1
|
Kinch S, Schou-Juul F, Skov SS, Kongsholm NCH, Lauridsen S. The use of advance directives for autonomy in dementia care: A scoping meta-review and thematic synthesis. Arch Gerontol Geriatr 2024; 126:105498. [PMID: 38901137 DOI: 10.1016/j.archger.2024.105498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/08/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024]
Abstract
Dementia may reduce individuals' capacity for autonomy and decision-making competence. Advance directives are subject to theoretical bioethical debate as tools to safeguard or extend autonomy in dementia. However, the extent and manner in which advance directives are actually used for these purposes in practice remain less examined. We aimed to examine how advance directives are used as tools for individual autonomy in dementia care. We systematically searched six databases and performed a thematic analysis and synthesis of included reviews based on an original model of six autonomy-relevant dimensions of advance directives. A total of 18 reviews met the inclusion criteria. We identified 12 themes across six dimensions. We found a lack of knowledge integration on the actual use of advance directives for autonomy in dementia care. Evidence suggests significant variation in the autonomy-relevant dimensions of advance directives, with a tendency towards an inconsistent or low level of implementation as a tool for autonomy. Further reviews and primary studies on all aspects of the use of advance directives for autonomy in dementia care would contribute significantly to dementia research and practice.
Collapse
Affiliation(s)
- Simon Kinch
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
| | - Frederik Schou-Juul
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sofie Smedegaard Skov
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Sigurd Lauridsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| |
Collapse
|
2
|
Underwood M, Noufaily A, Bain C, Harlock J, Griffiths F, Huxley C, Perkins G, Rees S, Slowther AM. Public attitudes to emergency care treatment plans: a population survey of Great Britain. BMJ Open 2024; 14:e080162. [PMID: 39313284 PMCID: PMC11429361 DOI: 10.1136/bmjopen-2023-080162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
OBJECTIVES To measure community attitudes to emergency care and treatment plans (ECTPs). DESIGN Population survey. SETTING Great Britain. PARTICIPANTS As part of the British Social Attitudes Survey, sent to randomly selected addresses in Great Britain, 1135 adults completed a module on ECTPs. The sample was nationally representative in terms of age and location, 619 (55%) were female and 1005 (89%) were of white origin. OUTCOME MEASURES People's attitudes having an ECTP for themselves now, and in the future; how comfortable they might be having a discussion about an ECTP and how they thought such a plan might impact on their future care. RESULTS Predominantly, respondents were in favour of people being able to have an ECTP, with 908/1135 (80%) being at least somewhat in favour. People in good health were less likely than those with activity-limiting chronic disease to want a plan at present (52% vs 64%, OR 1.78 (95% CI 1.30 to 2.45) p<0.001). Developing a long-term condition or becoming disabled would lead 42% (467/1112) and 43% (481/1112) of individuals, respectively, to want an ECTP. More, 634/1112 (57%) would want an ECTP if they developed a life-threatening condition. Predominantly, 938/1135 (83%) respondents agreed that an ECTP would help avoid their family needing to make difficult decisions on their behalf, and 939/1135 (83%) that it would ensure doctors and nurses knew their wishes. Nevertheless, a small majority-628/1135 (55%)-agreed that there was a serious risk of the plan being out of date when needed. A substantial minority-330/1135 (29%)-agreed that an ECTP might result in them not receiving life-saving treatment. CONCLUSIONS There is general support for the use of ECTPs by people of all ages. Nevertheless, many respondents felt these might be out of date when needed and prevent people receiving life-saving treatment.
Collapse
Affiliation(s)
- Martin Underwood
- Warwick Medical School, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | | | | | | | | | - Sophie Rees
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | | |
Collapse
|
3
|
Agyei KG, Yahaya AR, Dapilah E, Norton SA. Nurse-Led Advance Care Planning in Adults in the U.S.- A Scoping Review. Am J Hosp Palliat Care 2024:10499091241276009. [PMID: 39158935 DOI: 10.1177/10499091241276009] [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: 08/20/2024] Open
Abstract
BACKGROUND Advance care planning involves discussing individuals' future medical treatment and care preferences. Nurses, due to their close relationships with patients and families, may be well-positioned to lead these discussions. Exploring the components and characteristics of nurse-led ACP interventions is essential for enhancing their implementation, effectiveness, and sustainability. OBJECTIVE This scoping review aimed to explore the characteristics of nurse-led ACP interventions in adult patients, identify the populations and settings where these interventions have been utilized, and the outcomes of these interventions in the U.S. METHODS A scoping review was conducted following Arksey and O'Malley's five-stage framework. Using keywords related to nurse-led ACP interventions, a comprehensive search was performed across PubMed, Web of Science, CINAHL, EMBASE, and PsycINFO databases. RESULTS Twelve studies met the inclusion criteria. These studies were conducted in varied settings. Registered nurses, oncology nurse navigators, and other specialized nurses primarily delivered nurse-led ACP interventions. The interventions ranged from one to two sessions and utilized various models and resources such as the Five Wishes and Respecting Choices. CONCLUSIONS Nurse-led ACP interventions have shown significant positive outcomes, including increased engagement in ACP, improved attitudes towards ADs, higher completion rates of ADs, and enhanced patient-surrogate congruence. These interventions are well-received by patients and can be implemented in diverse settings. However, a general guideline regarding nurse-led ACP interventions is needed to address the specific duration, sessions, and mode of delivery required for their optimal effectiveness.
Collapse
Affiliation(s)
| | - Ahmed-Rufai Yahaya
- The Pennsylvania State University, Ross and Carol Nese College of Nursing, University Park, PA
| | | | - Sally A Norton
- School of Nursing, University of Rochester, Rochester, NY, USA
| |
Collapse
|
4
|
Tan M, Tang S, Feder S, Xiao J, Huang C, Cook A, Johnson CE, Ding J. Interventions to promote readiness for advance care planning: A systematic review and meta-analysis. Int J Nurs Stud 2024; 156:104778. [PMID: 38761437 DOI: 10.1016/j.ijnurstu.2024.104778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Advance care planning is recommended as part of standard medical services. Readiness, denoting stages of behavior change, exerts a substantial influence on its uptake. However, the characteristics and impacts of advance care planning interventions on readiness are not well-established. METHOD We systematically reviewed and conducted a meta-analysis of randomized controlled trials assessing the effects of advance care planning interventions on readiness. Studies were appraised using Joanna Briggs Institute Critical Appraisal tools. Meta-analyses were performed using mean difference of continuous variables or risk ratios of binary variables and their 95 % confidence interval as the pooled effect sizes. RESULTS Eight studies were included in this review and were all rated low quality. Meta-analysis showed that interventions resulted in slight improvement in overall readiness (mean difference = 0.19, 95 % confidence interval: 0.02-0.36) for advance care planning. However, statistically significant effects of interventions were not identified for readiness in relation to specific behaviors (appointment of a healthcare proxy, talking to a healthcare proxy, talking to a medical practitioner about living wills, and signing a living will). CONCLUSION Our meta-analyses demonstrated that interventions can improve the overall readiness for advance care planning, suggesting the necessity to integrate readiness into future health policies and clinical practices. Nevertheless, the absence of significant effects on specific behavioral readiness underscores the requirement for additional refinement in intervention design, advanced technologies, and theoretical foundations. REGISTRATION Not registered.
Collapse
Affiliation(s)
- Minghui Tan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Siyuan Tang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Shelli Feder
- Yale School of Nursing, West Haven, CT, United States
| | - Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chongmei Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Angus Cook
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Claire E Johnson
- Palliative Aged Care Outcomes Program, University of Wollongong, Wollongong, Australia
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China.
| |
Collapse
|
5
|
Lee S, Cui N, Kim H. Nurses' engagement in advance care planning practices: A descriptive cross-sectional study. J Clin Nurs 2024. [PMID: 39072827 DOI: 10.1111/jocn.17376] [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: 02/28/2024] [Revised: 05/17/2024] [Accepted: 07/04/2024] [Indexed: 07/30/2024]
Abstract
AIMS To describe and compare nurses' awareness of, attitudes toward, and participation in advance care planning, as well as related facilitators and challenges, in four types of healthcare settings. DESIGN A cross-sectional descriptive study. METHODS Four hundred and ninety-eight registered nurses from tertiary, secondary and primary healthcare institutions, along with long-term care centres in South Korea, participated in an investigator-developed online survey. The collected data were analysed using descriptive statistics, chi-squared test, one-way ANOVA, and binary logistic regression. RESULTS Participants were on average 30.6 ± 7.3 years old, mostly female (95.4%), employed as staff nurses (95.4%), held bachelor's degrees or higher (84.1%), and had worked for less than 5 years at their current institutions (69.7%). Overall, 49% of the participants were familiar with advance care planning. While most participants supported nurse involvement in advance care planning with patients and surrogates, fewer were willing to engage or recommend it. Less than half were actively engaged in advance care planning practices. A notable challenge was the lack of time due to excessive workload. Compared to those from tertiary healthcare institutions, participants from secondary and primary healthcare institutions and long-term care centres were less likely to be aware of advance care planning. Participants from secondary and primary healthcare institutions had lower odds of checking for the presence of advance directives and the physician orders for life-sustaining treatment. CONCLUSION Nurses demonstrated low awareness and participation in advance care planning. Nurses' insufficient time and competency to conduct advance care planning in their practice should be addressed. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Educational programs, initiatives (e.g. guidelines, position statements) and legal and policy-level efforts (e.g. nurse staffing, role clarification, reimbursement) are crucial to incorporate advance care planning into routine nursing practice. IMPACT What problem did the study address? Nurses play an important role in advance care planning; however, limited is understood about their readiness and involvement in such practices. What were the main findings? Nurses' awareness of advance care planning practices and their participation in such practices is low across care settings. Although nurses have a positive attitude toward advance care planning, there are challenges (e.g. insufficient time to conduct advance care planning discussions and lack of relevant knowledge and skills) that impede their participation in practice. Where and on whom will the research have an impact? This study may serve as a foundation for nursing societies in countries, where advance care planning is emerging, to discuss strategies to increase nurses' competency in advance care planning and promote their participation in the practice. REPORTING METHOD The STROBE checklist was followed. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
Collapse
Affiliation(s)
- Sangmin Lee
- Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Naixue Cui
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Hyejin Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| |
Collapse
|
6
|
Murata Murakami B, Latorre Souza V, Fadini Reis Brunori EH, Ribeiro Dos Santos E, Takáo Lopes C. Characteristics associated with the intention to complete advance directives and end-of-life preferences in Brazilians with heart failure. Int J Nurs Knowl 2024. [PMID: 38804834 DOI: 10.1111/2047-3095.12474] [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: 04/04/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE To identify characteristics associated with an intention to complete advance directives (ADs) and end-of-life treatment preferences for outpatients with heart failure (HF). METHODS A cross-sectional, analytical study. Sociodemographic and clinical data were collected from 108 patients with HF in an outpatient clinic in São Paulo, SP, Brazil. Quality of life (QoL) was assessed using the Minnesota Living with Heart Failure Questionnaire; knowledge about HF and the intention to complete ADs were assessed using a script. The relationships among variables were assessed through the chi-square and Mann-Whitney tests, with p < 0.05 considered significant. RESULTS The intention to complete ADs was significantly associated with reporting adherence to pharmacological recommendations (99% vs. 88.1%, p = 0.02), worse QoL (29.7 ± 18.2 vs. 20.9 ± 11.0; p = 0.0336), perceived knowledge about HF (89.7% vs. 63.6%, p = 0.0495), not wishing the healthcare providers would decide about treatment (27.3% vs. 2.15, p = 0.0026), and considering ADs useful (91.8% vs. 27.3%, p < 0.001). End-of-life treatment preferences included living as long as possible (50.5%), not being sedated (37.1%), and staying close to family and friends for as long as possible (32.0%). CONCLUSIONS Characteristics associated with an intention to complete ADs and end-of-life treatment preferences were identified in patients with HF. IMPLICATIONS FOR NURSING PRACTICE These results can help facilitate patients' completion of their ADs or activate their intention to maximize opportunities to exercise autonomy.
Collapse
Affiliation(s)
- Beatriz Murata Murakami
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil
- Educação Continuada, Hospital DF Star, Brasília, Brazil
| | - Vitor Latorre Souza
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil
- Setor de Hemodinâmica, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | | | - Camila Takáo Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo (EPE-UNIFESP), São Paulo, Brazil
| |
Collapse
|
7
|
Nakanishi M, Martins Pereira S, Van den Block L, Parker D, Harrison-Dening K, Di Giulio P, In der Schmitten J, Larkin PJ, Mimica N, Sudore RL, Holmerová I, Korfage IJ, van der Steen JT. Future policy and research for advance care planning in dementia: consensus recommendations from an international Delphi panel of the European Association for Palliative Care. THE LANCET. HEALTHY LONGEVITY 2024; 5:e370-e378. [PMID: 38608695 PMCID: PMC11262782 DOI: 10.1016/s2666-7568(24)00043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/14/2024] Open
Abstract
Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models.
Collapse
Affiliation(s)
- Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands; Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan; Mental Health Promotion Unit, Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics - Ethics and Sustainability Research Area, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Lieve Van den Block
- Vrije Universiteit Brussel-UGent End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Deborah Parker
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Karen Harrison-Dening
- Department of Research and Publications, Dementia UK, London, UK; Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Jürgen In der Schmitten
- Institute of General Practice/Family Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Philip J Larkin
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ninoslav Mimica
- School of Medicine, University of Zagreb, Zagreb, Croatia; Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands; Radboudumc Alzheimer Center and Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands; Cicely Saunders Institute, Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| |
Collapse
|
8
|
McMahan RD, Hickman SE, Sudore RL. What Clinicians and Researchers Should Know About the Evolving Field of Advance Care Planning: a Narrative Review. J Gen Intern Med 2024; 39:652-660. [PMID: 38169025 PMCID: PMC10973287 DOI: 10.1007/s11606-023-08579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
Advance care planning (ACP) has been recognized as crucial by patients, families, and clinicians; however, different definitions and measurements have led to inconsistencies in practice and mixed evidence in the literature. This narrative review explores ACP's evolution, innovations, and outcomes using thematic analysis to synthesize data from randomized controlled trials, reviews, and editorials. Key findings include (1) ACP has evolved over the past several decades from a sole focus on code status and advance directive (AD) forms to a continuum of care planning over the life course focused on tailored preparation for patients and surrogate decision-makers and (2) ACP measurement has evolved from traditional outcome metrics, such as AD completion, to a comprehensive outcomes framework that includes behavior change theory, systems, implementation science, and a focus on surrogate outcomes. Since the recent development of an ACP consensus definition and outcomes framework, high-quality trials have reported mainly positive outcomes for interventions, especially for surrogates, which aligns with the patient desire to relieve decision-making burden for loved ones. Additionally, measurement of "clinically meaningful" ACP information, including documented goals of care discussions, is increasingly being integrated into electronic health records (EHR), and emerging, real-time assessments and natural language processing are enhancing ACP evaluation. To make things easier for patients, families, and care teams, clinicians and researchers can use and disseminate these evolved definitions; provide patients validated, easy-to-use tools that prime patients for conversations and decrease health disparities; use easy-to-access clinician training and simple scripts for interdisciplinary team members; and document patients' values and preferences in the medical record to capture clinically meaningful ACP so this information is available at the point of care. Future efforts should focus on efficient implementation, expanded reimbursement options, and seamless integration of EHR documentation to ensure ACP's continued evolution to better serve patients and their care partners.
Collapse
Affiliation(s)
- Ryan D McMahan
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Veterans Administration Medical Center, San Francisco, CA, USA.
| | - Susan E Hickman
- Department of Community & Health Systems, Indiana University School of Nursing, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Regenstrief Institute Inc, Indianapolis, IN, USA
| | - Rebecca L Sudore
- Division of Geriatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Veterans Administration Medical Center, San Francisco, CA, USA
| |
Collapse
|
9
|
Adeyemi O, Walker L, Bermudez E, Cuthel AM, Zhao N, Siman N, Goldfeld K, Brody AA, Bouillon-Minois JB, DiMaggio C, Chodosh J, Grudzen CR. Emergency Nurses' Perceived Barriers and Solutions to Engaging Patients With Life-Limiting Illnesses in Serious Illness Conversations: A United States Multicenter Mixed-Method Analysis. J Emerg Nurs 2024; 50:225-242. [PMID: 37966418 PMCID: PMC10939973 DOI: 10.1016/j.jen.2023.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/27/2023] [Accepted: 09/06/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION This study aimed to assess emergency nurses' perceived barriers toward engaging patients in serious illness conversations. METHODS Using a mixed-method (quant + QUAL) convergent design, we pooled data on the emergency nurses who underwent the End-of-Life Nursing Education Consortium training across 33 emergency departments. Data were extracted from the End-of-Life Nursing Education Consortium post-training questionnaire, comprising a 5-item survey and 1 open-ended question. Our quantitative analysis employed a cross-sectional design to assess the proportion of emergency nurses who report that they will encounter barriers in engaging seriously ill patients in serious illness conversations in the emergency department. Our qualitative analysis used conceptual content analysis to generate themes and meaning units of the perceived barriers and possible solutions toward having serious illness conversations in the emergency department. RESULTS A total of 2176 emergency nurses responded to the survey. Results from the quantitative analysis showed that 1473 (67.7%) emergency nurses reported that they will encounter barriers while engaging in serious illness conversations. Three thematic barriers-human factors, time constraints, and challenges in the emergency department work environment-emerged from the content analysis. Some of the subthemes included the perceived difficulty of serious illness conversations, delay in daily throughput, and lack of privacy in the emergency department. The potential solutions extracted included the need for continued training, the provision of dedicated emergency nurses to handle serious illness conversations, and the creation of dedicated spaces for serious illness conversations. DISCUSSION Emergency nurses may encounter barriers while engaging in serious illness conversations. Institutional-level policies may be required in creating a palliative care-friendly emergency department work environment.
Collapse
Affiliation(s)
- Oluwaseun Adeyemi
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | | | | | - Allison M. Cuthel
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | - Nicole Zhao
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook NY
| | - Nina Siman
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
| | - Keith Goldfeld
- New York University Grossman School of Medicine, Department of Population Health, New York, New York, USA
| | - Abraham A. Brody
- New York University Rory Meyers College of Nursing, New York, NY, USA; Hartford Institute for Geriatric Nursing, New York, NY, USA; Division of Geriatric Medicine and Palliative Care, Department of Internal Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Jean-Baptiste Bouillon-Minois
- New York University Grossman School of Medicine, Ronald O. Perelman Department of Emergency Medicine, New York, New York, USA
- Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charles DiMaggio
- New York University Grossman School of Medicine, Department of Surgery, New York, New York, USA
| | - Joshua Chodosh
- New York University Grossman School of Medicine, Department of Population Health, New York, New York, USA
- New York University Grossman School of Medicine, Department of Medicine, New York, New York, USA
| | - Corita R. Grudzen
- New York University Grossman School of Medicine, Department of Surgery, New York, New York, USA
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
10
|
Gong M, Ding F, Zhu YP, Liu NW, Li YL, Qiu D, Fang Q. Knowledge, attitudes and practices towards advance directives among clinical nurses: Multicenter cross-sectional survey. J Clin Nurs 2024; 33:740-751. [PMID: 37888145 DOI: 10.1111/jocn.16911] [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: 12/05/2022] [Revised: 08/08/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to describe the knowledge, attitudes and practices (KAP) of nurses in implementing advance directives (ADs) for older patients and analyze the influencing factors before the establishment of the first advance directives act in China. DESIGN Multicenter cross-sectional survey. The standards for reporting the STROBE checklist are used. METHODS This cross-sectional study developed a self-designed structured questionnaire to assess nurses' knowledge, attitudes and practices about ADs. Nurses were recruited by stratified random sampling through the Nursing Departments of 12 hospitals in southwest China and were asked to fill out the questionnaire face to face about knowledge, attitudes and practices. Data were analyzed following descriptive statistics, rank-sum test and multiple linear regression. RESULTS This study included 950 nurses. The study found that nurses were extremely supportive of ADs. Unmarried nurses had better knowledge of ADs than married ones. Nevertheless, there was a discrepancy between the participants' knowledge, attitude and practice. The participants' practice was lower (4.3%) compared with their attitude (81.9%) and knowledge (42.2%). Knowledge on, attitudes towards and standardized procedures for ADs in the workplace affected nursing practice. CONCLUSIONS The study recommends that courses on ADs and appropriate support from medical institutions should be provided to nurses to increase their knowledge and confidence in implementing ADs. Healthcare professionals should be sufficiently equipped to implement ADs and handle their execution appropriately to provide adequate end-of-life care corresponding to patients' wishes. RELEVANCE TO CLINICAL PRACTICE The study results inform rich insights as it discusses the numerous interrelating factors influencing these three fundamental aspects that affect the success of any AD policy by surveying the knowledge, attitudes and practices of clinical nurses. Furthermore, our results hint at distinct areas of improvement in the nursing practice to facilitate the wider implementation and acceptance of ADs in China. PATIENT OR PUBLIC CONTRIBUTION This study involved no patient.
Collapse
Affiliation(s)
- Miao Gong
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fu Ding
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yue Ping Zhu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Na Wei Liu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ya Ling Li
- Nursing Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Qiu
- Department of Geratology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Fang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
11
|
Garcia P, Kim HJ, Barbour S, Cooper AS. Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project. JBI Evid Implement 2023; 21:310-324. [PMID: 37036334 DOI: 10.1097/xeb.0000000000000373] [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: 04/11/2023]
Abstract
INTRODUCTION AND OBJECTIVE Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients' preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses' capacity to engage in ACP. METHODS This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability. RESULTS Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients' treatment preferences. CONCLUSIONS Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.
Collapse
Affiliation(s)
- Philip Garcia
- University of California, San Francisco (UCSF) Health, San Francisco, CA, USA
| | - Hannah Jang Kim
- Kaiser Permanente National Patient Care Services, Oakland, CA, USA
- UCSF School of Nursing, San Francisco, CA, USA
| | - Susan Barbour
- University of California, San Francisco (UCSF) Health, San Francisco, CA, USA
| | - Adam S Cooper
- University of California, San Francisco (UCSF) Health, San Francisco, CA, USA
- UCSF School of Nursing, San Francisco, CA, USA
| |
Collapse
|
12
|
Westbye SF, Rostoft S, Romøren M, Thoresen L, Wahl AK, Pedersen R. Barriers and facilitators to implementing advance care planning in naïve contexts - where to look when plowing new terrain? BMC Geriatr 2023; 23:387. [PMID: 37353744 PMCID: PMC10290291 DOI: 10.1186/s12877-023-04060-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/23/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) is a way of applying modern medicine to the principle of patient autonomy and ensuring that patients receive medical care that is consistent with their values, goals and preferences. Robust evidence supports the benefits of ACP, but it remains an underutilized resource in most countries. This paper goes from the naïve point of view, and seeks to identify the barriers and facilitators to implementation in unfamiliarized contexts and in a whole system approach involving the clinical, institutional and policy level to improve the implementation of ACP. METHODS Qualitative interviews were chosen to enable an explorative, flexible design. Qualitative interviews were conducted with 40 health care professionals and chief physicians in hospitals and in municipalities. The thematic analysis was done following Braun and Clarke's strategy for thematic analysis. RESULTS The main reported barriers were the lack of time and space, a lack of culture and leadership legitimizing ACP, lack of common communication systems, and unclear responsibility about who should initiate, resulting in missed opportunities and overtreatment. Policy development, public and professional education, and standardization of documentation were reported as key to facilitate ACP and build trust across the health care system. CONCLUSIONS Progressively changing the education of health professionals and the clinical culture are major efforts that need to be tackled to implement ACP in unfamiliarized contexts, particularly in contexts where patient's wishes are not legally binding. This will need to be tackled through rectifying the misconception that ACP is only about death, and providing practical training for health professionals, as well as developing policies and legislation on how to include patients and caregivers in the planning of care.
Collapse
Affiliation(s)
- Siri Færden Westbye
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, Oslo, Norway.
| | - Siri Rostoft
- Institute for Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Maria Romøren
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, Oslo, Norway
| | - Lisbeth Thoresen
- Department for Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Astrid Klopstad Wahl
- Department for Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, Oslo, Norway
| |
Collapse
|
13
|
Zhu N, Yang L, Wang X, Tuo J, Chen L, Deng R, Kwan RYC. Experiences and perspectives of healthcare professionals implementing advance care planning for people suffering from life-limiting illness: a systematic review and meta-synthesis of qualitative studies. BMC Palliat Care 2023; 22:55. [PMID: 37149560 PMCID: PMC10163819 DOI: 10.1186/s12904-023-01176-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/24/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Life-limited patients may lose decision-making abilities during disease progression. Advance care planning can be used as a discussion method for healthcare professionals to understand patients' future care preferences. However, due to many difficulties, the participation rate of healthcare professionals in advance care planning is not high. AIM To explore the facilitators of and barriers to healthcare professionals' provision of advance care planning to life-limited patients to better implement it for this population. METHODS We followed ENTREQ and PRISMA to guide this study. We conducted a systematic search of PubMed, Web of Science, Embase, CINAHL, PsycINFO, CNKI, and SinoMed to include qualitative data on the experiences and perspectives of healthcare professionals in different professional fields in providing advance care planning for life-limited patients. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies. RESULTS A total of 11 studies were included. Two themes were identified: unsupported conditions and facilitative actions. Healthcare professionals regarded cultural concepts, limited time, and fragmented record services as obstacles to implementation. They had low confidence and were overly concerned about negative effects. They needed to possess multiple abilities, learn to flexibly initiate topics, and facilitate effective communication based on multidisciplinary collaboration. CONCLUSION Healthcare professionals need an accepting cultural environment to implement advance care planning, a sound legal system, financial support, and a coordinated and shared system to support them. Healthcare systems need to develop educational training programs to increase the knowledge and skills of healthcare professionals and to promote multidisciplinary collaboration to facilitate effective communication. Future research should compare the differences in the needs of healthcare professionals in different cultures when implementing advance care planning to develop systematic implementation guidelines in different cultures.
Collapse
Affiliation(s)
- Nanxi Zhu
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 121 Dalian Road, Zunyi City, Huichuan District, Guizhou Province, 563000, China
- Nursing Department, Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, 519100, China
| | - Liu Yang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 121 Dalian Road, Zunyi City, Huichuan District, Guizhou Province, 563000, China
| | - Xianlin Wang
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 121 Dalian Road, Zunyi City, Huichuan District, Guizhou Province, 563000, China
| | - Jinmei Tuo
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 121 Dalian Road, Zunyi City, Huichuan District, Guizhou Province, 563000, China
| | - Liuliu Chen
- School of Health, Zhuhai College of Science and Technology, Zhuhai, 519041, China
| | - Renli Deng
- Nursing Department, Affiliated Hospital of Zunyi Medical University, 121 Dalian Road, Zunyi City, Huichuan District, Guizhou Province, 563000, China.
- Nursing Department, Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, 519100, China.
| | | |
Collapse
|
14
|
Ludwick R, Baughman KR. Education, Policy, and Advocacy in Predicting Use of Do-Not-Hospitalize Orders in Skilled Nursing Facilities. J Gerontol Nurs 2022; 48:45-52. [PMID: 36286504 DOI: 10.3928/00989134-20221003-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nurses and social workers are uniquely positioned to advocate for patients' wishes for do-not-hospitalize (DNH) directives. The purpose of the current study was to explore the impact of DNH education, policy, and advocacy on the use of DNH orders by nurses (RNs and licensed practical nurses [LPNs]) and social workers employed in skilled nursing facilities (SNFs). This multisite secondary analysis used cross-sectional survey data and analyzed responses of RNs, LPNs, and social workers (N = 354) from 29 urban SNFs. Mixed model regression was used to examine possible predictors of frequency of DNH orders within SNFs while adjusting for random effects. Results showed that having a DNH written policy, education on DNH orders, and having an advanced care planning advocate in the facility were strongly associated with a higher reported frequency of DNH discussions with residents and their families (p < 0.01 for each variable). [Journal of Gerontological Nursing, 48(11), 45-52.].
Collapse
|
15
|
Ojedoyin OE, Jegede AS. A quantitative study of nurses perception to advance directive in selected private and public secondary healthcare facilities in Ibadan, Nigeria. BMC Med Ethics 2022; 23:87. [PMID: 36008832 PMCID: PMC9404628 DOI: 10.1186/s12910-022-00825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives The study evaluated nurses’ perceptions on the benefits, drawbacks, and their roles in initiating and implementing advance directives (AD) at private and public secondary healthcare units. Methods The study adopted a cross-sectional, comparative-descriptive research design and was anchored on the structural functional theory. A total of 401 nurses (131 private and 270 public) were chosen on purpose. The data was collected between January and March 2018 among nurses at the selected hospitals. Analysis was done via SPSSv28.0.1.0. Results Compared to nurses working in private healthcare facilities (72.5%), the majority of nurses at the public healthcare facilities (75.2%) indicated a more favorable opinion of AD’s benefits and (61.9%) felt they had a substantial involvement in the development and execution of AD than their private counterpart (56.5%). Similarly, 60.7% of nurses employed by the government agreed that AD has some disadvantages compared to those employed by the private sector (58.8%). Significantly, Christian nurses are 0.53 times less likely than Muslims to contest AD’s benefits; 0.78 times less likely than Muslim to disagree that AD has flaws; and 1.30 times more likely than Muslim nurses to deny they contributed to the development and execution of AD, though not significant. Conclusion Making decisions at the end-of-life can be challenging, thus AD should be supported across the board in the healthcare industry. Nurses should be trained on their role in developing and implementing AD, as well as on its advantages and how to deal with its challenges.
Collapse
|
16
|
Kirchner Ä, Langner H, Meyer G, Schnakenberg R, Silies K, Hoffmann F, Köpke S, Köberlein-Neu J, Berg A. Beratung zu Advance Care Planning in der ambulanten Pflege. Pflege 2022; 35:345-354. [DOI: 10.1024/1012-5302/a000897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund: StAdPlan ist eine multizentrische, Cluster-randomisierte kontrollierte Studie mit der Zielstellung, eine Intervention zu Advance Care Planning (ACP) für den Anwendungskontext der ambulanten Pflege in Deutschland zu entwickeln und zu evaluieren. Fragestellung/Ziel: In diesem Beitrag wird die Interventionsentwicklung unter Einbezug bestehender ACP-Konzepte und deren Anpassung auf die zeitlichen und personellen Ressourcen im System der ambulanten Pflege in Deutschland dargestellt. Pflegefachpersonen kommt dabei die Rolle zu, ältere pflegebedürftige Menschen und deren Angehörige im Rahmen von strukturierten Gesprächen für das Thema ACP zu sensibilisieren und die Nutzung bestehender Beratungsangebote zu fördern. Methoden: Die Interventionskomponenten wurden unter Anwendung des Behaviour Change Wheel (BCW) entwickelt. Ergebnisse: Die komplexe Intervention in Form eines niedrigschwelligen Beratungsangebotes richtet sich an Pflegebedürftige über 65 Jahre und ihre Angehörigen. Ein zweitägiges Schulungsangebot qualifiziert Pflegefachpersonen ambulanter Pflegedienste für leitfadengestützte Beratungsgespräche, die im häuslichen Umfeld der pflegebedürftigen Person, möglichst unter Einbeziehung Angehöriger, im Rahmen von mindestens zwei Terminen durchgeführt werden. Eine Broschüre ergänzt das Informationsangebot. Schlussfolgerungen: Das Vorgehen entlang des BCW-Modells war für Analyse, Beschreibung und Definition der spezifischen Funktionen der Intervention gut geeignet. Die Intervention wird in der anschließenden Studie auf ihre Effektivität untersucht.
Collapse
Affiliation(s)
- Änne Kirchner
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Henriette Langner
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| | - Rieke Schnakenberg
- Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Deutschland
| | - Katharina Silies
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Deutschland
| | - Falk Hoffmann
- Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Deutschland
| | - Sascha Köpke
- Institut für Pflegewissenschaft, Medizinische Fakultät, Universität zu Köln, Deutschland
| | - Juliane Köberlein-Neu
- Bergisches Kompetenzzentrum für Gesundheitsökonomik und Versorgungsforschung, Fakultät für Wirtschaftswissenschaft, Schumpeter School of Business and Economics, Bergische Universität Wuppertal, Deutschland
| | - Almuth Berg
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Deutschland
| |
Collapse
|
17
|
Ludwick R, Bakerjian D, Zalon ML, Melander SD, Crist JD. Advance care planning at life milestones. Nurs Outlook 2022; 70:451-457. [PMID: 35440365 DOI: 10.1016/j.outlook.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/02/2022] [Accepted: 02/15/2022] [Indexed: 11/18/2022]
Abstract
Much progress has been made in advance care planning (ACP), especially related to end of life and palliative care. These advances have moved thinking about ACP from a checklist approach to an upstream recognition that ACP is an iterative process that should begin early in adulthood and be revisited with each milestone or life-changing event. It is recognized that there are many stages and milestones in adult life that contribute to changing loci of responsibility and life goals. These changes impact how individuals view their lives, the complexity of health care, and the myriad of health conditions they may encounter. ACP discussions should routinely be started and reexamined at the time of key life events like starting a career or a marriage and not delayed until hospitalization, the occurrence of a serious accident, or the development of a catastrophic illness.
Collapse
Affiliation(s)
- Ruth Ludwick
- Kent State University, College of Nursing, Kent, OH.
| | - Deb Bakerjian
- Betty Irene Moore School of Nursing at UC Davis, Sacramento, CA
| | - Margarete L Zalon
- Health Informatics Program, Department of Nursing, University of Scranton, Scranton, PA
| | - Sheila D Melander
- MSN and DNP Faculty and Practice Affairs, University of Kentucky College of Nursing, Lexington, KY
| | - Janice D Crist
- College of Nursing, The University of Arizona, Tucson, AZ
| |
Collapse
|
18
|
Knowledge of and Barriers to Palliative Care Perceived by Healthcare Providers before and after Promotion of the Patient Autonomy Act: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073884. [PMID: 35409567 PMCID: PMC8997776 DOI: 10.3390/ijerph19073884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
This study was designed to investigate healthcare providers’ knowledge of palliative care and perceptions of palliative care barriers before and after promoting the Patient Autonomy Act (PAA). A convenience sample was recruited, including 277 healthcare providers in 2013 and 222 healthcare providers in 2018. Multivariate linear regression analyses were used to identify predictors of knowledge of and perceived barriers to palliative care. A principal component analysis was carried out to identify the most appropriate factorial structure for the contents of knowledge and perceived barriers to palliative care. Three factors related to knowledge of palliative care were identified in both 2013 and 2018 data: ‘policy, regulation, and promotion’, ‘philosophy and treatments’, and ‘myths and misunderstandings’. Study findings for the two periods were similar. As for barriers to providing palliative care, three factors were identified for 2013: ‘quality care’, ‘difficulties’ and ‘communication’, and for 2018, ‘information’, ‘attitudes’ and ‘quality care’ were identified. Study findings differed between the two periods. Policies can better reinforce mitigating strategies—including opportunities for education, shared decision making, and changes in institutions and care systems. Additionally, assessing barriers creates important opportunities for further research to address the most critical aspects in improving end-of-life care for patients and their families.
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Ho K, Wang K, Clay A, Gibbings E. Differences in goals of care discussion outcomes among healthcare professionals: an observational cross-sectional study. Palliat Med 2022; 36:358-364. [PMID: 34965781 PMCID: PMC8894680 DOI: 10.1177/02692163211058607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Goals of care discussions ensure patients receive the care that they want. Recent studies have recognized the opportunity for allied health professionals, such as nurses, in facilitating goals of care discussions. However, the outcomes of such interventions are not well studied. AIM To compare the outcomes of goals of care discussions led by physicians and nurses. DESIGN This is a retrospective cohort study of patients admitted to an Internal Medicine unit from January 2018 to August 2019. A comprehensive chart review was performed on a random sample of patients. Patient's decision to accept or refuse cardiopulmonary resuscitation was recorded and analyzed. Analysis was stratified by patients' comorbidity burden and illness severity. SETTING/PARTICIPANTS The study took place at a tertiary care center and included 200 patients. Patients aged ⩾ 18 were included. Patients who have had pre-existing goals of care documentation were excluded. RESULTS About 52% of the goals of care discussions were completed by nurses and 48% by physicians. Patients were more likely to accept cardiopulmonary resuscitation in nurse-led discussions compared to physician-led ones (80.8% vs 61.4%, p = 0.003). Multiple regression showed that patients with higher comorbidity burden (OR 0.71, 95% CI: 0.62-0.82), more severe illness (OR 0.89, 95% CI 0.88-0.99), and physician-led goals of care discussions (OR 0.30, 95% CI: 0.15-0.62) were less likely to accept cardiopulmonary resuscitation. CONCLUSIONS There was a significant difference between the outcomes of goals of care discussions led by nurses and physicians. Patients were more likely to accept aggressive resuscitative measures in nurse-led goals of care discussions. Further research efforts are needed to identify the factors contributing to this discrepancy, and to devise ways of improving goals of care discussion delivery.
Collapse
Affiliation(s)
- Karen Ho
- Department of Internal Medicine, University of Saskatchewan College of Medicine, Regina, SK, Canada
| | - Krystyna Wang
- Department of Internal Medicine, University of Saskatchewan College of Medicine, Regina, SK, Canada
| | - Adam Clay
- Department of Academic Family Medicine, University of Saskatchewan, Regina, SK, Canada
| | - Elizabeth Gibbings
- Department of Internal Medicine, University of Saskatchewan College of Medicine, Regina, SK, Canada.,Department of Internal Medicine, Regina General Hospital, Regina, SK, Canada
| |
Collapse
|
21
|
Rubin BR, Chung M, Hasdianda MA, Gray TF, Aaronson EL, Dundin A, Egorova NA, Revette AC, Berry D, Ouchi K. Refinement of an Emergency Department-Based, Advance Care Planning Intervention for Nurses. J Palliat Med 2022; 25:650-655. [PMID: 35100041 PMCID: PMC8982111 DOI: 10.1089/jpm.2021.0398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Most older adults visit the emergency department (ED) near the end of life without advance care planning (ACP) and thus are at risk of receiving care that does not align with their wishes and values. ED GOAL is a behavioral intervention administered by ED clinicians, which is designed to engage seriously ill older adults in serious illness conversations in the ED. Seriously ill older adults found it acceptable in the ED. However, its potential to be used by nurses remains unclear. Objective: The aim of this study is to identify refinements to adapt an ED-based ACP intervention by eliciting the perspectives of nurses. Design: This is a qualitative study using semistructured interviews. Data were analyzed using axial coding methods. Setting/Subjects: We recruited a purposeful sample of ED nurses in one urban academic ED and one urban community ED in the northeastern region of the United States. Results: Twenty-five nurses were interviewed (mean age 46 years, 84% female, and mean clinical experience of 16 years). Emerging themes were identified within six domains: (1) nurses' prior experience with serious illness conversations, (2) overall impression of ED GOAL, (3) refinements to ED GOAL, (4) implementation of ED GOAL by ED nurses, (5) specially trained nursing model, and (6) use of telehealth with ED GOAL. Conclusions: ED nurses were generally supportive of using ED GOAL and provided insight into how to best adapt and implement it in their clinical practice. Empirical evidence for adapting ED GOAL to the nursing practice remains to be seen.
Collapse
Affiliation(s)
- Batsheva R Rubin
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michelle Chung
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mohammad Adrian Hasdianda
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Emily L Aaronson
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrew Dundin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natasha A Egorova
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anna C Revette
- Survey and Data Management Core, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donna Berry
- Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, Washington, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Osman AD, Howell J, Smithies L, Wilson D, Lam L, Moran J, Jones D, Taylor DM. Assessment of emergency department staff awareness, access and utilisation of advance care directives and goals of care: A cross-sectional survey. Australas Emerg Care 2021; 25:235-240. [PMID: 34906442 DOI: 10.1016/j.auec.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency department staff awareness, access and implementation of advance care directives and goals of care documents and the related patient consent processes are important but not well understood. METHODS A cross-sectional survey using purposive sampling was undertaken at a tertiary hospital's Emergency Department from 15th March to 26th April 2021. Participants were recruited through online platforms. Pre-validated questionnaires were distributed by email or as QR codes on bulletin boards. Data collected included staff: demographics, knowledge, access and implementation of advance care directives and goals of care documentation. RESULTS One hundred thirty-four (28%) of 476 targeted participants responded with nursing forming largest group. Results showed that previous attendance of advance care planning education was low at 20%. Familiarity with advance care directive documentations was only 19% while with goals of care document was average. 61 (48%) respondents reported ease of accessing electronic documents and 21 (19%) reported feeling very comfortable discussing and setting goals of care with patients (p = <0.01). CONCLUSIONS Staff awareness of advance care directive was poor, while awareness of goals of care was average. There was no association between advance care directives awareness and staff age group, gender, length of: - professional practice, practice at the study site.
Collapse
Affiliation(s)
- Abdi D Osman
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; School of Health, Federation University Australia, Victoria, Australia.
| | - Jocelyn Howell
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Lisa Smithies
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; Faculty of Arts, University of Melbourne, Parkville, Victoria, Australia
| | - Damian Wilson
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Louisa Lam
- School of Health, Federation University Australia, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Juli Moran
- Department of Palliative Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - Daryl Jones
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - David M Taylor
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
23
|
Whitehead P, Frechman E, Johnstone-Petty M, Kates J, Tay DL, DeSanto K, Fink RM. A scoping review of nurse-led advance care planning. Nurs Outlook 2021; 70:96-118. [PMID: 34627618 DOI: 10.1016/j.outlook.2021.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/03/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Advance care planning (ACP) supports persons at any age or health status to determine their values, goals, and preferences regarding future medical care. The American Nurses Association endorses nurses to facilitate ACP to promote patient- and family-centered care. PURPOSE This project reviewed and synthesized literature on nurse-led ACP training models. METHODS A scoping review used the Arksey and O'Malley Framework to identify: (a) ACP training model type, (b) nurse-led ACP recipients, (c) ACP in special populations, (d) ACP outcomes. FINDINGS Of 33 articles reviewed, 19 included 11 established models; however, the primary finding was lack of a clearly identified evidence-based nurse-led ACP training model. DISCUSSION Nurses are integral team members, well positioned to be a bridge of communication between patients and care providers. This is a call to action for nurse leaders, researchers, educators to collaborate to identify and implement an evidence-based, effective nurse-led ACP training model.
Collapse
Affiliation(s)
- Phyllis Whitehead
- Palliative Medicine/Pain Management, Carilion Roanoke Memorial Hospital, Virginia Tech Carilion, School of Medicine, Roanoke, VA.
| | - Erica Frechman
- Palliative Care Atrium Health, PhD Candidate Nursing Science, Vanderbilt University School of Nursing, Nashville, TN
| | - Marianne Johnstone-Petty
- Palliative Care Department, Interprofessional Palliative Care Education, Providence Medical Group, Anchorage, AK
| | - Jeannette Kates
- College of Nursing, Thomas Jefferson University, Philadelphia, PA
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Regina M Fink
- School of Medicine and College of Nursing, Interprofessional MSPC & Palliative Care Certificate Programs, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
24
|
Poveda-Moral S, Falcó-Pegueroles A, Ballesteros-Silva MP, Bosch-Alcaraz A. Barriers to Advance Care Planning Implementation in Health care: An Umbrella Review with Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2021; 18:254-263. [PMID: 34506051 DOI: 10.1111/wvn.12530] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Advance care planning (ACP) refers to a process of discussions between professionals, patients, and their families, which allows the patient to define and communicate their care and treatment preferences. Understanding the barriers to advance care planning is the first step on the way to overcoming them and to improving person-centred care and attention. AIMS To identify the barriers perceived by professionals, patients, and family members when implementing ACP in a clinical context and to analyse the methodological quality of the evidence. METHODS An umbrella review guided by the Joanna Briggs Institute and a systematic review in accordance with PRISMA 2015 were utilized. Data were obtained from MEDLINE, Cochrane Library, The Joanna Briggs Institute, CINAHL, Scopus, and EMBASE in November 2018. RESULTS Fourteen systematic reviews were included. The main barriers reported by professionals were lack of knowledge and skills to carry out ACP, a certain fear of starting conversations about ACP, and a lack of time for discussions. Patients and family members considered that the main barriers were fear of discussing their relative's end of life, lack of ability to carry out ACP, and not knowing who was responsible for initiating conversations about ACP. LINKING EVIDENCE TO ACTION This review has examined the barriers presented by health professionals, patients, and family members, so that future lines of research can develop preventive or decisive measures that encourage the implementation of ACP in health care.
Collapse
Affiliation(s)
- Silvia Poveda-Moral
- Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa, School of Nursing, Faculty of Medicine and Health Sciences, Universitat Autònoma de Barcelona, University of Barcelona, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- Department of Fundamental Care and Medical-Surgical Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group SGR 269 Quantitative Psychology, University of Barcelona, Barcelona, Spain
| | | | - Alejandro Bosch-Alcaraz
- School of Nursing, Faculty of Medicine and Health Sciences, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| |
Collapse
|
25
|
Ohr SO, Cleasby P, Jeong SYS, Barrett T. Nurse-led normalised advance care planning service in hospital and community health settings: a qualitative study. BMC Palliat Care 2021; 20:139. [PMID: 34503475 PMCID: PMC8431845 DOI: 10.1186/s12904-021-00835-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advance Care Planning (ACP) by Registered Nurses (RNs) has been emerging. However, there is limited understanding about what RNs experience as they incorporate ACP into their practice. This study aimed to elicit the experiences of ACP RNs with the implementation of a normalised ACP (NACP) service in hospital and community care settings. METHODS A qualitative descriptive study invited four ACP RNs who delivered a nurse-led NACP for a 6 months duration at two hospital and two community health care settings in New South Wales (NSW), Australia. The experiences of the ACP RNs were captured through a semi-structured interview and weekly debriefing meetings. The interview recordings were transcribed verbatim and the minutes of weekly debriefing meetings were utilized. Data were analysed by two independent researchers using thematic analysis with the Normalisation Process Theory (NPT) as a methodological framework. FINDINGS The ACP RNs were females with a mean age of 43 years old. Their nursing experiences ranged 2 to 25 years but they had minimal experiences with ACP and had not attended any education about ACP previously. The following four themes were identified in the experiences of the ACP RNs; 1) Embracing NACP service; 2) Enablers and barriers related to patients and health professionals; 3) Enablers and barriers related to ACP RNs; and 4) What it means to be an ACP RN. CONCLUSION The introduction of a NACP service into existing clinical systems is complex. The study demonstrated the capacity of RNs to engage in ACP processes, and their willingness to deliver an NACP service with a raft of locally specific enablers and barriers. TRIAL REGISTRATION The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ). The URL of the trial registry record.
Collapse
Affiliation(s)
- Se Ok Ohr
- HNE Nursing and Midwifery Research Centre, Conjoint Lecturer University of Newcastle, James Fletcher Campus, Gate Cottage, 72 Watt Street, Hunter New England Local Health District, Newcastle, NSW 2300 Australia
| | - Peter Cleasby
- Division of Aged, Subacute and Complex Care, PO Box 6088, Central Coast Local Health District, Long Jetty, NSW 2261 Australia
| | - Sarah Yeun-Sim Jeong
- School of Nursing and Midwifery, The University of Newcastle, 10 Chittaway Road, Ourimbah, NSW 2258 Australia
| | - Tomiko Barrett
- Department of Aged Care Services, Wyong Hospital, PO Box 4200, Central Coast Local Health District, Lakehaven, NSW 2263 Australia
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Zhang X, Jeong SYS, Chan S. Advance care planning for older people in mainland China: An integrative literature review. Int J Older People Nurs 2021; 16:e12409. [PMID: 34291574 DOI: 10.1111/opn.12409] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, the attempts to promote advance care planning (ACP) and advance directives (ADs) have appeared in mainland China. However, anecdotal evidence suggests that the concept of ACP and ADs is not widely known to the public and healthcare professionals. AIM To examine and synthesise currently available research about ACP and ADs for older people in mainland China, and to discuss implications for future nursing practice and research. DESIGN An integrative literature review. METHODS A systematic search was conducted in seven English electronic databases (CINAHL, MEDLINE, ProQuest, Cochrane, JBI, Scopus and Wiley) and four Chinese electronic databases (CNKI, Wanfang, VIP and CBM). Eligible articles were critically appraised using the Mixed Methods Appraisal Tool (MMAT). FINDINGS From various groups including older people, families and healthcare professionals, low levels of knowledge and awareness about ACP and ADs are reported. Demographic characteristics such as age, gender, education and clinical conditions were related to positive or negative attitude towards ACP. The main reason people cited for being 'reluctant/fairly reluctant' to make an AD was that they were 'Not familiar with it'. CONCLUSIONS Given that older people showed positive attitudes towards ACP, policy support and practice guidelines about ADs and ACP are necessary to respect their wishes and to guide healthcare professionals in mainland China.
Collapse
Affiliation(s)
- Xuan Zhang
- School of Nursing, Fujian Medical University, Fujian, China
| | - Sarah Yeun-Sim Jeong
- The School of Nursing & Midwifery, The University of Newcastle, Callaghan, NSW, Australia
| | - Sally Chan
- The School of Nursing & Midwifery, The University of Newcastle, Callaghan, NSW, Australia
| |
Collapse
|
28
|
Park M, Park EJ, Jo M, Ahn J. Feasibility of an Advance Care Planning Program (ACP) for Korean Community-Dwelling Older Adults and ACP Training of Advance Practice Nurses. J Community Health Nurs 2021; 38:179-192. [PMID: 34148432 DOI: 10.1080/07370016.2021.1932963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to develop a locally suitable advance care planning (ACP) program for older community-dwelling adults and a training program for nurse facilitators in Korea, and to evaluate their feasibility from the facilitators' experiences. This was a mixed methods pilot study that assessed the feasibility of an ACP program by analyzing survey, checklist, and focus group interview data. The ACP program was named CLOSE (Communicating and Listening to Our Seniors' voices about End-of-life care). Home health care nurses (N = 9) participated in this study. The participants reported that CLOSE was applicable to older community-dwelling adults and the training program was useful for increasing facilitator competency. We suggest some lessons from this pilot study that can be used to improve the ACP program and encourage community health nurses to participate in ACP as facilitators.
Collapse
Affiliation(s)
- Mihyun Park
- Department of Health System, College of Nursing, the Catholic University of Korea, Seoul, South Korea
| | - Eun-Jun Park
- Department of Nursing, Konkuk University, Chungju, South Korea
| | - Minjeong Jo
- Department of Clinical Nursing, College of Nursing, the Catholic University of Korea, Seoul, South Korea
| | - Jinhee Ahn
- Maumahn Healing & Communication, Seoul, South Korea
| |
Collapse
|
29
|
The Role Complexities in Advance Care Planning for End-of-Life Care-Nursing Students' Perception of the Nursing Profession. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126574. [PMID: 34207258 PMCID: PMC8296407 DOI: 10.3390/ijerph18126574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 11/28/2022]
Abstract
Nurses’ perceptions of being responsible for advance care planning (ACP) vary greatly across different studies. It could, however, affect their involvement in advance care planning and patients’ quality of death. Recent studies on this topic have mostly focused on advance directives but not ACP and nurses in the ward setting. This study aimed to assess the perception of Hong Kong nursing undergraduates of the nurse’s role in advance care planning and examine its associations with knowledge, attitude, and experience. A cross-sectional 57-item survey was delivered to nursing undergraduates between June and August 2020. The chi-squared test or Fisher’s exact test were used for univariate analysis. The multiple logistic regression model was used for multivariate analysis. A total of 469 participants were assessed for eligibility; 242 of them were included in the data analysis, with a response rate of 97.6%. The majority of respondents—77.3% (95% CI: 72.0–82.6%)—perceived having a role in ACP, but large discrepancies were found between their perception of their role regarding different aspects of ACP. Participants who had a better knowledge status (p = 0.029) or supported the use of ACP (p < 0.001) were more likely to have a positive perception of their role in ACP. A negative correlation was found between the experience of life threat and positive role perception (p < 0.001). Through strengthening training, the role clarity of nursing undergraduates could be achieved, maximizing their cooperation with and implementation of ACP in their future nursing career. The enhancement of end-of-life education could also be undertaken to fill nursing undergraduates’ knowledge gap in this area and change their attitudes.
Collapse
|
30
|
Tang MY, Li XL, Shi ZY, Fu WJ. Knowledge of and willingness to promote advanced care planning among oncology nurses in southwest China. Int J Palliat Nurs 2021; 26:175-182. [PMID: 32378488 DOI: 10.12968/ijpn.2020.26.4.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nurses feature prominently in promoting advance care planning (ACP), but only a limited amount of relevant research has been conducted from the nurses' viewpoint, and little is known about the nurses' knowledge of and their willingness to promote ACP in China. AIMS The aims of this study were to investigate oncology nurses' knowledge of and their willingness to promote ACP, and to explore associated factors. METHODS A multi-centre study was conducted to investigate 350 nurses in the oncology departments of four university hospitals in southwestern China. Cluster sampling was used in data collection, which involved three categories of questionnaires concerning demographic characteristics, knowledge about ACP and willingness to promote ACP. Chi-squared tests and multiple linear regression were employed in data analysis. RESULTS Some 293 valid questionnaires were collected, among which, 60.1% of respondents never received palliative care education, 89.1% never received training about ACP and 72.7% had not even heard of ACP. Nurses with higher position titles (χ2=18.41, p<0.001) and longer working experience (χ2=12.25, p=0.001) were more likely to have received palliative care education; nurses with higher educational background levels (χ2=12.91, p<0.001), higher position titles (χ2=9.77, p=0.003) and longer working experience (χ2=7.92, p=0.006) were more likely to have learned about ACP; nurses with higher position titles had more access to relevant training (χ2=5.10, p=0.03). Furthermore, whether the nurse had 'heard about ACP' (B=3.113, p=0.018) and 'received training about ACP' (B=3.894, p=0.04) were both associated with their willingness to promote ACP. CONCLUSIONS The findings of this study indicated that oncology nurses were highly inclined to promote ACP, but limited by their lack of knowledge and understanding of it. Therefore, a systematic and adequate training programme about ACP for nurses is an urgent requirement to effectively enhance the implementation of ACP in China.
Collapse
Affiliation(s)
- Meng-Yan Tang
- Master's Student, School of Nursing, Sichuan University, China
| | - Xiao-Ling Li
- Professor, School of Nursing, Sichuan University; Department of Nursing, West China Hospital of Sichuan University, China
| | - Zheng-Yan Shi
- Master's Student, School of Nursing, Sichuan University, China
| | - Wen-Jing Fu
- Master's Student, School of Nursing, Sichuan University, China
| |
Collapse
|
31
|
Disler R, Pascoe A, Luckett T, Donesky D, Irving L, Currow DC, Smallwood N. Barriers to Palliative Care Referral and Advance Care Planning (ACP) for Patients With COPD: A Cross-Sectional Survey of Palliative Care Nurses. Am J Hosp Palliat Care 2021; 39:169-177. [PMID: 34013782 DOI: 10.1177/10499091211018192] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a progressive, life-limiting illness that requires end-of-life care planning, yet remains under-served. Understanding barriers to advance care planning (ACP) from different specialties' perspectives will enable a co-ordinated, cross-disciplinary approach to improving ACP access. METHODS Australia and New Zealand palliative care nurses were invited to complete an anonymous online cross-sectional survey. Questions tested knowledge of validated ACP-related practice indicators and canvassed perspectives on barriers to ACP in COPD. Data are described and free-text thematically analyzed. RESULTS The 90 participants had high knowledge and positive attitudes to ACP in COPD, however, lacked consensus as to whether patients want to know their prognosis or discuss treatment options and end-of-life wishes. 59% discussed ACP in more than half their patients with COPD, and 77% and 73% routinely initiated or followed-up these discussions. Key barriers included: lack of confidence and training in COPD; reluctance to distress patients and families; referral late in the disease course; lack of consensus on referral timing; and lack of patient and clinician understanding of COPD prognoses. Many reported that lack of consensus in the treating team, paired with prognostic uncertainty, precluded timely ACP engagement. CONCLUSIONS Palliative care nurses have substantial knowledge and positive beliefs regarding ACP, however, some beliefs and practices lack alignment with qualitative data on patients' wishes in COPD. While palliative care nurses are well placed to facilitate early implementation for patients with advanced COPD, ACP training and practice guidelines specific to COPD may increase implementation in this life-limiting disease.
Collapse
Affiliation(s)
- Rebecca Disler
- Department of Rural Health, 2281University of Melbourne, Shepparton, Victoria, Australia
| | - Amy Pascoe
- Department of Rural Health, 2281University of Melbourne, Shepparton, Victoria, Australia.,Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Monash University, Melbourne, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Trials (IMPACCT) Centre, Faculty of Health, University of Technology Sydney (UTS), New South Wales, Australia
| | - Doranne Donesky
- School of Nursing, 59431Touro University of California, Vallejo, CA, USA.,Department of Physiological Nursing, University of California San Francisco, CA, USA
| | - Louis Irving
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Monash University, Melbourne, Australia
| | - David C Currow
- Improving Palliative, Aged and Chronic Care through Clinical Trials (IMPACCT) Centre, Faculty of Health, University of Technology Sydney (UTS), New South Wales, Australia
| | - Natasha Smallwood
- Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Monash University, Melbourne, Australia.,Department of Immunology and Respiratory Medicine, Central Clinical School, The Alfred, Monash University, Melbourne, Australia
| |
Collapse
|
32
|
Gilissen J, Wendrich-van Dael A, Gastmans C, Vander Stichele R, Deliens L, Detering K, Van den Block L, Pivodic L. Differences in advance care planning among nursing home care staff. Nurs Ethics 2021; 28:1210-1227. [PMID: 33947293 DOI: 10.1177/0969733021994187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. OBJECTIVES To examine to what extent engagement in advance care planning practices (e.g. conversations, advance directives), knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. DESIGN Survey study. PARTICIPANTS/SETTING The study involved a purposive sample of 14 nursing homes in Flanders, Belgium. Nurses, care assistants and allied care staff (e.g. social workers, physical therapists) completed a survey. ETHICAL CONSIDERATIONS The study was approved by the University Hospital of Brussels (B.U.N. 143201834759), as part of a cluster randomized controlled trial (clinicaltrials.gov NCT03521206). RESULTS One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated (67% response rate). After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations (odds ratio 4; 95% confidence interval 1.73-9.82; p < 0.001) and documented advance care planning (odds ratio 2.67; 95% confidence interval 1.29-5.56; p < 0.001); differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses (estimated mean difference 0.13 (score range 0-1); 95% confidence interval 0.08-0.17; p < 0.001) and allied staff (estimated mean difference 0.07; 95% confidence interval 0.03-0.12; p < 0.001) scoring higher than care assistants. We found no significant differences regarding self-efficacy. DISCUSSION While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. CONCLUSIONS Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage.
Collapse
Affiliation(s)
- Joni Gilissen
- 70493Vrije Universiteit Brussel (VUB), Belgium; University California San Francisco, USA.,70493Vrije Universiteit Brussel (VUB), Belgium
| | | | - Chris Gastmans
- KU Leuven, Belgium.,70493Vrije Universiteit Brussel (VUB), Belgium
| | | | - Luc Deliens
- 70493Vrije Universiteit Brussel (VUB), Belgium; Ghent University, Belgium.,70493Vrije Universiteit Brussel (VUB), Belgium
| | - Karen Detering
- 3805Austin Health, Australia.,70493Vrije Universiteit Brussel (VUB), Belgium
| | | | | |
Collapse
|
33
|
Hobden B, Bryant J, Waller A, Shepherd J, Sanson-Fisher R. Oncology nurses' perceptions of advance directives for patients with cancer. Nurs Health Sci 2021; 23:439-446. [PMID: 33683793 DOI: 10.1111/nhs.12826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 01/15/2023]
Abstract
This study examined oncology nurses' perceptions of the impact of advance directives on oncology patients' end-of-life care. Nurses (n = 104), who were members of an oncology nursing society or worked in a large metropolitan cancer center, completed a cross-sectional survey assessing perceptions of advance directives. There was high agreement that advance directives (i) make decisions easier for family (87%) and providers (82%); (ii) are doctors' responsibility to implement (80%); (iii) reduce unwanted aggressive treatment in the last weeks of life (80%); (iv) protect patient autonomy (77%); and (v) increase the likelihood of dying in a preferred location (76%). There was moderate or low agreement that advance directives (i) are accessible when needed (60%); (ii) are oncology nurses' responsibility to implement (46%); (iii) are always followed (41%); (iv) reduce the likelihood of pain in the last weeks of life (31%); (v) contain difficult to follow statements (30%); and (vi) have no impact on comfort in the last weeks of life (15%). Most nurses perceive benefits for advance directives, however, there remains uncertainty around accessibility and implementation. Guidelines and education about advance directive processes in oncology could improve person-centered end-of-life care.
Collapse
Affiliation(s)
- Breanne Hobden
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Amy Waller
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jan Shepherd
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| |
Collapse
|
34
|
Cheng Q, Liu X, Li X, Qing L, Lin Q, Wen S, Chen Y. Discrepancies among knowledge, practice, and attitudes towards advance care planning among Chinese clinical nurses: A national cross-sectional study. Appl Nurs Res 2021; 58:151409. [PMID: 33745557 DOI: 10.1016/j.apnr.2021.151409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/31/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Abstract
AIMS AND OBJECTIVES To explore the Chinese nurses' knowledge and attitudes concerning advance care planning (ACP) and their engagement in ACP practice. BACKGROUND Nurses' knowledge, attitude, and practice of ACP are important in promoting ACP in patients, but little is known about knowledge, attitudes, and practice of ACP among nurses in countries where there are no national policies or regulations on ACP. DESIGN A descriptive study with a cross-sectional design. METHODS An online questionnaire survey was distributed to Chinese nurses who attended a national conference. RESULTS A total of 531 nurses completed the survey and were included in the final analysis. No nurses answered all questions correctly, while 31 (5.8%) answered all the survey questions wrong. The participants were most knowledgeable about the item "Once ACP is made, the content of advance directives cannot be revoked" and were least knowledgeable about the item "ACP is valid only when the patients are well informed of the medical condition". The implementation of ACP was favored by 92.5% of participants, but only 3.4% of them had actually engaged in all 5 ACP practices listed in the survey. Experience of dealing with death was positively associated with nurses' knowledge concerning ACP. The number of dying patients cared for in the past 6 months, school education of palliative care, knowledge of ACP, and age were related to engagement in the practice of ACP. CONCLUSION Chinese nurses have supportive attitudes towards ACP, but they have limited knowledge and little practice in ACP.
Collapse
Affiliation(s)
- Qinqin Cheng
- Pain Management Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Xiangyu Liu
- Health Management Centre, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Xuying Li
- Nursing Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Limin Qing
- Head and Neck Surgical Department, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Qin Lin
- Vascular Access Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, PR China
| | - Shiwu Wen
- OMNI Research Group, Ottawa Hospital Research Institute; Department of Obstetrics and Gynecology and School of Epidemiology and Public Health, University of Ottaw Faculty of Medicine.
| | - Yongyi Chen
- Administrative Office, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, P.R. China.
| |
Collapse
|
35
|
Nishikawa Y, Sato K, Mizuno A, Sasano T, Yoshikawa S, Ogata Y. Realization and personalization by facing fatality: A grounded theory of developing the view of dying in people with heart failure. J Adv Nurs 2021; 77:2796-2806. [PMID: 33749858 DOI: 10.1111/jan.14826] [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] [Received: 10/08/2020] [Revised: 01/25/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022]
Abstract
AIM To explore how people with heart failure develop and change their views of dying and death. DESIGN A Straussian grounded theory approach. METHODS Purposive and theoretical sampling were used. Data collection and analysis were repeated until reaching data saturation using the constant comparative method. We conducted semi-structured interviews between January 2019 and July 2020 with 24 people with heart failure from a university and a community hospital in Japan. RESULTS Initially, participants' views of dying and death were unrelated to their disease. After the first turning point, namely the confirmation of the deterioration and incurability of the disease, their views became related to their own disease, adding to the suffering caused by the exacerbated symptoms. After the second turning point, namely when participants became tormented by the inevitability of death, they added their struggles with physical, psychological, and spiritual pain owing to medical interventions to their views of dying and death. Only a few participants reached the last stage of this process as it was emotionally distressing; some chose not to proceed to the next stage. CONCLUSION Participants develop their views of dying and death gradually and in stages while they experience two turning points. Healthcare providers need to address this process while keeping in mind that proceeding this process requires some turning points, and it can be painful. IMPACT This study provides a theoretical framework on the development of the views regarding dying and death of people with heart failure; it showed that these people need some turning points and to pass through stages to develop/individualize their views, and that this process is inherently distressing. This theory provides a cornerstone for healthcare professionals to understand the disease-specific transition in views of dying and psychological readiness, and it may help establish a therapeutic relationship that includes advance care planning.
Collapse
Affiliation(s)
- Yuri Nishikawa
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kana Sato
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan.,Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shunji Yoshikawa
- Department of Cardiology, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yasuko Ogata
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
36
|
Hasdianda MA, Gray TF, Bello JL, Ballaron B, Egorova NA, Berry DL, Ouchi K. Nurses' Perceptions of Facilitating Advance Care Planning Conversations in the Emergency Department. Palliat Med Rep 2021; 2:65-70. [PMID: 34223506 PMCID: PMC8241390 DOI: 10.1089/pmr.2020.0116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nurses are well positioned to initiate advance care planning (ACP) conversations because of their unique strength in communication and central patient-facing role in the interdisciplinary team. Nurse-led ACP conversations have demonstrated promising results in settings outside of the emergency department (ED). Understanding ED nurses' perspectives regarding ACP conversations is needed before implementing similar practices in the ED. Objective: To explore ED nurses' perception of facilitating ACP conversations. Design: We conducted a cross-sectional survey to assess ED nurses' perceptions of facilitating ACP conversations in the ED. Setting: ED nurses at one academic hospital and one community hospital located within the northeastern region of the United States. Results: Seventy-seven (53.1%) out of 145 eligible ED nurses completed the survey. All participants perceived ACP conversations in the ED as at least somewhat important. Forty (51.9%) felt somewhat comfortable in facilitating these conversations. The majority of participants (77.9%) agreed that a specially trained nurse consultation model might be helpful in the ED. We found a correlation between total clinical experience and interest in facilitating ACP conversations in the ED (p = 0.045). Conclusion: ED nurses are well positioned to help patients clarify their goals-of-care and end-of-life care preferences. They perceived ACP conversations to be important and felt comfortable to facilitate them in the ED. Additional studies are needed to empirically test its implementation.
Collapse
Affiliation(s)
- Mohammad Adrian Hasdianda
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Josephine Lo Bello
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Brittany Ballaron
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natasha A Egorova
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Donna L Berry
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts, USA
| |
Collapse
|
37
|
Sullivan SS, Mann C, Mullen S, Chang YP. Homecare nurses guide goals for care and care transitions in serious illness: A grounded theory of relationship-based care. J Adv Nurs 2021; 77:1888-1898. [PMID: 33502029 DOI: 10.1111/jan.14739] [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] [Received: 06/24/2020] [Revised: 11/17/2020] [Accepted: 12/09/2020] [Indexed: 12/27/2022]
Abstract
AIMS To identify the process that homecare nurses use when recognizing serious illness, engaging patients and families in goals-for-care discussions and guiding transitions to comfort-focused care. DESIGN Constructivist grounded theory. METHODS Semi-structured focus group interviews of 31 homecare Registered Nurses were recorded and transcribed (June-August 2019). Line-by-line coding using the constant comparative method until saturation was achieved and a grounded theory was identified. Credibility, transferability, and confirmability establish study rigor. RESULTS A grounded theory of relationship-based care. Nurses cogitate and act when recognizing serious illness. They have difficult conversations and support care transitions with wisdom and knowing, by identifying changes in illness trajectories and being informed and alert to diminishing quality of life. Nurses are skilled at engaging patients, families, and the team and accommodate care in the home for as long as possible, while manoeuvring through complex systems of care; ultimately relinquishing and guiding care to other providers and settings. However, nurses feel inadequately prepared and frustrated with a fragmented healthcare system and lack of collaboration among the team. CONCLUSION This study identifies a grounded theory to support clinical decision-making and position homecare nurses as leaders in guiding goal care discussions and transitions to comfort-focused care. These findings reinforce the importance of developing health policy that ensures care continuity in serious illness. Further research is needed to improve relationships across care settings and enhance training for the delivery of comfort-focused care in the home as changing needs emerge during serious illness management.
Collapse
Affiliation(s)
- Suzanne S Sullivan
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Catherine Mann
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Samantha Mullen
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Yu-Ping Chang
- School of Nursing, University at Buffalo, State University of New York, Buffalo, NY, USA
| |
Collapse
|
38
|
Kim H, Cho J, Park WS, Kim SS. Characteristics of Advance Care Planning Interventions Across Dementia Stages: A Systematic Review. J Nurs Scholarsh 2021; 53:180-188. [PMID: 33476479 DOI: 10.1111/jnu.12624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Little is known regarding how advance care planning (ACP) interventions change with the progression of dementia. Thus, the primary purpose of this systematic review is to compare characteristics of ACP interventions across dementia stages. We also identify the role of nurses in implementing ACP interventions for persons with dementia and their surrogates. DESIGN A systematic review of ACP intervention studies. METHODS After searching PubMed, Web of Science, EMBASE, PsycArticles, the Cumulative Index to Nursing and Allied Health Literture (CINAHL), and Scopus, the final sample included 11 studies representing 10 interventions. We conducted a quality assessment and extracted data on dementia stage, intervention characteristics, and the role of nurses in the intervention. The extracted data were categorized according to stages of dementia, and analyzed to identify commonalities and differences between intervention characteristics. FINDINGS Three ACP interventions focused on mild dementia and seven on advanced dementia. We observed four primary findings. First, we found a major difference in intervention recipients between the two dementia stages. Second, most ACP interventions included structured discussions regarding the person's life goals and values, goals of care, and preferences concerning future care via individual, face-to-face interactions. Third, ACP interventions designed to promote ongoing discussions and documentation were lacking. Finally, nurses played important roles in implementing ACP interventions. CONCLUSIONS The findings suggest more nurse-led, dementia-related ACP interventions. In addition, ACP interventions should promote ongoing discussions and documentation and target persons with dementia and their surrogates in various countries. CLINICAL RELEVANCE Many persons with dementia and their surrogates have limited knowledge about ACP; thus, more nurse-led ACP programs that reflect dementia stages may help them prepare for the situations in which persons with dementia lack decision-making capacity.
Collapse
Affiliation(s)
- Hyejin Kim
- Xi, Assistant Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Jeonghyun Cho
- Assistant Professor, College of Nursing, Institute for Health Science Research, Inje University, Busan, Republic of Korea
| | - Won Seok Park
- Assistant Direct (Librarian), Subject Information Service Team, Chung-Ang University, Seoul, Republic of Korea
| | - Sang Suk Kim
- Associate Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| |
Collapse
|
39
|
Kuusisto A, Santavirta J, Saranto K, Haavisto E. Healthcare professionals' perceptions of advance care planning in palliative care unit: a qualitative descriptive study. J Clin Nurs 2020; 30:633-644. [PMID: 33275801 DOI: 10.1111/jocn.15578] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To describe healthcare professionals' perceptions of advance care planning (ACP) in palliative care unit in hospital ward or outpatient clinic. BACKGROUND Clinical guidelines recommend timely ACP as a central component of patient-centred palliative care. However, the ACP concept and terminology have been judged to be confusing, and practices are not established. Professionals' views are needed for ACP adoption and usage. DESIGN Qualitative descriptive design. METHODS The study used purposive sampling. The data were collected through focus group interviews with registered nurses and practical nurses and individual or couple interviews with physicians and social workers. The data (n = 33) were analysed by inductive content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS Three main categories emerged: Information content of ACP, coordination of care activities through ACP, and support for patients' and family members' coping. The information content of ACP included assessment of need for patient care, preparing for changes in patient's state of health and proactive medication. Coordination of care activities through ACP contained ACP care planning, cooperation and work practices between healthcare professionals. Support for patients' and family members' coping included communication between patient, family members and professionals and promoting patient self-care. CONCLUSIONS ACP is a useful and proactive tool for integrating patient-centred information, care and services as well as support for patients' and family members' coping. Palliative care activities can be coordinated through ACP in a multidisciplinary manner. ACP is significant and relevant for both professionals' work and patient care throughout the service system. RELEVANCE TO CLINICAL PRACTICE Results highlight the importance of proactive, concrete and holistic ACP. ACP should be up to date to reflect patient's current wishes. Raising professional awareness and implementing ACP into work processes are essential. Results can be utilised in planning and implementing interprofessional in-service training.
Collapse
Affiliation(s)
- Anne Kuusisto
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
| | | | - Kaija Saranto
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Elina Haavisto
- Department of Nursing Science, University of Turku, Turku, Finland.,Satakunta Hospital District, Pori, Finland
| |
Collapse
|
40
|
Patel MI, Khateeb S, Coker T. Lay Health Workers' Perspectives on Delivery of Advance Care Planning and Symptom Screening Among Adults With Cancer: A Qualitative Study. Am J Hosp Palliat Care 2020; 38:1202-1211. [PMID: 33267632 DOI: 10.1177/1049909120977841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Advance care planning and symptom screening among patients with cancer require team-based approaches to ensure that these services are equitably and appropriately delivered. In several organizations across the United States, we trained and employed lay health workers (LHWs) to assist with delivering these services for patients with cancer. The aim of this study was to understand LHWs' views on delivering these services. METHODS We conducted semi-structured interviews with 22 LHWs in 6 US-based clinical cancer care settings in 4 large cities. We recorded, transcribed, and analyzed interviews using the constant comparative method of qualitative analysis. RESULTS Participants noted the importance of their role in assisting with the delivery of advance care planning (ACP) and symptom screening services. Participants noted the importance of developing relationships with patients to engage openly in ACP and symptom screening discussions. Participants reported that ongoing training provided skills and empowered them to discuss sensitive issues with patients and their caregivers. Participants described challenges in their roles including communication with oncology providers and their own emotional well-being. Participants identified solutions to these challenges including formal opportunities for introduction with oncology clinicians and staff and grievance sessions with LHWs and other team members. DISCUSSION LHWs from several organizations endorsed the importance of their roles in ensuring the delivery of ACP and proactive symptom screening. LHWs noted challenges and specific solutions to improve their effectiveness in delivering these important services to patients after their diagnosis of cancer.
Collapse
Affiliation(s)
- Manali I Patel
- Division of Oncology, 6429Stanford University School of Medicine, Stanford, CA, USA.,Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Primary Care and Outcomes Research/Health Research and Policy, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - Sana Khateeb
- Division of Oncology, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - Tumaini Coker
- Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, 12353University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
41
|
Cha E, Lee S, Lee J, Lee I. Health Personnel's Knowledge, Attitudes, and Self-Efficacy Related to Providing Palliative Care in Persons with Chronic Diseases. HAN'GUK HOSUP'ISU WANHWA UIRYO HAKHOE CHI = THE KOREAN JOURNAL OF HOSPICE AND PALLIATIVE CARE 2020; 23:198-211. [PMID: 37497473 PMCID: PMC10332728 DOI: 10.14475/kjhpc.2020.23.4.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/25/2020] [Accepted: 10/02/2020] [Indexed: 07/28/2023]
Abstract
Purpose The purpose of this study was to examine the relationships of knowledge, attitudes, and self-efficacy related to palliative care among health care providers (doctors and nurses) in order to provide a basis to develop a training program for health care providers. Methods A correlational and descriptive study design was used. Participants were recruited from a university-affiliated hospital located in Daejeon and an e-nurse community. After IRB approval, data were collected from July 12, 2018, to September 30, 2018. A total of 169 responses were finally analyzed using version SPSS 24. The data were analyzed in terms of descriptive statistics (frequency and percentage or mean and standard deviation, as appropriate), the t-test, analysis of variance (with the Duncan post hoc test), and Pearson correlation coefficients. Results Knowledge, attitudes, and self-efficacy were significantly higher in those who had received palliative care training or had been exposed to awareness-raising initiatives. There were positive relationships among knowledge, attitudes, and self-efficacy, with small to moderate effect sizes. Conclusion Palliative care training for health care professionals is necessary to meet patients' needs. Such programs should take into account not only knowledge about palliative care, but also ways to improve empathy and resolve ethical dilemmas. Interprofessional training would be an excellent option to share therapeutic goals and develop communication skills among multidisciplinary team members.
Collapse
Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Sojung Lee
- Department of Nursing, Korean Bible University, Seoul, Korea
| | - Jooseon Lee
- Department of Public Health, Chungnam National University Hospital, Daejeon, Korea
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Insil Lee
- College of Nursing, Chungnam National University, Daejeon, Korea
| |
Collapse
|
42
|
Chan HYL, Kwok AOL, Yuen KK, Au DKS, Yuen JKY. Association between training experience and readiness for advance care planning among healthcare professionals: a cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:451. [PMID: 33228655 PMCID: PMC7684716 DOI: 10.1186/s12909-020-02347-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/30/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Training has been found effective in improving healthcare professionals' knowledge, confidence, and skills in conducting advance care planning (ACP). However, the association between training and its actual practice in the clinical setting has not been well demonstrated. To fill this gap, this paper examines the association between their readiness for ACP, in terms of perceived relevancy of ACP with their clinical work, attitudes toward and confidence and willingness to perform it, based on the Theory Planned Behavior and relevant training experiences. METHODS An online survey about experiences about ACP of healthcare professionals, including physicians, nurses, social workers, and allied healthcare professionals, currently working in hospital and community care in Hong Kong was conducted. RESULTS Of 250 respondents, approximately half (52.0%) had received ACP-related training. Those with relevant training reported significantly more positive in the perceived clinical relevance, willingness, and confidence in conducting ACP and different levels of agreement with 19 out of the 25 statements in a questionnaire about attitudes toward ACP than those without (ps ≤ 0.001-0.05). Respondents who received training only in a didactic format reported a significantly lower level of confidence in conducting ACP than did others who received a blended mode of learning (p = 0.012). Notwithstanding significant differences between respondents with and without relevant training, respondents generally acknowledged their roles in initiating conversations and appreciated ACP in preventing decisional conflict in surrogate decision-making regardless of their training experience. CONCLUSIONS This paper revealed the association between training and higher level of readiness toward ACP among healthcare professionals. The findings showed that training is a predictor of their readiness for ACP in terms of perceived relevancy, willingness, and confidence. Those who had received training were less likely to consider commonly reported barriers such as time constraints, cultural taboos, and avoidance among patients and family members as hindrances to ACP implementation.
Collapse
Affiliation(s)
- Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, 7/F. Esther Lee Building, Hong Kong SAR, China.
| | - Annie Oi-Ling Kwok
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong SAR, China
| | - Kwok-Keung Yuen
- Department of Clinical Oncology, Queen Mary Hospital, Hong Kong SAR, China
| | - Derrick Kit-Sing Au
- CUHK Centre for Bioethics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jacqueline Kwan-Yuk Yuen
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
43
|
Lall P, Kang N, Tan WS, Dutta O, Patinadan PV, Low CK, Car J, Ho AHY. Competing expectations: Advance care planning from the perspectives of doctors and nurses in the South-East Asian context. DEATH STUDIES 2020; 46:1716-1727. [PMID: 33215980 DOI: 10.1080/07481187.2020.1848943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study qualitatively examines the perspectives of doctors and nurses on the implementation of the Advance Care Planning program in Singapore. Findings suggest that a combination of structural and conceptual factors hindered the performance of ACP. Themes on structural factors indicated that low awareness of ACP among senior staff resulted overall lack of buy-in and incorrect implementation of the program due to misconceptions. Conceptual factors pointed to lack of clarity on intended outcomes or roles. Consequently, participants drew meaning through the prism of their profession, resulting in competing expectations and tensions on possible outcomes of the program.
Collapse
Affiliation(s)
- Priya Lall
- International Institute for Rural Health, College of Social Science, University of Lincoln, Lincoln, UK
| | - Natalie Kang
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Woan Shin Tan
- Centre of Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore
| | - Oindrila Dutta
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Paul Victor Patinadan
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Chan Kee Low
- Economics Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Centre of Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Global Digital Health Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Andy Hau Yan Ho
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education (PalC), Singapore, Singapore
| |
Collapse
|
44
|
Development of a Japanese version of the Advance Care Planning Engagement Survey: Examination of its reliability and validity. Palliat Support Care 2020; 19:341-347. [PMID: 33118902 DOI: 10.1017/s1478951520001108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The importance of supporting advance care planning (ACP) by healthcare professionals is recognized worldwide, and assessing the outcomes, such as people's understanding and readiness for ACP, using an appropriate instrument is essential. We, therefore, developed a Japanese version of the Advance Care Planning Engagement Survey (ACP Engagement Survey; 15 items, 9 items, and 4 items), an international scale for assessing the progress of the ACP, and examined its validity and reliability. METHODS The ACP Engagement Survey was translated into Japanese, back-translated, and culturally adapted, and the final version was reviewed by the author of the original version. Data on basic demographic information and ACP-related experiences were simultaneously collected as external criteria in an online survey of older adults with chronic diseases. The Cronbach's alpha was calculated to assess its internal consistency, and a retest was performed three days later to calculate the intra-class correlation coefficients (ICCs). RESULTS A total of 200 respondents (mean age 70; 9.5% female) were included in the analysis. None of the items showed a ceiling effect, but several items did exhibit a floor effect. The factor structure was the same 2-factor structure as the original version, and both factors exhibited a high cumulative contribution rate. The Cronbach's alphas were 0.94 (15-item version), 0.91 (9-item version), and 0.95 (4-item version), and ICCs were of 0.88 (15-item version), 0.9 (9-item version), and 0.84 (4-item version). SIGNIFICANCE OF RESULTS The Japanese version of the ACP Engagement Survey was confirmed to have very good reliability regarding both internal consistency and test-retest reliability. Together with the result of the item analysis, we can conclude that the Japanese version of the ACP Engagement Survey is sufficiently reliable to be utilized in interventional studies, and it has acceptable content validity, construct validity, and criterion-related validity.
Collapse
|
45
|
McMahan RD, Tellez I, Sudore RL. Deconstructing the Complexities of Advance Care Planning Outcomes: What Do We Know and Where Do We Go? A Scoping Review. J Am Geriatr Soc 2020; 69:234-244. [PMID: 32894787 DOI: 10.1111/jgs.16801] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/30/2020] [Accepted: 08/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVES Advance care planning (ACP) has shown benefit in some, but not all, studies. It is important to understand the utility of ACP. We conducted a scoping review to identify promising interventions and outcomes. DESIGN Scoping review. MEASUREMENTS We searched MEDLINE/PubMed, EMBASE, CINAHL, PsycINFO, and Web of Science for ACP randomized controlled trials from January 1, 2010, to March 3, 2020. We used standardized Preferred Reporting Items for Systematic Review and Meta-Analyses methods to chart study characteristics, including a standardized ACP Outcome Framework: Process (e.g., readiness), Action (e.g., communication), Quality of Care (e.g., satisfaction), Health Status (e.g., anxiety), and Healthcare Utilization. Differences between arms of P < .05 were deemed positive. RESULTS Of 1,464 articles, 69 met eligibility; 94% were rated high quality. There were variable definitions, age criteria (≥18 to ≥80 years), diseases (e.g., dementia and cancer), and settings (e.g., outpatient and inpatient). Interventions included facilitated discussions (42%), video only (20%), interactive, multimedia (17%), written only (12%), and clinician training (9%). For written only, 75% of primary outcomes were positive, as were 69% for multimedia programs; 67% for facilitated discussions, 59% for video only, and 57% for clinician training. Overall, 72% of Process and 86% of Action outcomes were positive. For Quality of Care, 88% of outcomes were positive for patient-surrogate/clinician congruence, 100% for patients/surrogate/clinician satisfaction with communication, and 75% for surrogate satisfaction with patients' care, but not for goal concordance. For Health Status outcomes, 100% were positive for reducing surrogate/clinician distress, but not for patient quality of life. Healthcare Utilization data were mixed. CONCLUSION ACP is complex, and trial characteristics were heterogeneous. Outcomes for all ACP interventions were predominantly positive, as were Process and Action outcomes. Although some Quality of Care and Health Status outcomes were mixed, increased patient/surrogate satisfaction with communication and care and decreased surrogate/clinician distress were positive. Further research is needed to appropriately tailor interventions and outcomes for local contexts, set appropriate expectations of ACP outcomes, and standardize across studies.
Collapse
Affiliation(s)
- Ryan D McMahan
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Ismael Tellez
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Health Care System, San Francisco, California
| |
Collapse
|
46
|
Dowling T, Kennedy S, Foran S. Implementing advance directives-An international literature review of important considerations for nurses. J Nurs Manag 2020; 28:1177-1190. [PMID: 32663341 DOI: 10.1111/jonm.13097] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022]
Abstract
AIM(S) To review the global literature on the implementation of advance health care directives to date, and the experiences of the health care professionals who must initiate the discussions around advance care planning, as well as support patients' ultimate decisions. BACKGROUND Ireland's Assisted Decision-Making (Capacity) Act 2015 legalizes advance health care directives. It promotes the autonomy of the person and enables them to have treatment in accordance with their will and preferences. However, there is professional uncertainty on how to support and integrate assisted decision-making. EVALUATION 16 studies featuring the views of health care professionals are included and evaluated using a framework of 'benefits versus challenges'. KEY ISSUE(S) Four themes clearly emerge during the review process: the concept of capacity and who decides; autonomy versus paternalism-conflict among the health care professional/patient/family caregiver triad; barriers to advance directives; and timing issues. CONCLUSION(S) Significant benefits of advance health care directives exist for all parties including less stress for patients and families alike, less burden and less residual guilt for surviving relatives, and an over-arching prevention of 'crisis' decision-making. IMPLICATIONS FOR NURSING MANAGEMENT This review highlights the central role of the nurse in empowering patients to express their wills and preferences, supporting patients' capacity to make decisions about their own care, initiating end-of-life care discussions and advocating to have advance health care directives acknowledged. Moreover, it identifies the challenges ahead for all nurse managers in implementing this new mandate.
Collapse
Affiliation(s)
- Teresa Dowling
- Department of Nursing & Healthcare, Waterford Institute of Technology, Waterford, Ireland
| | - Sara Kennedy
- Department of Nursing & Healthcare, Waterford Institute of Technology, Waterford, Ireland
| | - Sinead Foran
- Department of Nursing & Healthcare, Waterford Institute of Technology, Waterford, Ireland
| |
Collapse
|
47
|
Gilissen J, Pivodic L, Wendrich-van Dael A, Cools W, Vander Stichele R, Van den Block L, Deliens L, Gastmans C. Nurses' self-efficacy, rather than their knowledge, is associated with their engagement in advance care planning in nursing homes: A survey study. Palliat Med 2020; 34:917-924. [PMID: 32383636 DOI: 10.1177/0269216320916158] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Considering social cognitive theory and current literature about successful advance care planning in nursing homes, sufficient knowledge and self-efficacy are important preconditions for staff to be able to carry out advance care planning in practice. AIM Exploring to what extent nurses' knowledge about and self-efficacy is associated with their engagement in advance care planning in nursing homes. DESIGN Survey study as part of a baseline measurement of a randomised controlled cluster trial (NCT03521206). SETTING/PARTICIPANTS Nurses in a purposive sample of 14 nursing homes in Belgium. METHODS A survey was distributed among nurses, evaluating knowledge (11 true/false items), self-efficacy (12 roles and tasks on 10-point Likert-type scale) and six advance care planning practices (yes/no), ranging from performing advance care planning conversations to completing advance directives. RESULTS A total of 196 nurses participated (66% response rate). While knowledge was not significantly associated with advance care planning practices, self-efficacy was. One unit's increase in self-efficacy was statistically associated with an estimated 32% increase in the number of practices having carried out. CONCLUSIONS Nurses' engagement in advance care planning practices is mainly associated with their self-efficacy rather than their knowledge. Further research is necessary to improve the evidence regarding the causal relationship between constructs. However, these results suggest that educational programmes that focus solely on knowledge might not lead to increasing uptake of advance care planning in nurses.
Collapse
Affiliation(s)
- Joni Gilissen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Interfaculty Center for Data Processing and Statistics (ICDS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Annelien Wendrich-van Dael
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Wilfried Cools
- Interfaculty Center for Data Processing and Statistics (ICDS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | | | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| |
Collapse
|
48
|
Khairuddin NNB, Lau ST, Ang WHD, Tan PH, Goh ZWD, Ang NKE, Lau Y. Implementing advance care planning: A qualitative exploration of nurses' perceived benefits and challenges. J Nurs Manag 2020; 28:1080-1087. [DOI: 10.1111/jonm.13056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Nur Nadhirah Binte Khairuddin
- Department of Nursing Khoo Teck Puat Hospital Yishun Health Campus National Healthcare Group Singapore City Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Poh Hoon Tan
- Alexandra Hospital National University Health System Singapore City Singapore
| | | | - Neo Kim Emily Ang
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies Yong Loo Lin School of Medicine National University of Singapore Singapore City Singapore
| |
Collapse
|
49
|
Raftery C, Lewis E, Cardona M. The Crucial Role of Nurses and Social Workers in Initiating End-of-Life Communication to Reduce Overtreatment in the Midst of the COVID-19 Pandemic. Gerontology 2020; 66:427-430. [PMID: 32516766 PMCID: PMC7316661 DOI: 10.1159/000509103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/30/2020] [Indexed: 11/19/2022] Open
Abstract
The large scale and rapid spread of the current COVID-19 pandemic has changed the way hospitals and other health services operate. Opportunities for patient-centered decision-making at the end of life are being jeopardized by a scarcity of health system resources. In response, the traditional doctor-initiated advanced care planning (ACP) for critical illness may also need to be readjusted. We propose nurse-led and allied health-led ACP discussions to ensure patient and family inclusion and understanding of the disease prognosis, prevention of overtreatment, and potential outcomes in crisis times. We highlight known barriers and list enablers, long-term and short-term opportunities to assist in the culture change.
Collapse
Affiliation(s)
- Chris Raftery
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Ebony Lewis
- School of Public Health and Community Medicine, The Universityof New South Wales, Randwick, New South Wales, Australia.,School of Psychology, The University of New South Wales, Randwick, New South Wales, Australia
| | - Magnolia Cardona
- Gold Coast Hospital and Health Service, Southport, Queensland, Australia, .,Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia,
| |
Collapse
|
50
|
Fretwell C, Worlock P, Gleeson A. Delivering an advance care planning facilitated model. Int J Palliat Nurs 2020; 25:264-273. [PMID: 31242092 DOI: 10.12968/ijpn.2019.25.6.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Advance care planning is increasingly recognised as an integral part of achieving excellence at the end of life (EoL), but barriers still prevent individuals from having the opportunity to discuss their wishes and preferences for the future. AIM To describe the development and initial evaluations of an innovative facilitated ACP model, the ACP Triple E, which empowers individuals through education to engage in ACP conversations. METHODS This model uses a collaborative approach involving all sectors of a large university health board to equip all health and social care professionals with the knowledge, skills and confidence to engage in ACP discussion and also raise public awareness of the benefits of ACP. CONCLUSION This model includes recognised elements that support successful implementation of ACP. Initial evaluations of the model are extremely positive. Further analysis of the data is now needed to evaluate the model's flexibility and its ability to change practice and achieve strategic objectives.
Collapse
Affiliation(s)
- Christine Fretwell
- Advance Care Planning Facilitator, Aneurin Bevan University Health Board, Wales
| | - Pat Worlock
- Advance Care Planning Facilitator, Aneurin Bevan University Health Board, Wales
| | - Aoife Gleeson
- Palliative Care Consultant, Aneurin Bevan University Health Board, Wales
| |
Collapse
|