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Xu Y, Han PP, Su XQ, Xue P, Guo YJ. Exploration of decision aids to support advance care planning: A scoping review. J Clin Nurs 2024; 33:3477-3497. [PMID: 38661107 DOI: 10.1111/jocn.17187] [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: 12/20/2023] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Advance care planning is a process through which people communicate their goals and preferences for future medical care. Due to the complexity of the decision-making process, decision aids can assist individuals in balancing potential benefits and risks of treatment options. OBJECTIVE While decision aids have the potential to better promote advance care planning, their characteristics, content and application effectiveness are unclear and lack systematic review. Therefore, we aimed to explore these three aspects and establish a foundation for future research. DESIGN Scoping review. METHODS This scoping review adheres to the framework proposed by Arksey and O'Malley and the PRISMA-ScR list. Six English-language databases were systematically searched from the time of construction until 1 December 2023. Two researchers conducted the article screening and data extraction, and the extracted data was presented in written tables and narrative summaries. RESULTS Of the 1479 titles and abstracts, 20 studies fulfilled the inclusion criteria. Types of decision aids were employed, mainly websites and videos. Decision aid's primary components center around 11 areas, such as furnishing information, exploring treatment and care preferences. The main manifestations were a significant increase in knowledge and improved recognition of patients' target value preferences. Among the aids, websites and videos for advance care planning have relatively high content acceptability and decision-making process satisfaction, but their feasibility has yet to be tested. CONCLUSIONS Decision aids were varied, with content focused on describing key information and exploring treatment and care preferences. Regarding application effects, the aids successfully facilitated the advance care planning process and improved the quality of participants' decisions. Overall, decision aids are efficient in improving the decision-making process for implementing advance care planning in cancer and geriatric populations. In the future, personalised decision aids should be developed based on continuous optimization of tools' quality and promoted for clinical application. REPORTING METHOD The paper has adhered to the EQUATOR guidelines and referenced the PRISMAg-ScR checklist. NO PATIENT OR PUBLIC CONTRIBUTION This is a review without patient and public contribution. REGISTRATION https://doi.org/10.17605/OSF.IO/YPHKF, Open Science DOI: 10.17605/OSF.IO/YPHKF.
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Affiliation(s)
- Ying Xu
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Ping-Ping Han
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Xiao-Qin Su
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
| | - Ping Xue
- Office of Joint Medicine, Taizhou Second People's Hospital, Taizhou, Jiangsu, China
| | - Yu-Jie Guo
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu, China
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Michael N, Symons X, Mendz GL, Kissane D. Vulnerability and Resilience: Phenomenological Analysis of Cancer Patients Value Directives. J Pain Symptom Manage 2022; 64:438-448. [PMID: 35932954 DOI: 10.1016/j.jpainsymman.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Personal values are individual conceptions of the desirable appraisals and actions that guide our attitudes and behaviour. Advance care planning (ACP) now emphasises the consideration of personal life goals and values expressed as a Values Directive (VD) to guide discussions concerning medical treatment. OBJECTIVE To investigate the diversity of values, experiences and adaptations expressed in cancer patients VDs. METHODS Contents of the VDs of ACPs of cancer patients who participated in a randomised control trial comparing a video intervention showing values communication between cancer patient-caregivers with usual care were analysed. Qualitative phenomenological content analysis was used to understand how participants made meaning of their lived experiences. RESULTS Forty-two participants completed an ACP (37.2% response rate), with 97.6% of these completing a VD (57.1% female, mean age 72 years, 30.1% gastrointestinal cancer). Participants described diverse adjustments to frailty and adaptive coping with deteriorating functionality. Emotional and financial concerns were eased through experiencing benevolence and trust established through family and friendship bonds and reciprocation of care. Death anxiety and ambivalence were expressed concurrently with the experiential acceptance of dying. Secular and sacred rituals featured as an affirmation of their faith or beliefs. CONCLUSION Cancer patients seek to make meaning of their experiences, concurrently posturing vulnerability and resilience, despite conflicting emotions and experiences. Given that the choices people make as they approach dying relate to their most deeply held values, ACP conversations should explore how patients draw from their values and life goals to optimise their adaptations to illness.
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Affiliation(s)
- Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department (N.M., D.K.), Cabrini Health, VIC Australia; School of Medicine (N.M., G.L.M., D.K.), University of Notre Dame Australia Darlinghurst, NSW, Australia; Faculty of Medicine (N.M., D.K.), Nursing and Health Sciences, Monash University, VIC, Australia.
| | - Xavier Symons
- Plunkett Centre for Ethics (X.S.), St Vincent's Hospital, NSW, Australia; Institute of Ethics and Society (X.S.), University of Notre Dame, Australia, NSW, Australia
| | - George L Mendz
- School of Medicine (N.M., G.L.M., D.K.), University of Notre Dame Australia Darlinghurst, NSW, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department (N.M., D.K.), Cabrini Health, VIC Australia; School of Medicine (N.M., G.L.M., D.K.), University of Notre Dame Australia Darlinghurst, NSW, Australia; Faculty of Medicine (N.M., D.K.), Nursing and Health Sciences, Monash University, VIC, Australia; Sacred Heart Health Service (D.K.), St. Vincent's Hospital, Sydney, NSW, Australia
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Michael N, Gorelik A, Georgousopoulou E, Sulistio M, Tee P, Hauser K, Kissane D. Patient-caregiver communication concordance in cancer-refinement of the Cancer Communication Assessment Tool in an Australian sample. Support Care Cancer 2022; 30:7387-7396. [PMID: 35612665 PMCID: PMC9385757 DOI: 10.1007/s00520-022-07163-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this study was to expand the international psychometric validation of the Cancer Communication Assessment Tool for Patients and Families (CCAT-PF) within a sample of Australian cancer patients. METHODS Survey data from 181 cancer patient-caregiver dyads ≥ 18 years of age with solid or haematological cancers were analysed (85.4% response rate). Spearman's rho was used to examine the correlation between CCAT-P and CCAT-F scores and weighted kappa the agreement between them. Exploratory factor analysis using scree plot and Kaiser-Guttman criteria was conducted to evaluate the scale structure. Cronbach's α and Pearson correlation coefficients were used to measure internal consistency and concurrent validity respectively. RESULTS Mean scores were the following: CCAT-P 46.2 (9.8), CCAT-F 45.7 (9.4), and CCAT-PF 24.1 (8.0). We confirmed the poor concordance between patient and caregiver reporting of items in the CCAT-PF, with all but two items having weighted kappa values < 0.20 and Spearman's rho < 0.19. We derived a three-factor solution, disclosure, limitation of treatment, and treatment decision making, with reliability ranging from Cronbach's α = 0.43-0.53. The CCAT-P and CCAT-F showed strong correlations with preparation for decision-making (CCAT-P: r = 0.0.92; CCATF: r = 0.0.93) but were weakly associated with patient/caregiver distress related with having difficult conversations on future care planning. CONCLUSION Preliminary validation of the CCAT-PF in the Australian setting has shown some similar psychometric properties to previously published studies, further supporting its potential utility as a tool to assess patient-caregiver dyadic communication. TRIAL REGISTRATION ACTRN12620001035910 12/10/2020 retrospectively registered.
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Affiliation(s)
- Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 646 High Street, Prahran, Melbourne, VIC, Australia.
- School of Medicine, University of Notre Dame Australia , NSW, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne VIC, Australia.
| | - Alex Gorelik
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne VIC, Australia
- Department of Medicine (RMH), University of Melbourne, Melbourne VIC, Australia
| | | | - Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 646 High Street, Prahran, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia , NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne VIC, Australia
| | - Patrick Tee
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 646 High Street, Prahran, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia , NSW, Australia
| | - Katherine Hauser
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 646 High Street, Prahran, Melbourne, VIC, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, 646 High Street, Prahran, Melbourne, VIC, Australia
- School of Medicine, University of Notre Dame Australia , NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne VIC, Australia
- Sacred Heart Health Service, St. Vincent's Hospital, Sydney, NSW, Australia
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Michael NG, Georgousopoulou E, Hepworth G, Melia A, Tuohy R, Sulistio M, Kissane D. Patient-caregiver dyads advance care plan value discussions: randomised controlled cancer trial of video decision support tool. BMJ Support Palliat Care 2022:bmjspcare-2021-003240. [PMID: 35078875 DOI: 10.1136/bmjspcare-2021-003240] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/01/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Uptake of advance care planning (ACP) in cancer remains low. An emphasis on personal value discussions and adoption of novel interventions may serve as the catalyst to increase engagement. This study examined the effectiveness of a video decision support tool (VDST) modelling values conversations in cancer ACP. METHODS This single site, open-label, randomised controlled trial allocated patient-caregiver dyads on a 1:1 ratio to VDST or usual care (UC). Previously used written vignettes were converted to video vignettes using standard methodology. We evaluated ACP document completion rates, understanding and perspectives on ACP, congruence in communication and preparation for decision-making. RESULTS Participants numbered 113 (60.4% response rate). The VDST did not improve overall ACP document completion (37.7% VDST; 36.7% UC). However, the VDST improved ACP document completion in older patients (≥70) compared with younger counterparts (<70) (OR=0.308, 95% CI 0.096 to 0.982, p=0.047), elicited greater distress in patients (p=0.015) and improved patients and caregivers ratings for opportunities to discuss ACP with health professionals. ACP improved concordance in communication (VDST p=0.006; UC p=0.045), more so with the VDST (effect size: VDST 0.7; UC 0.54). Concordance in communication also improved in both arms with age. CONCLUSION The VDST failed to improve ACP document completion rates but highlighted that exploring core patient values may improve concordance in patient-caregiver communication. Striving towards a more rigorous design of the VDST intervention, incorporating clinical outcome scenarios with values conversations may be the catalyst needed to progress ACP towards a more fulfilling process for those who partake in it. TRIAL REGISTRATION NUMBER ACTRN12620001035910.
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Affiliation(s)
- Natasha G Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Ekavi Georgousopoulou
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Carlton, Victoria, Australia
| | - Adelaide Melia
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
| | - Roisin Tuohy
- Faulty of Business and Economics, Monash University, Clayton, Victoria, Australia
| | - Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Malvern, Victoria, Australia
- School of Medicine, The University of Notre Dame Australia, Sydney, New South Wales, Australia
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Michael N, O'Callaghan C, Georgousopoulou E, Melia A, Sulistio M, Kissane D. Video decision support tool promoting values conversations in advanced care planning in cancer: protocol of a randomised controlled trial. BMC Palliat Care 2021; 20:95. [PMID: 34167538 PMCID: PMC8229383 DOI: 10.1186/s12904-021-00794-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Views on advance care planning (ACP) has shifted from a focus solely on treatment decisions at the end-of-life and medically orientated advanced directives to encouraging conversations on personal values and life goals, patient-caregiver communication and decision making, and family preparation. This study will evaluate the potential utility of a video decision support tool (VDST) that models values-based ACP discussions between cancer patients and their nominated caregivers to enable patients and families to achieve shared-decisions when completing ACP's. METHODS This open-label, parallel-arm, phase II randomised control trial will recruit cancer patient-caregiver dyads across a large health network. Previously used written vignettes will be converted to video vignettes using the recommended methodology. Participants will be ≥18 years and be able to complete questionnaires. Dyads will be randomised in a 1:1 ratio to a usual care (UC) or VDST group. The VDST group will watch a video of several patient-caregiver dyads communicating personal values across different cancer trajectory stages and will receive verbal and written ACP information. The UC group will receive verbal and written ACP information. Patient and caregiver data will be collected individually via an anonymous questionnaire developed for the study, pre and post the UC and VDST intervention. Our primary outcome will be ACP completion rates. Secondarily, we will compare patient-caregiver (i) attitudes towards ACP, (ii) congruence in communication, and (iii) preparation for decision-making. CONCLUSION We need to continue to explore innovative ways to engage cancer patients in ACP. This study will be the first VDST study to attempt to integrate values-based conversations into an ACP intervention. This pilot study's findings will assist with further refinement of the VDST and planning for a future multisite study. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry No: ACTRN12620001035910 . Registered 12 October 2020. Retrospectively registered.
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Affiliation(s)
- Natasha Michael
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia.
- School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Clare O'Callaghan
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia
- Departments of Psychosocial Cancer Care, St Vincent's Hospital, Sydney, NSW, Australia
| | - Ekavi Georgousopoulou
- School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia
| | - Adelaide Melia
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia
| | - Merlina Sulistio
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia
- School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David Kissane
- Supportive, Psychosocial and Palliative Care Research Department, Cabrini Health, Melbourne, VIC, Australia
- School of Medicine, Sydney Campus, University of Notre Dame Australia Darlinghurst, Darlinghurst, NSW, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Combes S, Gillett K, Norton C, Nicholson CJ. The importance of living well now and relationships: A qualitative study of the barriers and enablers to engaging frail elders with advance care planning. Palliat Med 2021; 35:1137-1147. [PMID: 33934669 PMCID: PMC8189003 DOI: 10.1177/02692163211013260] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The population of frail elders is growing, and due to their vulnerability to sudden deterioration, advance care planning is particularly important. However, advance care planning is uncommon for multiple reasons, some of which are linked to the perceptions of frail elders and their families. AIM To explore the barriers and enablers to advance care planning engagement with frail elders. DESIGN Qualitative in-depth interviews with thematic analysis. SETTING/PARTICIPANTS Purposive sample of 10 frail elders and 8 nominated family members using a community-based older persons' service run by a large urban UK hospice. Frail elders had capacity, were ⩾65 (median 85, range 71-95), scored 6 or 7 (median 6.5) on the Clinical Frailty Scale, and 70% were female. RESULTS Key barriers were: Advance care planning is unclear, in terms of meaning and the language used; Lack of relevance, with frail elders preferring to focus on living well now; and the Importance of family, relationships and home, and the influence of relationship on end of life decision-making. Engagement strategies included preparing the frail elder for advance care planning conversations and using a gentle, honest, individualised approach. CONCLUSIONS Essential enablers for frail elders are understanding what advance care planning is and why it may be relevant to them. For professionals, enablers include recognising the importance of living well now and relational decision-making. To further support advance care planning, recommendations include early engagement and re-conceptualising advance care planning as an ongoing process which encompasses current and future care. Further research is needed in different cultures and care contexts.
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Affiliation(s)
- Sarah Combes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,St Christopher's Hospice, London, UK
| | - Karen Gillett
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Caroline Jane Nicholson
- St Christopher's Hospice, London, UK.,Faculty of Health and Medical Sciences, Surrey University, Guildford, UK
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Silies KT, Köpke S, Schnakenberg R. Informal caregivers and advance care planning: systematic review with qualitative meta-synthesis. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003095. [PMID: 33952583 DOI: 10.1136/bmjspcare-2021-003095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Advance care planning (ACP) is a communication process about a person's values, life goals and preferences for current and future treatment and care. It can improve end-of-life care experiences for care recipients as well as for family caregivers. Knowledge about caregivers' needs might support implementation of ACP interventions suitable to both care recipients and their caregivers. OBJECTIVE To explore the experiences and attitudes of informal family caregivers, and their knowledge, regarding ACP. METHODS A systematic literature search was conducted (participants: family caregivers; intervention: advance care planning; databases: MEDLINE, PsycINFO, CINAHL, Cochrane Library). Thematic synthesis was applied to qualitative and mixed methods studies; quantitative studies were described in relation to the themes of the meta-synthesis. RESULTS 57 studies were included, of these 51 in the meta-synthesis. Three themes emerged: (1) caregiver's individual conceptualisation of ACP, (2) caregiver's relationships and (3) ACP process. These themes were incorporated into a longitudinal perspective on the caregiver's ACP trajectory, encompassing the phases (A) life before, (B) ACP process, (C) utilisation of ACP and (D) life after. The implications for ACP activities are described according to each phase. CONCLUSION For the benefit of care recipients, healthcare professionals should carefully consider caregivers' conceptualisations of ACP as well as the relationships within the family. They need to be skilled communicators, sensitive to individual needs and equipped with sufficient time resources to tailor ACP interventions to their clients' unique situation. Thus, they will support decision-making according to care recipients' wishes, caregivers' end-of-life experience and their life after bereavement. PROSPERO REGISTRATION NUMBER CRD42018082492.
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Affiliation(s)
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rieke Schnakenberg
- Department for Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Goswami P. Advance Care Planning and End-Of-Life Communications: Practical Tips for Oncology Advanced Practitioners. J Adv Pract Oncol 2021; 12:89-95. [PMID: 33552664 PMCID: PMC7844190 DOI: 10.6004/jadpro.2021.12.1.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Advance care planning discussions ensure patients' values and goals of care, including the freedom to choose their place of death, are respected. The benefits of advance care planning and early end-of-life care discussions are often delayed, as these discussions are not initiated early in patients' cancer trajectories. As a result, patients' wishes often remain unknown until the last phase of their life. Evidence suggests that many patients inappropriately receive aggressive treatment near the end of life, which leads to higher resource utilization, decreased quality of life, and increased cost. The purpose of this article is to provide practical tips to the oncology advanced practitioner on initiating advance care planning and end-of-life care discussions with patients and their families or caregivers.
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Affiliation(s)
- Poonam Goswami
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Griffith MF, Levy CR, Parikh TJ, Stevens-Lapsley JE, Eber LB, Palat SIT, Gozalo PL, Teno JM. Nursing Home Residents Face Severe Functional Limitation or Death After Hospitalization for Pneumonia. J Am Med Dir Assoc 2020; 21:1879-1884. [PMID: 33263287 PMCID: PMC7577734 DOI: 10.1016/j.jamda.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 11/18/2022]
Abstract
Objectives Pneumonia is a common cause of hospitalization for nursing home residents and has increased as a cause for hospitalization during the COVID-19 pandemic. Risks of hospitalization, including significant functional decline, are important considerations when deciding whether to treat a resident in the nursing home or transfer to a hospital. Little is known about postdischarge functional status, relative to baseline, of nursing home residents hospitalized for pneumonia. We sought to determine the risk of severe functional limitation or death for nursing home residents following hospitalization for treatment of pneumonia. Design Retrospective cohort study. Setting and Participants Participants included Medicare enrollees aged ≥65 years, hospitalized from a nursing home in the United States between 2013 and 2014 for pneumonia. Methods Activities of daily living (ADL), patient sociodemographics, and comorbidities were obtained from the Minimum Data Set (MDS), an assessment tool completed for all nursing home residents. MDS assessments from prior to and following hospitalization were compared to assess for functional decline. Following hospital discharge, all patients were evaluated for a composite outcome of severe disability (≥4 ADL limitations) following hospitalization or death prior to completion of a postdischarge MDS. Results In 2013 and 2014, a total of 241,804 nursing home residents were hospitalized for pneumonia, of whom 89.9% (192,736) experienced the composite outcome of severe disability or death following hospitalization for pneumonia. Although we found that prehospitalization functional and cognitive status were associated with developing the composite outcome, 53% of residents with no prehospitalization ADL limitation, and 82% with no cognitive limitation experienced the outcome. Conclusions and Implications Hospitalization for treatment of pneumonia is associated with significant risk of functional decline and death among nursing home residents, even those with minimal deficits prior to hospitalization. Nursing homes need to prepare for these outcomes in both advance care planning and in rehabilitation efforts.
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Affiliation(s)
- Matthew F Griffith
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO, USA.
| | - Cari R Levy
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO, USA
| | - Toral J Parikh
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Jennifer E Stevens-Lapsley
- Geriatric Research Education and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA
| | | | - Sing-I T Palat
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Pedro L Gozalo
- Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
| | - Joan M Teno
- Division of General Internal Medicine, Oregon Health and Science University, Portland, OR, USA
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Dodd SR, Payne SA, Preston NJ, Walshe CE. Understanding the Outcomes of Supplementary Support Services in Palliative Care for Older People. A Scoping Review and Mapping Exercise. J Pain Symptom Manage 2020; 60:449-459.e21. [PMID: 32201310 DOI: 10.1016/j.jpainsymman.2020.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Supplementary support services in palliative care for older people are increasingly common, but with neither recommended tools to measure outcomes nor reviews synthesizing anticipated outcomes. Common clinically focused tools may be less appropriate. OBJECTIVES To identify stakeholder perceptions of key outcomes from supplementary palliative care support services, then map these onto outcome measurement tools to assess relevance and item redundancy. METHODS A scoping review using the design by Arksey and O'Malley. EMBASE, CINAHL, MEDLINE, and PSYCHinfo searched using terms relating to palliative care, qualitative research, and supplementary support interventions. Articles were imported into Endnote™, and Covidence™ was used by two reviewers to assess against inclusion criteria. Included articles were imported into NVivo™ and thematically coded to identify key concepts underpinning outcomes. Each item within contender outcome measurement tools was assessed against each concept. RESULTS Sixty included articles focused on advance care planning, guided conversations, and volunteer befriending services. Four concepts were identified: enriching relationships; greater autonomy and perceived control; knowing more; and improved mental health. Mapping concepts to contender tool items revealed issues of relevance and redundancy. Some tools had no redundant items but mapped only to two of four outcome themes; others mapped to all concepts, but with many redundant questions. Tools such as ICECAP-Supportive Care Measure and McGill Quality of Life had high relevance and low redundancy. CONCLUSION Pertinent outcome concepts for these services and population are not well represented in commonly used outcome measurement tools, and this may have implications in appropriately measuring outcomes. This review and mapping method may have utility in fields where selecting appropriate outcome tools can be challenging.
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Affiliation(s)
- Steven R Dodd
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Sheila A Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy J Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Catherine E Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
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Ogrin R, Dickins M, Johnstone G, Mortimer D, Iezzi A, Lowthian J. Co-creation of services to maintain independence and optimise well-being: Learnings from Australia's Older Women Living Alone (OWLA) project. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:494-504. [PMID: 31663214 DOI: 10.1111/hsc.12882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/12/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
For many populations at risk of social isolation, including Older Women Living Alone (OWLA), existing services to maintain independence and optimise well-being are difficult to access, unsuitable or unavailable. Co-creation is a strategy to develop 'person-centred' services that meet the needs of individuals. We adapted an existing framework for co-creation and used participatory action research methods, supported by an evidence base comprising a systematic review, analysis of routinely collected data and interviews, to develop person-centred services for OWLA. This approach achieved co-creation through an iterative process of consultation and review, involving a series of facilitated discussions with women living alone and stakeholders. A total of 13 women living alone, aged ≥55 years, and 11 stakeholders representing service providers and advocacy groups, were recruited to participate in these discussions. Sessions with between three and five OWLA, were held across Melbourne. The information was compiled and presented to service stakeholders in a single facilitated forum, held in central Melbourne. Smaller facilitated sessions with OWLA followed, to review and discuss the collated service stakeholder input. The information from these OWLA sessions were again compiled and directed back to the service stakeholders for consideration and further discussion. The two groups came together for a final forum to prioritise the co-created ten services that they believed would be feasible and would address unmet need to support OWLA maintain independence. The process of co-creation was time-consuming and required considerable preparation to facilitate input from the target population. Small groups, gathering at convenient local locations, with transport support were essential in removing barriers to participation. However, co-creation was a viable method of eliciting the women's preferences and developing services more likely to meet their needs.
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Affiliation(s)
- Rajna Ogrin
- Bolton Clarke Research Institute, Bentleigh, Vic., Australia
- Department of International Business and Asian Studies, Griffith University, Brisbane, Qld, Australia
- Biosignals for Affordable Healthcare, Royal Melbourne Institute of Technology University, Melbourne, Vic., Australia
- Austin Health Department of Medicine, University of Melbourne, Heidelberg, Vic., Australia
| | - Marissa Dickins
- Bolton Clarke Research Institute, Bentleigh, Vic., Australia
- Southern Synergy, Department of Psychiatry at Monash Health, Southern Clinical School, Monash University, Melbourne, Vic., Australia
| | | | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Vic., Australia
| | - Angelo Iezzi
- Centre for Health Economics, Monash Business School, Monash University, Clayton, Vic., Australia
| | - Judy Lowthian
- Bolton Clarke Research Institute, Bentleigh, Vic., Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
- Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Qld, Australia
- Institute of Future Environments, Queensland University of Technology, Brisbane, Qld, Australia
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Pack AP, Golin CE, Hill LM, Carda-Auten J, Wallace DD, Cherkur S, Farel CE, Rosen EP, Gandhi M, Asher Prince HM, Kashuba ADM. Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data. PATIENT EDUCATION AND COUNSELING 2019; 102:1090-1097. [PMID: 30626550 PMCID: PMC6525638 DOI: 10.1016/j.pec.2018.12.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/26/2018] [Accepted: 12/31/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE New pharmacological measures assessing medication adherence, including longitudinal drug levels in hair, are emerging. Little is known, however, about how best to present results from such measures to patients and clinicians in comprehensive, easy-to-understand, acceptable formats. We, therefore, developed three graphical display prototypes of hypothetical daily drug concentrations measured in hair, and assessed their acceptability among participants. METHODS We interviewed 30 HIV-positive patients and 29 clinicians to examine perceived acceptability for each graphical display prototype. RESULTS Patients and clinicians generally found the prototypes acceptable for facilitating understanding of patient adherence; however, areas for optimization were identified. For patients with lower health literacy, prototypes did not provide sufficient understanding of the link between medication-taking and drug concentrations in hair. These patients also preferred pictographs over bar or line graphs. Clinicians largely preferred daily drug concentration data in bar graphs with information included about the measure's accuracy. Participants questioned the utility of showing drug concentrations above a therapeutic range, though they found color-coding results acceptable. CONCLUSIONS Assessing prototype versions of graphical displays of hypothetical longitudinal adherence data indicated ways to optimize their acceptability. PRACTICE IMPLICATIONS Acceptable prototype-tested graphical displays of longitudinal patient-specific drug concentrations may enhance adherence monitoring in clinical settings.
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Affiliation(s)
- Allison P Pack
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States.
| | - Carol E Golin
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; School of Medicine, University of North Carolina at Chapel Hill, United States; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States
| | - Lauren M Hill
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States
| | - Jessica Carda-Auten
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Deshira D Wallace
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Sruthi Cherkur
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States
| | - Claire E Farel
- School of Medicine, University of North Carolina at Chapel Hill, United States
| | - Elias P Rosen
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
| | - Monica Gandhi
- School of Medicine, University of California, San Francisco, United States
| | | | - Angela D M Kashuba
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, United States
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Downing NR, Goodnight S, Chae S, Perlmutter JS, McCormack M, Hahn E, Barton SK, Carlozzi N. Factors Associated With End-of-Life Planning in Huntington Disease. Am J Hosp Palliat Care 2017; 35:440-447. [PMID: 28655280 DOI: 10.1177/1049909117708195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Knowledge of one's gene status for adult onset conditions provides opportunity to make advance end-of-life (EOL) plans. The purposes of these analyses were to (1) determine the prevalence of EOL plans, including advance directives (ADs) among persons across 3 stages of Huntington disease (HD) and (2) examine factors associated with having ADs in this sample. METHODS Data are from 503 participants in the HD Quality of Life study. Participants completed an online health-related quality-of-life survey that included questions regarding EOL planning and self-reported HD symptoms. Frequencies were calculated for EOL planning by the HD stage. Bivariate analysis and logistic regression were used to identify variables associated with having ADs. RESULTS A total of 38.2% of participants stated they had ADs and fewer than half had other EOL plans. Being older, increased HD stage, more years of education, lower anxiety, more swallowing symptoms, and higher meaning and purpose were associated with having ADs. CONCLUSION The prevalence of ADs in our sample is comparable to the general US population, but surprisingly low, considering the severity and long disease course of HD. PRACTICE IMPLICATIONS Health-care providers should develop specific interventions early in the disease process to increase ADs in this population.
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Affiliation(s)
| | - Siera Goodnight
- 2 University of Michigan, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI, USA
| | - Sena Chae
- 3 University of Iowa College of Nursing, Iowa City, IA, USA
| | - Joel S Perlmutter
- 4 HDSA Center of Excellence, Washington University at St Louis School of Medicine, St Louis, MO, USA
| | - Michael McCormack
- 5 Department of Pathology, Rowan SOM, Piscataway, NJ, USA.,6 Department of Psychiatry, Rutgers-RWJMS, Piscataway, NJ, USA
| | - Elizabeth Hahn
- 7 Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stacey K Barton
- 4 HDSA Center of Excellence, Washington University at St Louis School of Medicine, St Louis, MO, USA
| | - Noelle Carlozzi
- 2 University of Michigan, Department of Physical Medicine & Rehabilitation, Ann Arbor, MI, USA
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