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Collins EF, Galloway-Salazar Q, Johnson E, Blechman J, Rush M, Clare E, Johnson A, Sethi A, Rosa WE, Izumi S. Top Ten Tips Palliative Care Clinicians Should Know About End-of-Life Doulas. J Palliat Med 2024. [PMID: 39069890 DOI: 10.1089/jpm.2024.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Palliative care has made great strides in improving the lives of people living with serious illness, with an empirical premise for increasing quality, and sometimes quantity of life. Yet in some cases, there exist gaps that impede the ability of palliative care clinicians to truly advocate, procure, and provide the comprehensive services needed for patients, family caregivers, and communities, particularly in the contexts of caring for marginalized populations and working in under-resourced practice settings. The end-of-life doula role has emerged over the last decade and the availability of trained doulas in the community has burgeoned. An end-of-life doula is a nonmedical, holistic support person who provides education, guidance, emotional, spiritual, and practical support to persons and families navigating serious and terminal illness, ideally early in the disease process, throughout the time surrounding death, and during bereavement. A pervasive Western culture of avoiding the subject of death means that we, as a society, often do not know or remember how to navigate the journey of end of life in a way that is caring, compassionate, skilled, holistic, and centered on the needs and worldview of the dying one. The ten tips provided here can guide palliative care clinicians to leverage collaboration with trusted, community-based end-of-life doulas to ensure comprehensive and people-centered palliative care.
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Affiliation(s)
| | | | | | | | | | - Emma Clare
- End-of-Life Doula International Research Group, End-of-Life Doula UK, University of Derby, York, United Kingdom
| | - Ashley Johnson
- National End-of-life Doula Alliance, Orlando, Florida, USA
| | - Aditi Sethi
- Center for Conscious Living and Dying, Asheville, North Carolina, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Seiko Izumi
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
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Spadoni N, Baron A, Zavala E, Burns M, Draw K, Hernandez W, Bennett J, Gleason LJ, Levine S. Community health worker training on older adults: A qualitative needs assessment. J Am Geriatr Soc 2024. [PMID: 39016122 DOI: 10.1111/jgs.19077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/24/2024] [Accepted: 06/14/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Community health workers (CHWs) are frontline public health personnel who serve as liaisons between vulnerable patient populations and the healthcare system. They are instrumental in health promotion and education for urban-dwelling older adults. However, no research exists on training that CHWs receive on age-friendly health care. This article explores CHW education on the 4Ms of an Age-Friendly Health System and identifies areas where additional training may be necessary. METHODS As part of a two-pronged qualitative needs assessment, four focus groups were held with a total of 17 CHWs and semistructured interviews were conducted with 10 clinicians, including both healthcare providers and social workers. Focus group and interview transcripts were then analyzed for major themes in Dedoose, a qualitative coding software. RESULTS Clinicians most often identified Mentation and Mobility as areas where CHWs can have the greatest impact. Correspondingly, CHWs felt under-equipped to assist patients in these areas and expressed strong interest in additional training. In general, CHWs and clinicians agreed that Medications and What Matters do not fall under CHW scope of practice. CONCLUSIONS Our findings confirm the critical role that CHWs can play in promoting the health and well-being of urban-dwelling older adults. However, we also demonstrate that many CHWs lack adequate training in age-friendly care. To meet the social and medical needs of a rapidly aging US population, there is a pertinent need to develop a novel community health worker training curriculum on Mentation and Mobility.
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Affiliation(s)
- Nora Spadoni
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Aliza Baron
- Section of Geriatrics & Palliative Medicine, Department of Medicine, UChicago Medicine, Chicago, IL, USA
| | - Elizabeth Zavala
- Section of Geriatrics & Palliative Medicine, Department of Medicine, UChicago Medicine, Chicago, IL, USA
| | | | - Kandis Draw
- The HAP Foundation, Oakbrook Terrace, IL, USA
| | - Wandy Hernandez
- National Association of Community Health Workers, Boston, MA, USA
| | - Jenil Bennett
- Section of Geriatrics & Palliative Medicine, Department of Medicine, UChicago Medicine, Chicago, IL, USA
| | - Lauren J Gleason
- Section of Geriatrics & Palliative Medicine, Department of Medicine, UChicago Medicine, Chicago, IL, USA
| | - Stacie Levine
- Section of Geriatrics & Palliative Medicine, Department of Medicine, UChicago Medicine, Chicago, IL, USA
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Nummedal MA, King S, Uleberg O, Pedersen SA, Bjørnsen LP. Non-emergency department (ED) interventions to reduce ED utilization: a scoping review. BMC Emerg Med 2024; 24:117. [PMID: 38997631 PMCID: PMC11242019 DOI: 10.1186/s12873-024-01028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Emergency department (ED) crowding is a global burden. Interventions to reduce ED utilization have been widely discussed in the literature, but previous reviews have mainly focused on specific interventions or patient groups within the EDs. The purpose of this scoping review was to identify, summarize, and categorize the various types of non-ED-based interventions designed to reduce unnecessary visits to EDs. METHODS This scoping review followed the JBI Manual for Evidence Synthesis and the PRISMA-SCR checklist. A comprehensive structured literature search was performed in the databases MEDLINE and Embase from 2008 to March 2024. The inclusion criteria covered studies reporting on interventions outside the ED that aimed to reduce ED visits. Two reviewers independently screened the records and categorized the included articles by intervention type, location, and population. RESULTS Among the 15,324 screened records, we included 210 studies, comprising 183 intervention studies and 27 systematic reviews. In the primary studies, care coordination/case management or other care programs were the most commonly examined out of 15 different intervention categories. The majority of interventions took place in clinics or medical centers, in patients' homes, followed by hospitals and primary care settings - and targeted patients with specific medical conditions. CONCLUSION A large number of studies have been published investigating interventions to mitigate the influx of patients to EDs. Many of these targeted patients with specific medical conditions, frequent users and high-risk patients. Further research is needed to address other high prevalent groups in the ED - including older adults and mental health patients (who are ill but may not need the ED). There is also room for further research on new interventions to reduce ED utilization in low-acuity patients and in the general patient population.
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Affiliation(s)
- Målfrid A Nummedal
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Sarah King
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Oddvar Uleberg
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Sindre A Pedersen
- The Medicine and Health Library, Library Section for Research Support, Data and Analysis, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Petter Bjørnsen
- Trondheim Emergency Department Research Group (TEDRG), Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Emergency Medicine and Prehospital Care, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Landau AY, Venkatram C, Song J, Topaz M, Klitzman R, Shang J, Stone P, McDonald M, Cohen B. Home Care Clinicians' Perspectives on Advance Care Planning for Patients at Risk for Becoming Incapacitated With No Evident Advance Directives or Surrogates. J Hosp Palliat Nurs 2024; 26:74-81. [PMID: 38340056 PMCID: PMC10940180 DOI: 10.1097/njh.0000000000000998] [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] [Indexed: 02/12/2024]
Abstract
Advance care planning is important and timely for patients receiving home health services; however, opportunities to facilitate awareness and engagement in this setting are often missed. This qualitative descriptive study elicited perspectives of home health nurses and social workers regarding barriers and facilitators to creating advance care plans in home health settings, with particular attention to patients with few familial or social contacts who can serve as surrogate decision-makers. We interviewed 15 clinicians employed in a large New York City-based home care agency in 2021-2022. Participants reported a multitude of barriers to supporting patients with advance care planning at the provider level (eg, lack of time and professional education, deferment, discomfort), patient level (lack of knowledge, mistrust, inadequate support, deferment, language barriers), and system level (eg, discontinuity of care, variations in advance care planning documents, legal concerns, lack of institutional protocols and centralized information). Participants noted that greater socialization and connection to existing educational resources regarding the intended purpose, scope, and applicability of advance directives could benefit home care patients.
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Carter RZ, Hassan E, Porterfield P, Barwich D. A model for community-led peer-facilitated advance care planning workshops for the public. Palliat Care Soc Pract 2023; 17:26323524231212515. [PMID: 38033874 PMCID: PMC10685751 DOI: 10.1177/26323524231212515] [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: 08/14/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023] Open
Abstract
Background The core to successful advance care planning (ACP) facilitation is helping people determine their values, beliefs and wishes, and understand substitute decision-making. Recognizing the potential for community members to support public awareness and education we developed a model of ACP education, whereby peer facilitators associated with community organizations host workshops that educate and assist members of the public with ACP. Objectives Describe the development and evaluation of the model for community-led peer-facilitated ACP workshops for the public. Design Descriptive mixed methods. Methods A training curriculum and program model were co-developed with two community organizations that had been successful in delivering ACP workshops independently in their communities. Herein we describe a mixed-methods evaluation of three cycles of implementation and improvement of the model. Results The model centers on three key concepts; the right content (based around three steps Think, Talk, Plan), the right facilitator, and the right approach. A suite of tools was designed to support the three groups involved in the delivery of the ACP workshops: the public participants, the peer facilitators, and the community-based organizations. The peer-facilitator training addresses the facilitator's learning needs of ACP content knowledge, facilitation skills, and understanding change behavior. Training evaluation data from 106 facilitators confirmed that the curriculum prepared them to facilitate the workshops. Qualitative data revealed that support from organizations with established reputations in their community is critical, with mentoring from more experienced facilitators beneficial. Conclusion Our model demonstrates the potential of community-led, peer-facilitated ACP initiatives to enhance the capacity of community to upstream ACP conversations. Reaching a broader audience and creating a supportive, inclusive environment for individuals to comfortably learn about ACP can drive the much-needed culture shift to normalize ACP. Meaningful community engagement, empowerment, and partnerships are essential for the successful development and widespread impact of these initiatives.
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Affiliation(s)
- Rachel Z Carter
- Division of Palliative Care, The University of British Columbia, 6389 Stadium Road, Vancouver, BC V6T 1Z4, Canada
- BC Centre for Palliative Care, PMB 691, 101-1001 W. Broadway, Vancouver, BC V6H 4E4, Canada
| | - Eman Hassan
- BC Centre for Palliative Care, Vancouver, BC, Canada
- Division of Palliative Care, The University of British Columbia, Vancouver, BC, Canada
| | | | - Doris Barwich
- BC Centre for Palliative Care, Vancouver, BC, Canada
- Division of Palliative Care, The University of British Columbia, Vancouver, BC, Canada
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Reinschmidt KM, Philip TJ, Alhay ZA, Braxton T, Jennings LA. Training Community Health Workers to Address Disparities in Dementia Care: A Case Study From Oklahoma With National Implications. J Ambul Care Manage 2023; 46:272-283. [PMID: 36939639 DOI: 10.1097/jac.0000000000000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
The projected increase of dementia in the diverse aging US population calls for a well-prepared public health workforce. Community health workers (CHWs) can address dementia in culturally appropriate ways. Collaborating with stakeholders, we developed a train-the-trainer curriculum for CHWs and used a virtual training platform to test its feasibility with 77 CHWs. Pre-/post-evaluation data demonstrated modestly increased dementia knowledge scores. Training participants valued the resources shared and interacting with peers. Disseminating this training could contribute to closing gaps in dementia care in diverse communities, along with policies supporting CHWs as a workforce that reduces age-related disparities and promotes health equity.
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Affiliation(s)
- Kerstin M Reinschmidt
- Health Promotion Sciences, Hudson College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City (Dr Reinschmidt and Ms Alhay); The University of Oklahoma Health Sciences Center, Oklahoma City, and Baylor Scott & White All Saints Medical Center, Fort Worth, Texas (Dr Philip); Oklahoma City County Health Department, and Guiding Right, Inc., Oklahoma City (Ms Braxton); and Department of Internal Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City (Dr Jennings)
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Brean SJ, Recoche K, William L, Lakhani A, Zhong Y, Shimoinaba K. Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis. BMJ Support Palliat Care 2023:spcare-2023-004162. [PMID: 37380215 DOI: 10.1136/spcare-2023-004162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Evidence suggests that there is a gap in advance care planning (ACP) completion between vulnerable and disadvantaged populations compared with the general population. This review seeks to identify tools, guidelines or frameworks that have been used to support ACP interventions with vulnerable and disadvantaged adult populations as well as their experiences and outcomes with them. The findings will inform practice in ACP programmes. METHODS A systematic search of six databases from 1 January 2010 to 30 March 2022 was conducted to identify original peer-reviewed research that used ACP interventions via tools, guidelines or frameworks with vulnerable and disadvantaged adult populations and reported qualitative findings. A narrative synthesis was conducted. RESULTS Eighteen studies met the inclusion criteria. Relatives, caregivers or substitute decision-makers were included in eight studies. SETTINGS hospital outpatient clinics (N=7), community settings (N=7), nursing homes (N=2), prison (N=1) and hospital (N=1). A variety of ACP tools, guidelines or frameworks were identified; however, the facilitator's skills and approach in delivering the intervention appeared to be as important as the intervention itself. Participants indicated mixed experiences, some positive, some negative and four themes emerged: uncertainty, trust, culture and decision-making behaviour. The most common descriptors relating to these themes were prognosis uncertainty, poor end-of-life communication and the importance of building trust. CONCLUSION The findings indicate that ACP communication could be improved. ACP conversations should incorporate a holistic and personalised approach to optimise efficacy. Facilitators should be equipped with the necessary skills, tools and information needed to assist ACP decision-making.
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Affiliation(s)
- Samantha Jane Brean
- Advance Care Planning, Eastern Health, Wantirna, Victoria, Australia
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Katrina Recoche
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Leeroy William
- Supportive and Palliative Care Service, Eastern Health, Wantirna, Victoria, Australia
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Ali Lakhani
- La Trobe University, School of Psychology and Public Health, Melbourne, Victoria, Australia
| | - Yaping Zhong
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Kaori Shimoinaba
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
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Sakamoto A, Inokuchi R, Iwagami M, Sun Y, Tamiya N. Association between advanced care planning and emergency department visits: A systematic review. Am J Emerg Med 2023; 68:84-91. [PMID: 36958094 DOI: 10.1016/j.ajem.2023.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/16/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Advance care planning can help provide optimal medical care according to a patient's wishes as a part of patient-centered discussions on end-of-life care. This can prevent undesired transfers to emergency departments. However, the effects of advance care planning on emergency department visits and ambulance calls in various settings or specific conditions remain unclear. AIM To evaluate whether advanced care planning affected the frequency of emergency department visits and ambulance calls. DESIGN Systematic review. This study was registered in PROSPERO (CRD42022340109). We assessed risk of bias using RoB 2.0, ROBINS-I, and ROBINS-E. DATA SOURCES We searched the PubMed, Cochrane CENTRAL, and EMBASE databases from their inception until September 22, 2022 for studies comparing patients with and without advanced care planning and reported the frequency of emergency department visits and ambulance calls as outcomes. RESULTS Eight studies were included. Regarding settings, two studies on patients in nursing homes showed that advanced care planning significantly reduced the frequency of emergency department visits and ambulance calls. However, two studies involving several medical care facilities reported inconclusive results. Regarding patient disease, a study on patients with depression or dementia showed that advanced care planning significantly reduced emergency department visits; in contrast, two studies on patients with severe respiratory diseases and serious illnesses showed no significant reduction. Seven studies showed a high risk of bias. CONCLUSIONS Advanced care planning may lead to reduced emergency department visits and ambulance calls among nursing home residents and patients with depression or dementia. Further research is warranted to identify the effectiveness of advanced care planning in specific settings and diseases.
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Affiliation(s)
- Ayaka Sakamoto
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan
| | - Ryota Inokuchi
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan.
| | - Masao Iwagami
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan
| | - Yu Sun
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8577, Japan
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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.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, McGill University, Montreal, QC, Canada
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Sussman T, Lawrence J, Pimienta R. "This is how I want it": Exploring the use of a workbook with persons with dementia to support advance care planning engagement. DEMENTIA 2022; 21:2601-2618. [PMID: 36151606 PMCID: PMC9583280 DOI: 10.1177/14713012221127358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This mixed method sequential study reports focus group and pilot intervention
findings that (1) explore the views of persons with dementia and their
caregivers on using a self-directed advance care planning engagement workbook
(Your Conversation Starter Kit) and (2) uncover the
conditions that encouraged and hindered workbook use. In Phase 1, we conducted
five focus groups consisting of 10 persons with dementia and eight family
members/caregivers from two urban Canadian cities to explore overall impressions
of the workbook and factors that might affect its use. In Phase 2, we
empirically explored the factors identified in Phase 1 by distributing the
workbook to 24 persons with dementia. The combined findings suggest that the
workbook offers promise in supporting advance care planning engagement for
persons with dementia in the early stages of their condition. Involving
family/caregivers and clarifying some of the ranked questions might improve the
workbook’s use. Persons with dementia without familial support or those who have
never contemplated advance care planning may require additional guidance prior
to workbook distribution.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, 5620McGill University, Montreal, Canada
| | - Jack Lawrence
- School of Social Work, 5620McGill University, Montreal, Canada
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Miao Q, Xing B, Li J, Li Y. The development of a questionnaire to assess the willingness of Chinese community health workers to implement advance care planning. BMC Palliat Care 2022; 21:157. [PMID: 36085142 PMCID: PMC9461251 DOI: 10.1186/s12904-022-01046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/24/2022] [Indexed: 11/14/2022] Open
Abstract
Background To develop a questionnaire to evaluate the willingness of Chinese health care workers to implement an advance care planning (ACP) program for patients in a Chinese cultural context. Methods Guided by the framework of the theory of planned behavior (TPB), a literature analysis and semi-structured interviews were conducted to create a pool of questionnaire items, and then the initial assessment questionnaire was developed by two rounds of expert consultations. A random sampling method was used to pre-survey 204 health care workers in community health service centers (CHSCs) in three urban areas of Hangzhou, Zhejiang Province. The final questionnaire was derived from item analysis and exploratory factor analysis. Results Based on exploratory factor analysis, five common factors were identified from the questionnaire on community health care workers‘(CHWs) willingness to implement ACP. In general, the content validity of the questionnaire was 0.91, and the content validity of each of the entries ranged from 0.80 to 1.00, indicating acceptable overall questionnaire content validity. The total Cronbach coefficient for the questionnaire was 0.966, the Cronbach coefficient for each dimension ranged from 0.865 to 0.954, and the retest reliability was 0.856. The questionnaire produced a final draft containing five dimensions (behavioral attitudes, subjective norms, direct control, indirect control, and behavioral intentions) and 30 items. Conclusion The questionnaire on the willingness of CHWs to implement ACP was validated and found to be reliable. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01046-8.
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Patel MI, Kapphahn K, Dewland M, Aguilar V, Sanchez B, Sisay E, Murillo A, Smith K, Park DJ. Effect of a Community Health Worker Intervention on Acute Care Use, Advance Care Planning, and Patient-Reported Outcomes Among Adults With Advanced Stages of Cancer: A Randomized Clinical Trial. JAMA Oncol 2022; 8:1139-1148. [PMID: 35771552 PMCID: PMC9247857 DOI: 10.1001/jamaoncol.2022.1997] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Deficiencies in advance care planning and symptom management are associated with avoidable acute care use among patients with cancer. Community health worker (CHW)-led approaches may be an approach to reduce acute care use but remain untested in community settings. Objective To determine whether a CHW-led advance care planning and symptom screening intervention can reduce acute care use more than usual care in a community setting. Design, Setting, and Participants This randomized clinical trial was conducted among patients with newly diagnosed advanced-stage or recurrent solid and hematologic cancers from August 8, 2017, through November 30, 2021. Data analysis was performed November 30, 2021, through January 1, 2022, by intention to treat. Interventions Participants were randomized 1:1 to usual care (control group) or usual care with the 6-month CHW-led intervention (intervention group). Main Outcomes and Measures The primary outcome was acute care use. Secondary outcomes included advance care planning documentation, supportive care use, patient-reported outcomes, survival, and end-of-life care use. Results Among 128 participants, median (range) age was 67 (19-89) years; 61 (47.7%) were female; and 2 (1.6%) were American Indian or Alaska Native, 11 (8.6%) were Asian, 5 (3.9%) were Black, 23 (18.0%) were Hispanic or Latino, 2 (1.6%) were of mixed race, 2 (1.6%) were Native Hawaiian or other Pacific Islander, 86 (67.2%) were White, and 20 (15.6%) did not report race. Intervention participants had 62% lower risk of acute care use than the control (hazard ratio, 0.38; 95% CI, 0.19-0.76) within 6 months. At 12 months, intervention participants had 17% lower odds of acute care use (odds ratio [OR], 0.83; 95% CI, 0.69-0.98), 8 times the odds of advance care planning documentation (OR, 7.18; 95% CI, 2.85-18.13), 4 times the odds of palliative care (OR, 4.46; 95% CI, 1.88-10.55), nearly double the odds of hospice (OR, 1.83; 95% CI, 1.16-2.88), and nearly double the odds of improved mental and emotional health from enrollment to 6 and 12 months postenrollment (OR, 1.82; 95% CI, 1.03-3.28; and OR, 2.20; 95% CI, 1.04-4.65, respectively) than the control. There were no differences in the death (control, 26 [40.6%] vs intervention, 32 [50.0%]). Fewer intervention participants had acute care use (0 vs 6 [23.1%]) in the month before death than the control. Conclusions and Relevance In this randomized clinical trial, integration of a CHW-led intervention into cancer care reduced acute care use and is one approach to improve cancer care delivery for patients with advanced stages of disease in community settings. Trial Registration ClinicalTrials.gov Identifier: NCT03154190.
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Affiliation(s)
- Manali I. Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, California,Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, California,Center for Primary Care and Outcomes Research/Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Kristopher Kapphahn
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | | | | | | | | | - Ariana Murillo
- Division of Oncology, Stanford University School of Medicine, Stanford, California
| | - Kim Smith
- St Jude Crosson Cancer Institute, Center for Hematology and Oncology, Fullerton, California
| | - David J. Park
- St Jude Crosson Cancer Institute, Center for Hematology and Oncology, Fullerton, California
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Xu Y, Koh XH, Chua YTS, Tan CGI, Aloweni FAB, Yap BEJ, Tan PC, Chua X, Lim YKS, Oh HC, Teo SHS, Lim SF. The impact of community nursing program on healthcare utilization: A program evaluation. Geriatr Nurs 2022; 46:69-79. [DOI: 10.1016/j.gerinurse.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
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Dube D, Sussman T, Brotman S, de Vries B, Gutman G. Advance Care Planning among Older Gay Men Living with HIV in Montreal, Canada: Challenges to Thinking and Talking about Future Care. JOURNAL OF HOMOSEXUALITY 2022; 69:756-772. [PMID: 33433307 DOI: 10.1080/00918369.2020.1855029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This qualitative study employed a cross sectional focus group design to explore how older gay men living with HIV, experience, perceive, and engage with advance care planning (ACP). Seven gay men 50+, residing in Montreal, Canada, participated in a focus group that was audio-recorded, transcribed, and thematically analyzed. Findings suggested that social isolation, preoccupations with day-to-day living, and managing disclosures related to sexual orientation and HIV status created barriers to these men's capacities to think about let alone talk about future care. These findings challenge current conceptualizations of ACP, which position reflection as an individual process that precedes allocating a decision-maker and communicating care preferences. Analyses further revealed that relational connections helped create a space where ACP could occur for participants. Hence, improving the uptake of ACP amongst older gay men with HIV may require interventions that embed such discussions into broader programs aimed at building support and community.
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Affiliation(s)
- Denis Dube
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Shari Brotman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Brian de Vries
- Department of Gerontology, San Francisco State University, San Francisco, California, USA
| | - Gloria Gutman
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
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Bigger SE, Glenn L. Emergency Department Use and Advance Care Planning in Home Health Value-Based Purchasing. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221082660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Advance care planning (ACP) is a conversation about values, future treatment choices, and designation of a surrogate decision-maker, held in advance of a health crisis. ACP protocols are established by home health agencies (HHAs) to support the staff in talking about patients’ future treatment choices, which can include opting against acute care use. In 2016, Medicare implemented an experimental incentive program called Home Health Value-Based Purchasing (HHVBP) in 9 regionally representative states. These agencies were required to compete on value, where reimbursement rates were tied to outcomes in a Total Performance Score (TPS). With home health’s aim of avoiding unplanned acute care use, in-patient hospitalization was weighted the heaviest as a poor outcome, followed by emergency department (ED) use. The purpose of this quasi-interventional study was to determine the relationship between advance care planning protocols and ED use among HHAs in the U. S. by the status of participation HHVBP intervention group. The Advance Care Planning Protocol (ACPP) score was measured by scoring survey questions. Our findings show (1) ACPP score intensity was higher in states that participated in the HHVBP program; (2) high measurement reliability for the ACPP scores; (3) no significant relationship between ACPP and ED use overall; but (4) the relationship between ACPP intensity and ED use was equal-and-opposite for the HHVBP and non-HHVBP groups. These findings suggest that the HHVBP intervention altered the influence of ACPP intensity on ED use. Recommendations are made for the HHVBP program regarding ACP’s role in goal-concordant care.
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Affiliation(s)
| | - Lee Glenn
- East Tennessee State University, Johnson City, TN, USA
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16
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Johnson J, Hayden T, Taylor LA. Evaluation of the LIGHT Curriculum: An African American Church-Based Curriculum for Training Lay Health Workers to Support Advance Care Planning, End-of-Life Decision Making, and Care. J Palliat Med 2022; 25:413-420. [PMID: 34515525 PMCID: PMC8968829 DOI: 10.1089/jpm.2021.0235] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Lay health workers (LHWs) engaging African Americans in conversations about advance care planning (ACP) often have felt unprepared for the challenges of communicating with patients as they approach the end of life. We developed a church-based training curriculum, LIGHT (Listening, Identifying, Guiding, Helping, Translating), in response to this need. Objectives: To evaluate the LIGHT Curriculum by assessing its impact on knowledge, beliefs and attitudes, and self-efficacy of the learners; describing their assessment of the classroom component of the training; and describing their visit activities, and perceptions derived during client visits. Design: prospective, descriptive, pre- and post-training evaluation. Settings/Subjects: Thirty-seven LHWs (Comfort Care Supporters [CCSs]) from three African American Churches (United States). Measurements: knowledge, beliefs and attitudes, assessment of classroom training, self-efficacy, visit activities, and perceptions. Results: Pre-to-post knowledge scores (range 0-26) increased by a mean of 5.23, p < 0.0001. Agreement with favorable beliefs about palliative and hospice care (HC) did not change significantly post-training. Disagreement with unfavorable beliefs about hospice increased, most notably, the belief that hospice means a place where people go to die (43% to 87%, p = 0.003) and HC means giving up (77% to 93%, p = 0.03). Post-training, 94% of the CCSs felt prepared to function in their roles. The CCSs who visited clients demonstrated the ability to engage clients and families in conversations about issues important to ACP, end-of-life decision making and care, and the ability to identify relevant benefits and challenges of their roles. Conclusions: LHWs, trained using the LIGHT Curriculum, can acquire the knowledge and self-efficacy necessary to support African American clients with ACP, end-of-life decision making, and end-of-life care.
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Affiliation(s)
- Jerry Johnson
- Perelman School of Medicine, University of Pennsylvania, Elkins Park, Pennsylvania, USA
- Address correspondence to: Jerry Johnson, MD, Perelman School of Medicine, University of Pennsylvania, 806 Hilton Lane, Elkins Park, PA 19027, USA
| | - Tara Hayden
- Perelman School of Medicine, University of Pennsylvania, Elkins Park, Pennsylvania, USA
| | - Lynne Allen Taylor
- Perelman School of Medicine, University of Pennsylvania, Elkins Park, Pennsylvania, USA
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Kaasalainen S, Mccleary L, Vellani S, Pereira J. Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond. Can Geriatr J 2021; 24:164-169. [PMID: 34484498 PMCID: PMC8390320 DOI: 10.5770/cgj.24.493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.
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Affiliation(s)
| | - Lynn Mccleary
- Faculty of Applied Health Sciences, Nursing, Brock University, St. Catharines, ON
| | - Shirin Vellani
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Jose Pereira
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON.,Pallium Canada, Ottawa, ON
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Eneslätt M, Helgesson G, Tishelman C. Dissemination, use, and impact of a community-based, conversational advance care planning intervention: ripple effects of the Swedish DöBra cards. Palliat Care Soc Pract 2021; 15:26323524211032983. [PMID: 34409297 PMCID: PMC8365019 DOI: 10.1177/26323524211032983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION & AIM Despite increasing interest in community-based advance care planning interventions, few studies investigate the societal impact of such initiatives. The DöBra cards, a Swedish adaptation of the GoWish cards, were first used for advance care planning conversations in a participatory action research project and later, due to popular demand, made available for purchase by the general public. We explore how the DöBra cards were disseminated and used publicly, to understand their impact in the community. METHODS We used Ripple Effects Mapping to follow three dissemination ripples, based on interviews with 20 participants, analyzed with directed content analysis. FINDINGS Key factors influencing dissemination of the DöBra cards included 'champions' with a mandate within their context or organization, policy documents including use of the cards, media coverage, and presentations of the cards in various settings. The DöBra cards were adapted for use individually and in groups in different private, professional, and organizational settings. Perceived benefits of the cards included acting as an icebreaker in initiating end-of-life conversations and having preformulated statements to reflect upon. Other positive experiences included discussions on different interpretations of card statements, thus opening new perspectives regarding end-of-life. The DöBra cards functioned both as means to raise end-of-life issues in different contexts, and as an end in themselves, for example, by facilitating advance care planning conversations for those with serious disease. Impact also included personal development and strengthening of private and professional relationships, with potential to affect end-of-life care. CONCLUSION The broad dissemination of the DöBra cards influenced capacity-building in dealing with end-of-life issues in communities, as the topic of dying and death was brought to agendas in new contexts.
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Affiliation(s)
- Malin Eneslätt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Gert Helgesson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services (SLSO), Region Stockholm, Stockholm, Sweden; School of Health Sciences, University of Southampton, Southampton, UK
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Bigger SE, Haddad L, Ahluwalia SC, Glenn L. Advance Care Planning Protocols and Hospitalization Rates in Home Health Value-Based Purchasing. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211021393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Advance care planning is a conversation about personal values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on advance care planning have taken place outside of home health among populations with HIV/AIDS, cancer, dementia, and end stage renal disease. The U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses, and hospitalization is a poor outcome. In 2016, Medicare implemented the Home Health Value-Based Purchasing Model, in which reimbursement rates for agencies in 9 regionally representative states were dependent on quantitative measures of quality performance. Part of the program was a process-level mandate requiring agencies to report on advance care planning. The aim of this study was to examine the relationship of home health advance care planning protocols with hospitalization rates. Descriptive and regression analyses were conducted on survey data of protocols and agency data of demographics and outcomes. Statistical significance was found in the positive correlation between advance care planning protocols and hospitalization. Recommendations are made for broadening the scope of evaluation of quality in home health to include goal-concordant care and transitions to appropriate services.
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Affiliation(s)
| | - Lisa Haddad
- East Tennessee State University, Johnson City, TN, USA
| | | | - Lee Glenn
- East Tennessee State University, Johnson City, TN, USA
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20
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Brasil CCP, Silva RMD, Bezerra IC, Vieira LJEDS, Figueiredo MDLF, Castro FRVF, Queiroz FFDSN, Capelo MRTF. Community health workers caring for dependent elderly people. CIENCIA & SAUDE COLETIVA 2021; 26:109-118. [PMID: 33533831 DOI: 10.1590/1413-81232020261.31992020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022] Open
Abstract
Community Health Workers (CHWs) are a link between Family Health Strategy (FHS) professionals and the community. This study aims to analyze health care professionals' perceptions and health management about CHWs' role in caring for dependent elderly people. A qualitative study was carried out, from a hermeneutic-dialectic perspective, with 38 professionals working in elderly people's health in cities in the five regions of Brazil. The results identified CHWs as facilitators of access to elderly people dependent on the health care network, gaps in continuing education and the reduced number of these professionals to meet the demand in primary care. Respondents attributed great importance to CHW's performance, valued their participation in FHS, but pointed out a lack of knowledge and difficulties to supply the adequate amount in health care services and in assistance of elderly people with dependence and family. It is concluded that health professionals and managers consider CHWs to be a great workforce and essential to the dependent elderly people and their caregivers. The number of CHWs is insufficient in relation to FHS, and there is a lack of training to deal with various types of dependence.
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Affiliation(s)
- Christina César Praça Brasil
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza. Av. Washington Soares, 1321, Edson Queiroz. 60811-905 Fortaleza CE Brasil.
| | - Raimunda Magalhães da Silva
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza. Av. Washington Soares, 1321, Edson Queiroz. 60811-905 Fortaleza CE Brasil.
| | | | - Luiza Jane Eyre de Souza Vieira
- Programa de Pós-Graduação em Saúde Coletiva, Universidade de Fortaleza. Av. Washington Soares, 1321, Edson Queiroz. 60811-905 Fortaleza CE Brasil.
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21
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Johnson JC, Hayden T, Taylor LA, Gilbert A, Mitchell MPH. LIGHT: A Church-Based Curriculum for Training African American Lay Health Workers to Support Advance Care Planning and End-of-Life Decision-Making. Health Equity 2020; 4:533-541. [PMID: 34095700 PMCID: PMC8175257 DOI: 10.1089/heq.2020.0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose: African Americans with life-limiting illnesses experience significant health inequities. Lay health workers (LHWs) may help overcome existing challenges of communicating with African Americans about advance care planning (ACP) and end-of-life decision-making. Church-based LHWs have some advantages over other LHWs but no curriculum exists to fully prepare them. This article describes the development, content, format, and implementation of a curriculum designed to meet this need. Methods: We created a church-based curriculum to train African American, LHWs as communications-facilitators who can support persons with life-limiting illnesses, not only with ACP but also with issues that arise as illnesses progress. Learners are church members whom we call comfort care supporters. The curriculum organizes the LHW interactions with clients by the mnemonic LIGHT: Listening, Identifying, Guiding, Helping, and Translating. Results: The final curriculum consists of three parts: (1) a 26-h classroom component delivered in nine modules organized around eight themes: meaning and prognosis of a life-limiting illness, spirituality and the meaning of death, understanding the dying process, major decisions and choices, goals of care, end-of-life services, and resources, intrafamily communication, and role and activities of the LHW; (2) a visit component; and (3) experiential, case-based discussions during monthly meetings. Conclusions: LHWs may improve quality of care and thus reduce health inequities at the end-of-life. Preparing LHWs for conversations about ACP is necessary but insufficient. This curriculum also prepares LHWs to attend to the spiritual needs of clients and to support clients with their other needs as their illness progresses.
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Affiliation(s)
- Jerry C. Johnson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tara Hayden
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lynne Allen Taylor
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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22
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Sussman T, Pimienta R, Hayward A. Engaging persons with dementia in advance care planning: Challenges and opportunities. DEMENTIA 2020; 20:1859-1874. [PMID: 33290098 DOI: 10.1177/1471301220973059] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study reports findings from a series of focus groups with persons with dementia and family caregivers intended to explore: (1) perceptions of and experiences with advance care planning (ACP); (2) concerns related to future care including, but not limited to, end-of-life care; and (3) practices that may support positive engagement with ACP. A total of 18 participants including 10 persons with dementia and eight family caregivers participated in five focus groups held in two urban cities in Canada. All focus group deliberations were audio recorded, transcribed verbatim, and analyzed in five stages using a semantic thematic approach. All participants expressed some form of engagement in ACP, but understandings were limited and divergence was expressed regarding the timing of more expansive conversations about future care. Although some persons with dementia were ready to engage in future care discussions, most preferred focusing on the present and suggested their families did not require direction. This placed families in the complex dilemma of protecting their loved ones while compromising their own needs for dialogue. Although individually focused models of ACP engagement hold promise for those persons with dementia ready to engage in future planning, our findings suggest that early engagement of families in the reflective process may go a long way in supporting ACP activation. Our findings further suggest that persons with dementia who do not have close family/friends may require extensive ACP encouragement and support from service providers.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, 5620McGill University, Montreal, Quebec, Canada
| | - Rebecca Pimienta
- School of Social Work, 5620McGill University, Montreal, Quebec, Canada
| | - April Hayward
- Special Care Counselling, 91424Vanier College, Montreal, Quebec, Canada
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23
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Nouri SS, Ritchie C, Volow A, Li B, McSpadden S, Dearman K, Kotwal A, Sudore RL. A Toolkit for Community-Based, Medicaid-Funded Case Managers to Introduce Advance Care Planning to Frail, Older Adults: A Pilot Study. J Palliat Med 2020; 24:428-432. [PMID: 32865472 DOI: 10.1089/jpm.2020.0200] [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: 12/24/2022] Open
Abstract
Background: Advance care planning (ACP) among frail, older adults receiving in-home care is low. Leveraging case managers to introduce ACP may increase engagement. Objective: Pilot an ACP-Toolkit for case managers and their clients. Design: Feasibility pilot of an ACP-Toolkit for case managers to introduce ACP and the PREPAREforYourCare.org website and advance directives. Setting/Subjects: Case managers from four local aging service organizations who referred English-speaking clients ≥55 years old. Measurements: Using validated surveys (five-point Likert scales), we assessed changes in case managers' attitudes, confidence, and readiness to facilitate ACP and clients' readiness to engage in ACP from baseline to follow-up (one-week) using Wilcoxon signed-rank tests. Results: We enrolled 9 case managers and 12 clients (median age 69 [standard deviation 8], 75% minority race/ethnicity). At follow-up, case managers' confidence increased (3.2 [0.7] to 4.2 [0.7]; p = 0.02), and clients' readiness increased (2.8 [1.5] to 3.4 [1.4]; p = 0.06). All case managers agreed the Toolkit was easy to use, helped start ACP conversations, and would recommend it to others. All clients found the Toolkit easy to understand and were comfortable with case managers using it. Nearly all clients (92%) would recommend it to others. Suggestions for improvement included offering the Toolkit in other languages and disseminating it in clinical and community settings. Conclusions: The ACP-Toolkit resulted in higher case manager confidence in facilitating ACP and client readiness to engage in ACP, and usability was high. A brief ACP-Toolkit may be a feasible solution to increase ACP engagement among frail, older adults receiving in-home care.
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Affiliation(s)
- Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Christine Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Aiesha Volow
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Brookelle Li
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Shireen McSpadden
- San Francisco Department of Disability and Aging Services, San Francisco, California, USA
| | - Kelly Dearman
- San Francisco In-Home Supportive Services Public Authority, San Francisco, California, USA
| | - Ashwin Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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How to Screen Suitable Service Improve Community Health Care Services by University Students in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155402. [PMID: 32727094 PMCID: PMC7432445 DOI: 10.3390/ijerph17155402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/14/2022]
Abstract
Engaging in social contributions to enhance social participation and attending community experiential service learning or internship courses have become an essential learning experience for university students. On the basis of postmodern education theories, this study adopted images and oral accounts involving personal experiences to construct a postmodern education research scheme by using the method of collaborative ethnography. This study selected and performed the following services: filming a community documentary, administering community health dance classes, and archiving community cultural artifacts in databases. Interviews were also administered to facilitate implementation of the actual services. Community health services commonly seen in Taiwan and abroad were compiled, and the resources required for each service were examined. Subsequently, factor analysis was performed to explore the characteristic of these services in order to recommend feasible services for university students to undertake. The results indicated that the eight resources required for the 59 common community health services were (1) a designated space or venue, (2) materials, (3) monetary resources, (4) human resources, (5) expertise, (6) professional equipment, (7) patience, and (8) empathy. The results revealed three principal components, namely labor services, high-resource services, and professional services, for a total explanatory power of 67.99%; the individual explanatory power of these components accounted for 25.04%, 21.81%, and 21.15%, respectively. Next, community health care services suitable for university students to perform were selected and implemented, and these services were well received. The study results indicated that community and environmental justice can be realized by identifying with the value of community health services and promoting postmodern education theories and social norms. The research results are suitable for implementation after the COVID-19 pandemic.
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25
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Allen CG, Barbero C, Shantharam S, Moeti R. Is Theory Guiding Our Work? A Scoping Review on the Use of Implementation Theories, Frameworks, and Models to Bring Community Health Workers into Health Care Settings. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:571-580. [PMID: 30180116 PMCID: PMC6395551 DOI: 10.1097/phh.0000000000000846] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Community health workers (CHWs) are becoming a well-recognized workforce to help reduce health disparities and improve health equity. Although evidence demonstrates the value of engaging CHWs in health care teams, there is a need to describe best practices for integrating CHWs into US health care settings. The use of existing health promotion and implementation theories could guide the research and implementation of health interventions conducted by CHWs. We conducted a standard 5-step scoping review plus stakeholder engagement to provide insight into this topic. Using PubMed, EMBASE, and Web of Science, we identified CHW intervention studies in health care settings published between 2000 and 2017. Studies were abstracted by 2 researchers for characteristics and reported use of theory. Our final review included 50 articles published between January 2000 and April 2017. Few studies used implementation theories to understand the facilitators and barriers to CHW integration. Those studies that incorporated implementation theories used RE-AIM, intervention mapping, cultural tailoring, PRECEDE-PROCEED, and the diffusion of innovation. Although most studies did not report using implementation theories, some constructs of implementation such as fidelity or perceived benefits were assessed. In addition, studies that reported intervention development often cited specific theories, such as the transtheoretical or health belief model, that helped facilitate the development of their program. Our results are consistent with other literature describing poor uptake and use of implementation theory. Further translation of implementation theories for CHW integration is recommended.
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Affiliation(s)
- Caitlin G Allen
- Emory University School of Public Health, Atlanta, Georgia (Ms Allen); Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Barbero and Ms Moeti; and IHRC, Inc, Atlanta, Georgia (Ms Shantharam)
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26
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Feuz MA, Odierna DH, Katen M, Volow A, McMahan RD, Ritchie CS, McSpadden S, Dearman K, Sudore RL. Leveraging In-Home Supportive Services Programs to Engage People in Advance Care Planning: Input from Staff, Providers, and Client Stakeholders. J Palliat Med 2019; 22:1430-1438. [PMID: 31596644 DOI: 10.1089/jpm.2018.0429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In-Home Supportive Services (IHSS) cares for millions of Medicaid-eligible older adults who are often homebound and socially isolated. Advance care planning (ACP) can be challenging for this population, and IHSS programs may play an important role. Objective: To explore the feasibility of an IHSS ACP program for frail older adults. Design: Semistructured focus groups. Setting/Subjects: Fifty IHSS stakeholders (20 administrators, 9 case managers, 13 in-home caregivers, and 8 clients) participated in 10 focus groups in San Francisco. Measurements: Qualitative thematic content analysis by two independent coders. Results: Four main themes emerged: (1) Unmet needs: patients' wishes unknown during a medical crisis, lack of education/training for clients and staff; (2) Barriers: conflict of interest and potential medical overreach of IHSS caregivers, lack of billing avenues, time limitations, and cultural, literacy, and language barriers; (3) Facilitators: leveraging established workflows, available technology, and training programs; and (4) Implementation: use a tailored, optional approach based on clients' readiness, focus on case managers not caregivers to prevent conflict of interest; use established intake, follow-up, and training procedures; consider cultural and literacy-appropriate messaging; and standardize easy-to-use procedures, simple scripts, and educational guides, within established workflow to support case managers. Conclusions: An IHSS ACP program is important and feasible for Medicaid-eligible, frail older adults. Implementation suggestions for success by IHSS stakeholders include focusing on case managers rather than in-home caregivers to prevent conflict of interest; tailoring programs to clients' readiness, literacy, and language; creating educational programs for IHSS staff, clients, and community; and standardizing easy-to-use guides and procedures into IHSS workflows.
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Affiliation(s)
- Mariko A Feuz
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Donna H Odierna
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Mary Katen
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Aiesha Volow
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Ryan D McMahan
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Christine S Ritchie
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, California.,Tideswell at UCSF and the Innovation and Implementation Center on Aging and Palliative Care at the University of California, San Francisco, San Francisco, California
| | - Shireen McSpadden
- San Francisco Department of Aging and Adult Services, San Francisco, California
| | - Kelly Dearman
- San Francisco In-Home Supportive Services Public Authority, San Francisco, California
| | - Rebecca L Sudore
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California.,Tideswell at UCSF and the Innovation and Implementation Center on Aging and Palliative Care at the University of California, San Francisco, San Francisco, California
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27
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Abstract
The purpose of this article is to synthesize the evidence on advance care planning (ACP), determine what is applicable to the home health (HH) setting, and find where gaps in knowledge may exist. An integrative review methodology was chosen. Although there is ample literature on the topic of ACP, most research has been conducted in the acute care, outpatient, and general community settings. There is limited literature regarding ACP with patients living with chronic cardiovascular and pulmonary illnesses, who comprise the majority of the HH population. Some literature has been published regarding the interprofessional team's role in ACP in the HH setting. A gap in knowledge exists regarding ACP in HH, and recommendations for future research are provided.
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Nelson-Brantley H, Buller C, Befort C, Ellerbeck E, Shifter A, Ellis S. Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care. J Nurs Scholarsh 2019; 52:55-64. [PMID: 31545557 DOI: 10.1111/jnu.12513] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 01/15/2023]
Abstract
PURPOSE To analyze the literature on advance care planning (ACP) in primary care through the lens of implementation science, with a focus on implications for rural settings. DESIGN Scoping review of the literature. METHODS The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO, and the Psychology and Behavioral Sciences Collection databases were searched for studies related to ACP adoption and implementation in primary care. The Theoretical Domains Framework was used to map the literature to 14 determinants that serve as barriers or facilitators to ACP. The Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors was used to analyze the stage of implementation for each of the included studies. FINDINGS Four steps to ACP were specified: identification, conversation, documentation, and follow-up. Determinants were identified for each step, but studies largely focused on the conversation step. Professional role and identity, environmental context and resources, and emotion were the most frequently cited determinants in initiating conversations. The identification step was largely determined by behavioral regulation. For documenting ACP, environmental context and resource determinants were most prevalent. In the few studies that addressed follow-up, providers expressed a desire for electronic reminders as a behavioral regulator to follow-up. CONCLUSIONS While ACP has been shown to have patient, family, and societal benefits, its uptake in primary care has been minimal. Because ACP is a complex process that is highly context dependent, implementation science is critical to inform its successful adoption and implementation. Smaller healthcare networks, adaptable professional roles, trusted relationships, and tight-knit community might be important facilitators of ACP in rural primary care. CLINICAL RELEVANCE Findings from this study can be used to accelerate ACP implementation in rural primary care.
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Affiliation(s)
| | - Carol Buller
- Delta, Clinical Assistant Professor, University of Kansas School of Nursing, Kansas City, KS, USA
| | - Christie Befort
- Associate Professor and Associate Director for Cancer Prevention and Control, Department of Preventative Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Edward Ellerbeck
- Professor and Chair of the Department of Preventative Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Ariel Shifter
- Graduate Research Assistant, Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Shellie Ellis
- Assistant Professor, Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS, USA
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29
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Britt HR, JaKa MM, Fernstrom KM, Bingham PE, Betzner AE, Taghon JR, Shippee ND, Shippee TP, Schellinger SE, Anderson EW. Quasi-Experimental Evaluation of LifeCourse on Utilization and Patient and Caregiver Quality of Life and Experience. Am J Hosp Palliat Care 2019; 36:408-416. [PMID: 30541333 PMCID: PMC6442020 DOI: 10.1177/1049909118817740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Whole-person care is a new paradigm for serious illness, but few programs have been robustly studied. We sought to test the effect of LifeCourse (LC), a person-centered program for patients living with serious illness, on health-care utilization, care experience, and quality of life, employing a quasi-experimental design with a Usual Care (UC) comparison group. The study was conducted 2012 to 2017 at an upper-Midwest not-for-profit health-care system with outcomes measured every 3 months until the end of life. Enrolled patients (N = 903) were estimated to be within 3 years of end of life and diagnosed with 1+ serious illness. Exclusion criteria included hospice enrollment at time of screening or active dying. Community health workers (CHWs) delivered standardized monthly 1-hour home visits based on palliative care guidelines and motivational interviewing to promote patients' physical, psychosocial, and financial well-being. Primary outcomes included health-care utilization and patient- and caregiver-experience and quality of life. Patients were elderly (LC 74, UC 78 years) and primarily non-Hispanic, white, living at home with cardiovascular disease as the primary diagnosis (LC 69%, UC 57%). A higher proportion of LC patients completed advance directives (N = 173, 38%) than UC patients (N = 66, 15%; P < .001). LifeCourse patients who died spent more days in hospice (88 ± 191 days) compared to UC patients (44 ± 71 days; P = .018). LifeCourse patients reported greater improvements than UC in communication as part of the care experience ( P = .016). Implementation of person-centered programs delivered by CHWs is feasible; inexpensive upstream expansion of palliative care models can yield benefits for patients and caregivers. Trial Registration: Trial NCT01746446 was registered on November 27, 2012 at ClinicalTrials.gov .
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Affiliation(s)
| | | | | | | | | | | | - Nathan D. Shippee
- Division of Health Policy-Management, University of Minnesota, Minneapolis,
MN, USA
| | - Tetyana P. Shippee
- Division of Health Policy-Management, University of Minnesota, Minneapolis,
MN, USA
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30
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Clarifying Values and Preferences for Care Near the End of Life: The Role of a New Lay Workforce. J Community Health 2018; 42:926-934. [PMID: 28353007 DOI: 10.1007/s10900-017-0336-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Community health workers (CHWs) can engage elderly persons in advance care planning (ACP) conversations. We report how trained CHWs used Go Wish cards (GW R cards) to identify patients' highest priority preferences and evaluated whether engaging in ACP conversations was associated with subsequent health care utilization. A one-year long, pre-post longitudinal design was used to evaluate our educational intervention using mixed-methods. 392 patients (mean of 73.3 years, 82% women, 48% African American, 43% Caucasian) enrolled in the Aging Brain Care (ABC) program and participated in ACP discussions with CHWs. We expanded the role of the ABC's CHW, who work directly with individuals and caregivers during home visits to monitor bio-psycho-social needs, to include ACP conversations. The CHWs received ACP training, practice with tools such as GW R cards, and support from an electronic health record (EHR) clinical decision support tool. Quantitative measures of patients' ACP preferences and health care utilization were abstracted from the EHR. Qualitative data about patients' perceptions of CHWs in facilitating ACP discussions was obtained through semi-structured interviews. Eighty-six patients' data indicated that they had engaged in a preferences-for-care process using GW R cards. The top-three card choices by patients was attending to spirituality and religious concerns, preparing for end of life, and maintaining personal wholeness. CHWs were able to effectively engage in ACP conversations with patients and GW R cards were a positive way to stimulate discussion of issues previously undiscussed.
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31
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deLima Thomas J, Sanchez-Reilly S, Bernacki R, O'Neill L, Morrison LJ, Kapo J, Periyakoil VS, Carey EC. Advance Care Planning in Cognitively Impaired Older Adults. J Am Geriatr Soc 2018; 66:1469-1474. [PMID: 30277566 DOI: 10.1111/jgs.15471] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 02/02/2023]
Abstract
Older adults with cognitive impairment face many healthcare challenges, chief among them participating in medical decision-making about their own health care. Advance care planning (ACP) is the process whereby individuals communicate their wishes for future care with their clinicians and surrogate decision-makers while they are still able to do so. ACP has been shown to improve important outcomes for individuals with cognitive impairment, but rates of ACP for these individuals are low because of individual-, clinician-, and system-related factors. Addressing ACP early in the illness trajectory can maximize the chances that people can participate meaningfully. This article recommends best practices for approaching ACP for older adults with cognitive impairment. The importance of providing anticipatory guidance and eliciting values to guide future care to create a shared framework between clinicians, individuals, and surrogate decision-makers is emphasized. It is recommended that ACP be approached as an iterative process to continue to honor and support people's wishes as cognitive impairment progresses and increasingly threatens independence and function. The article describes effective strategies for assessing decision-making capacity, identifying surrogate decision-makers, and using structured communication tools for ACP. It also provides guidelines for documentation and billing. Finally, special considerations for individuals with advanced dementia are described, including the use of artificial hydration and nutrition, decisions about site of care, and the role of hospice care.
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Affiliation(s)
- Jane deLima Thomas
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Sandra Sanchez-Reilly
- Geriatrics and Extended Care/Geriatric Research, Education, and Clinical Center, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Rachelle Bernacki
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts.,Ariadne Labs, Boston, Massachusetts
| | - Lynn O'Neill
- Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, Atlanta, Georgia
| | - Laura J Morrison
- Palliative Care Program, School of Medicine, Yale University, New Haven, Connecticut
| | - Jennifer Kapo
- Palliative Care Program, School of Medicine, Yale University, New Haven, Connecticut
| | - Vyjeyanthi S Periyakoil
- VA Palo Alto Health Care System and, Stanford University School of Medicine, Stanford, California
| | - Elise C Carey
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota
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32
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Cain CL, Surbone A, Elk R, Kagawa-Singer M. Culture and Palliative Care: Preferences, Communication, Meaning, and Mutual Decision Making. J Pain Symptom Manage 2018; 55:1408-1419. [PMID: 29366913 DOI: 10.1016/j.jpainsymman.2018.01.007] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 01/11/2023]
Abstract
Palliative care is gaining acceptance across the world. However, even when palliative care resources exist, both the delivery and distribution of services too often are neither equitably nor acceptably provided to diverse population groups. The goal of this study was to illustrate tensions in the delivery of palliative care for diverse patient populations to help clinicians to improve care for all. We begin by defining and differentiating culture, race, and ethnicity, so that these terms-often used interchangeably-are not conflated and are more effectively used in caring for diverse populations. We then present examples from an integrative literature review of recent research on culture and palliative care to illustrate both how and why varied responses to pain and suffering occur in different patterns, focusing on four areas of palliative care: the formation of care preferences, communication patterns, different meanings of suffering, and decision-making processes about care. For each area, we provide international and multiethnic examples of variations that emphasize the need for personalization of care and the avoidance of stereotyping beliefs and practices without considering individual circumstances and life histories. We conclude with recommendations for improving palliative care research and practice with cultural perspectives, emphasizing the need to work in partnerships with patients, their family members, and communities to identify and negotiate culturally meaningful care, promote quality of life, and ensure the highest quality palliative care for all, both domestically and internationally.
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Affiliation(s)
- Cindy L Cain
- Department of Health Policy and Management, University of California-Los Angeles, Los Angeles, California.
| | - Antonella Surbone
- Department of Medicine, Division of Haematology and Medical Oncology, New York University Medical School, New York, New York
| | - Ronit Elk
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Marjorie Kagawa-Singer
- Department of Community Health Sciences and Asian American Studies Center, University of California-Los Angeles, Los Angeles, California
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34
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Hunt LJ, Coombs LA, Stephens CE. Emergency Department Use by Community-Dwelling Individuals With Dementia in the United States: An Integrative Review. J Gerontol Nurs 2018; 44:23-30. [PMID: 29355877 DOI: 10.3928/00989134-20171206-01] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 08/29/2017] [Indexed: 11/20/2022]
Abstract
As part of the National Plan to Address Alzheimer's Disease, reducing potentially avoidable emergency department (ED) use by individuals with dementia has been identified as a component of enhancing the quality and efficiency of care for this population. To help inform the development of interventions to achieve this goal, an integrative review was conducted to: (a) compare rates and reasons for ED visits by community-dwelling individuals with and without dementia, considering also the effect of dementia subtype and severity; and (b) identify other risk factors for increased ED use among community-dwelling individuals with dementia. Nineteen articles met inclusion criteria. Individuals with dementia had higher rates of ED visits compared to those without dementia, although differences were attenuated in the last year of life. Increased symptoms and disability were associated with increased rates of ED visits, whereas resources that enabled effective management of increased need decreased rates. Gerontological nurses across settings are on the frontlines of preventing potentially avoidable ED visits by community-dwelling individuals with dementia through patient and family education and leadership in the development of new models of care. [Journal of Gerontological Nursing, 44(3), 23-30.].
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35
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Sussman T, Kaasalainen S, Bui M, Akhtar-Danesh N, Mintzberg S, Strachan P. "Now I Don't Have to Guess": Using Pamphlets to Encourage Residents and Families/Friends to Engage in Advance Care Planning in Long-Term Care. Gerontol Geriatr Med 2017; 3:2333721417747323. [PMID: 29308424 PMCID: PMC5751914 DOI: 10.1177/2333721417747323] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/27/2017] [Indexed: 11/24/2022] Open
Abstract
Objective: This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC) can encourage residents and families/friends to openly engage in advance care planning (ACP) discussions with one another and with health providers. Method: In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Results: Survey results suggested that access to pamphlets encouraged residents and families/friends to reflect on future care (48/57, 84%), clarified what questions to ask (40/57, 70%), and increased comfort in talking about end of life (EOL) care (36/57, 63%). Discussions between relatives and friends/families (32/57, 56%) or with health providers (21/57, 37%) were less common. Focus group deliberations illuminated that while reading illness-specific information was validating, a tendency to protect one another from an emotional topic, prevented residents and families/friends from conversing with one another about EOL issues. Discussion: Having access to pamphlets with information about EOL care provides important and welcome opportunities for reflection for both residents in LTC and their families/friends. Moving residents and families/friends from reflecting on issues to discussing them together could require staff support through planned care conferences or staff initiated conversations at the bedside.
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Affiliation(s)
| | | | - Matthew Bui
- McMaster University, Hamilton, Ontario, Canada
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36
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Engaging Community Health Workers in the Effort to Prevent Sudden Unexpected Death and Death From Chronic Illness. Med Care 2017; 55:1061. [PMID: 28984706 DOI: 10.1097/mlr.0000000000000817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Rietjens JAC, Sudore RL, Connolly M, van Delden JJ, Drickamer MA, Droger M, van der Heide A, Heyland DK, Houttekier D, Janssen DJA, Orsi L, Payne S, Seymour J, Jox RJ, Korfage IJ. Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care. Lancet Oncol 2017; 18:e543-e551. [DOI: 10.1016/s1470-2045(17)30582-x] [Citation(s) in RCA: 404] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 01/31/2023]
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