnaire (36%, n = 48), notably the Decision Conflict Scale (15% of questionnaires, n = 7); and interview (31%, n = 42), often with loved ones after death (40% of interviews, n = 17). Studies, especially those employing medical record review, did not always present enough detail to be reproducible, a concerning limitation. Despite the many existing studies aiming to track whether advance care planning leads to goal concordant care, significant work remains to establish sound methodology to do so meaningfully. "

Lessons Learned From a Pilot Project on Telemedicine Advance Care Planning in an Urban Geriatric Primary Care Office

2021 ◽  
pp. 104990912110369
Author(s):  
Olivia M. Seecof ◽  
Molly Allanoff ◽  
John Liantonio ◽  
Susan Parks
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Medical Record ◽  
Advance Care Planning ◽  
Pilot Project ◽  
Lessons Learned ◽  
Care Planning ◽  
Geriatric Population ◽  
Advance Care ◽  
Primary Care Office

Purpose: There is a dearth of literature regarding the documentation of advance care planning (ACP) in the geriatric population, despite the controversial, yet well-studied need for ACP. The purpose of this pilot study was to provide an update to a prior study from our institution that outlined the need for increased documentation of advance care planning (ACP) in an urban geriatric population. Methods: Our study involved using telemedicine to conduct dedicated ACP visits and an electronic medical record (EMR) note-template specifically designed for these visits in an attempt to increase the amount of documented ACP in the EMR in this population. Results: The study did not yield significant results due to the inability to schedule enough patients for these dedicated visits. Discussion: While our study was ultimately unsuccessful, 3 crucial lessons were identified that will inform and fuel future interventions by the authors to further the study of documentation of ACP.

scholarly journals Advance care planning evaluation: a scoping review of best research practice

2021 ◽  
pp. bmjspcare-2021-003193
Author(s):  
Sophie Gloeckler ◽  
Tanja Krones ◽  
Nikola Biller-Andorno
Keyword(s):  
Advance Care Planning ◽  
Scoping Review ◽  
Retrospective Chart Review ◽  
Evidence Base ◽  
Future Research ◽  
Care Planning ◽  
Completion Rates ◽  
Future Care ◽  
Actual Care ◽  
Advance Care

Various indicators have been used to evaluate advance care planning, including completion rates, type of care received, and satisfaction. Recent consensus suggests, though, that receiving care consistent with one’s goals is the primary outcome of advance care planning and assessment should capture this metric. Goal concordant care is challenging to measure, and there is little clarity about how best to do so. The aim of this scoping review is to explore what methods have been used to measure goal concordant care in the evaluation of advance care planning. PubMed, Embase, PsycINFO, CINAHL and Cochrane were searched in September 2020 to identify studies that aimed to track whether advance care planning affected the likelihood of patients receiving care that matched their preferred care. 135 original studies were included for review. Studies used retrospective chart review (36%, n=49), questionnaire (36%, n=48) and interview (31%, n=42), focusing on both patients and proxies. Studies considered both actual care received (55%, n=74) and hypothetical scenarios anticipating possible future care (49%, n=66); some studies did both. While the reviewed studies demonstrate the possibility of working towards a solid methodology, there were significant weaknesses. Notably, studies often lacked enough reporting clarity to be reproducible and, relatedly, key concepts, such as end-of-life or preferred care, were left undefined. The recommendations that follow from these findings inform future research approaches, supporting the development of a strong evidence base to guide advance care planning implementation in practice.

scholarly journals Emergency Physicians' Experience with Advance Care Planning Documentation in the Electronic Medical Record: Useful, Needed, and Elusive

2016 ◽  
Vol 19 (6) ◽  
pp. 632-638 ◽  
Author(s):  
Joshua R. Lakin ◽  
Eric Isaacs ◽  
Erin Sullivan ◽  
Heather A. Harris ◽  
Ryan D. McMahan ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Advance Care Planning ◽  
Care Planning ◽  
Emergency Physicians ◽  
Advance Care

scholarly journals Framing advance care planning in Parkinson disease

Neurology ◽  
2019 ◽  
Vol 92 (22) ◽  
pp. e2571-e2579 ◽  
Author(s):  
Hillary D. Lum ◽  
Sarah R. Jordan ◽  
Adreanne Brungardt ◽  
Roman Ayele ◽  
Maya Katz ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Advance Care Planning ◽  
Best Practice ◽  
Clinical Care ◽  
Active Role ◽  
Care Planning ◽  
Care Partners ◽  
Interdisciplinary Approaches ◽  
Advance Care ◽  
Partner Perceptions

ObjectiveAdvance care planning (ACP) is a core quality measure in caring for individuals with Parkinson disease (PD) and there are no best practice standards for how to incorporate ACP into PD care. This study describes patient and care partner perspectives on ACP to inform a patient- and care partner-centered framework for clinical care.MethodsThis is a qualitative descriptive study of 30 patients with PD and 30 care partners within a multisite, randomized clinical trial of neuropalliative care compared to standard care. Participants were individually interviewed about perspectives on ACP, including prior and current experiences, barriers to ACP, and suggestions for integration into care. Interviews were analyzed using theme analysis to identify key themes.ResultsFour themes illustrate how patients and care partners perceive ACP as part of clinical care: (1) personal definitions of ACP vary in the context of PD; (2) patient, relationship, and health care system barriers exist to engaging in ACP; (3) care partners play an active role in ACP; (4) a palliative care approach positively influences ACP. Taken together, the themes support clinician initiation of ACP discussions and interdisciplinary approaches to help patients and care partners overcome barriers to ACP.ConclusionsACP in PD may be influenced by patient and care partner perceptions and misperceptions, symptoms of PD (e.g., apathy, cognitive dysfunction, disease severity), and models of clinical care. Optimal engagement of patients with PD and care partners in ACP should proactively address misperceptions of ACP and utilize clinic teams and workflow routines to incorporate ACP into regular care.

95 Goals-Of-Care and Advance Care Planning Discussions with Hospitalised Frail Older People: What is the Evidence?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i30-i32
Author(s):  
S A Hopkins ◽  
A Bentley ◽  
V Phillips ◽  
S Barclay
Keyword(s):  
Literature Review ◽  
Older People ◽  
Advance Care Planning ◽  
Controlled Trial ◽  
Care Planning ◽  
Frail Older People ◽  
National Guidelines ◽  
Goals Of Care ◽  
Hospitalised Patients ◽  
Advance Care

Abstract Introduction National guidelines suggest that patients in the last year of life should be identified, their prognosis and future care options discussed, with advance care planning (ACP) recorded. Goals-of-care should be discussed with hospitalised patients at risk of deteriorating or with life-limiting conditions. The stated purpose of ACP and goals-of-care discussions is to increase goal-concordant care (i.e. patients receiving treatments they would wish to receive, and not receiving those they would not want). This literature review investigates the evidence-base for these policies and outcomes. Review question What is the evidence for goals-of-care and ACP discussions with hospitalised frail older people? Methods Systematic literature review and narrative synthesis. Electronic search of MEDLINE, CINAHL, ASSIA, PsycINFO, and Embase databases from January 1990 to September 2017. An updated search until May 2019 is currently underway. Results Of 8077 unique articles identified, 17 met inclusion criteria. There is no evidence that goals-of-care discussions lead to increased goal-concordant care; there is observational evidence that they increase the accuracy of documented preferences. Currently, rates of goals-of-care discussions are variable (38-72%), and there is poor concordance between patients’ actual and documented preferences, with agreement in only 31-33% of cases. Present rates of ACP are very low (0-3%), with mixed evidence for benefits of ACP. One single-centre randomised controlled trial suggests ACP improves outcomes for patients who die within 6 months of discharge, including increased goal-concordant care and reduced family distress. There is very limited evidence concerning patients’ and family members’ experiences of these discussions, their reasons for wishing (or not) to participate in discussions, or their perceptions of the important outcomes. Most (80%) patients would like to be involved in decisions about their care; 48% consider these conversations very important. The views and experiences of healthcare professionals have been little studied. Conclusions The asserted aim of goals-of-care and ACP discussions is to increase goal-concordant care; the extent to which this reflects patients’ priorities is unknown. In younger patient populations, while 40% of patients consider goal-concordant care the most important outcome, one third of patients consider family-related outcomes to be more important. Further research is needed to understand the perspectives of frail older patients, their families and clinicians, in order to make these discussions and subsequent care truly patient-centred.

Experience of use of advance care planning in care homes

2018 ◽  
Author(s):  
Maggie Stobbart-Rowlands ◽  
Mandy Thorn
Keyword(s):  
Advance Care Planning ◽  
Best Practice ◽  
Care Home ◽  
Training Programme ◽  
Best Interests ◽  
Care Homes ◽  
Care Planning ◽  
Home Setting ◽  
People With Dementia ◽  
Advance Care

This chapter describes the care home setting, aspects that have an impact on use of Advance care planning (ACP) in care homes, examples of challenges and best practice, use of ACP in the GSF Care Homes Training Programme, ACP with people with dementia, and culture change. Many people in care homes are in the last year/s of life, and ACP discussions are especially important for them to ensure that the care they receive is in line with what they want. Care homes lead the way in their extensive use of ACP discussions. ACP is more routinely used by care home staff than is often recognized, and can be easier to introduce in care homes than in other settings. Key challenges include poor means of communication due to dementia/cognitive impairment or physical deterioration, and how staff address the expectations of families, and ensure any interventions are in the best interests of the person.

Implementation of group visits to improve outpatient oncology advance care planning.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 11-11
Author(s):  
Sarah Lowry ◽  
Hillary Lum ◽  
Seiko Izumi ◽  
Erik K Fromme
Keyword(s):  
Medical Record ◽  
Advance Care Planning ◽  
Decision Makers ◽  
Care Planning ◽  
Medical Visit ◽  
Improvement Project ◽  
Surrogate Decision Makers ◽  
Advance Care ◽  
Surrogate Decision ◽  
First Session

11 Background: Oncology patients that participate in advance care planning (ACP) and complete advance directives (AD) are more likely to receive goal-concordant end of life care. The AD documentation rate within our academically-affiliated community outpatient oncology clinic is below national and institutional averages. A group medical visit effectively facilitated ACP in a geriatric primary care setting. This quality improvement project implemented a similar ACP conversation group (ACPCG) in an outpatient oncology setting. Methods: Adult patients in a community oncology clinic were contacted and invited to participate in ACPCG by a nurse practitioner who works in the clinic. Using a facilitation guide, the 2-session intervention included sharing past ACP experiences, identifying surrogate decision makers, starting conversations, and discussing surrogate flexibility. Recruitment, retention, and patient ACP outcomes were measured. Results: Seventy-six patients were successfully contacted and seventeen signed up (22% recruitment rate). Twelve patients participated in the first session, and five attended the second session (42% retention). Recruitment was time intensive, and several patients responded that ACP was not relevant to their situation. Six participants completed an AD prior to attending the first session (50%) but only one had an AD in their medical record. Two had surrogate decision makers documented prior to the intervention (16%). Participants reported the ACPCG as helpful in making the process less overwhelming. There was no increase in AD documentation rates within the medical record four weeks after the intervention, but the rate of surrogate documentation increased to seven (58%). Conclusions: Participants had higher than average rates of AD completion prior to the intervention but had not shared the document with their providers. While the ACPCG was well received by patients, implementation faced multiple challenges. More efficient recruitment methods and strategies to facilitate better patient understanding of ACP are needed.

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