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Mathew T, Patel A, DiGrande K, Michelis ND, Mody B, Lombardo D. Improving Advance Care Planning for Hospitalized Patients With Heart Failure. Palliat Med Rep 2023; 4:339-343. [PMID: 38155912 PMCID: PMC10754343 DOI: 10.1089/pmr.2023.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 12/30/2023] Open
Abstract
Advance care planning (ACP) is a valuable and proven approach for enhancing end-of-life communication and quality of life for individuals with heart failure (HF) and their family members. However, the adoption of ACP in practice is still lower than desired. According to University of California, Irvine Medical Center HF metrics, only 15.3% of hospitalized HF patients had completed ACP documentation before discharge, as recorded in the electronic medical record (EMR). This quality improvement project aimed to investigate whether the rate of ACP completion could be increased by utilizing EMR reminders to health care teams regarding individual patients. Personalized reminders were sent to providers for each hospitalized patient diagnosed with HF, who did not have existing ACP documentation in the EMR, to encourage completion of ACP documentation. Our findings have shown that, during the three-month intervention period, the average ACP completion rate was 21.0%. This represents a 5.7% absolute increase in ACP completion compared to the six months before our intervention (15.3%); a relative increase of 37.3%. Direct message reminders to providers prove to be an effective method for enhancing ACP completion among this specific patient group.
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Affiliation(s)
- Tobin Mathew
- Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California, USA
| | - Akash Patel
- Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California, USA
| | - Kyle DiGrande
- Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California, USA
| | - Nathalie De Michelis
- Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California, USA
| | - Behram Mody
- Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California, USA
| | - Dawn Lombardo
- Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California, USA
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Mohan D, O'Malley AJ, Chelen J, MacMartin M, Murphy M, Rudolph M, Engel JA, Barnato AE. Using a Video Game Intervention to Increase Hospitalists' Advance Care Planning Conversations with Older Adults: a Stepped Wedge Randomized Clinical Trial. J Gen Intern Med 2023; 38:3224-3234. [PMID: 37429972 PMCID: PMC10651818 DOI: 10.1007/s11606-023-08297-y] [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: 01/01/2023] [Accepted: 06/16/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Guidelines recommend Advance Care Planning (ACP) for seriously ill older adults to increase the patient-centeredness of end-of-life care. Few interventions target the inpatient setting. OBJECTIVE To test the effect of a novel physician-directed intervention on ACP conversations in the inpatient setting. DESIGN Stepped wedge cluster-randomized design with five 1-month steps (October 2020-February 2021), and 3-month extensions at each end. SETTING A total of 35/125 hospitals staffed by a nationwide physician practice with an existing quality improvement initiative to increase ACP (enhanced usual care). PARTICIPANTS Physicians employed for ≥ 6 months at these hospitals; patients aged ≥ 65 years they treated between July 2020-May 2021. INTERVENTION Greater than or equal to 2 h of exposure to a theory-based video game designed to increase autonomous motivation for ACP; enhanced usual care. MAIN MEASURE ACP billing (data abstractors blinded to intervention status). RESULTS A total of 163/319 (52%) invited, eligible hospitalists consented to participate, 161 (98%) responded, and 132 (81%) completed all tasks. Physicians' mean age was 40 (SD 7); most were male (76%), Asian (52%), and reported playing the game for ≥ 2 h (81%). These physicians treated 44,235 eligible patients over the entire study period. Most patients (57%) were ≥ 75; 15% had COVID. ACP billing decreased between the pre- and post-intervention periods (26% v. 21%). After adjustment, the homogeneous effect of the game on ACP billing was non-significant (OR 0.96; 95% CI 0.88-1.06; p = 0.42). There was effect modification by step (p < 0.001), with the game associated with increased billing in steps 1-3 (OR 1.03 [step 1]; OR 1.15 [step 2]; OR 1.13 [step 3]) and decreased billing in steps 4-5 (OR 0.66 [step 4]; OR 0.95 [step 5]). CONCLUSIONS When added to enhanced usual care, a novel video game intervention had no clear effect on ACP billing, but variation across steps of the trial raised concerns about confounding from secular trends (i.e., COVID). TRIAL REGISTRATION Clinicaltrials.gov; NCT04557930, 9/21/2020.
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Affiliation(s)
- Deepika Mohan
- Department of Critical Care Medicine, University of Pittsburgh, Room 638 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice and Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Julia Chelen
- Advanced Communications Research Group, National Institute of Standards and Technology, U.S. Department of Commerce, Boulder, CO, USA
| | - Meredith MacMartin
- Department of Medicine and The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Megan Murphy
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Jaclyn A Engel
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy & Clinical Practice and Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Kim J, Heo S, Yang J, Kim M, Park S, Cho K, Kang J, Yi H, An M. The moderating effect of attitudes in the relationship between knowledge and self-efficacy in palliative care among nurses: A cross-sectional, correlational study. PLoS One 2023; 18:e0292135. [PMID: 37796889 PMCID: PMC10553266 DOI: 10.1371/journal.pone.0292135] [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: 05/19/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
Provision of palliative care to patients with advanced chronic diseases or old populations is suboptimal, which results in unnecessary suffering of and burden to patients, caregivers, and society. Low self-efficacy in palliative care among nurses is a factor affecting suboptimal utilization of palliative care. Poor knowledge is a factor affecting low self-efficacy in palliative care of nurses. Attitudes may contribute to the relationship between knowledge and self-efficacy in palliative care, but these relationships have been rarely examined in nurses. This study aimed to determine whether nurses' attitudes moderate the relationship between knowledge and self-efficacy in palliative care. In a cross-sectional, correlational study, online or offline survey on self-efficacy, knowledge, attitudes, and covariates was conducted from 282 nurses in South Korea. PROCESS v4.1 for SPSS was used to address the study aim. Higher levels of knowledge (p = .048) and attitudes (p < .001), and the interaction term of knowledge and attitudes (p = .025) were significantly associated with higher levels of self-efficacy (F = 6.12, p < .001, R2 = .152), indicating the moderating effects of attitudes. The relationships between higher levels of knowledge and self-efficacy were significant only in nurses with highly and moderately positive attitudes (R2 change = .016, F = 5.11, p = .025), but not nurses with lack of positive attitudes. Our results supported the moderating role of nurses' attitudes in the relationship between knowledge and self-efficacy. To improve self-efficacy in palliative care in nurses, improvement in knowledge and facilitation of positive attitudes are needed.
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Affiliation(s)
- JinShil Kim
- College of Nursing, Gachon University, Incheon, South Korea
| | - Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, United States of America
| | - Jisun Yang
- College of Nursing, Gachon University, Incheon, South Korea
| | - Miyeong Kim
- Department of Nursing, Gachon University Gil Medical Center, Incheon, Korea
| | - SeongHu Park
- College of Nursing Sciences, Sungshin Women’s University, Seoul, South Korea
| | - KyungAh Cho
- College of Nursing, Gachon University, Incheon, South Korea
| | - JungHee Kang
- College of Nursing, University of Kentucky, Lexington, Kentucky, United States of America
| | - Hani Yi
- Department of Nursing, Asan Medical Center, Seoul, South Korea
| | - Minjeong An
- College of Nursing, Chonnam National University, Gwangju, South Korea
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Ayre E, Lee JJ, Frie K, Aveyard P, Albury CVA. GP delivered brief weight loss advice: associations between in-consultation behaviour change techniques and patient weight loss in recorded primary care discussions. Health Psychol Behav Med 2023; 11:2213751. [PMID: 37223642 PMCID: PMC10201997 DOI: 10.1080/21642850.2023.2213751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/05/2023] [Indexed: 05/25/2023] Open
Abstract
Background Primary care clinicians are encouraged to intervene opportunistically, offering weight-loss advice to people living with obesity. The BWeL trial showed patients receiving brief weight-loss advice from their general practitioner lost weight at one year follow-up. We examined the behaviour change techniques (BCTs) clinicians used to identify which BCTs are associated with this weight loss. Methods We coded 224 audio recorded interventions from the BWeL trial using the behavioural change techniques version one taxonomy (BCTTv1) and the 'refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours' (CALOR-RE taxonomy). Linear and logistic regressions were performed to analyse associations between behaviour change techniques used in these taxonomies and patient weight loss. Results Mean intervention length was 86 s. We identified 28 different BCTs BCTTv1 and 22 from CALOR-RE. No BCTs or BCT domains were associated with mean weight loss at 12 months, loss of 5% bodyweight, or action taken at 3 months. The BCT 'Feedback on outcomes of behaviour (future)' was associated with an increased likelihood that the patient reported taking action to lose weight by 12 months (OR = 6.10, 95%CI = 1.20, 31.0). Conclusion Although we found no evidence to support the use of particular BCTs, our results suggest that it is the brief intervention itself, rather than specific content, which may motivate weight loss. This can support clinicians to confidently intervene without needing complex training. Offering follow-up appointments can support positive changes to health behaviours, even if these are not associated with weight loss.
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Affiliation(s)
- Eleanor Ayre
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joseph J. Lee
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kerstin Frie
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Aveyard
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Lee JH, Hwang KK. End-of-Life Care for End-stage Heart Failure Patients. Korean Circ J 2022; 52:659-679. [PMID: 36097835 PMCID: PMC9470494 DOI: 10.4070/kcj.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022] Open
Abstract
Although recent heart failure (HF) guidelines highlight integrative palliative care, including end-of-life (EOL), appropriate discussing EOL issues can be challenging due to possibility of unexpected deterioration throughout HF trajectory. Open communication and discussions with multidisciplinary team are important for setting patient and family expectations and establishing mutually agreed goals of care based firmly on the patient’s ‘human dignity’ and ‘right to self-determination.’ Especially when quality-of-life outweighs expanding quantity-of-life, transition to EOL care should be considered. Advanced care planning including resuscitation, device deactivation, site for last days, and bereavement support should focus on ensuring a good death, and be reviewed regularly. Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.
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Affiliation(s)
- Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
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Effects of Targeted Intervention plus Comprehensive Nursing on the Quality of Life and Nursing Satisfaction in Multiple Traumas. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:8929418. [PMID: 35836828 PMCID: PMC9276470 DOI: 10.1155/2022/8929418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the effect of targeted intervention plus comprehensive nursing on quality of life and nursing satisfaction of patients with multiple traumas. Methods Totally 68 cases with multiple traumas admitted to Xishan People's Hospital from September 2018 to September 2019 were recruited and randomized into a control group and a study group via the random number table method, with 34 cases in each group. The control group received conventional nursing, and the study group adopted targeted intervention plus comprehensive nursing. Results The study group showed significantly lower life scores and Hospital Anxiety and Depression Scale (HADS) scores after the intervention, as compared to the control group. The average Newcastle Nursing Service Satisfaction Scale (NSNS) scores, various self-care ability scores, and comprehensive self-care ability scores were higher than those of the control group. Significantly lower Numerical Rating Scale (NRS) scores were observed in the study group at 7 d and 10 d of intervention than those of the control group. Conclusion Targeted intervention plus comprehensive nursing enhances the quality of life of patients and nursing satisfaction, which merits clinical promotion.
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Stevens J, Deliens L, Pype P, De Vleminck A, Pardon K. Complex advance care planning interventions for chronic serious illness: how do they work: a scoping review. BMJ Support Palliat Care 2021; 12:bmjspcare-2021-003310. [PMID: 34610911 PMCID: PMC9380502 DOI: 10.1136/bmjspcare-2021-003310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/02/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Advance care planning (ACP) interventions have the potential to improve outcomes for patients with chronic serious illness. Yet the rationale for outcome choices and the mechanisms by which outcomes are achieved are not always clear. OBJECTIVES To identify and map proposed mechanisms on how complex ACP interventions can impact outcomes for patients with chronic serious illness and to explore factors that might explain intervention outcomes. METHODS This is a scoping review of randomised controlled trials of complex ACP interventions for patients with chronic serious illness which explicitly stated the mechanism(s) by which the intervention was thought to work. We searched six databases and hand-searched key journals and reference lists. RESULTS Inclusion yielded 16 articles. Inclusion procedures and mapping of mechanisms and outcomes indicated that causality between components and outcomes was not always clearly described. Tailoring intervention content to patients' needs was linked to the greatest number of different outcome categories, while promoting competence and confidence to engage in ACP was most often explicitly linked to a primary outcome. Three main factors which might have affected intended outcomes were identified: participant characteristics, such as illness experience or cultural differences; the setting of implementation; or methodological limitations of the study. CONCLUSION Findings highlighted two main points of consideration for future ACP intervention studies: the need for clearly stated logic in how interventions are expected to impact primary outcomes and the importance of considering how an intervention may function for patients with chronic serious illnesses within a specific setting.
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Affiliation(s)
- Julie Stevens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Luc Deliens
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Pype
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Aline De Vleminck
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Koen Pardon
- Vrije Universiteit Brussel (VUB) & Ghent University, End-of-life Care Research Group, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Fernández-Rodríguez Á, Molina-Mula J, Sarabia-Cobo C. Educational intervention: Improving the knowledge and attitudes of health professionals on living wills. NURSE EDUCATION TODAY 2021; 105:105016. [PMID: 34237513 DOI: 10.1016/j.nedt.2021.105016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/20/2021] [Accepted: 06/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Health professionals have limited knowledge of advanced directives or living wills, which may hamper understandings among the general population. This could impact on the current low registration rates for advanced directives. OBJECTIVE To evaluate a single-group educational intervention to improve the knowledge and attitudes concerning advanced directives in the short and medium term among health professionals working in nursing homes for older adults. DESIGN An educational intervention was carried out. SETTINGS Fourteen nursing homes in Cantabria, Spain. PARTICIPANTS 201 healthcare professionals. METHODS A theoretical presentation, questions and debates took place between November 2018 and May 2019. Baseline, post-intervention, and follow-up measurements were made to evaluate knowledge and attitudes towards advanced directives. Descriptive and inferential statistical analyses were performed using the Student's t-test and the one-factor ANOVA. ETHICAL CONSIDERATIONS This study was approved by the Clinical Research Ethics Committee of Cantabria. FINDINGS No statistically significant differences were found for any of the socio-demographic variables at baseline, post-intervention, or follow-up. In relation to the baseline questionnaire, knowledge and attitudes increased after the intervention (p = .000 for both blocks of questions) as well as in the follow-up questionnaire (p = .000 for both blocks). DISCUSSION A single-group educational intervention increases knowledge and improves attitudes towards advanced directives. Educated professionals can become health agents in this area, which can lead to an increase in the registration of advanced directives. CONCLUSIONS Educational interventions represent a cost-effective measure that may provide benefits at the end of life for patients and their families, as well as for the healthcare team.
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Affiliation(s)
| | - Jesús Molina-Mula
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Mallorca, Spain
| | - Carmen Sarabia-Cobo
- Faculty of Nursing, University of Cantabria; IDIVAL Nursing Research Group, Santander, Spain
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De Panfilis L, Veronese S, Bruzzone M, Cascioli M, Gajofatto A, Grasso MG, Kruger P, Lugaresi A, Manson L, Montepietra S, Patti F, Pucci E, Solaro C, Giordano A, Solari A. Study protocol on advance care planning in multiple sclerosis (ConCure-SM): intervention construction and multicentre feasibility trial. BMJ Open 2021; 11:e052012. [PMID: 34389580 PMCID: PMC8365819 DOI: 10.1136/bmjopen-2021-052012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/02/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is the most common cause of progressive neurological disability in young adults. The use of advance care planning (ACP) for people with progressive MS (pwPMS) remains limited. The ConCure-SM project aims to assess the effectiveness of a structured ACP intervention for pwPMS. The intervention consists of a training programme on ACP for healthcare professionals caring for pwPMS, and a booklet to be used during the ACP conversation. Herein, we describe the first two project phases. METHODS In phase 1 we translated and adapted, to the Italian legislation and MS context, the ACP booklet of the National ACP Programme for New Zealand. Acceptability, comprehensibility and usefulness of the booklet were assessed via 13 personal cognitive interviews with pwPMS and significant others (SOs), and one health professional focus group. Based on these findings, we will revise the booklet. In phase 2 we will conduct a single-arm pilot/feasibility trial with nested qualitative study. Participants will be 40 pwPMS, their SOs, health professionals from six MS and rehabilitation centres in Italy. In the 6 months following the ACP conversation, we will assess completion of an advance care plan document (primary outcome), as well as safety of the intervention. Secondary outcomes will be a range of measures to capture the full process of ACP; patient-carer congruence in treatment preferences; quality of patient-clinician communication and caregiver burden. A qualitative process evaluation will help understand the factors likely to influence future implementation and scalability of the intervention. ETHICS AND DISSEMINATION The project is coleaded by a neurologist and a bioethicist. Phase 1 has received ethical approvals from each participating centre, while phase 2 will be submitted to the centres in May 2021. Findings from both phases will be disseminated widely through peer-reviewed publications, conferences and workshops. TRIAL REGISTRATION NUMBER ISRCTN48527663; Pre-results.
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Affiliation(s)
| | | | | | - Marta Cascioli
- Hospice "La Torre sul Colle", USL Umbria 2, Spoleto (PG), Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Unit of Neurology, Borgo Roma Hospital, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Paola Kruger
- EUPATI Fellow (European Patients Academy for Therapeutic Innovation) Italy, Roma, Italy
| | - Alessandra Lugaresi
- UOSI Riabilitazione Sclerosi Multipla, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Leigh Manson
- New Zealand Health Quality and Safety Commission, Nelson, New Zealand
| | - Sara Montepietra
- Multiple Sclerosis Center, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Patti
- Multiple Sclerosis Center, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Claudio Solaro
- Department of Rehabilitation, M.L. Novarese Hospital, Moncrivello (VC), Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Fomin IV, Vinogradova NG, Polyakov DS, Pogrebetskaya VA. Experience of introducing a new form of organization of medical care for patients with heart failure in the Russian Federation. ACTA ACUST UNITED AC 2021; 61:42-51. [PMID: 33849418 DOI: 10.18087/cardio.2021.3.n1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/27/2021] [Indexed: 11/18/2022]
Abstract
Aim To present clinical characteristics of patients after hospitalization for acute decompensated heart failure (ADHF) and to analyze hemodynamic indexes and compliance with the treatment at two years depending on the conditions of outpatient follow-up.Material and methods The study included 942 patients with chronic heart failure (CHF) older than 18 years who had been hospitalized for ADHF. Based on patients' decisions, two groups were isolated: patients who continued the outpatient follow-up at the Center of CHF (CCHF) (group 1, n=510) and patients who continued the follow-up in outpatient multidisciplinary clinics (OMC) at their place of residence (group 2, n=432). The clinical portrait of patients was evaluated after ADHF, and hemodynamic parameters were evaluated on discharge from the hospital. Also, the patient compliance with the treatment was analyzed during two years of follow-up. Statistical analysis was performed with Statistica 7.0 for Windows.Results The leading causes for CHF included arterial hypertension, ischemic heart disease, atrial fibrillation, and type 2 diabetes mellitus. With the mean duration of hospitalization of 11 inpatient days, 88.1 % and 88.4 % of patients of groups 1 and 2 were discharged with complaints of shortness of breath; 62 % and 70.4 % complained of palpitations; and 73.6 % and 71.8 % complained of general weakness. On discharge from the hospital, the following obvious signs of congestion remained: peripheral edema in 54.3 % and 57.9 %; pulmonary rales in 28.8 % and 32.4 %; orthopnea in 21.4 % and 26.2 %; and cough in 16,5 % and 15.5 % of patients of groups 1 and 2, respectively. For the time of hospitalization, CHF patients did not achieve their targets of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR). Patients of group 1 achieved the recommended values of SBP, DBP and HR already at one year of the follow-up at CCHF. Patients of group 2 had no significant changes in hemodynamic indexes. At one and two years of the follow-up, group 2 showed a considerable impairment of the compliance with the basis therapy for CHF compared to group 1.Conclusions During the short period of hospitalization (11 inpatient days), the patients retained pronounced symptoms of HF and clinical signs of congestion and did not achieve their hemodynamic targets. The patients who were followed up for a long time at CCHF were more compliant with the basis therapy, which resulted in improvement of hemodynamic indexes, compared to the patients who were managed in OMS at the place of residence.
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Affiliation(s)
- I V Fomin
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
| | - N G Vinogradova
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia City Clinical Hospital #38, Nizhny Novgorod, Russia
| | - D S Polyakov
- Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia
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Yen CC, Lin CP, Su YT, Tsu CH, Chang LM, Sun ZJ, Lin BS, Wu JS. The Characteristics and Motivations of Taiwanese People toward Advance Care Planning in Outpatient Clinics at a Community Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062821. [PMID: 33802074 PMCID: PMC7999986 DOI: 10.3390/ijerph18062821] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
Advance care planning (ACP) provides access to complete advance decisions (ADs). Despite the legalization of ACP in Taiwan, it is underutilized in community settings. The objective of this study is to describe the service at a community hospital in Southern Taiwan. We retrospectively analyzed participants who were engaged in ACP consultations from January 2019 to January 2020. The characteristics, motivations, content, and satisfaction of participants are reported. Factors associated with refusing life-sustaining treatments (LST) or artificial nutrition/hydration (ANH) were analyzed using multivariate logistic regression. Of the 178 participants, 123 completed the ACP. The majority were female (64.2%), aged 61 on average and more than 80% had never signed a do-not-resuscitate order. In the ADs, most participants declined LST (97.2%) and ANH (96.6%). Family-related issues (48.9%) were the most prevalent motivations. Rural residence (OR 8.6, p = 0.005), increased age (OR 7.2, p = 0.025), and reluctance to consent to organ donation (OR 5.2, p = 0.042) correlated with refusing LST or ANH. Participants provided a positive feedback regarding overall satisfaction (good, 83%) compared to service charge (fair/poor, 53%). The study demonstrated high AD completion when refusing LST or ANH. These findings may facilitate the development of ACP as a community-based service.
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Affiliation(s)
- Chih-Chieh Yen
- Division of Hematology/Oncology, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan;
- Institute of Clinical Medicine, School of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Cheng-Pei Lin
- Institute of Community Health Care, School of Nursing, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
| | - Yu-Ting Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Chiu-Hua Tsu
- Department of Social Work, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan;
| | - Li-Mei Chang
- Department of Nursing, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan;
| | - Zih-Jie Sun
- Division of Family Medicine, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan; (Z.-J.S.); (B.-S.L.)
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Bing-Sheng Lin
- Division of Family Medicine, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan; (Z.-J.S.); (B.-S.L.)
| | - Jin-Shang Wu
- Division of Family Medicine, Department of Internal Medicine, Douliou Branch, National Cheng Kung University Hospital, Yunlin 640, Taiwan; (Z.-J.S.); (B.-S.L.)
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Correspondence:
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12
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Preferences on the Timing of Initiating Advance Care Planning and Withdrawing Life-Sustaining Treatment between Terminally-Ill Cancer Patients and Their Main Family Caregivers: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217954. [PMID: 33138212 PMCID: PMC7662916 DOI: 10.3390/ijerph17217954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/29/2022]
Abstract
Background: The Western individualistic understanding of autonomy for advance care planning is considered not to reflect the Asian family-centered approach in medical decision-making. The study aim is to compare preferences on timing for advance care planning initiatives and life-sustaining treatment withdrawal between terminally-ill cancer patients and their family caregivers in Taiwan. Methods: A prospective study using questionnaire survey was conducted with both terminally-ill cancer patient and their family caregiver dyads independently in inpatient and outpatient palliative care settings in a tertiary hospital in Northern Taiwan. Self-reported questionnaire using clinical scenario of incurable lung cancer was employed. Descriptive analysis was used for data analysis. Results: Fifty-four patients and family dyads were recruited from 1 August 2019 to 15 January 2020. Nearly 80% of patients and caregivers agreed that advance care planning should be conducted when the patient was at a non-frail stage of disease. Patients’ frail stage of disease was considered the indicator for life-sustaining treatments withdrawal except for nutrition and fluid supplements, antibiotics or blood transfusions. Patient dyads considered that advance care planning discussions were meaningful without arousing emotional distress. Conclusion: Patient dyads’ preferences on the timing of initiating advance care planning and life-sustaining treatments withdrawal were found to be consistent. Taiwanese people’s medical decision-making is heavily influenced by cultural characteristics including relational autonomy and filial piety. The findings could inform the clinical practice and policy in the wider Asia–Pacific region.
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Love KR, Karin E, Morogo D, Toroitich F, Boit JM, Tarus A, Barasa FA, Goldstein NE, Koech M, Vedanthan R. "To Speak of Death Is to Invite It": Provider Perceptions of Palliative Care for Cardiovascular Patients in Western Kenya. J Pain Symptom Manage 2020; 60:717-724. [PMID: 32437947 DOI: 10.1016/j.jpainsymman.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/02/2023]
Abstract
CONTEXT Cardiovascular disease (CVD) is the leading cause of death globally and a significant health burden in Kenya. Despite improved outcomes in CVD, palliative care has limited implementation for CVD in low-income and middle-income countries. This may be partly because of providers' perceptions of palliative care and end-of-life decision making for patients with CVD. OBJECTIVES Our goal was to explore providers' perceptions of palliative care for CVD in Western Kenya to inform its implementation. METHODS We conducted eight focus group discussions and five key informant interviews. These were conducted by moderators using structured question guides. Qualitative analysis was performed using the constant comparative method. A coding scheme was developed and agreed on by consensus by two investigators, each of whom then independently coded each transcript. Relationships between codes were formulated, and codes were grouped into distinct themes. New codes were iteratively added with successive focus group or interview until thematic saturation was reached. RESULTS Four major themes emerged to explain the complexities of integrating of palliative care for patients with CVD in Kenya: 1) stigma of discussing death and dying, 2) mismatch between patient and clinician perceptions of disease severity, 3) the effects of poverty on care, and 4) challenges in training and practice environments. All clinicians expressed a need for integrating palliative care for patients with CVD. CONCLUSION These results suggest that attainable interventions supported by local providers can help improve CVD care and quality of life for patients living with advanced heart disease in low-resource settings worldwide.
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Affiliation(s)
- Keith R Love
- Yale New Haven Hospital, New Haven, Connecticut, USA.
| | - Elizabeth Karin
- Tacoma Family Medicine, University of Washington, Tacoma, Washington, USA
| | - Daniel Morogo
- Living Room Ministries International, Eldoret, Kenya
| | | | - Juli M Boit
- Living Room Ministries International, Eldoret, Kenya
| | - Allison Tarus
- Living Room Ministries International, Eldoret, Kenya
| | | | - Nathan E Goldstein
- The Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Myra Koech
- Department of Pediatrics, MUSOM, MUCHS, Eldoret, Kenya
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York, New York, USA
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Abstract
PURPOSE OF REVIEW With an aging population with heart failure, there is a growing need for end-of-life care in this population, including a focus on symptom management and quality-of-life considerations. RECENT FINDINGS Targeted therapies focusing on symptom control and improving quality of life is the cornerstone of providing care in patients with heart failure near the end of life. Such therapies, including the use of inotropes for palliative purposes, have been shown to improve symptoms without an increase in mortality. In addition, recent evidence shows that implementing certain strategies in planning for end of life, including advance care planning and palliative care involvement, can significantly improve symptoms and quality of life, reduce hospitalizations, and ensure care respects patient values and preferences. SUMMARY Shifting focus from prolonging life to enhancing quality of life in heart failure patients approaching the end of life can be achieved by recognizing and managing end-stage heart failure-related symptoms, advanced care planning, and a multidisciplinary care approach.
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Stoevelaar R, Brinkman-Stoppelenburg A, van Bruchem-Visser RL, van Driel AG, Bhagwandien RE, Theuns DAMJ, Rietjens JAC, van der Heide A. Implantable cardioverter defibrillators at the end of life: future perspectives on clinical practice. Neth Heart J 2020; 28:565-570. [PMID: 32548800 PMCID: PMC7596123 DOI: 10.1007/s12471-020-01438-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The implantable cardioverter defibrillator (ICD) is effective in terminating life-threatening arrhythmias. However, in the last phase of life, ICD shocks may no longer be appropriate. Guidelines recommend timely discussion with the patient regarding deactivation of the shock function of the ICD. However, research shows that such conversations are scarce, and some patients experience avoidable and distressful shocks in the final days of life. Barriers such as physicians’ lack of time, difficulties in finding the right time to discuss ICD deactivation, patients’ reluctance to discuss the topic, and the fragmentation of care, which obscures responsibilities, prevent healthcare professionals from discussing this topic with the patient. In this point-of-view article, we argue that healthcare professionals who are involved in the care for ICD patients should be better educated on how to communicate with patients about ICD deactivation and the end of life. Optimal communication is needed to reduce the number of patients experiencing inappropriate and painful shocks in the terminal stage of their lives.
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Affiliation(s)
- R Stoevelaar
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - A Brinkman-Stoppelenburg
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - R L van Bruchem-Visser
- Department of Internal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A G van Driel
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
- Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - R E Bhagwandien
- Department of Cardiology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - D A M J Theuns
- Department of Cardiology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - J A C Rietjens
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A van der Heide
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Editorial: Supportive care for people living with the manifold burden of heart failure. Curr Opin Support Palliat Care 2020; 14:1-2. [DOI: 10.1097/spc.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
The heart failure (HF) guidelines recommend palliative care; however, it can often be difficult to determine the timing of palliative care referral. Because HF with fluid retention and low-cardiac output may trigger several unpleasant symptoms, continuous HF treatment is required to alleviate these symptoms in advanced HF. The patients with HF often suffer from total pain; therefore, the support from a multidisciplinary team plays a crucial role to improve quality of life of the patients and their families not only in the terminal phase but also from the early stage.
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Affiliation(s)
- Keisuke Kida
- Department of Pharmacology, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae, Kawasaki, Kanagawa 216-8511, Japan.
| | - Shunichi Doi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae, Kawasaki, Kanagawa 216-8511, Japan
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, 1197-1 Yasachi-chou, Asahi-ku, Yokohama, Kanagawa 241-0811, Japan
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Otto CM. Heartbeat: Predictors of left atrial thrombus in patient with atrial fibrillation. BRITISH HEART JOURNAL 2019; 105:1293-1294. [DOI: 10.1136/heartjnl-2019-315683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Affiliation(s)
- Miriam Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, The University of Hull, Hull, UK
| | - Daisy Janssen
- Department of Research & Education, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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