1
|
Kim J, Heo S, Yang J, Kim M, Park S, Cho K, Kang J, Yi H, An M. The moderating effect of attitudes in the relationship between knowledge and self-efficacy in palliative care among nurses: A cross-sectional, correlational study. PLoS One 2023; 18:e0292135. [PMID: 37796889 PMCID: PMC10553266 DOI: 10.1371/journal.pone.0292135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
Provision of palliative care to patients with advanced chronic diseases or old populations is suboptimal, which results in unnecessary suffering of and burden to patients, caregivers, and society. Low self-efficacy in palliative care among nurses is a factor affecting suboptimal utilization of palliative care. Poor knowledge is a factor affecting low self-efficacy in palliative care of nurses. Attitudes may contribute to the relationship between knowledge and self-efficacy in palliative care, but these relationships have been rarely examined in nurses. This study aimed to determine whether nurses' attitudes moderate the relationship between knowledge and self-efficacy in palliative care. In a cross-sectional, correlational study, online or offline survey on self-efficacy, knowledge, attitudes, and covariates was conducted from 282 nurses in South Korea. PROCESS v4.1 for SPSS was used to address the study aim. Higher levels of knowledge (p = .048) and attitudes (p < .001), and the interaction term of knowledge and attitudes (p = .025) were significantly associated with higher levels of self-efficacy (F = 6.12, p < .001, R2 = .152), indicating the moderating effects of attitudes. The relationships between higher levels of knowledge and self-efficacy were significant only in nurses with highly and moderately positive attitudes (R2 change = .016, F = 5.11, p = .025), but not nurses with lack of positive attitudes. Our results supported the moderating role of nurses' attitudes in the relationship between knowledge and self-efficacy. To improve self-efficacy in palliative care in nurses, improvement in knowledge and facilitation of positive attitudes are needed.
Collapse
Affiliation(s)
- JinShil Kim
- College of Nursing, Gachon University, Incheon, South Korea
| | - Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, United States of America
| | - Jisun Yang
- College of Nursing, Gachon University, Incheon, South Korea
| | - Miyeong Kim
- Department of Nursing, Gachon University Gil Medical Center, Incheon, Korea
| | - SeongHu Park
- College of Nursing Sciences, Sungshin Women’s University, Seoul, South Korea
| | - KyungAh Cho
- College of Nursing, Gachon University, Incheon, South Korea
| | - JungHee Kang
- College of Nursing, University of Kentucky, Lexington, Kentucky, United States of America
| | - Hani Yi
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Minjeong An
- College of Nursing, Chonnam National University, Gwangju, South Korea
| |
Collapse
|
2
|
Sakamoto A, Inokuchi R, Iwagami M, Hanari K, Tamiya N. Association between physicians' characteristics and their knowledge, attitudes, and practices regarding advance care planning: a cross-sectional study. BMC Palliat Care 2023; 22:134. [PMID: 37697265 PMCID: PMC10494406 DOI: 10.1186/s12904-023-01253-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Despite physicians' vital role in advance care planning, a limited number of physicians practice it. This study assessed factors associated with physicians' knowledge, attitudes, and practices regarding advance care planning. METHODS This cross-sectional study used data from an anonymous survey conducted by the Japanese Ministry of Health, Labour and Welfare. Questionnaires were mailed to 4500 physicians in November and December 2022. Data from 1260 respondents were analyzed. RESULTS Of the respondents, 46.4%, 77.0%, and 82.0% reported good knowledge of advance care planning, agreed with promoting it, and with its provision by medical/care staff, respectively. Male physicians were significantly less likely to support advance care planning (odds ratio: 0.54, 95% confidence interval: 0.35-0.84) or agree to its provision by medical/care staff (odds ratio: 0.47, 95% confidence interval: 0.29-0.78) but significantly more likely to practice it (odds ratio: 1.58, 95% confidence interval: 1.05-2.36). Physicians specialized in surgery or internal/general/palliative medicine were more knowledgeable about advance care planning and more likely to practice it. Physicians working in clinics were significantly less knowledgeable (odds ratio: 0.33, 95% confidence interval: 0.25-0.44) about advance care planning and less likely to support it (odds ratio: 0.37, 95% confidence interval: 0.27-0.50), agree with its provision by medical/care staff (odds ratio: 0.54, 95% confidence interval: 0.39-0.75), or to practice it (odds ratio: 0.16, 95% confidence interval: 0.12-0.22). CONCLUSIONS Physicians working in clinics had less knowledge of advance care planning, less supportive attitudes, and less likely to practice it. Knowledge, attitudes and practice also varied by gender and specialty. Interventions should target physicians working in clinics.
Collapse
Affiliation(s)
- Ayaka Sakamoto
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
- Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Ryota Inokuchi
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan.
| | - Masao Iwagami
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Kyoko Hanari
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8577, Japan
| |
Collapse
|
3
|
van Gaans D, Erny-Albrecht K, Tieman J. Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review. Public Health Rev 2022; 43:1604856. [PMID: 36148429 PMCID: PMC9485459 DOI: 10.3389/phrs.2022.1604856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This scoping review identifies and details the scope of practice of health professionals who provide palliative care within the primary health setting in Australia.Methods: A scoping review approach was conducted on the Cinahl (Ebsco), Scopus, Medline (Ovid) and PubMed databases to extract articles from 1 December 2015 to 1 December 2020. Broad text words and MeSH headings were used with relevance to palliative care, general practice, primary health, and community setting. Extracted journal articles were limited to those based on the Australian population or Australian health system.Results: Eighty-four papers met the inclusion criteria and were included in the review. The review identified the following health professional roles within the Primary Health Care setting undertaking palliative care: General Practitioner, Nurse, Pharmacist, Paramedics, Carers, and Allied Health professionals.Conclusion: This review offers a first understanding of the individual health professional roles and multidisciplinary team approach to actively providing palliative care within the Primary Health Care setting in Australia.
Collapse
|
4
|
Ding J, Cook A, Saunders C, Chua D, Licqurish S, Mitchell G, Johnson CE. Uptake of advance care planning and its circumstances: An nationwide survey in Australian general practice. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1913-1923. [PMID: 34529292 DOI: 10.1111/hsc.13570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/04/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
There are potential benefits associated with advance care planning (ACP), and general practitioners (GPs) are well placed to coordinate ACP initiatives with their patients. Few studies have reported on the uptake of different forms of advance care plan conducted by GPs and how this affects patients' place of death. The primary aims of the study were to examine uptake of verbal (conversations regarding care preferences) and written (documented care preferences) advance care plans and their associated factors from the perspective of Australian GPs. The secondary aim was to determine the impact of different types of advance care plans on place of death. Sixty-one GPs from three Australian states used a validated clinic-based data collection process to report on care provided for decedents in the last year of life, including provision of services, place of death, and uptake of ACP. We found that 58 (27.9%), 91 (43.7%) and 59 (28.4%) reported decedents had no advance care plans, verbal plans or written plans, respectively. There were increased uptake of both verbal plans (relative risk ratio [RRR] = 13.10, 95% confidence interval [CI]: 2.18-77.34) and written plans (RRR = 10.61, 95% CI: 1.72-65.57) if GPs foresaw the death for >90 days versus <7 days. Palliative care training history for GPs predicted uptake of verbal plans (RRR = 5.83, 95% CI: 1.46-31.93). Patients with verbal plans versus no plans were more likely to die at a private residence (odds ratio = 4.97, 95% CI: 1.32-18.63). Our findings suggest that expectation of death for at least three months prior to the event (where clinically possible) and palliative care training for GPs improve the uptake of ACP in general practice. Larger pragmatic trials are required to determine the impact of ACP on patients' place of death.
Collapse
Affiliation(s)
- Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, P.R. China
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Christobel Saunders
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - David Chua
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Sharon Licqurish
- Monash Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Claire E Johnson
- Monash Nursing and Midwifery, Monash University, Melbourne, Australia
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, Australia
| |
Collapse
|
5
|
Cole L, Bisquera A, Samsi K, Manthorpe J. Factors affecting dementia care practitioners' decision-making on moves to a care home for persons living with dementia: A factorial survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1651-e1661. [PMID: 34617362 DOI: 10.1111/hsc.13591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/27/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
Deciding if and when might be the 'optimal' time for a person living with dementia to move to a care home is often difficult for the individual, family and practitioners. In this study, we describe the outcome of a factorial survey conducted with 100 dementia care practitioners (a frontline health or social care worker who works with people living with dementia) in England, which investigated factors used in deciding when a person living with dementia moves to a care home. Using findings from qualitative interviews with older people living with dementia, family carers, care home managers and social workers, we identified four factors that appeared to influence the decision to move to a care home: (1) Family carers' ability to support the person with daily activities, (2) amount of support provided by home care workers, (3) level of risk of harm and (4) the person living with dementia's wishes. These factors were then randomised within skeleton vignettes that told the story of a fictitious woman (Jane) living with dementia at home with her husband. Fifty-four variations of the vignettes were produced and randomly assigned to 100 surveys. A total of 100 volunteer dementia care practitioners (78% female, 54% over 50 years of age) received their own personalised online survey link via email and were asked to read each vignette and decide whether to suggest Jane (a) move to a care home or (b) continue living at home. Results indicated that Jane's wishes principally drove most dementia care practitioners' decision on whether to suggest a move to a care home or stay living at home (odds ratio = 6.5-19.5). Findings will inform a better understanding of the factors that contribute toward a decision to move to a care home and be of relevance to policy, practice, training and support.
Collapse
Affiliation(s)
- Laura Cole
- Geller Institute of Ageing and Memory, University of West London, London, UK
| | | | - Kritika Samsi
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK
| |
Collapse
|
6
|
Emergency Healthcare Providers' Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031158. [PMID: 33525577 PMCID: PMC7908551 DOI: 10.3390/ijerph18031158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
This study aimed to explore and compare knowledge levels about advance directives (ADs) and life-sustaining treatment (LST) plans in end-of-life patients between emergency nurses and emergency medical technicians (EMTs). Using a cross-sectional study design and convenience sampling, 96 nurses and 68 EMTs were recruited from 12 emergency medical centers. A survey on knowledge about and attitudes toward ADs was performed using both online and offline methods between November and December 2019. Emergency healthcare providers were conceptually knowledgeable regarding ADs and LST, although approximately half or fewer had knowledge about ADs (such as the legal process for preparation, family or healthcare providers’ role, and the healthcare proxy). The knowledge levels of nurses and EMTs were moderate. Nurses had significantly greater knowledge relative to EMTs about ADs and LST. Positive attitudes of emergency healthcare providers were also moderately low, with nurses having less positive views than EMTs. Significant differences regarding ADs were found, with younger emergency healthcare providers having fewer career years, no personal end-of-life experiences, and less need for ADs having less knowledge. Emergency healthcare providers’ knowledge about and attitudes toward ADs were moderately low, with EMTs demonstrating a greater knowledge deficit and nurses exhibiting lower positive attitudes. Younger and novice providers had lower knowledge, but younger providers had more positive attitudes, implying that professional education and training should begin early in their careers to enhance their confidence for emergency delivery of advanced care planning.
Collapse
|
7
|
Mohan C, Sonntag E, Ehlers M, Akerman J, Hayon S, Figler B, Coward RM. Challenging Ethical Scenarios in the Surgical Treatment of Erectile Dysfunction: A Survey of High-Volume Penile Prosthesis Surgeons. Urology 2020; 148:166-172. [PMID: 33285211 DOI: 10.1016/j.urology.2020.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate how surgeons approach ethically challenging scenarios that arise in penile prosthesis surgery and identify patient-related factors that impact their approach. METHODS A survey was distributed to the Society for Urologic Prosthetic Surgeons membership consisting of 6 ethically challenging scenarios: an HIV+ patient, a patient with cognitive disability, a registered sex offender, a nonverbal patient, a litigious patient, and an uncontrolled diabetic patient whose insurance will lapse soon. Additional clinical information was provided to assess how the likelihood to offer surgery might change. The primary outcome was the likelihood of offering surgery in each scenario. RESULTS The response rate was 15.6% (n = 29). When compared to the baseline patient, respondents had a lower likelihood of offering surgery in all scenarios except the HIV+ patient, with the lowest likelihood of offering surgery to a sex offender (P < .01). Within each scenario, factors associated with an increased odds of offering surgery included knowledge that a patient with Down Syndrome is high functioning (odds ratio [OR] 5.0, confidence interval [CI]: 1.4-17.8), that a prior sex offender is currently married (OR 16.5, CI:3.5-99.8), that a litigious patient sued a surgeon for a retained sponge (OR 6.3, CI:1.7-24.3), and that a nonverbal patient had expressed prior interest in penile prosthesis surgery (OR 4.5, CI: 1.3-16.2). CONCLUSION Ethical principles, including respect for autonomy, nonmaleficence, beneficence, and justice, are appropriately applied by urological prosthetic surgeons when ethical challenges arise. While the likelihood of offering penile prosthesis surgery is decreased with most ethical dilemmas, specific clinical factors often augment decision-making.
Collapse
Affiliation(s)
- Charan Mohan
- The Smith Institute for Urology, New Hyde Park, NY
| | - Elizabeth Sonntag
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Mark Ehlers
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Jason Akerman
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Solomon Hayon
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Brad Figler
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, NC; UNC Fertility, Raleigh, NC.
| |
Collapse
|
8
|
Goossens B, Sevenants A, Declercq A, Van Audenhove C. Improving shared decision-making in advance care planning: Implementation of a cluster randomized staff intervention in dementia care. PATIENT EDUCATION AND COUNSELING 2020; 103:839-847. [PMID: 31818522 DOI: 10.1016/j.pec.2019.11.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/04/2019] [Accepted: 11/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Increasing staff engagement level of shared decision-making in advance care planning for persons with dementia in nursing homes. Perceived importance, competence and frequency of staff members applying shared decision-making were measured. Additionally, facilitators and barriers in the implementation process were described. METHODS In this pretest-posttest cluster randomized trial, 311 staff members from 65 Belgian nursing home wards participated. Key components of the intervention were knowledge on shared decision-making, role-play exercises and internal policies on advance care planning. Audio recordings of advance care planning conversations between residents, families and staff were compared before and after the intervention. Participants filled in questionnaires and provided feedback. RESULTS Wards demonstrated a higher level of shared decision-making after the intervention (p < 0.001) while time spent on the conversations did not increase. This effect persisted at 6 months follow-up (p < 0.001). Participants perceived shared decision-making as more important (p = 0.031) and felt more competent (p = 0.010), though frequency of use did not change (p = 0.201). High staff turnover and difficult co-operation with GP's were barriers. CONCLUSION Nursing home staff benefits from this training in shared decision-making. PRACTICE IMPLICATIONS Learning shared decision-making in advance care planning for persons with dementia is possible and sustainable in the time-constricted context of nursing homes.
Collapse
Affiliation(s)
- Bart Goossens
- LUCAS - Centre for Care Research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal Box 5310, 3000, Leuven, Belgium.
| | - Aline Sevenants
- LUCAS - Centre for Care Research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal Box 5310, 3000, Leuven, Belgium; Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33j, Postal Box 7001, 3000, Leuven, Belgium.
| | - Anja Declercq
- LUCAS - Centre for Care Research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal Box 5310, 3000, Leuven, Belgium; Centre for Sociological Research, KU Leuven, Parkstraat 45, Postal Box 3601, 3000, Leuven, Belgium.
| | - Chantal Van Audenhove
- LUCAS - Centre for Care Research & Consultancy, KU Leuven, Minderbroedersstraat 8, Postal Box 5310, 3000, Leuven, Belgium; Academic Center for General Practice, KU Leuven, Kapucijnenvoer 33j, Postal Box 7001, 3000, Leuven, Belgium.
| |
Collapse
|
9
|
Hamano J, Oishi A, Morita T, Kizawa Y. Frequency of discussing and documenting advance care planning in primary care: secondary analysis of a multicenter cross-sectional observational study. BMC Palliat Care 2020; 19:32. [PMID: 32183800 PMCID: PMC7079526 DOI: 10.1186/s12904-020-00543-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 03/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve the quality of advance care planning (ACP) in primary care, it is important to understand the frequency of and topics involved in the ACP discussion between patients and their family physicians (FPs). METHODS A secondary analysis of a previous multicenter cross-sectional observational study was performed. The primary outcome of this analysis was the frequency of and topics involved in the ACP discussion between outpatients and FPs. In March 2017, 22 family physicians at 17 clinics scheduled a day to assess outpatients and enrolled patients older than 65 years who were recognized by FPs as having regular visits. We defined three ACP discussion topics: 1) future decline in activities of daily living (ADL), 2) future inability to eat, and 3) surrogate decision makers. FPs assessed whether they had ever discussed any ACP topics with each patient and their family members, and if they had documented the results of these discussions in medical records before patients were enrolled in the present study. We defined patients as being at risk of deteriorating and dying if they had at least 2 positive general indicators or at least 1 positive disease-specific indicator in the Japanese version of the Supportive and Palliative Care Indicators Tool. RESULTS In total, 382 patients with a mean age of 77.4 ± 7.9 years were enrolled, and 63.1% were female. Seventy-nine patients (20.7%) had discussed at least one ACP topic with their FPs. However, only 23 patients (6.0%) had discussed an ACP topic with family members and their FPs, with the results being documented in their medical records. The topic of future ADL decline was discussed and documented more often than the other two topics. Patients at risk of deteriorating and dying discussed ACP topics significantly more often than those not at risk of deteriorating and dying (39.4% vs. 16.8%, p < 0.001). CONCLUSION FPs may discuss ACP with some of their patients, but may not often document the results of this discussion in medical records. FPs need to be encouraged to discuss ACP with patients and family members and describe the decisions reached in medical records.
Collapse
Affiliation(s)
- Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Ai Oishi
- Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School (Doorway 1), Teviot Place, Edinburgh, UK
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| |
Collapse
|
10
|
Sævareid TJL, Thoresen L, Gjerberg E, Lillemoen L, Pedersen R. Improved patient participation through advance care planning in nursing homes-A cluster randomized clinical trial. PATIENT EDUCATION AND COUNSELING 2019; 102:2183-2191. [PMID: 31200952 DOI: 10.1016/j.pec.2019.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To improve patient participation in advance care planning in nursing homes where most patients have some degree of cognitive impairment. METHODS This was a pair-matched cluster randomized clinical trial with eight wards in eight Norwegian nursing homes. We randomized one ward from each of the matched pairs to the intervention group. We included all patients above 70. The primary outcome was prevalence of documented patient participation in end-of-life treatment conversations. The intervention included implementation support using a whole-ward approach where regular staff perform advance care planning and invite all patients and next of kin to participate. RESULTS In intervention group wards the patients participated more often in end-of-life treatment conversations (p < 0.001). Moreover, the patient's preferences, hopes AND worries (p = 0,006) were more often documented, and concordance between provided TREATMENT and patient preferences (p = 0,037) and next of kin participation in advance care planning with the patient (p = 0,056) increased. CONCLUSION Improved patient participation - also when cognitively impaired - is achievable through advance care planning in nursing homes using a whole-ward approach. PRACTICE IMPLICATIONS Patients with cognitive impairment should be included in advance care planning supported by next of kin. A whole-ward approach may be used to implement advance care planning. TRIAL REGISTRATION ISRCTN registry (ID ISRCTN69571462) - retrospectively registered.
Collapse
Affiliation(s)
- Trygve J L Sævareid
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Lisbeth Thoresen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway; Department of Health Sciences, University of Oslo, Forskningsveien 3A Harald Schjelderups hus, 0373, Oslo, Norway.
| | - Elisabeth Gjerberg
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Lillian Lillemoen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Frederik Holsts hus, 0450, Oslo, Norway.
| |
Collapse
|
11
|
Risk J, Mohammadi L, Rhee J, Walters L, Ward PR. Barriers, enablers and initiatives for uptake of advance care planning in general practice: a systematic review and critical interpretive synthesis. BMJ Open 2019; 9:e030275. [PMID: 31537570 PMCID: PMC6756326 DOI: 10.1136/bmjopen-2019-030275] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES How advance care planning (ACP) is conceptualised in Australia including when, where and how ACP is best initiated, is unclear. It has been suggested that healthcare delivered in general practice provides an optimal setting for initiation of ACP discussions but uptake remains low. This systematic review and critical interpretive synthesis sought to answer two questions: (1) What are the barriers and enablers to uptake of ACP in general practice? (2) What initiatives have been used to increase uptake of ACP in general practice? DESIGN A systematic review and critical interpretive synthesis of the peer-reviewed literature was undertaken. A socioecological framework was used to interpret and map the literature across four contextual levels of influence including individual, interpersonal, provider and system levels within a general practice setting. SETTING Primary care general practice settings DATA SOURCES: Searches were undertaken from inception to July 2019 across Ovid Medline, Cumulative Index to Nursing and Allied Health Literature, Scopus, ProQuest and Cochrane Library of systematic reviews. RESULTS The search yielded 4883 non-duplicate studies which were reduced to 54 studies for synthesis. Year of publication ranged from 1991 to 2019 and represented research from nine countries. Review findings identified a diverse and disaggregated body of ACP literature describing barriers and enablers to ACP in general practice, and interventions testing single or multiple mechanisms to improve ACP generally without explicit consideration for level of influence. There was a lack of cohesive guidance in shaping effective ACP interventions and some early indications of structured approaches emerging. CONCLUSION Findings from this review present an opportunity to strategically apply the ACP research evidence across targeted levels of influence, and with an understanding of mediators and moderators to inform the design of new and enhanced ACP models of care in general practice. PROSPERO REGISTRATION NUMBER CRD42018088838.
Collapse
Affiliation(s)
- Jo Risk
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Leila Mohammadi
- Library, Flinders University, Adelaide, South Australia, Australia
| | - Joel Rhee
- General Practice Academic Unit, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lucie Walters
- Rural Health, Flinders University, Adelaide, South Australia, Australia
| | - Paul R Ward
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
12
|
Littlewood J, Hinchcliff R, Lo W, Rhee J. Advance care planning in rural New South Wales from the perspective of general practice registrars and recently fellowed general practitioners. Aust J Rural Health 2019; 27:398-404. [PMID: 31251442 DOI: 10.1111/ajr.12525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 04/16/2019] [Accepted: 05/06/2019] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE This study examined advance care planning as delivered by general practice registrars and recently fellowed GPs in New South Wales rural settings. The facilitators and barriers to advance care planning uptake in these areas were investigated, as well as the state of general practice training on advance care planning. DESIGN Qualitative descriptive methodology, involving semi-structured face-to-face and telephone interviews. SETTING Primary care. PARTICIPANTS General practice registrars and recently fellowed GPs in New South Wales rural settings. Definition of rural using the Australian Standard Geographical Classification - Remoteness Area. Thirteen participants were included in the study. MAIN OUTCOME MEASURES Thematic analysis of interview transcripts elucidated key issues emerging from participants' accounts. RESULTS Key barriers included doctor-dependent uptake, demands on doctor's time and the limited relevant resources available. Facilitators recognised were patient control in end-of-life care and long-standing relationships between GPs and their patients. Uptake among patients was low, and minimal training on advance care planning reported. CONCLUSION The lack of training opportunities in advance care planning during vocational training, especially when combined with the essential role played by rural GPs in initiating advance care planning and providing end-of-life care, appears to be a major problem that might contribute to poor uptake among patients in rural areas. This study demonstrated, however, the significant benefits that advance care planning could bring in patients living in rural communities if delivered effectively. Given that rural GPs face a number of barriers to providing routine health care, these results highlight an important need to provide GPs and rural communities with support, education, incentive, better administrative tools, options and greater awareness of advance care planning.
Collapse
Affiliation(s)
- Jean Littlewood
- School of Public Health and Community Medicine, UNSW Medicine, UNSW, Sydney, New South Wales, Australia
| | - Reece Hinchcliff
- Centre for Health Services Management, University of Technology Sydney, Sydney, New South Wales, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Winston Lo
- Centre for Primary Health Care and Equity, UNSW, Sydney, New South Wales, Australia.,School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
| | - Joel Rhee
- Centre for Primary Health Care and Equity, UNSW, Sydney, New South Wales, Australia.,School of Medicine, University of Wollongong, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Hemsley B, Meredith J, Bryant L, Wilson NJ, Higgins I, Georgiou A, Hill S, Balandin S, McCarthy S. An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation. PATIENT EDUCATION AND COUNSELING 2019; 102:1067-1079. [PMID: 30799141 DOI: 10.1016/j.pec.2019.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/05/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. METHOD An integrative review of 93 studies, analysed according to their content themes. RESULTS Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. CONCLUSIONS There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. PRACTICE IMPLICATIONS It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.
Collapse
Affiliation(s)
- Bronwyn Hemsley
- The University of Technology Sydney, Building 7, Faculty of Science and Graduate School of Health Building, 67 Thomas Street, Ultimo, Australia @BronwynHemsley.
| | - Jacqueline Meredith
- The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| | - Lucy Bryant
- The University of Technology Sydney, Building 7, Faculty of Science and Graduate School of Health Building, 67 Thomas Street, Ultimo, Australia @BronwynHemsley.
| | - Nathan J Wilson
- Western Sydney University, Building G10/Office 10, Hawkesbury Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Isabel Higgins
- The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| | - Andrew Georgiou
- Macquarie University, Room L6 36, Level 6, 75 Talavera Road, NSW, 2109, Australia.
| | - Sophie Hill
- La Trobe University, School of Psychology and Public Health, College of Science, Health and Engineering, VIC, 3086, Australia.
| | - Susan Balandin
- Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Shaun McCarthy
- The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| |
Collapse
|
14
|
Hirakawa Y, Chiang C, Yasuda Uemura M, Aoyama A. Involvement of Japanese Care Managers and Social Workers in Advance Care Planning. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2018; 14:315-327. [PMID: 30653395 DOI: 10.1080/15524256.2018.1533912] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Successful advance care planning relies heavily on effective communication between the elderly and their families, care managers, and social workers. However, care managers and social workers are often not adequately prepared to conduct such discussion. The aim of the present study was to identify the specific challenges facing Japanese care managers and social workers when involvement in advance care planning. Two focus group discussions were held between August and November 2017, involving eleven care managers and three social workers employed at two long-term care facilities actively pursuing advance care planning initiatives. Four main themes were identified, through content analysis, as barriers and facilitators: client readiness, communication, variation-rich client individuality, and difficult-to-explain end-of-life options. This study revealed the importance of building rapport with the residents and their families in order to assess their readiness to discuss care options and preferences. Obstacles included lack of medical knowledge of care managers and social workers. Study findings suggested that a multi-disciplinary team, facilitated by care managers and social workers, was fundamental to achieving the goals of advance care planning.
Collapse
Affiliation(s)
- Yoshihisa Hirakawa
- a Department of Public Health and Health Systems , Nagoya University Graduate School of Medicine , Aichi , Japan
| | - Chifa Chiang
- a Department of Public Health and Health Systems , Nagoya University Graduate School of Medicine , Aichi , Japan
| | - Mayu Yasuda Uemura
- a Department of Public Health and Health Systems , Nagoya University Graduate School of Medicine , Aichi , Japan
| | - Atsuko Aoyama
- a Department of Public Health and Health Systems , Nagoya University Graduate School of Medicine , Aichi , Japan
| |
Collapse
|
15
|
Sinclair C, Auret KA, Evans SF, Williamson F, Dormer S, Wilkinson A, Greeve K, Koay A, Price D, Brims F. Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention. BMJ Open 2017; 7:e013415. [PMID: 28237955 PMCID: PMC5337715 DOI: 10.1136/bmjopen-2016-013415] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease. DESIGN A multicentre open-label randomised controlled trial with preference arm. SETTING Metropolitan teaching hospital and a rural healthcare network. PARTICIPANTS 149 participants with respiratory malignancy, chronic obstructive pulmonary disease or interstitial lung disease. INTERVENTION Nurse facilitators offered facilitated ACP discussions, prompted further discussions with doctors and loved ones, and assisted participants to appoint a substitute medical decision-maker (SDM) and complete an advance directive (AD). OUTCOME MEASURES The primary measure was formal (AD or SDM) or informal (discussion with doctor) ACP uptake assessed by self-report (6 months) and medical notes audit. Secondary measures were the factors predicting baseline readiness to undertake ACP, and factors predicting postintervention ACP uptake in the intervention arm. RESULTS At 6 months, formal ACP uptake was significantly higher (p<0.001) in the intervention arm (54/106, 51%), compared with usual care (6/43, 14%). ACP discussions with doctors were also significantly higher (p<0.005) in the intervention arm (76/106, 72%) compared with usual care (20/43, 47%). Those with a strong preference for the intervention were more likely to complete formal ACP documents than those randomly allocated. Increased symptom burden and preference for the intervention predicted later ACP uptake. Social support was positively associated with ACP discussion with loved ones, but negatively associated with discussion with doctors. CONCLUSIONS Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion of formal documents. Awareness of symptom burden, readiness to engage in ACP and relevant psychosocial factors may facilitate effective tailoring of ACP interventions and achieve greater uptake. TRIAL REGISTRATION NUMBER ACTRN12614000255684.
Collapse
Affiliation(s)
- Craig Sinclair
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | - Kirsten Anne Auret
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | - Sharon Frances Evans
- Rural Clinical School of Western Australia, University of Western Australia,Perth, Western Australia, Australia
| | - Fiona Williamson
- Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia
| | - Siobhan Dormer
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anne Wilkinson
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia
| | - Kim Greeve
- Department of Health, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Audrey Koay
- Department of Health, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Dot Price
- Western Australian Country Health Service, District Health Advisory Committee, Albany, Western Australia, Australia
| | - Fraser Brims
- Respiratory Department, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| |
Collapse
|