1
|
Nouri S, Li L, Huang C, Chung A, Stokes SC, Pan S, Wong EC, Newman J, Woo JW, Cheng J, Tan CH, Wertz M, Wood-Hughes E, Quinn M, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "At the End I Have a Say": Engaging the Chinese Community in Advance Care Planning. J Pain Symptom Manage 2023; 66:551-560.e1. [PMID: 37536524 PMCID: PMC10593504 DOI: 10.1016/j.jpainsymman.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/22/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023]
Abstract
CONTEXT Despite the association of advance care planning (ACP) with improved patient and caregiver outcomes, Chinese American elders have low rates of ACP. OBJECTIVES Assess ACP facilitators/barriers in the San Francisco (SF) Chinese community and codesign, implement, and test community-based ACP-promoting pilot events. METHODS A Chinese Community Committee (N = 19 community-based organization leaders, health system representatives, community members) conducted focus groups in Cantonese and English with Chinese older adults (age ≥55), caregivers, and community leaders. The Committee designed and implemented pilot events in-person and online. We analyzed focus group data using thematic analysis; assessed pre-to-post-event readiness to engage in ACP (validated survey; 14 scale, 4 = most ready); and assessed event acceptability. RESULTS A total of 34 people participated in six focus groups. Themes described Chinese community-specific importance of ACP (e.g., reduces family burden), barriers (e.g., younger generations lack tools to discuss ACP with elders and vice versa), and facilitators (e.g., intergenerational events, culturally/linguistically appropriate materials). Based on focus groups findings, the Committee developed a novel ACP tool and designed intergenerational events. A total of 195 participants attended 10 events; 95% were Chinese, 90% spoke Chinese languages, 80% were women. ACP readiness increased significantly (1.66 [SD 0.84] vs. 2.03 [SD 0.85]; P < 0.001); 94% of participants were comfortable attending and 96% would recommend events. CONCLUSION Community-developed intergenerational events that highlight the value of ACP and address barriers are acceptable and increase ACP engagement in the Chinese community.
Collapse
Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA.
| | - Lingsheng Li
- Division of Geriatrics, Department of Medicine (L.L.), University of California San Francisco, San Francisco, California, USA
| | - Carrie Huang
- Thriving in Place (C.H.), San Francisco, California, USA
| | - Anni Chung
- Self-Help for the Elderly (A.C.), San Francisco, California, USA
| | - Sandy Chen Stokes
- Chinese American Coalition for Compassionate Care (S.C.S., S.P.), Cupertino, California, USA
| | - Shirley Pan
- Chinese American Coalition for Compassionate Care (S.C.S., S.P.), Cupertino, California, USA
| | - Elizabeth C Wong
- Independent community advocate (E.C.W.), San Francisco, California, USA
| | - Jeffrey Newman
- Institute for Health & Aging, University of California San Francisco (J.N.), San Francisco, California, USA
| | - Joseph W Woo
- Chinese Community Healthcare Association (J.W.W.), San Francisco, California, USA
| | - Joyce Cheng
- Chinese Community Health Resource Center (J.C.), San Francisco, California, USA
| | - Charissa H Tan
- John A. Burns School of Medicine, University of Hawai'i at Mānoa (C.H.T.), Honolulu, Hawaii, USA
| | - Molly Wertz
- Molly Wertz Consulting (M.W.), San Francisco, California, USA
| | - Elyse Wood-Hughes
- Richmond Senior Center, Golden Gate Senior Services (E.W.H.), San Francisco, California, USA
| | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine (S.N., M.Q., S.Z.P.), University of California San Francisco, San Francisco, California, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine (C.R.L.), Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine (C.S.R.), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine (R.L.S.), University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
2
|
Haroen H, Harun H, Sari CWM, Witdiawati W. Uncovering Methods and Outcomes of Palliative Care for Geriatric Patients: A Scoping Review. J Multidiscip Healthc 2023; 16:2905-2920. [PMID: 37790991 PMCID: PMC10544005 DOI: 10.2147/jmdh.s429323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023] Open
Abstract
Background Palliative care is an integral part of care for patients with life-limited diseases that focuses on reducing symptoms and maintaining and increasing the quality of life (QoL) for patients and their families. Geriatric patients were more likely to receive palliative care and had unique needs compared to the general population. To improve the quality of palliative care, especially for geriatric patients, it is necessary to have a better understanding of methods and outcomes for geriatric patients when delivering palliative care. Objective This study aims to identify the methods and outcomes of palliative care in geriatric patients across the globe. Methods This scoping review was guided by Arksey and 'O Malley's framework and utilized the Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist for providing transparent reporting to the readers. EBSCO, PubMed, and Scopus databases were used to search the relevant articles with a publication range of 2013-2023. Thematic analysis was used to identify and summarize palliative care methods and outcomes for geriatric patients in this review. Results Twenty-one studies were included in this review, and it was found that there were many types of methods for delivering palliative care to geriatric patients. In both acute care settings and community settings, a wide range of methods for delivering palliative care to geriatric patients were identified. Outcomes of palliative care in geriatric patients in hospitals and community settings, were reduced pain, depressive symptoms and anxiety, edema, constipation, odds of in-hospital death, and increased spiritual well-being, QoL and well-being, being comfortable, patient readiness, place of death, sleep quality, and quality of dying. Conclusion Geriatric patients had a variety of methods and outcomes in palliative care. This study suggests that outcomes should be evaluated continuously after implementing methods for delivering palliative care to geriatric patients.
Collapse
Affiliation(s)
- Hartiah Haroen
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Hasniatisari Harun
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Citra Windani Mambang Sari
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| | - Witdiawati Witdiawati
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Indonesia
| |
Collapse
|
3
|
Nouri S, Tan CH, Rangel M, Wertz M, Sanchez A, Alvarado A, Arreola E, Quinn M, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "Advocating for what we need": A CBPR approach to advance care planning in the Latinx older adult community. J Am Geriatr Soc 2023; 71:2601-2614. [PMID: 36651685 PMCID: PMC10352463 DOI: 10.1111/jgs.18236] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Advance care planning (ACP) is low among Latinx older adults. We used community-based participatory research (CBPR) to identify ACP barriers/facilitators and design community-based ACP events. METHODS In partnership with community-based organizations, clinicians, and local government, we formed a Latinx Community Committee (n = 13 community members). We then conducted 6 focus groups with Latinx-identifying, English or Spanish-speaking older adults (age ≥ 55), caregivers, and community leaders to assess ACP barriers/facilitators. We analyzed transcripts using thematic analysis and, based on these learnings, designed and implemented community-based ACP events. Using a validated survey, we assessed acceptability and pre-to-post-event ACP readiness (4-point scale; 4 = most ready; 0.2 change considered meaningful) with Wilcoxon signed-rank tests. RESULTS Focus groups included 10 Spanish-speaking older adults, 8 caregivers, and 10 community leaders. Themes highlighted the importance of ACP (e.g., means of advocacy), barriers (e.g., how to start conversations), and facilitators (e.g., trusted community spaces) in the Latinx community. Ninety-seven people attended 5 events targeting 3 Latinx populations (LGBTQI+, intergenerational, and older adults broadly). Overall pre-to-post-event ACP readiness increased (2.62 (SD 0.97) to 2.95 (SD 0.93); p = 0.05). Readiness to document wishes increased significantly (2.44 (SD 1.0) to 2.98 (SD 0.95); p = 0.003). Most reported being comfortable attending events (85%) and would recommend them to others (90%). CONCLUSIONS This study describes a feasible, acceptable, and effective CBPR ACP intervention. Co-developed community events represent a promising approach to reducing disparities in ACP among the Latinx population.
Collapse
Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Charissa H. Tan
- John A. Burns School of Medicine, University of Hawai’i at Mānoa, Honolulu, Hawaii
| | | | - Molly Wertz
- Molly Wertz Consulting, San Francisco, California
| | | | | | | | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Steven Z. Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Courtney R. Lyles
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rebecca L. Sudore
- Division of Geriatrics, Department of Medicine, University of California San Francisco
| |
Collapse
|
4
|
Sussman T, Tétrault B. "People are more afraid of a dementia diagnosis than of death": The challenges of supporting advance care planning for persons with dementia in community settings. FRONTIERS IN DEMENTIA 2022; 1:1043661. [PMID: 39081479 PMCID: PMC11285647 DOI: 10.3389/frdem.2022.1043661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 08/02/2024]
Abstract
Improving early uptake of advance care planning (ACP) for persons with dementia and their families requires that staff in community-based settings feel armed and equipped to encourage and support this process. Yet few studies have explored whether staff within non-medical environments feel prepared to support early ACP engagement for persons with early-stage dementia and their families. Our qualitative interpretivist study aimed to fill this gap by facilitating, transcribing and thematically analyzing deliberations from three focus groups with 17 community-based staff. Our findings revealed four key barriers to ACP activation in community settings: (1) the stigma associated with the condition; (2) lack of knowledge about end-of-life concerns for persons with dementia; (3) uncertainties about managing complex family dynamics and (4) worries that opening up conversations about future care may lead to the expression of wishes that could not be actualized (e.g., dying at home). Our findings further revealed that ACP engagement was facilitated when staff expressed confidence in their capacities to gauge readiness, viewed themselves as guides rather than experts and had access to resources to supplement their knowledge. Reflexive training opportunities and access to materials and resources around end-of-life care for persons with dementia, could equip staff in these non-medical settings with the skills to engage in ongoing dialogue about future care issues with persons living with dementia and their families.
Collapse
Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, QC, Canada
| | | |
Collapse
|
5
|
Combes S, Forbes G, Gillett K, Norton C, Nicholson CJ. Development of a theory-based intervention to increase cognitively able frail elders' engagement with advance care planning using the behaviour change wheel. BMC Health Serv Res 2021; 21:712. [PMID: 34284759 PMCID: PMC8290869 DOI: 10.1186/s12913-021-06548-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022] Open
Abstract
Background Advance care planning (ACP) conversations support people to think about, discuss and document their beliefs, values and preferences regarding future care. This process means that should the person loose capacity in the future, care can be provided, consistent with their personal values and beliefs. The ACP process is particularly relevant for older people living with frailty (frail elders) as they are vulnerable to sudden deterioration. However, ACP is rarely undertaken by frail elders. The aim of this study was to develop an intervention to increase multidisciplinary health and social care professionals’ (H&SCPs) engagement of cognitively able, domestic-dwelling frail elders with ACP. Methods Intervention development was guided by the Medical Research Council framework for complex interventions and the Behaviour Change Wheel. Multiple methods were used to understand ACP barriers and enablers: a systematic integrative review, a survey (n = 73 H&SCPs), and semi-structured interviews (n = 10 frail elders, n = 8 family members). A conceptual model, developed from the integrative review, underpinned data collection for the survey and interviews. Synthesis of this data, including patient and public involvement, was then used to identify H&SCPs behaviours that needed to change for ACP to be implemented and decide content and implementation for the intervention. Results Following the Behaviour Change Wheel system, and based on the findings of the review, survey and interviews, the prototype intervention, Conversations on Living and Dying (CLaD), was developed. The CLaD prototype consisted of one 3.5-hour educational skills session for H&SCPs supported by a toolkit. Content focussed on the relevance of ACP for frail elders, experience of ACP by frail elders, and strategies H&SCPs could adopt to encourage frail elders’ engagement with ACP. Strategies include recognising the importance of relationships and living well now, preparing frail elders for ACP conversations and starting ACP early. Participants who took part in initial prototype refinement reported that the intervention helped them think differently about ACP and encouraged them to engage with frail elders. Conclusions The use of behavioural theory enabled the development of CLaD, an evidence-based, theory-driven, person-centred intervention to support ACP engagement with frail elders. While feasibility testing is required, initial prototype refinement demonstrated that H&SCPs found the intervention to be acceptable, engaging, and clinically valuable in their practice with frail elders and their families. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06548-4.
Collapse
Affiliation(s)
- S Combes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK. .,St Christopher's Hospice, London, UK.
| | - G Forbes
- Centre for Behaviour Change, University College London, London, UK
| | - K Gillett
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - C Norton
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - C J Nicholson
- St Christopher's Hospice, London, UK.,Faculty of Health and Medical Sciences, Surrey University, Guildford, UK
| |
Collapse
|