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Pearse W, Saxon R, Plowman G, Hyde M, Oprescu F. Continuing Education Outcomes for Advance Care Planning: A Systematic Review of the Literature. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:39-58. [PMID: 33433128 DOI: 10.1097/ceh.0000000000000323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Advance care planning (ACP) is a process of considering future health and care needs for a time when a person may be unable to speak for themselves. Health professional continuing education programs have been proposed for facilitating patient participation in ACP; however, their impacts on participants, patient and clinical outcomes, and organizational approaches to ACP are not well understood. METHODS This systematic literature review examined interventional studies of education programs conducted with health professionals and care staff across a broad range of settings. Five electronic databases were searched up to June 2020, and a manual search of reference lists was conducted. The quality of studies was appraised by the first, second, and third authors. RESULTS Of the 7993 articles identified, 45 articles met the inclusion criteria. Program participants were predominantly medical, nursing, and social work staff, and students. Interventions were reported to improve participants' self-perceived confidence, knowledge, and skills; however, objectively measured improvements were limited. Multimodal programs that combined initial didactic teaching and role-play simulation tasks with additional activities were most effective in producing increased ACP activity in medical records. Evidence for improved clinical outcomes was limited. DISCUSSION Further studies that use rigorous methodological approaches would provide further evidence about what produces improved patient and clinical outcomes. Needs analyses and quality indicators could be considered to determine the most appropriate and effective education resources and monitor their impacts. The potential contribution of a broader range of health professionals and interprofessional learning approaches could be considered to ultimately improve patient care.
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Affiliation(s)
- Wendy Pearse
- Ms. Pearse: End of Life Care Project Manager, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia, and School of Health and Sports Sciences, University of the Sunshine Coast, Queensland, Australia. Dr. Saxon: Allied Health Data and Informatics, Advanced Speech Pathologist, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia. Dr. Plowman: Physician, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia. Dr. Hyde: Professor, School of Education, University of the Sunshine Coast, Queensland, Australia. Dr. Oprescu: Associate Professor, School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
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Fretwell C, Worlock P, Gleeson A. Delivering an advance care planning facilitated model. Int J Palliat Nurs 2020; 25:264-273. [PMID: 31242092 DOI: 10.12968/ijpn.2019.25.6.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advance care planning is increasingly recognised as an integral part of achieving excellence at the end of life (EoL), but barriers still prevent individuals from having the opportunity to discuss their wishes and preferences for the future. AIM To describe the development and initial evaluations of an innovative facilitated ACP model, the ACP Triple E, which empowers individuals through education to engage in ACP conversations. METHODS This model uses a collaborative approach involving all sectors of a large university health board to equip all health and social care professionals with the knowledge, skills and confidence to engage in ACP discussion and also raise public awareness of the benefits of ACP. CONCLUSION This model includes recognised elements that support successful implementation of ACP. Initial evaluations of the model are extremely positive. Further analysis of the data is now needed to evaluate the model's flexibility and its ability to change practice and achieve strategic objectives.
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Affiliation(s)
- Christine Fretwell
- Advance Care Planning Facilitator, Aneurin Bevan University Health Board, Wales
| | - Pat Worlock
- Advance Care Planning Facilitator, Aneurin Bevan University Health Board, Wales
| | - Aoife Gleeson
- Palliative Care Consultant, Aneurin Bevan University Health Board, Wales
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Wong SM, Kamaka M, Carpenter DAL, Seamon EM. A Review of the Literature on Native Hawaiian End-of-Life Care: Implications for Research and Practice. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2019; 78:41-44. [PMID: 31930201 PMCID: PMC6949468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The need for cultural understanding is particularly important in end-of-life (EOL) care planning as the use of EOL care in minority populations is disproportionately lower than those who identify as Caucasian. Data regarding the use of EOL care services by Native Hawaiians in Hawai'i and the United States is limited but expected to be similarly disproportionate as other minorities. In a population with a lower life expectancy and higher prevalence of deaths related to chronic diseases such as cardiovascular disease, diabetes, and obesity, as compared to the state of Hawai'i as a whole, our objective was to review the current literature to understand the usage and perceptions of EOL care planning in the Native Hawaiian population. We searched ten electronic databases and after additional screening, seven articles were relevant to our research purpose. We concluded that limited data exists regarding EOL care use specifically in Native Hawaiians. The available literature highlighted the importance of understanding family and religion influences, educating staff on culturally appropriate EOL care communication, and the need for more research on the topic. The paucity of data in EOL care and decision-making in Native Hawaiians is concerning and it is evident this topic needs more study. From national statistics it looks as though this is another health disparate area that needs to be addressed and is especially relevant when considering the rapid increase in seniors in our population.
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Affiliation(s)
- Shelley M. Wong
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
| | - Martina Kamaka
- John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI
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Nussbaum SE, Oyola S, Egan M, Baron A, Wackman S, Williams S, Benson J, Limaye S, Levine S. Incorporating Older Adults as "Trained Patients" to Teach Advance Care Planning to Third-Year Medical Students. Am J Hosp Palliat Care 2019; 36:608-615. [PMID: 30909719 DOI: 10.1177/1049909119836394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is a critical component of end-of-life (EoL) care, yet infrequently taught in medical training. OBJECTIVE We designed a novel curriculum that affords third-year medical students (MS3s) the opportunity to practice EoL care discussions with a trained older adult in the patient's home. DESIGN Volunteers were instructed as trained patients (TPs) to evaluate MS3s interviewing and communication skills. The MS3s received a didactic lecture and supplemental material about ACP. Pairs of MS3s conducted ACP interviews with TPs who gave verbal and written feedback to students. Student evaluations included reflective essays and pre/postsurveys in ACP skills. SETTINGS AND PARTICIPANTS A total of 223 US MS3s participated in the curriculum. RESULTS Qualitative analysis of reflective essays revealed 4 themes: (1) students' personal feelings, attitudes, and observations about conducting ACP interviews; (2) observations about the process of relationship building; (3) learning about and respecting patients' values and choices; and (4) the importance of practicing the ACP skills in medical school. Students' confidence in skills significantly improved in all 7 domains ( P < .001): (1) introduce subject of EoL; (2) define advance directives; (3) assess values, goals, and priorities; (4) discuss prior experience with death; (5) assess expectations about treatment and hospitalization; (6) explain cardiopulmonary resuscitation and outcomes; and (7) deal with own feelings about EoL and providers' limitations. CONCLUSIONS The use of older adults as TPs in an ACP curriculum provides students an opportunity to practice skills and receive feedback in the nonmedical setting, thereby improving comfort and confidence in approaching these conversations for future patients.
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Affiliation(s)
- Sarah E Nussbaum
- 1 Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Sonia Oyola
- 2 Department of Family Medicine, University of Chicago, Chicago, IL, USA
| | - Mari Egan
- 3 Presence Saint Mary's and Elizabeth Medical Center, Chicago, IL, USA
| | - Aliza Baron
- 4 Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Shewanna Wackman
- 2 Department of Family Medicine, University of Chicago, Chicago, IL, USA
| | - Shellie Williams
- 4 Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
| | - Janice Benson
- 5 NorthShore University Health System, Evanston, IL, USA
| | - Seema Limaye
- 6 Edward Hines Jr. Veterans Administration Hospital, Maywood, IL, USA
| | - Stacie Levine
- 4 Section of Geriatrics and Palliative Medicine, University of Chicago, Chicago, IL, USA
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Pereira-Salgado A, Mader P, O'Callaghan C, Boyd L. A Website Supporting Sensitive Religious and Cultural Advance Care Planning (ACPTalk): Formative and Summative Evaluation. JMIR Res Protoc 2018; 7:e78. [PMID: 29661749 PMCID: PMC5928329 DOI: 10.2196/resprot.8572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/24/2017] [Accepted: 11/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) promotes conversations about future health care needs, enacted if a person is incapable of making decisions at end-of-life that may be communicated through written documentation such as advance care directives. To meet the needs of multicultural and multifaith populations in Australia, an advance care planning website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific advance care planning content and complement existing resources. OBJECTIVE The purpose of this paper was to utilize the context, input, process, and product (CIPP) framework to conduct a formative and summative evaluation of ACPTalk. METHODS The CIPP framework was used, which revolves around 4 aspects of evaluation: context, input, process, and product. Context: health professionals' solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes. Input: Project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes. Process: To ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a Web-based survey. Product: Website analytics were used to report utilization, and stakeholder perceptions were captured through interviews and a website survey. RESULTS Context: A total of 16 key stakeholder health professional (7 general practitioners, 2 primary health nurses, and 7 palliative care nurses) interviews were analyzed. Website solutions included religious and cultural information, communication ideas, legal information, downloadable content, and Web-based accessibility. Christian and non-Christian faiths were to be included in the religion-specific content. Input: Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback. Process: A total of 37 content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5), and community organizations (n=3). The majority strongly agree or agree that the content used appropriate language and tone (92%, 34/37), would support health professionals (89%, 33/37), and was accurate (83%, 24/29). Product: Resource usage within the first 9 months was 12,957 page views in 4260 sessions; majority were (83.45%, 3555/4260) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (77.6%, 83/107), easy to understand (82.2%, 88/107), useful (86.0%, 92/107), and appropriate (86.0%, 92/107). A total of 20 nurses (general practice n=10, palliative care n=8, and both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design, and increased knowledge of advance care planning. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations. CONCLUSIONS The CIPP framework was effectively applied to evaluate the development and end product of an advance care planning website.Although overall findings were positive, further advance care planning website development should consider the recommendations derived from this study.
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Affiliation(s)
- Amanda Pereira-Salgado
- Centre for Nursing Research, Cabrini Institute, Malvern, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Patrick Mader
- Centre for Nursing Research, Cabrini Institute, Malvern, VIC, Australia
| | - Clare O'Callaghan
- Palliative and Supportive Care Research Department, Cabrini Institute, Malvern, VIC, Australia.,Departments of Psychosocial Cancer Care and Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, VIC, Australia.,Institute for Ethics and Society, The University of Notre Dame, Sydney, NSW, Australia
| | - Leanne Boyd
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.,Cabrini Institute, Malvern, VIC, Australia.,Australian Catholic University, Fitzroy, VIC, Australia
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Myers J, Cosby R, Gzik D, Harle I, Harrold D, Incardona N, Walton T. Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review. Am J Hosp Palliat Care 2018. [PMID: 29529884 DOI: 10.1177/1049909118760303] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. AIM To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. DATA SOURCES A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. CONCLUSIONS Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.
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Affiliation(s)
- Jeff Myers
- 1 Sinai-Bridgepoint Palliative Care Unit, Toronto, Ontario, Canada
| | - Roxanne Cosby
- 2 Program in Evidence-Based Care, McMaster University, Hamilton, Canada
| | - Danusia Gzik
- 3 North Simcoe Muskoka Regional Cancer Program, Cancer Care Ontario, Barrie, Canada
| | - Ingrid Harle
- 4 Department of Medicine, Queen's University, Kingston, Canada.,5 Department of Oncology, Queen's University, Kingston, Canada
| | - Deb Harrold
- 3 North Simcoe Muskoka Regional Cancer Program, Cancer Care Ontario, Barrie, Canada
| | - Nadia Incardona
- 6 Michael Garron Hospital, Toronto East Health Network, Ontario, Canada.,7 Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Tara Walton
- 8 Ontario Palliative Care Network Secretariat, Toronto, Canada
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Lum HD, Dukes J, Church S, Abbott J, Youngwerth JM. Teaching Medical Students About "The Conversation": An Interactive Value-Based Advance Care Planning Session. Am J Hosp Palliat Care 2017; 35:324-329. [PMID: 28273761 DOI: 10.1177/1049909117696245] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) promotes care consistent with patient wishes. Medical education should teach how to initiate value-based ACP conversations. OBJECTIVE To develop and evaluate an ACP educational session to teach medical students a value-based ACP process and to encourage students to take personal ACP action steps. DESIGN Groups of third-year medical students participated in a 75-minute session using personal reflection and discussion framed by The Conversation Starter Kit. The Conversation Project is a free resource designed to help individuals and families express their wishes for end-of-life care. SETTING AND PARTICIPANTS One hundred twenty-seven US third-year medical students participated in the session. MEASUREMENTS Student evaluations immediately after the session and 1 month later via electronic survey. RESULTS More than 90% of students positively evaluated the educational value of the session, including rating highly the opportunities to reflect on their own ACP and to use The Conversation Starter Kit. Many students (65%) reported prior ACP conversations. After the session, 73% reported plans to discuss ACP, 91% had thought about preferences for future medical care, and 39% had chosen a medical decision maker. Only a minority had completed an advance directive (14%) or talked with their health-care provider (1%). One month later, there was no evidence that the session increased students' actions regarding these same ACP action steps. CONCLUSION A value-based ACP educational session using The Conversation Starter Kit successfully engaged medical students in learning about ACP conversations, both professionally and personally. This session may help students initiate conversations for themselves and their patients.
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Affiliation(s)
- Hillary D Lum
- 1 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,2 Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Joanna Dukes
- 1 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Skotti Church
- 1 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,2 Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Jean Abbott
- 3 Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Jean M Youngwerth
- 1 Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Sanders S, Robinson EL. Engaging College Undergraduates in Advance Care Planning. OMEGA-JOURNAL OF DEATH AND DYING 2016; 74:329-344. [PMID: 28038509 DOI: 10.1177/0030222815598912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Advance care planning (ACP) is a critical part of long-term health-care planning, as no one knows when the ability to make personal medical decisions may be impaired. Many assume ACP is only necessary for older adults or those with life-threatening health conditions; however, there are growing discussions about healthy, young adults also engaging in ACP, as they too suffer from unexpected medical events that limit their ability to make medical decisions. The current study examined the reactions of college students following the completion of their advance care plans and then sharing these plans with friends and family. The students reported that while completing their advance care plans created many emotions, they found the experience to be valuable and facilitated conversations with family and friends about end-of-life care that may not have occurred otherwise.
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Affiliation(s)
- Sara Sanders
- 1 The University of Iowa School of Social Work, IA, USA
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Hagiwara Y, Villarreal D, Sanchez-Reilly S. Present Planning versus Future Planning: We Need a Shift Toward Goals of Care Education for Physicians. J Palliat Med 2015; 18:99. [DOI: 10.1089/jpm.2014.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yuya Hagiwara
- Division of Geriatrics, Gerontology and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Deborah Villarreal
- Division of Geriatrics, Gerontology and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Geriatric Research Education Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Sandra Sanchez-Reilly
- Division of Geriatrics, Gerontology and Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Geriatric Research Education Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
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