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Baughman KR, Ludwick R, Jarjoura D, Yeager M, Kropp D. Multi-Site Study of Provider Self-Efficacy and Beliefs in Explaining Judgments About Need and Responsibility for Advance Care Planning. Am J Hosp Palliat Care 2021; 38:1276-1281. [PMID: 33291962 PMCID: PMC8490652 DOI: 10.1177/1049909120979977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We examined the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgments about resident need and provider responsibility for initiating ACP conversations. RESEARCH DESIGN AND METHODS This observational multi-site study of 348 registered nurses, licensed practical nurses, and social workers within 29 SNFs used an anonymous survey in which providers judged vignettes with assigned situational features of a typical SNF resident. Mixed modeling was used to analyze the vignette responses. RESULTS Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring ACP took place. Self-efficacy did not have a significant impact on judgments of need, but did significantly increase judgments of responsibility for ensuring ACP conversations. Providers with the highest levels of ACP self-efficacy were most likely to feel responsible for ensuring ACP conversations. In an exploratory analysis, these relationships remained the same whether responding to high or low risk residents (i.e., based on risk of hospitalization, type of diagnosis, functional status, and rate of declining health). DISCUSSION AND IMPLICATIONS Both negative beliefs about ACP and self-efficacy in one's ability to conduct ACP discussions were associated with professional judgments regarding ACP. The findings illustrate the importance of addressing negative beliefs about ACP and increasing provider ACP self-efficacy through education and policies that empower nurses and social workers.
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Affiliation(s)
- Kristin R. Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Ruth Ludwick
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
- Kent State University, OH, USA
| | | | - Mia Yeager
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Denise Kropp
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Coyle A, Bhatia S, Reyes Arnaldy A, Wang K, Lindenberger EC, Fishman M. Advance care planning clinic: A structured clinical experience for internal medicine residents. J Am Geriatr Soc 2021; 69:2931-2938. [PMID: 34374990 DOI: 10.1111/jgs.17411] [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: 03/09/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Advance care planning (ACP) is an important step to provide medical care consistent with patients' preferences and values. Nationally, rates of ACP completion are low, and internal medicine residency clinics face additional barriers. To address this need, we implemented an ACP clinic for internal medicine residents. METHODS An ACP clinical experience was created for PGY2 residents beginning in 2018, with 6 total sessions, consisting of consolidated didactics, protected time to identify, outreach, and schedule patients, and two half days of dedicated ACP visits. Residents were surveyed before (end of PGY1) and after (end of PGY2) the intervention. The preceding residency class, serving as a historic control, only received the curriculum and were surveyed at the end of their PGY2 year. Electronic medical record (EMR) data was accessed to track ACP documentation. RESULTS The overall survey response rate was 124/134 (93%). Comparing the intervention cohort before and after the intervention, there was a significant increase in self-assessed confidence in completing ACP (2.1/4.0 vs 3.5/4.0, p < 0.01). Comparing the intervention and historic cohorts (end of PGY2), the intervention was associated with improved confidence in ability to complete ACP for their patients (3.5/4.0 vs 2.7/4.0, p < 0.01). The historic control had no increase in ACP documentation rates over time, while the intervention cohort had a 13.9% absolute increase in ACP documentation for their patients over the course of residency (p < 0.01). CONCLUSION The creation of an ACP-specific clinical experience, in conjunction with existing curricula, resulted in significant improvements in knowledge, self-assessed skills and behavior, and EMR documentation.
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Affiliation(s)
- Andrew Coyle
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonica Bhatia
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Katherine Wang
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elizabeth C Lindenberger
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA
| | - Mary Fishman
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Walter KL, Joehl HE, Alrifai T, Varghese TG, Tyler MJ. A Quality Improvement Initiative to Increase Completion and Documentation of Advanced Directives in the ICU at a U.S. Community Teaching Hospital. Crit Care Explor 2021; 3:e0413. [PMID: 33977277 PMCID: PMC8104255 DOI: 10.1097/cce.0000000000000413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: Advance directives can help guide care in the ICU. As a healthcare quality improvement initiative, we sought to increase the percentage of patients with a healthcare power of attorney and/or practitioner orders for life-sustaining treatment in our ICU and to increase medical resident experience with advance directives through routine screening and documentation of advance directives in the ICU. Design: Prospective analysis. Setting: Urban U.S. community teaching hospital. Patients: All patients admitted to the ICU from September 2018 to February 2019. Interventions: Internal medicine residents in the ICU received a lecture about advance directives and instructions to screen their patients for advance directives. For willing and decisional patients, residents facilitated the creation of a healthcare power of attorney and/or practitioner orders for life-sustaining treatment. Residents were anonymously surveyed at the beginning and end of the ICU rotation about their experience and level of comfort with healthcare power of attorney and practitioner orders for life-sustaining treatment completion. Measurements and Main Results: Three-hundred seventy-five patients were admitted to the ICU during the study period. Healthcare power of attorney documents were generated by 34% of all ICU patients without a prior healthcare power of attorney, increased from a baseline rate of 10% (p < 0.001). The number of practitioner orders for life-sustaining treatment documents for patients with code status of “no cardiopulmonary resuscitation” did not increase significantly. The percentage of residents who facilitated completion of a healthcare power of attorney document increased significantly from 56% to 100% (p < 0.001), whereas their practitioner orders for life-sustaining treatment experience did not change significantly by the end of their ICU rotation. On a Likert scale of 0–10, mean resident comfort increased significantly both with healthcare power of attorney documentation, rising from 6.14 to 8.84 (p = 0.005) and with practitioner orders for life-sustaining treatment form completion, increasing from 6.00 to 7.84 (p = 0.008). Conclusions: Training ICU medical residents to routinely screen for and facilitate completion of advance directives significantly increased the percentage of ICU patients with a healthcare power of attorney and significantly improved medical resident comfort with healthcare power of attorney and practitioner orders for life-sustaining treatment form completion.
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Affiliation(s)
- Kristin L Walter
- Department of Medicine, AMITA Health St. Joseph Hospital Chicago, Chicago, IL
| | - Hillarie E Joehl
- Division of Palliative Medicine, AMITA Health St. Joseph Hospital Chicago, Chicago, IL
| | - Taha Alrifai
- Department of Medicine, AMITA Health St. Joseph Hospital Chicago, Chicago, IL
| | - Thomas G Varghese
- Department of Medicine, AMITA Health St. Joseph Hospital Chicago, Chicago, IL
| | - Matthew J Tyler
- Division of Palliative Medicine, AMITA Health St. Joseph Hospital Chicago, Chicago, IL
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Pearse W, Saxon R, Plowman G, Hyde M, Oprescu F. Continuing Education Outcomes for Advance Care Planning: A Systematic Review of the Literature. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2021; 41:39-58. [PMID: 33433128 DOI: 10.1097/ceh.0000000000000323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Advance care planning (ACP) is a process of considering future health and care needs for a time when a person may be unable to speak for themselves. Health professional continuing education programs have been proposed for facilitating patient participation in ACP; however, their impacts on participants, patient and clinical outcomes, and organizational approaches to ACP are not well understood. METHODS This systematic literature review examined interventional studies of education programs conducted with health professionals and care staff across a broad range of settings. Five electronic databases were searched up to June 2020, and a manual search of reference lists was conducted. The quality of studies was appraised by the first, second, and third authors. RESULTS Of the 7993 articles identified, 45 articles met the inclusion criteria. Program participants were predominantly medical, nursing, and social work staff, and students. Interventions were reported to improve participants' self-perceived confidence, knowledge, and skills; however, objectively measured improvements were limited. Multimodal programs that combined initial didactic teaching and role-play simulation tasks with additional activities were most effective in producing increased ACP activity in medical records. Evidence for improved clinical outcomes was limited. DISCUSSION Further studies that use rigorous methodological approaches would provide further evidence about what produces improved patient and clinical outcomes. Needs analyses and quality indicators could be considered to determine the most appropriate and effective education resources and monitor their impacts. The potential contribution of a broader range of health professionals and interprofessional learning approaches could be considered to ultimately improve patient care.
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Affiliation(s)
- Wendy Pearse
- Ms. Pearse: End of Life Care Project Manager, Nambour General Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia, and School of Health and Sports Sciences, University of the Sunshine Coast, Queensland, Australia. Dr. Saxon: Allied Health Data and Informatics, Advanced Speech Pathologist, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia. Dr. Plowman: Physician, Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Queensland, Australia. Dr. Hyde: Professor, School of Education, University of the Sunshine Coast, Queensland, Australia. Dr. Oprescu: Associate Professor, School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia
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Ko JJ, Ballard MS, Shenkier T, Simon J, Roze des Ordons A, Fyles G, Lefresne S, Hawley P, Chen C, McKenzie M, Ghement I, Sanders JJ, Bernacki R, Jones S. Serious Illness Conversation-Evaluation Exercise: A Novel Assessment Tool for Residents Leading Serious Illness Conversations. Palliat Med Rep 2020; 1:280-290. [PMID: 34223487 PMCID: PMC8241377 DOI: 10.1089/pmr.2020.0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background/Objectives: The serious illness conversation (SIC) is an evidence-based framework for conversations with patients about a serious illness diagnosis. The objective of our study was to develop and validate a novel tool, the SIC-evaluation exercise (SIC-Ex), to facilitate assessment of resident-led conversations with oncology patients. Design: We developed the SIC-Ex based on SIC and on the Royal College of Canada Medical Oncology milestones. Seven resident trainees and 10 evaluators were recruited. Each trainee conducted an SIC with a patient, which was videotaped. The evaluators watched the videos and evaluated each trainee by using the novel SIC-Ex and the reference Calgary-Cambridge guide (CCG) at months zero and three. We used Kane's validity framework to assess validity. Results: Intra-class correlation using average SIC-Ex scores showed a moderate level of inter-evaluator agreement (range 0.523–0.822). Most evaluators rated a particular resident similar to the group average, except for one to two evaluator outliers in each domain. Test–retest reliability showed a moderate level of consistency among SIC-Ex scores at months zero and three. Global rating at zero and three months showed fair to good/very good inter-evaluator correlation. Pearson correlation coefficients comparing total SIC-Ex and CCG scores were high for most evaluators. Self-scores by trainees did not correlate well with scores by evaluators. Conclusions: SIC-Ex is the first assessment tool that provides evidence for incorporating the SIG guide framework for evaluation of resident competence. SIC-Ex is conceptually related to, but more specific than, CCG in evaluating serious illness conversation skills.
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Affiliation(s)
- Jenny J Ko
- Department of Medical Oncology, University of British Columbia, BC Cancer-Abbotsford, Abbotsford, British Columbia, Canada
| | - Mark S Ballard
- Department of Internal Medicine, Chilliwack General Hospital, Chilliwack, British Columbia, Canada
| | - Tamara Shenkier
- Department of Medical Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Jessica Simon
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gillian Fyles
- BC Centre for Palliative Care, Vancouver, British Columbia, Canada
| | - Shilo Lefresne
- Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Philippa Hawley
- Pain and Symptom Management/Palliative Care Program, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Charlie Chen
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Michael McKenzie
- Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | | | - Justin J Sanders
- Ariadne Labs, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rachelle Bernacki
- Ariadne Labs, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Scott Jones
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Beck BM, Coda C, Gerges J, Allen J, Agarwal A, Mutchie HL, Baek D, Millstein LS. Advance Care Planning: An Interprofessional Approach to Resident Education. J Am Geriatr Soc 2020; 68:E66-E68. [DOI: 10.1111/jgs.16821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 08/06/2020] [Accepted: 08/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Brenna M. Beck
- University of Maryland School of Medicine Baltimore Maryland
| | - Clare Coda
- Patient First Urgent Care and Primary Care Clinic Richmond Virginia
- Departments of Internal Medicine and Pediatrics University of Maryland School of Medicine Baltimore Maryland
| | - Jocelyn Gerges
- Albert Einstein Medical Center Philadelphia Pennsylvania
| | - John Allen
- Department of Internal Medicine University of Maryland School of Medicine Baltimore Maryland
| | - Amanda Agarwal
- Maryland Department of Human Services Baltimore City Department of Social Services Baltimore Maryland
| | - Heather L. Mutchie
- Department of Internal Medicine University of Maryland School of Medicine Baltimore Maryland
- University of Maryland Baltimore Baltimore Maryland
| | - Danielle Baek
- Department of Internal Medicine University of Maryland School of Medicine Baltimore Maryland
| | - Leah S. Millstein
- Departments of Internal Medicine and Pediatrics University of Maryland School of Medicine Baltimore Maryland
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Nassikas NJ, Baird GL, Duffy CM. Improving Advance Care Planning in a Resident Primary Care Clinic. Am J Hosp Palliat Care 2019; 37:185-190. [PMID: 31476887 DOI: 10.1177/1049909119872757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Two-thirds of chronically ill patients do not have an advance directive. The primary aim of this study was to develop an intervention to increase the documentation of advance directives in elderly adults in an internal medicine resident primary care clinic. The secondary aims were to improve resident confidence in discussing advance care planning and increase the number of discussions. METHODS The study was a pre- and postintervention study. The study intervention was a 30-minute educational session on advance care planning. Study participants were patients aged 65 years and older who were seen in an internal medicine residency primary care clinic over a 6-month period and internal medicine residents. Clinic encounters were reviewed for the presence of advance care planning discussions before and after the intervention. Resident confidence was measured on a Likert scale. RESULTS Two hundred ninety-five eligible patients were seen in the clinic from January 1, 2017, to June 30, 2017, and included in the analysis performed between 2017 and 2018. The mean number of documented advance care planning discussions increased from 2.24 (95% confidence interval [CI]: 1.0-4.9) during the preintervention period to 8.94 (95% CI: 5.94-13.24]) during the postintervention period (P = .0011). Following the intervention, residents overall reported increased confidence in discussing advance care planning. CONCLUSION A relatively modest intervention to increase advance care planning discussions is feasible in an internal medicine primary care clinic and can improve the confidence of residents with end-of-life discussion.
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Affiliation(s)
- Nicholas J Nassikas
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Grayson L Baird
- Lifespan Biostatistics Core, Rhode Island Hospital, Providence, RI, USA
| | - Christine M Duffy
- Department of Medicine, Warren Alpert Medical School, Providence, RI, USA
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Berns SH, Camargo M, Meier DE, Yuen JK. Goals of Care Ambulatory Resident Education: Training Residents in Advance Care Planning Conversations in the Outpatient Setting. J Palliat Med 2017; 20:1345-1351. [PMID: 28661787 DOI: 10.1089/jpm.2016.0273] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Advance care planning (ACP) discussions often occur in the inpatient setting when patients are too ill to participate in decision making. Although the outpatient setting is the preferred time to begin these discussions, few physicians do so in practice. Many internal medicine (IM) residents report inadequate training as a barrier to having outpatient ACP discussions. OBJECTIVE To assess whether a novel curriculum entitled Goals of Care Ambulatory Resident Education (GOCARE) improved resident physicians' understanding of and preparedness for conducting ACP discussions in the outpatient setting. DESIGN The curriculum was delivered over four weekly three-hour small group sessions to IM residents. Each session included didactics, a demonstration of skills, and a simulated patient communication laboratory that emphasized deliberate practice. SETTING/SUBJECTS IM residents from an urban, academic ambulatory care practice. MEASUREMENTS Impact of the intervention was evaluated using a retrospective pre-post design. Residents completed surveys immediately after the course and six months later. RESULTS Forty-two residents participated in the curriculum and 95% completed the postcourse survey. Residents' self-rated level of preparedness increased for ACP discussions overall (4.0 pre vs. 5.2 post on 7-point Likert scale) and for communication steps involved in ACP (p < 0.001). Fifty-nine percent of participants completed the six-month follow-up survey. Residents' self-rated preparedness to engage in outpatient ACP discussions remained high (4.5 pre vs. 5.5 post at six months p < 0.001). Residents also reported increased use of ACP communication skills (p < 0.001) six months later. CONCLUSIONS The GOCARE curriculum provides an alternative model of communication training that can be integrated into residency training and improve residents' skills in outpatient ACP discussions.
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Affiliation(s)
- Stephen H Berns
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Marianne Camargo
- 2 Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Diane E Meier
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Jacqueline K Yuen
- 1 Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
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Hayek S, Nieva R, Corrigan F, Zhou A, Mudaliar U, Mays D, Massoomi M, Ilksoy N. End-of-Life Care Planning: Improving Documentation of Advance Directives in the Outpatient Clinic Using Electronic Medical Records. J Palliat Med 2014; 17:1348-52. [DOI: 10.1089/jpm.2013.0684] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Salim Hayek
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Ria Nieva
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Frank Corrigan
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Amy Zhou
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Uma Mudaliar
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - David Mays
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Michael Massoomi
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Nurcan Ilksoy
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
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Blackford J, Street AF. Facilitating advance care planning in community palliative care: conversation starters across the client journey. Int J Palliat Nurs 2013; 19:132-9. [PMID: 23665571 DOI: 10.12968/ijpn.2013.19.3.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper describes the development of a tool for palliative care nurses to initiate and facilitate advance care planning (ACP) conversations in community palliative care practice. Seven community palliative care services located across Australia participated in a multi-site action research project. Data included participant observation, individual and focus group interviews with palliative care health professionals, and medical record audit. A directed content analysis used a pre-established palliative care practice framework of referral, admission, ongoing management, and terminal/discharge care. From this framework a Conversation Starter Tool for ACP was developed. The Tool was then used in orientation and continuing nurse education programmes. It provided palliative care nurses the opportunity to introduce and progress ACP conversations.
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Bravo G, Dubois MF, Cohen C, Wildeman S, Graham J, Painter K, Bellemare S. Are Canadians providing advance directives about health care and research participation in the event of decisional incapacity? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:209-18. [PMID: 21507277 DOI: 10.1177/070674371105600404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Advance planning for health care and research participation has been promoted as a mechanism to retain some control over one's life, and ease substitute decision making, in the event of decisional incapacity. Limited data are available on Canadians' current advance planning activities. We conducted a postal survey to estimate the frequency with which Canadians communicate their preferences about health care and research should they become incapacitated. METHOD We surveyed 5 populations (older adults, informal caregivers, physicians, researchers in aging, and research ethics board members) from Nova Scotia, Ontario, Alberta, and British Columbia. We asked respondents whether they had expressed their preferences regarding a substitute decision maker, health care, and research participation in the event of incapacity. RESULTS Two out of 3 respondents (62.0%; 95% CI 59.1% to 64.8%) had been advised to communicate their health care preferences in advance. Oral expression of wishes was reported by 69.1% of respondents (95% CI 66.8% to 71.3%), and written expression by 46.7% (95% CI 44.3% to 49.2%). Among respondents who had expressed wishes in advance (orally or in writing), 91.2% had chosen a substitute decision maker, 80.9% had voiced health care preferences, and 19.5% had voiced preferences regarding research participation. Having been advised to communicate wishes was a strong predictor of the likelihood of having done so. CONCLUSIONS Advance planning has increased over the last 2 decades in Canada. Nonetheless, further efforts are needed to encourage Canadians to voice their health care and research preferences in the event of incapacity. Physicians are well situated to promote advance planning to Canadians.
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Affiliation(s)
- Gina Bravo
- Department of Community Health Sciences, University of Sherbrooke, Sherbrooke, Quebec.
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Colbert CY, Mirkes C, Ogden PE, Herring ME, Cable C, Myers JD, Ownby AR, Boisaubin E, Murguia I, Farnie MA, Sadoski M. Enhancing competency in professionalism: targeting resident advance directive education. J Grad Med Educ 2010; 2:278-82. [PMID: 21975633 PMCID: PMC2941387 DOI: 10.4300/jgme-d-10-00003.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 02/12/2010] [Accepted: 04/22/2010] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. METHODS In 2009, 59 internal medicine and family medicine residents (postgraduate year 2-3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n = 32) and The University of Texas Medical School at Houston (n = 27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. RESULTS While 53% of residents agreed/strongly agreed they had "sufficient knowledge of advance directives, given my years of training," 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that "didactic sessions on advance directives should be offered by my hospital, residency program, or medical school." A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: "Advance directives should only be discussed with patients over 60," "I have sufficient knowledge of advance directives, given my years of training," and "I believe my experience with advance directives is adequate for the situations I routinely encounter." CONCLUSION Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.
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Affiliation(s)
- Colleen Y. Colbert
- Corresponding author: Colleen Y. Colbert, PhD, Scott & White Healthcare, 2401 South 31st Street, Temple, TX 76508, 254.724.8882,
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