scholarly journals Advance Care Planning for Patients with New Serious Illnesses after Medicare’s New Payments

2021 ◽  
Vol 7 (4) ◽  
pp. 1-3
Author(s):  
Ming Tai-Seale ◽  
Keyword(s):  
Medical Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Current Procedural Terminology ◽  
Serious Illness ◽  
Advance Care

Advance Care Planning (ACP) supports adults to understand and communicate their values and wishes for future medical care in order to ensure goal-concordant care in serious illness when patients are too ill to make their own decisions [1,2]. In recognition of the misalignment between payment for ACP and its value, the Center for Medicare & Medicaid Services (CMS) authorized payment for ACP through new Current Procedural Terminology (CPT) codes (99497 and 99498) in 2016 [1].

scholarly journals Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

2020 ◽  
Vol 17 (5) ◽  
pp. 1594
Author(s):  
Fu-Ming Chiang ◽  
Jyh-Gang Hsieh ◽  
Sheng-Yu Fan ◽  
Ying-Wei Wang ◽  
Shu-Chen Wang
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
Advance Care Planning ◽  
Qualitative Content Analysis ◽  
Care Planning ◽  
Medical Decisions ◽  
Self Blame ◽  
Advance Care ◽  
Past Experiences ◽  
Eol Care

The aging of the Taiwanese population has become a major issue. Previous research has focused on the burden and stress faced by caregivers, but has not explored how the experience of these caregivers influences decisions of advance care planning (ACP). Semi-structured and in-depth interviews were conducted. Qualitative content analysis was used to identify important themes. Five themes and fourteen sub-themes were identified: (1) Past experiences: patient wishes, professional recommendations, and expectation about disease progress; (2) Impact of care on family members: positive affirmation, open-minded life, social isolation and health effects, and financial and life planning effects; (3) Attitude toward life: not forcing to stay, and not becoming a burden, (4) Expected proxy dilemmas: torment between doing or not, seeing the extension of suffering and toil, and remorse and self-blame; (5) Expectation of end of life (EOL) care: caregiver’s experience and EOL care decisions, and practicality of EOL decision making. After making multiple medical decisions for their disabled relatives, caregivers are able to calmly face their own medical decisions, and “not becoming a burden” is their primary consideration. It’s suggested that implementation of shared decision-making on medical care for patients with chronic disability will not only improve the quality of their medical care but also reduce the development of remorse and guilty feelings of caregivers after making medical decisions.

scholarly journals 2439 Depression, anxiety, and planning for the future: Associations with advance care planning

2018 ◽  
Vol 2 (S1) ◽  
pp. 39-39
Author(s):  
Ryan McMahan ◽  
Evan Walker ◽  
Rebecca Sudore
Keyword(s):  
Medical Care ◽  
San Francisco ◽  
Advance Care Planning ◽  
Life Extension ◽  
Worth Living ◽  
Care Planning ◽  
Depression And Anxiety ◽  
Spanish Speaking ◽  
Advance Care ◽  
Item Scale

OBJECTIVES/SPECIFIC AIMS: Millions of diverse, older adults live with serious and chronic illness for which they will face complex, ongoing medical decisions. Advance care planning (ACP) has been conceptualized as a health behavior that supports adults in understanding and sharing their values, goals, and preferences for future medical care. Depression and anxiety are known barriers to participation in health behaviors. It is unknown whether depression and anxiety are associated with ACP participation or with patients’ values for future medical care. Understanding whether depression and anxiety are associated with ACP would be important to tailor ACP interventions. METHODS/STUDY POPULATION: In total, 908 English-speaking and Spanish-speaking participants ≥55 years of age were recruited from a San Francisco county hospital. We measured depression (Patient Health Questionnaire 8-item scale) and anxiety (Generalized Anxiety Disorder 7-item scale), dichotomized into none-to-mild Versus moderate-to-severe. We measured ACP engagement using a validated survey of Behavior Change Processes (e.g., knowledge, self-efficacy, readiness; 5-point Likert) and Action Measures (e.g., ask, discuss, and document one’s wishes; yes/no). We elicited values concerning life extension categorized as “life is always worth living no matter the health situation” Versus “some health situations would make life not worth living.” To explore associations, we usedχ2, Mann-Whitney tests, linear and logistic regressions. RESULTS/ANTICIPATED RESULTS: Mean participant age was 64 years±6, 80% were non-White, 40% had limited literacy, 45% were Spanish-speaking, and the prevalence of depression and anxiety was 12% and 10%, respectively. Depression and anxiety were not associated with ACP Engagement, p>0.05. However, participants with depression had an increased odds of reporting “some health situations would make life not worth living” than those not depressed, p=0.02. In multivariate linear and logistic regression, controlling for age, gender, literacy, and health status, having depression increased the odds of not valuing life extension OR 2.9 (CI: 1.7–4.9). Anxiety was not associated with values concerning life extension, p>0.05. DISCUSSION/SIGNIFICANCE OF IMPACT: Depression and anxiety were not associated with prior ACP engagement suggesting engaging patients in ACP does not increase these conditions. However, depression was associated with an increased odds of not valuing life extension and, therefore, may influence treatment choices. Longitudinal randomized controlled trials of an ACP intervention are currently underway to investigate these associations further.

Advance care planning among seniors of a diverse city.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 117-117
Author(s):  
Randi Belisomo ◽  
Daniel M. Gaitan ◽  
Amy R. Eisenstein ◽  
Mary Frances Mulcahy
Keyword(s):  
Medical Care ◽  
Advance Care Planning ◽  
Family Satisfaction ◽  
Care Patient ◽  
Healthcare Team ◽  
Care Planning ◽  
Racial Groups ◽  
Information Awareness ◽  
Advance Care ◽  
Eol Care

117 Background: Advance care planning (ACP) is a system of education, reflection and documentation of health care wishes. Respecting Choices has been successful in implementing ACP throughout Lacrosse County, WI (J Am Geriatr Soc 2010;58:1249–1255)..A single center study in Melbourne, AU, showed that ACP improves end of life (EOL) care, patient and family satisfaction, and reduces stress, anxiety, and depression in surviving relatives (BMJ 2010;340:c1345).We aim to quantify knowledge about ACP, interest in engaging in ACP, and barriers to effective ACP among the older adults of Chicago. The results will provide actionable items to implement an ACP program in a diverse city. Methods: 17 of the 22 City of Chicago senior centers participated in a survey and education forum “Starting the Conversation”. Participants provided demographic information, awareness and knowledge of EOL wishes and advance directives (AD). Data was tabulated and analyzed using descriptive statistics in IBM SPSS Statistics 22 Software. Results: 375 people completed the survey, the average age was 70+8, (range 41 to 93), 93.3% in English, and 6.7% in Spanish. Respondents live alone (44.5%), with a spouse (29.9%) or child (14.4%). 71% have thought about the medical care they would want at the EOL, 60% have discussed their EOL wishes with their loved ones, and 4% with their doctor. 60.5% do not know what an AD is, 25% have an AD, 76% know who would speak for them if they were unable, 58% have discussed their wishes with that person. Using neighborhood demographics, there was no difference in having an AD for predominately African American neighborhoods compared to others (33% and 27%). Respondents from lower income neighborhoods were less likely to think about medical care at the EOL (65% and 77%), less likely to have discussed EOL care (41% and 30% have not discussed EOL care) and less likely to have an AD (19% and 31%). Conclusions: ACP is underutilized in Chicago. The frequency of AD completion among Chicago seniors mirrors that of the US (Am J Public Health. 2013;103(6):e8-e10). Unlike other population studies, no difference was found among racial groups. Participants are aware of EOL wishes, are interested in engaging in these conversations, but lack the knowledge and collaboration of their healthcare team.

“There were more decisions and more options than just yes or no”: Evaluating a decision aid for advanced cancer patients and their family caregivers

2016 ◽  
Vol 15 (1) ◽  
pp. 44-56 ◽  
Author(s):  
Marie Bakitas ◽  
J. Nicholas Dionne-Odom ◽  
Lisa Jackson ◽  
Jennifer Frost ◽  
Margaret F. Bishop ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Advance Care Planning ◽  
Decision Aid ◽  
Care Planning ◽  
Serious Illness ◽  
Early Palliative Care ◽  
Advance Care ◽  
Seriously Ill Patients ◽  
Seriously Ill

AbstractObjective:Few decision aids are available for patients with a serious illness who face many treatment and end-of-life decisions. We evaluated the Looking Ahead: Choices for Medical Care When You're Seriously Ill® patient decision aid (PtDA), one component of an early palliative care clinical trial.Method:Our participants included individuals with advanced cancer and their caregivers who had participated in the ENABLE (Educate, Nurture, Advise, Before Life Ends) early palliative care telehealth randomized controlled trial (RCT) conducted in a National Cancer Institute-designated cancer center, a U.S. Department of Veterans Affairs medical center, and affiliated outreach clinics in rural New England. ENABLE included six weekly patient and three weekly family caregiver structured sessions. Participants watched the Looking Ahead PtDA prior to session 3, which covered content on decision making and advance care planning. Nurse coaches employed semistructured interviews to obtain feedback from consecutive patient and caregiver participants approximately one week after viewing the Looking Ahead PtDA program (booklet and DVD).Results:Between April 1, 2011, and October 31, 2012, 57 patients (mean age = 64), 42% of whom had lung and 23% gastrointestinal cancer, and 20 caregivers (mean age = 59), 80% of whom were spouses, completed the PtDA evaluation. Participants reported a high degree of satisfaction with the PtDA format, as well as with its length and clarity. They found the format of using patient interviews “validating.” The key themes were: (1) “the earlier the better” to view the PtDA; (2) feeling empowered, aware of different options, and an urgency to participate in advance care planning.Significance of results:The Looking Ahead PtDA was well received and helped patients with a serious illness realize the importance of prospective decision making in guiding their treatment pathways. We found that this PtDA can help seriously ill patients prior to the end of life to understand and discuss future healthcare decision making. However, systems to routinely provide PtDAs to seriously ill patients are yet not well developed.

scholarly journals Advance Care Planning (ACP) vs. Advance Serious Illness Preparations and Planning (ASIPP)

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 218 ◽  
Author(s):  
Daren K. Heyland
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Older Persons ◽  
Clinical Decision Making ◽  
Past Research ◽  
Care Planning ◽  
Shared Decision ◽  
Serious Illness ◽  
Advance Care

COVID-19 has highlighted the reality of an impending serious illness for many, particularly for older persons. Those faced with severe COVID-19 infection or other serious illness will be faced with decisions regarding admission to intensive care and use of mechanical ventilation. Past research has documented substantial medical errors regarding the use or non-use of life-sustaining treatments in older persons. While some experts advocate that advance care planning may be a solution to the problem, I argue that the prevailing understanding and current practice of advance care planning perpetuates the problem and results in patients not receiving optimal patient-centered care. Much of the problem centers on the framing of advance care planning around end of life care, the lack of use of decision support tools, and inadequate language that does not support shared decision-making. I posit that a new approach and new terminology is needed. Advance Serious Illness Preparations and Planning (ASIPP) consists of discrete steps using evidence-based tools to prepare people for future clinical decision-making in the context of shared decision-making and informed consent. Existing tools to support this approach have been developed and validated. Further dissemination of these tools is warranted.

scholarly journals Advance care planning in patients referred to hospital for acute medical care: Results of a national day of care survey

2020 ◽  
Vol 19 ◽  
pp. 100235 ◽  
Author(s):  
Thomas Knight ◽  
Alexandra Malyon ◽  
Zoe Fritz ◽  
Chris Subbe ◽  
Tim Cooksley ◽  
...  
Keyword(s):  
Medical Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Care Survey ◽  
Advance Care ◽  
Acute Medical Care

The acceptability to African-Americans of a structured conversation guide to improve advance care planning in the setting of cancer: A focus-group study.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 11-11 ◽  
Author(s):  
Justin J Sanders ◽  
Katherine W. Sterba ◽  
Dee Ford ◽  
Susan Block
Keyword(s):  
African Americans ◽  
Advance Care Planning ◽  
Community Outreach ◽  
Care Planning ◽  
Focus Group Study ◽  
Serious Illness ◽  
Patient Goals ◽  
Advance Care ◽  
The Individual ◽  
The Impact

11 Background: African-Americans are less likely than whites to participate in advance care planning (ACP), which may contribute to disparities in the receipt of goal-concordant care. Literature points to multiple factors: the impact of religion, mistrust, different preferences for life-sustaining measures, family-decision making styles and poor knowledge about ACP. Early ACP conversations are associated with improved outcomes at the end of life, including goal-concordant care. A systematically-developed, serious illness conversation guide (“guide”) for oncologists, embedded in a systems-based approach to improving illness care, has demonstrated more frequent, higher-quality, and earlier ACP conversations in a predominantly white and middle class cohort of cancer patients. This study aimed to explore the acceptability and need for modification of the guide in more diverse populations. Methods: We conducted a series of focus groups with panels of clinicians and researchers, African-American church members, and seriously ill patients and their caregivers to assess barriers to ACP and preferences concerning modifications to the guide. We used template analysis to code themes at the individual, interpersonal and systems levels. Results: At the individual level, participants confirmed the importance of religion and the impact of perceived discrimination (e.g., receipt of inferior care) and superstition (e.g., talking about death may make it happen). Interpersonal-level factors influencing ACP included family, trust, and concerns about provider abandonment. Participants confirmed systems-level barriers of access and mistrust in the healthcare system and highlighted community outreach as a key part of the process. Participants reported positive responses to the tone and content of the guide and found the guide to be acceptable when it included a question that elicited coping mechanisms, including religion. Conclusions: Participants in our study found the use of a serious illness conversation guide to identify patient goals and priorities acceptable, and emphasized the importance of adding a question focused on coping and religion.

Serious Illness Conversations in advanced kidney disease: a mixed-methods implementation study

2021 ◽  
pp. bmjspcare-2020-002830
Author(s):  
Natanong Thamcharoen ◽  
Pitchaphon Nissaisorakarn ◽  
Robert A Cohen ◽  
Mara A Schonberg
Keyword(s):  
Mixed Methods ◽  
Pilot Study ◽  
Kidney Disease ◽  
Advance Care Planning ◽  
Disease Stage ◽  
Treatment Preferences ◽  
Care Planning ◽  
Goals Of Care ◽  
Serious Illness ◽  
Advance Care

ObjectiveAdvanced kidney disease is associated with a high risk of morbidity and mortality. Consequently, invasive treatments such as dialysis may not yield survival benefits. Advance care planning has been encouraged. However, whether such discussions are acceptable when done earlier, before end-stage kidney treatment decision-making occurs, is unclear. This pilot study aimed to explore whether use of the Serious Illness Conversation Guide to aid early advance care planning is acceptable, and to evaluate the information gained from these conversations.MethodsPatients with advanced kidney disease (stage 3B and above) and high mortality risk at 2 years were enrolled in this mixed-methods study from an academic nephrology clinic. Semi-structured interviews were conducted using the adapted Serious Illness Conversation Guide. Thematic analysis was used to assess patients’ perceptions of the conversation. Participants completed a questionnaire assessing conversation acceptability.ResultsTwenty-six patients participated, 50% were female. Participants felt that the conversation guide helped them reflect on their prognosis, goals of care and treatment preferences. Most did not feel that the conversation provoked anxiety (23/26, 88%) nor that it decreased hopefulness (24/26, 92%). Some challenges were elicited; patients expressed cognitive dissonance with the kidney disease severity due to lack of symptoms; had difficulty conceptualising their goals of care; and vocalised fear of personal failure without attempting dialysis.ConclusionsPatients in this pilot study found the adapted Serious Illness Conversation Guide acceptable. This guide may be used with patients early in the course of advanced kidney disease to gather information for future advanced care planning.

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