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Baylina Melé M, Villavicencio-Chávez C, Garzón Rodríguez C, Edo-Gual M, Crespo I. Design and development of a new pictorial tool to facilitate communication around advance care planning. Age Ageing 2024; 53:afae148. [PMID: 39023235 DOI: 10.1093/ageing/afae148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Advance care planning (ACP) aims to ensure that people with chronic or advanced disease receive medical care that is consistent with their values and preferences. However, professionals may find it challenging to engage these patients in conversations about the end of life. We sought to develop a pictorial tool to facilitate communication around ACP. METHODS This was a three-phase study. In phase 1, we used the nominal group and Delphi techniques to achieve expert consensus regarding the conceptual content of the tool. In phase 2, a professional cartoonist was commissioned to create a series of cartoons representing each of the content areas resulting from the Delphi process. The pictorial tool was then administered (phase 3) with a sample of individuals with advanced/chronic disease to explore whether the cartoons were easy to understand and conveyed the intended message. RESULTS Following a three-round Delphi process, consensus was reached regarding a set of 12 key content areas that should be considered in the context of an ACP interview. The cartoons created to represent each of the 12 areas were then reviewed and ordered so as to reflect the typical stages of an end-of-life care interview. After administering the pictorial tool with 24 frail older adults with advanced/chronic disease, changes were made to 9 of the 12 cartoons. CONCLUSIONS The new pictorial tool comprises a set of 12 cartoons that can guide professionals as they seek to engage frail older adults with advanced/chronic disease in conversations about the end of life and ACP.
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Affiliation(s)
- Mireia Baylina Melé
- Convalescent Care Geriatric Unit, Centre Assistencial Prytanis, Sant Boi de Llobregat (Barcelona), Spain
- Research Unit, Fundación Caredoctors, Barcelona, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles (Barcelona), Spain
| | - Christian Villavicencio-Chávez
- Research Unit, Fundación Caredoctors, Barcelona, Spain
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Valles (Barcelona), Spain
| | - Cristina Garzón Rodríguez
- Research Unit, Fundación Caredoctors, Barcelona, Spain
- Department of Internal Medicine, Hospital San Juan de Dios, Seville, Spain
| | - Montserrat Edo-Gual
- Escoles Universitàries Gimbernat, Universitat Autònoma de Barcelona, Sant Cugat del Vallès (Barcelona), Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Marshall KH, Riddiford-Harland DL, Meller AE, Caplan GA, Naganathan V, Cullen J, Gonski P, Zwar NA, O’Keeffe JA, Krysinska K, Rhee JJ. Feasibility and Acceptability of Facilitated Advance Care Planning in Outpatient Clinics: A Qualitative Study of Patient and Caregivers Experiences. J Appl Gerontol 2024; 43:339-348. [PMID: 37949095 PMCID: PMC10875901 DOI: 10.1177/07334648231206742] [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: 05/10/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023] Open
Abstract
Guidelines recommend advance care planning (ACP) for people with advanced illness; however, evidence supporting ACP as a component of outpatient care is lacking. We sought to establish the feasibility and acceptability of a facilitated ACP intervention for people attending tertiary outpatient clinics. Data from 20 semi-structured interviews with patient (M = 79.3 ± 7.7, 60% male) and caregiver (M = 68.1 ± 11.0, 60% female) participants recruited as part of a pragmatic, randomized controlled trial (RCT) were analyzed using qualitative descriptive methodology. Patients were randomized to intervention (e.g., facilitated support) or control (e.g., standard care). Intervention patients expressed high satisfaction, reporting the facilitated ACP session was clear, straightforward, and suited to their needs. Intervention caregivers did not report any significant concerns with the facilitated ACP process. Control participants reported greater difficulty completing ACP compared to intervention participants. Embedding facilitated ACP into tertiary outpatient care appears feasible and acceptable for people with advanced illnesses.
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Affiliation(s)
- Kate H. Marshall
- UNSW Academic General Practice Network, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Anne E. Meller
- Advance Care Planning Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Gideon A. Caplan
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John Cullen
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Peter Gonski
- Southcare Aged and Extended Community Care, Sutherland Hospital, Sydney, NSW, Australia
| | - Nicholas A. Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Julie-Ann O’Keeffe
- Aged, Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, NSW, Australia
| | - Karolina Krysinska
- Centre for Primary Health Care and Equity, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Joel J. Rhee
- UNSW Academic General Practice Network, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Härkönen H, Lakoma S, Verho A, Torkki P, Leskelä RL, Pennanen P, Laukka E, Jansson M. Impact of digital services on healthcare and social welfare: An umbrella review. Int J Nurs Stud 2024; 152:104692. [PMID: 38301306 DOI: 10.1016/j.ijnurstu.2024.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/27/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Digital services can be effective and cost-efficient options for treating non-communicable diseases, but generalizability is limited due to heterogeneous treatment effects. This umbrella review aims to evaluate the impact of digital services on population health, costs, and patient and healthcare professional satisfaction, and to identify facilitators and barriers to using digital services in healthcare and social welfare. METHODS The protocol of the study was registered on the 4th of September 2022 to the International Prospective Register of Systematic Reviews, PROSPERO (CRD42022355635). The review was performed using the Centre for Reviews and Dissemination, Cochrane, Ovid Medline, Scopus, and Web of Science in June 2022. The methodological quality of the included reviews was assessed. The impact of digital services was categorized as no evidence, no dominance, and mixed and positive effect. Inductive content analysis was used to identify facilitators and barriers. RESULTS A total of 66 studies were included in the review, 64 % of which were evaluated as high quality. Studies on the impact of digital services in social welfare were not identified. Sixty-five percent of reviews evaluated the impact of digital services on population health with mixed effects; 21 % were on costs with mixed effects; 27 % were on patient satisfaction with positive effects; and 7.6 % were on healthcare professionals' satisfaction with mixed effects. Various features, allocation, end-user support, organized services, and service development facilitated the use of digital services. Correspondingly, barriers were related to service limitations, digital competency, funding- and service strategies, resources and change management. CONCLUSIONS Compared to usual care, digital services had a mixed impact on population health and costs with high satisfaction in patients. Mixed healthcare professionals' satisfaction was associated with the use of digital services, and it was less studied. To ensure successful implementation and sustainability of digital services, attention must be paid to address barriers and supporting facilitators at all levels.
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Affiliation(s)
- Henna Härkönen
- University of Oulu, Research Unit of Health Sciences and Technology (HST), P.O. BOX 8000, FI-90014, Finland.
| | - Sanna Lakoma
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | - Anastasiya Verho
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | - Paulus Torkki
- University of Helsinki, Faculty of Medicine, Department of Public Health, P.O. BOX 00020, 00014, Finland
| | | | - Paula Pennanen
- Nordic Healthcare Group, Vattuniemenranta 2, 00210 Helsinki, Finland
| | - Elina Laukka
- Nordic Healthcare Group, Vattuniemenranta 2, 00210 Helsinki, Finland
| | - Miia Jansson
- University of Oulu, Research Unit of Health Sciences and Technology (HST), P.O. BOX 8000, FI-90014, Finland; RMIT University, GPO Box 2476, Melbourne, VIC 3001, Australia
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Trevizan FB, Paiva CE, de Almeida LF, de Oliveira MA, Bruera E, Paiva BSR. When and how to discuss about palliative care and advance care planning with cancer patients: A mixed-methods study. Palliat Support Care 2024; 22:387-395. [PMID: 37885316 DOI: 10.1017/s1478951523001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVES To identify the patients who are most likely to participate in discussions about palliative care (PC) and advance care planning (ACP), and to determine their preferred timing and approach of discussion. METHODS The study included women aged 18-75 years diagnosed with breast cancer. In the quantitative phase, sociodemographic and clinical characteristics, knowledge, decision-making, and stigmas were evaluated. The qualitative phase included questions about patients' understanding, timing, and method of discussing PC and ACP, which were analyzed by Bardin's content analysis. RESULTS In Phase 1, a total of 115 participants were included, with 53.04% completing both phases and 46.96% declining further participation. Those who completed both phases exhibited higher rates of marriage and educational attainment, while those who declined Phase 2 had a higher prevalence of advanced-stage cancer and palliative treatment. Completion of both phases was associated with a greater knowledge of reality and increased awareness of PC and ACP. Furthermore, the qualitative analysis revealed 5 convergent themes: timing, demystification, patient empowerment, misconception elimination, and open communication. These themes informed the development of a conceptual model that provides a framework for discussing PC and ACP with patients at different stages of cancer diagnosis and treatment, highlighting appropriate and inappropriate approaches and timing. SIGNIFICANCE OF RESULTS Early discussion is beneficial, but withholding information or infringing on autonomy should be avoided. The study reveals that married and highly educated individuals tend to be more receptive to these discussions. However, patients with late-stage cancer tend to decline participation. Patients value open communication, demystification of PC, and empowering discussions that eliminate misunderstandings. Efforts should be made to reach patients with limited familiarity, particularly those with late-stage cancer, to increase their receptiveness to enable well-informed decision-making.
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Affiliation(s)
- Fulvio Bergamo Trevizan
- GPQual - Research Group on Palliative Care and Quality of Life - Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Carlos Eduardo Paiva
- GPQual - Research Group on Palliative Care and Quality of Life - Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Laura Fiacadori de Almeida
- GPQual - Research Group on Palliative Care and Quality of Life - Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marco Antonio de Oliveira
- GPQual - Research Group on Palliative Care and Quality of Life - Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bianca Sakamoto Ribeiro Paiva
- GPQual - Research Group on Palliative Care and Quality of Life - Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Lim MK, Wong PS, Othman S, Mohd Mydin FH, Lim PS, Lai PSM. A Systematic Review of Non-Seriously Ill Community-Dwelling Asians' Views on Advance Care Planning. J Am Med Dir Assoc 2023; 24:1831-1842. [PMID: 37844872 DOI: 10.1016/j.jamda.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To systematically synthesize the views of community-dwelling Asians on Advance care planning and to summarize the factors and reasons affecting their uptake of ACP. DESIGN Mixed-methods systematic review (PROSPERO: CRD42018091033). SETTING AND PARTICIPANTS Asian adults (≥18 years old) living in the community globally. METHODS Medline (Ovid), Web of Science, CINAHL (EBSCO), Open Grey, and Google Scholar were searched from inception to June 30, 2022. Qualitative, quantitative, or mixed-methods studies reporting on the views of non-seriously ill community-dwelling Asian adults on ACP or the factors influencing their ACP uptake were included. Secondary research, studies not published in English, or studies not available as full text were excluded. Two independent teams of researchers extracted data, assessed methodologic quality, and performed the data analysis. Data analysis was conducted using the multistep convergent integrated approach based on Joanna Briggs Institute methodology for mixed-methods systematic review. RESULTS Fifty-eight studies were included. Non-seriously ill community-dwelling Asians were willing to engage in ACP (46.5%-84.4%) although their awareness (3.1%-42.9%) and uptake of ACP remained low (14.0%-53.4%). Background factors (sociodemographic factors, and health status, as well as experience and exposure to information) and underlying beliefs (attitude toward ACP, subjective norm, and perceived behavioral control) were found to affect their uptake of ACP. A conceptual framework was developed to facilitate a proper approach to ACP for this population. CONCLUSIONS AND IMPLICATIONS A flexible approach toward ACP is needed for non-seriously ill community-dwelling Asians. There is also a need to raise end-of-life and ACP literacy, and to explore ways to narrow the gap in the expectations and implementation of ACP so that trust in its effective execution can be built.
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Affiliation(s)
- Mun Kit Lim
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia; School of Pharmacy, Monash University, Selangor, Malaysia
| | - Pei Se Wong
- International Medical University, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Sajaratulnisah Othman
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Fadzilah Hanum Mohd Mydin
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - Pei Shan Lim
- Anaesthetic Department, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia.
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Malhotra C. Advance care planning: It is time to rethink our goals. J Am Geriatr Soc 2023; 71:3963-3966. [PMID: 37522615 DOI: 10.1111/jgs.18511] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Quail P, Keller H, Vucea V, Heckman G, Sasan M, Boscart V, Ramsey C, Garland A. A Qualitative Study of Nursing Home Staff Lived Experience With Advance Care Planning. J Am Med Dir Assoc 2023; 24:1761-1766. [PMID: 37536660 DOI: 10.1016/j.jamda.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Advance care planning (ACP) within nursing homes (NHs) is an integral component of resident-centered care yet remains an ongoing area for improvement. This study explored health care providers' experiences when facilitating ACP discussions with residents and their families. DESIGN Interpretive description was used to explore meanings and generate knowledge that is applicable for clinical contexts. SETTING AND PARTICIPANTS A purposive sample of 27 staff members (2 directors of care, 3 assistant directors of care, 1 nurse practitioner, 11 registered nurses, 3 registered practical nurses, and 7 social workers) from 29 NHs located across 3 Canadian provinces that participated in cluster-randomized intervention study to improve ACP. METHODS Semistructured interviews were conducted between January and July 2020. Interpretive description methods were used for analysis. RESULTS Three themes were identified. "Navigating Relational Tensions During ACP with Families" captures the relational tensions that participants experienced while navigating ACP processes with residents and their families. The second theme, "Where's the Doctor?" highlights the general lack of physician involvement in ACP discussions and the subsequent pressures faced by participants when supporting residents and families. The last theme, "Crises Change the Best Laid Plans," illustrates the challenges participants face when trying to adhere to existing care plans during residents' medical crises. CONCLUSION AND IMPLICATIONS Participants' experiences indicate that current ACP processes in NHs do not meet the needs of residents, families, or care teams. Additional support from physicians and changes to structural processes are needed to support resident-centered end-of-life planning within this care context.
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Affiliation(s)
- Patrick Quail
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Vanessa Vucea
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - George Heckman
- Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Mehar Sasan
- McMaster University, Hamilton, Ontario, Canada
| | - Veronique Boscart
- Conestoga College, Schlegel-UW Research Institute for Aging, University of Waterloo, Waterloo, Ontario, Canada
| | - Clare Ramsey
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan Garland
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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