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Askari A, Roshan HM, Abbaszadeh N, Salesi M, Hosseini SM, Golmohammadi M, Barasteh S, Nademi O, Mashayekh R, Sadeghi MH. Readiness for advance care planning and related factors in the general population: a cross sectional study in Iran. BMC Palliat Care 2024; 23:167. [PMID: 38982407 PMCID: PMC11234553 DOI: 10.1186/s12904-024-01496-2] [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: 12/16/2023] [Accepted: 06/28/2024] [Indexed: 07/11/2024] Open
Abstract
CONTEXT Advance Care Planning (ACP), as a process for expressing and recording patients' preferences about end-of-life care, has received increasing attention in recent years. However, implementing ACP has been challenging in Iran. OBJECTIVES To assess the readiness for advance care planning and related factors in the general population of Iran. METHODS This cross-sectional study was conducted on the general population of Iran in 2022. The data was collected using demographic information questionnaire and The RACP Scale. The purpose and methodology of the research was explained to all participants, and upon their agreement an informed consent was obtained. Participants were invited to fill out the questionnaires wherever is more convenient for them, either alone or if needed, with the help of the researcher to protect their privacy. Chi-square, fisher exact test and multiple logistic Regression model were used to assess the effective factors on the RACP. The data were analyzed by SPSS software version 26. RESULTS A total of 641 people with an average age of 36.85 ± 12.05 years participated in this study. Of those, 377 (58.8%) had high RACP. The logistics model showed an association between the chance of readiness for receiving ACP with participants' education level, such that the chance of readiness in those with Master's or Ph.D. degrees was three times higher than those with a diploma (p = 0.00, OR:3.178(1.672, 6.043)). However, the chances of readiness in those with bachelor's degrees was not significantly different from those with a diploma (p = 0.936, OR: 0.984 (0.654, 1.479)). Moreover, the chance of readiness was 1.5 higher in participants over 40 years of age compared with participants under the age of 40 (P = 0.01, OR: 1.571(1.10, 2.23)). CONCLUSION According to the findings of this study, it can be concluded that there is a relatively RACP among people in Iranian society. The readiness of individuals for ACP increases by their age and education level. Therefore, by holding appropriate training intervention, we can increase the readiness of the public for ACP to improve their end-of-life outcome.
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Affiliation(s)
- Ali Askari
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Nasim Abbaszadeh
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Seyed Morteza Hosseini
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mobina Golmohammadi
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Nursing Care Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Omid Nademi
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Razieh Mashayekh
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Stevens J, Miranda R, Deliens L, Pype P, De Vleminck A, Pardon K. Advance care planning engagement in patients with chronic, life-limiting illness: baseline findings from a cluster-randomised controlled trial in primary care. Br J Gen Pract 2023; 73:e384-e391. [PMID: 37012079 PMCID: PMC10098835 DOI: 10.3399/bjgp.2022.0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) has been characterised as a complex process of communication and decision making. For ACP behaviour change, underlying processes such as self-efficacy and readiness are needed. However, studies about which patient characteristics are associated with ACP have mainly focused on whether ACP actions are completed, leaving behaviour change processes unexplored. AIM To assess whether patients' characteristics and patient-perceived quality of GP ACP communication were associated with patients' ACP engagement. DESIGN AND SETTING Baseline data were used from the ACP-GP cluster-randomised controlled trial in patients with chronic, life-limiting illness (n = 95). METHOD Patients completed questionnaires detailing demographic and clinical characteristics, and their perception about their GPs' ACP information provision and listening. Engagement was measured using the 15-item ACP Engagement Survey, with self-efficacy and readiness subscales. Linear mixed models tested associations with engagement. RESULTS Demographic and clinical characteristics were not associated with engagement; nor was how much ACP information patients received from their GP or the extent to which the GP listened to what was important for the patient to live well or important to the patient regarding future care. Higher overall ACP engagement (P = 0.002) and self-efficacy (P<0.001) were observed in patients who gave a high rating for the extent to which their GP listened to their worries regarding future health. CONCLUSION This study suggests that GPs providing information about ACP alone is not associated with a patient's ACP engagement; an important element is to listen to patients' worries regarding their future health.
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Affiliation(s)
- Julie Stevens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Universiteit Gent; Department of Family Medicine and Chronic Care, VUB, Brussels; Department of Public Health and Primary Care, Universiteit Gent, Ghent
| | - Rose Miranda
- End-of-Life Care Research Group, VUB and Universiteit Gent; Department of Family Medicine and Chronic Care, VUB, Brussels
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Universiteit Gent; Department of Family Medicine and Chronic Care, VUB, Brussels; Department of Public Health and Primary Care, Universiteit Gent, Ghent
| | - Peter Pype
- End-of-Life Care Research Group, VUB, and Universiteit Gent; Department of Public Health and Primary Care, Universiteit Gent, Ghent
| | - Aline De Vleminck
- End-of-Life Care Research Group, VUB and Universiteit Gent; Department of Family Medicine and Chronic Care, VUB, Brussels
| | - Koen Pardon
- End-of-Life Care Research Group, VUB and Universiteit Gent; Department of Family Medicine and Chronic Care, VUB, Brussels
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Yu TH, Lu FL, Wei CJ, Wu WW. The impacts of the scope of benefits expansion on hospice care among adult decedents: a nationwide longitudinal observational study. BMC Palliat Care 2023; 22:29. [PMID: 36978057 PMCID: PMC10053103 DOI: 10.1186/s12904-023-01146-z] [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: 11/21/2022] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVES Compared to aggressive treatment for patients at the end stage of life, hospice care might be more likely to satisfy such patients' need and benefits and improve their dignity and quality of life. Whether the reimbursement policy expansion affect the use of hospice care among various demographics characteristics and health status was unknown. Therefore, the purpose of this study was to explore the impacts of reimbursement policy expansion on hospice care use, and to investigate the effects on people with various demographics characteristics and health status. METHODS We used the 2001-2017 Taiwan NHI claims data, Death Registry, and Cancer Registry in this study, and we included people who died between 2002 and 2017. The study period was divided into 4 sub-periods. hospice care use and the initiation time of 1st hospice care use were used as dependent variables; demographic characteristics and health status were also collected. RESULTS There were 2,445,781 people who died in Taiwan during the study period. The results show that the trend of hospice care use increased over time, going steeply upward after the scope of benefits expansion, but the initiation time of 1st hospice care use did not increase after the scope of benefits expansion. The results also show that the effects of expansion varied among patients by demographic characteristics. CONCLUSION The scope of benefits expansion might induce people's needs in hospice care, but the effects varied by demographic characteristics. Understanding the reasons for the variations in all populations would be the next step for Taiwan's health authorities.
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Affiliation(s)
- Tsung-Hsien Yu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Frank Leigh Lu
- Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
- School of Medicine, National Taiwan University, No.1 Jen-Ai Road section 1 Taipei 100, Taipei, Taiwan
| | - Chung-Jen Wei
- Department of Public Health, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Wei-Wen Wu
- School of Medicine, National Taiwan University, No.1 Jen-Ai Road section 1 Taipei 100, Taipei, Taiwan.
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
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Tang JMS, Cher BXBB, Lim SF, Siah CJR. A meta-synthesis on the older adults' perspective of advance care planning. J Clin Nurs 2023. [PMID: 36710379 DOI: 10.1111/jocn.16629] [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: 06/16/2022] [Revised: 12/14/2022] [Accepted: 01/04/2023] [Indexed: 01/31/2023]
Abstract
AIM To synthesise the evidence regarding older adults' perception of advance care planning in preparation for end-of-life care. BACKGROUND Advance care planning involves continuous communication of end-of-life care goals involving an individual's medical treatment preferences. However, its uptake among older adults remains low. DESIGN The meta-synthesis was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative research (ENTREQ) guidelines and thematic synthesis was employed to synthesise the qualitative findings in an inductive manner. DATA SOURCE A search was completed on six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus), for publications from 1 January 2000 to 4 December 2021. REVIEW METHOD The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation and Confidence (GRADE-CERQual) in the Evidence from Reviews of Qualitative research. Two independent reviewers conducted this process, and disagreements were resolved through discussions. RESULTS Fourteen studies were analysed. Four major themes and eleven subthemes emerged from the thematic synthesis: (1) psychosocial preparedness, (2) medical preparedness, (3) psychological barriers towards advance care planning and (4) extrinsic barriers towards advance care planning. DISCUSSION These themes consolidated older adults' views of advance care planning and how engagement in this planning affected their end-of-life preparedness. CONCLUSION This review suggested psychological and extrinsic factors were barriers to the uptake of advance care planning and provided directions for future research to achieve a holistic understanding of the impact of advance care planning on end-of-life preparedness. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals could maintain close communication with older adults and families periodically to evaluate their readiness to discuss advance care planning to improve their preparedness. Healthcare professionals could also provide psychological support during the discussion of clinical decision-making to enhance readiness and confidence among older adults and their families.
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Affiliation(s)
| | | | - Su-Fee Lim
- National University of Singapore, Singapore, Singapore
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Tan MM, Villamar DM, Huard C, Nicholson L, Medina HN, Moreno PI. Advance Care Planning With Black Women with Breast Cancer: A Community Health Worker Model. Cancer Control 2023; 30:10732748231162479. [PMID: 36916318 PMCID: PMC10020146 DOI: 10.1177/10732748231162479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Despite the importance of advance care planning (ACP), a process that optimizes future medical treatment and end-of-life care, for at-risk populations, rates of patient-provider ACP conversations are extremely low among Black women with breast cancer. Community health workers (CHWs) are well-positioned to support patients in engaging in ACP conversations with their providers; yet research on integrating CHWs to promote ACP is scant. The current study examined multilevel facilitators and barriers to successful ACP conversations among Black women from the perspective of providers and CHWs who serve this community. METHODS Providers and CHWs were recruited from an academic medical center in a large urban city. Retrospective qualitative data on barriers and facilitators to ACP conversations, as well as CHWs' training needs, were collected from two focus groups (N = 5 providers, N = 5 CHWs) and one individual interview (N = 1 provider), and transcribed and coded for themes. RESULTS All providers reported working primarily with Black patients, and identified stigma and time constraints as major barriers to ACP discussions; they also identified the structural barriers and injustices that their patients face during medical care. CHWs reported having a trusted relationship with their patients and flexibility in their care that would allow for ongoing ACP conversations, discussing their ability to serve as a bridge between the patient and provider. However, CHWs discussed that they lacked the tools and skills to have ACP conversations, largely because existing formal trainings in ACP are cost prohibitive. DISCUSSION Competing priorities of the provider to discuss/treat the patient's disease and medical mistrust were major barriers to successful ACP conversations among Black women with breast cancer, leading to ACP completion occurring late in treatment. CHWs are uniquely qualified to overcome multilevel barriers to ACP and establish trusting relationships with patients in order to facilitate earlier and ongoing communication between patients and providers.
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Affiliation(s)
- Marcia M. Tan
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL, USA
| | - Dario M. Villamar
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL, USA
| | - Clarissa Huard
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL, USA
| | - Lian Nicholson
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL, USA
| | - Heidy N. Medina
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Patricia I. Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Maniam R, Tan MP, Chong MC. End of life care preference among hemodialysis population: Revisit Q methodology. PATIENT EDUCATION AND COUNSELING 2022; 105:1495-1502. [PMID: 34625322 DOI: 10.1016/j.pec.2021.09.026] [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: 07/15/2020] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE End-of-life care is often overlooked in the dialysis unit despite high mortality rates. This study aimed to understand the diverse subjectivity of opinions on end-of-life care preferences, feelings, needs, value and goals in life among a haemodialysis population. METHODS The Q methodology was used where 37 opinion statements were ranked in order of importance in a unimodal shaped grid. Results were explored using the Centroids factor extraction and Varimax rotation. RESULTS Four-three persons living with haemodialysis, mean age± SD= 56.58 ± 10.22 years, participated in the study. Five-factors were identified: living in the present, family preference, self preservation, power vs. control and autonomy in decision making, loaded by eleven, four, four, three and three participants with 16 individuals not loading significantly and two were confounded. Preferences for remaining positive in the face of illness through a healthy lifestyle and preserving relationships and autonomy were demonstrated. CONCLUSIONS End-of-life discussions are potentially inhibited by preferences to live for the present which should be explored in future studies. PRACTICE IMPLICATION Statement sets may be used to help facilitate end-of-life discussions through identification of opinion groups. Establishing preferences may guide identification of those willing to initiate discussions.
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Affiliation(s)
- Radha Maniam
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur Malaysia.
| | - Mei Chan Chong
- Department of Nursing Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Is This ACP? A Focus Group Study of Patient Experiences of Advance Care Planning. J Gen Intern Med 2022; 37:1484-1493. [PMID: 35018570 PMCID: PMC9086090 DOI: 10.1007/s11606-021-07208-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/08/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND To date, most research on patients' experiences with advance care planning (ACP) focuses on motivations to engage in discussions and how patients prepare. Gaps remain in understanding how non-critically ill Medicare patients perceive ACP encounters, including how they characterize positive and negative experiences with ACP. OBJECTIVES Understanding these patients' perceptions is imperative as Medicare has sought to incentivize provision of ACP services via two billing codes in 2016. DESIGN Qualitative focus group study. Thematic analysis was performed to assess participants ACP experience. PARTICIPANTS Medicare beneficiaries who had engaged in or were billed for ACP. KEY RESULTS Seven focus groups were conducted with 34 Medicare beneficiaries who had engaged in ACP across 5 US health systems. Participants described a spectrum of perceptions regarding ACP, and a range of delivery approaches, including group ACP, discussions with specialists during serious illness, and ACP in primary care settings during wellness visits. Despite being billed for ACP or having ACP services noted in their medical record, many did not recognize that they had engaged in ACP, expressed lack of clarity over the term "ACP," and were unaware of the Medicare billing codes. Among participants who described quality patient-centered ACP experiences, three additional themes were identified: trusted and established patient/clinician relationships, transparent communication and documentation, and an understanding that ACP is revisable. Participants offered recommendations for clinicians and health systems to improve the patient ACP experience. CONCLUSIONS Findings include actionable steps to promote patient-centered ACP experiences, including clinician training to support improved communication and facilitating shared decision-making, allocating sufficient clinical time for discussions, and ensuring that documentation of preferences is clear and accessible. Other approaches such as group ACP and ACP navigators may help to support patient interests within clinical constraints and need to be further explored.
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Abstract
ZusammenfassungPatientenverfügungen und andere Arten gesundheitlicher Vorausverfügungen wie Advance Care Planning und in gewisser Hinsicht auch Vorsorgevollmachten und Betreuungsverfügungen schließen evaluativ gehaltvolle Annahmen und Werturteile über den weiteren Verlauf des eigenen Lebens ein, die sich als mehr oder weniger angemessen erweisen können und daher einer ethischen Klärung und Reflexion bedürfen. Der Beitrag geht der Frage nach den Grundlagen dieser Annahmen und Urteile nach und argumentiert, dass für ihre Analyse eine strebensethische Perspektive auf Vorstellungen eines guten Lebens in der Zeit besonders geeignet ist. Dazu geben wir zunächst einen kurzen Überblick über die empirische Forschung zu Einflussfaktoren bei der Abfassung gesundheitlicher Vorausverfügungen, insbesondere der Bedeutung von individuellen Wertvorstellungen und Lebensorientierungen. Im nächsten Schritt wenden wir uns vor diesem Hintergrund der Bewertung von Lebensqualität im Lebensverlauf zu. Wie sich dabei zeigt, verweisen die betreffenden Werturteile in mehrfacher Hinsicht auf umfassendere Vorstellungen eines guten Lebens und seines zeitlichen Verlaufs. Daher nehmen wir im Anschluss die Frage des guten Lebens in der Zeit in den Blick und arbeiten typologisierend unterschiedliche Vorstellungen heraus, an denen sich die Implikationen der zeitlichen Erstreckung und Verlaufsstruktur guten Lebens für gesundheitliche Vorausverfügungen deutlich machen lassen. Der Aufsatz formuliert so nicht nur wichtige Perspektiven für eine eingehendere empirische Erforschung evaluativer Aspekte der Abfassung gesundheitlicher Vorausverfügungen. Die Klärung der Bedeutung der Zeitstruktur guten Lebens für solche Verfügungen eröffnet auch einen theoretischen Zugang zu den grundlegenden strebensethischen Fragen, mit denen sich die Betroffenen innerhalb des Rahmens des sollensethisch gut begründeten, gesellschaftlich weithin anerkannten und gesetzlich abgesicherten Rechtes auf ein selbstbestimmtes Sterben konfrontiert sehen.
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Assaf G, Jawhar S, Wahab K, El Hachem R, Kaur T, Tanielian M, Feghali L, Al Hazzouri AZ, Elbejjani M. Awareness and attitudes towards advance care planning in primary care: role of demographic, socioeconomic and religiosity factors in a cross-sectional Lebanese study. BMJ Open 2021; 11:e052170. [PMID: 34711599 PMCID: PMC8557299 DOI: 10.1136/bmjopen-2021-052170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess awareness and attitudes towards engaging in advance care planning (ACP) and their relationship with demographic, socioeconomic and religiosity factors among Lebanese middle-aged to older-aged adults in primary care. DESIGN A cross-sectional survey study. SETTING Tertiary referral hospital in Beirut, Lebanon. PARTICIPANTS A total of 215 middle-aged to older-aged adults. RESULTS Out of 215 participants, 18.6% of participants knew about ACP; 94% favoured truth-telling; 87.4% favoured healthcare autonomy; 77.2% favoured documenting their own health values and preferences; and 29.3% were willing to undergo life-prolonging interventions. Among participants who were aware of ACP, 67.5% preferred ACP documentation and 85% had negative attitudes towards life-sustaining interventions. Women were more aware about ACP than men. Those who were willing to undergo life-prolonging interventions were found to be men and had higher religiosity scores. CONCLUSION Large deficit in ACP awareness was evident despite the high preference for healthcare autonomy. Medical and public health efforts should strive to enhance patients' ACP awareness and engagement in ACP while considering factors relevant to gender, culture and religiosity.
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Affiliation(s)
- Georges Assaf
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sarah Jawhar
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Kamal Wahab
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rita El Hachem
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Tanjeev Kaur
- Department of Academic Internal Medicine and Geriatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria Tanielian
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lea Feghali
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adina Zeki Al Hazzouri
- Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Martine Elbejjani
- Clinical Research Institute, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Could Caregivers' Stressful Care Experiences Be Related to Their Attitudes towards Advance Care Planning? A Cross-Sectional Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179038. [PMID: 34501627 PMCID: PMC8430880 DOI: 10.3390/ijerph18179038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Previous research has shown that care experiences influence the willingness for advance care planning (ACP). Family caregivers have increased contact with medical providers and procedures in the process of caring, and they have also witnessed the disability and suffering of patients. However, few studies have focused on family caregivers to understand their attitudes towards ACP. The aim of this cross-sectional study was to acknowledge family caregivers' attitudes towards ACP and the related factors, especially care stress and experiences during the care process. We interviewed 291 family caregivers, and the demographics of the caregivers and care recipients, the clinical condition of care recipients, and the caregivers' stress and care experiences were collected via anonymous questionnaires. Multiple logistic regression was performed to determine the factors associated with the attitudes towards ACP. We found that the caregiver having private health insurance (p < 0.001) and a completed DNR (p < 0.001) and the experience of recipients admitted to the ICU (p = 0.019) are associated with caregiver's positive attitudes towards ACP. The greater the stress of conflict within a family over care decisions, the more participants think that ACP is important (p = 0.011). It is suggested that (1) in a family-centered culture, a public strategy for promoting ACP could be to emphasize the benefits of ACP in reducing family conflicts, and (2) when people make financial plans, they should also be provided with information about ACP to enable them to form a more integral plan for their future.
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Factors associated with willingness to complete advance directives in older adults. Geriatr Nurs 2021; 42:1042-1047. [PMID: 34256154 DOI: 10.1016/j.gerinurse.2021.05.006] [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: 01/24/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/30/2022]
Abstract
This study aimed to examine the factors associated with willingness to complete advance directives (ADs) in community-dwelling older adults. In total, 121 community-dwelling older adults in Korea completed the questionnaires inquiring about their willingness and perceptions in completing ADs (susceptibility, severity, benefits, barriers, and cues to action), which were based on the Health Belief Model. The mean score for willingness to complete ADs was 6.2 (SD = 3.6). A multiple linear regression analysis showed that higher scores of perceived severity (β = 0.199, p = 0.021), perceived benefits (β = 0.221, p = 0.016), and cues to action (β = 0.159, p = 0.030) were associated with a greater willingness to complete ADs. However, higher scores of perceived barriers (β = -0.409, p < 0.001) were likely to lower the willingness to complete ADs. This study highlights that future interventions aimed at increasing AD completion rates in older adults should consider improving perceived severity, benefits, and cues to action and minimizing perceived barriers.
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Martz K, Alderden J, Bassett R, Swick D. Outcomes Associated With a Nurse-Driven Palliative Care Screening Tool in the Intensive Care Unit. Crit Care Nurse 2021; 40:23-29. [PMID: 32476026 DOI: 10.4037/ccn2020702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools. OBJECTIVE To identify outcomes associated with specialty palliative care referral among patients with critical illness. METHODS Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care. RESULTS Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation (χ2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult (χ2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult (χ2 = 19.39, P < .001). CONCLUSIONS Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.
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Affiliation(s)
- Kim Martz
- Kim Martz is Associate Professor Emeritus, Boise State University School of Nursing, Faculty Mentor, St Luke's Health System, Boise, Idaho
| | - Jenny Alderden
- Jenny Alderden is an assistant professor, University of Utah College of Nursing, Salt Lake City, Utah
| | - Rick Bassett
- Rick Bassett is an adult clinical nurse specialist, St Luke's Health System
| | - Dawn Swick
- Dawn Swick is a staff nurse, St Luke's Health System
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Sörensen S, Missell RL, Eustice-Corwin A, Otieno DA. Perspectives on Aging-Related Preparation. JOURNAL OF ELDER POLICY 2021; 1:10.18278/jep.1.2.7. [PMID: 35169787 PMCID: PMC8841953 DOI: 10.18278/jep.1.2.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
When older adults face age-related life challenges, anticipating what to expect and how to access potential coping strategies can both prevent and provide the possibility of easier recovery from crises. Aging-Related Preparation (ARP) is defined as the continuum of thoughts and activities about how to age well, often beginning with the awareness of age-related changes, or the anticipation of retirement, and concluding with specifying end-of-life wishes. In the current paper, we introduce the concept of ARP and related formulations regarding plans for aging well, describe both predictors and outcomes of ARP for several the domains of ARP, and consider the elements of ARP within the context of existing social policy. We conclude that ARP is determined by a variety of influences both intrinsic to the older person (e.g., personality, cognitive ability, beliefs about planning, problem-solving skills), linked to social class and education, as well as dependent on family structures, access to and knowledge of options, services, and local community resources, and social policy. We further provide evidence that ARP has positive effects in the domain of pre-retirement planning (for retirement adjustment), of preparation for future care (for emotional well-being), and of ACP (for a good death). However, other domains of ARP, including planning for leisure, housing, and social planning are under-researched. Finally, we discuss policy implications of the existing research.
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Affiliation(s)
- Silvia Sörensen
- Corresponding Author: Silvia Sörensen, PhD, Associate Professor, Counseling and Human Development, Warner School of Education and Human Development:
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14
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A realist review of advance care planning for people with multiple sclerosis and their families. PLoS One 2020; 15:e0240815. [PMID: 33064749 PMCID: PMC7567361 DOI: 10.1371/journal.pone.0240815] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022] Open
Abstract
Background Advance care planning (ACP) is reported to improve the quality of outcomes of care among those with life-limiting conditions. However, uptake is low among people living with multiple sclerosis (MS) and little is known about why or how people with MS engage in this process of decision-making. Aims To develop and refine an initial theory on engagement in ACP for people with MS and to identify ways to improve its uptake for those who desire it. Methods Realist review following published protocol and reporting following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multi-disciplinary team searched MEDLINE, PsychInfo, CINAHL, Scopus, Web of Science, Embase, Google Scholar in addition to other sources from inception to August 2019. Quantitative or qualitative studies, case reports, and opinion or discussion articles related to ACP and/or end of life discussions in the context of MS were included, as well as one article on physical disability and one on motor neuron disease, that contributed important contextual information. Researchers independently screened abstracts and extracted data from full-text articles. Using abductive and retroductive analysis, each article was examined for evidence to support or refute ‘context, mechanism, and outcome’ (CMO) hypotheses, using the Integrated Behaviour Model to guide theory development. Quality was assessed according to methodological rigour and relevance of evidence. Those studies providing rich descriptions were synthesised using a realist matrix to identify commonalities across CMO configurations. Results Of the 4,034 articles identified, 33 articles were included in the synthesis that supported six CMO hypotheses that identified contexts and mechanisms underpinning engagement in ACP for people with MS and included: acceptance of their situation, prior experiences, confidence, empowerment, fear (of being a burden, of death and of dying) and the desire for autonomy. Acceptance of self as a person with a life-limiting illness was imperative as it enabled people with MS to see ACP as pertinent to them. We identified the context of MS—its long, uncertain disease trajectory with periods of stability punctuated by crisis—inhibited triggering of mechanisms. Similarly, the absence of skills and confidence in advanced communication skills among health professionals prevented possibilities for ACP discussions taking place. Conclusion Although mechanisms are inhibited by the context of MS, health professionals can facilitate greater uptake of ACP among those people with MS who want it by developing their skills in communication, building trusting relationships, sharing accurate prognostic information and sensitively discussing death and dying.
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Kermel-Schiffman I, Werner P. Beliefs of Israeli Family Caregivers of People with Dementia toward Advance Care Planning. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2020; 16:250-265. [PMID: 32251608 DOI: 10.1080/15524256.2020.1745729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Family caregivers of people with dementia often must make crucial medical decisions for them that may increase the burden of care experienced. Although undertaking Advance Care Planning (ACP) might reduce their decision-making burden, completion rates remain very low. The present study aimed to explore the common beliefs of family caregivers of people with dementia about undertaking ACP for themselves. A qualitative study was conducted, using a semi-structured questionnaire based on the Theory of Planned Behavior. Face-to-face interviews were conducted with a convenience sample of 20 family caregivers of people with dementia in Israel. The behavioral beliefs expressed by the participants referred to the dual benefits of ACP, for the person who will not be able to make medical decisions at the end of life and for themselves. Participants mentioned that family members and friends were the main persons with whom they would consult in making decisions regarding ACP. Personal characteristics and instrumental factors were mentioned as enablers and barriers to undertaking ACP. Findings from the study provide an important basis for expanding research and for developing interventions that can encourage undertaking ACP.
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Affiliation(s)
| | - Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Seelman KL, Lewinson T, Engleman L, Allen A. Motivations for advance care and end-of-life planning among lesbian, gay, and bisexual older adults. QUALITATIVE SOCIAL WORK : QSW : RESEARCH AND PRACTICE 2019; 18:1002-1016. [PMID: 33343234 PMCID: PMC7747803 DOI: 10.1177/1473325018792396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Lesbian, gay, and bisexual (LGB) older adults are more likely than their heterosexual peers to experience health disparities, discrimination from healthcare providers based on sexual orientation, and rejection from their family of origin, all of which can complicate medical care and decision making, as well as end-of-life arrangements. Yet, relatively few studies of LGB seniors have looked at motivations for advance care and end-of-life planning, which are strategies that can help ensure that healthcare treatment and end-of-life wishes are enacted as desired. The present qualitative study investigated this topic with a purposive sample of nine LGB and same-gender-loving adults in a metropolitan region of the Southeastern United States. The study involved in-depth face-to-face interviews, followed by a brief pen-and-paper survey. Participants' ages ranged from 65 to 77; the sample included five men and four women. Six individuals were white/Caucasian, while three were African American/Black. We identified three themes related to motivations for advance care and end-of-life planning: wanting a sense of agency, learning from others, and reducing conflict and confusion for loved ones. We discuss the importance of these findings for social work practice with LGB older adults and for social work education, as well as implications for future research.
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17
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Combes S, Nicholson CJ, Gillett K, Norton C. Implementing advance care planning with community-dwelling frail elders requires a system-wide approach: An integrative review applying a behaviour change model. Palliat Med 2019; 33:743-756. [PMID: 31057042 PMCID: PMC6620766 DOI: 10.1177/0269216319845804] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Facilitating advance care planning with community-dwelling frail elders can be challenging. Notably, frail elders' vulnerability to sudden deterioration leads to uncertainty in recognising the timing and focus of advance care planning conversations. AIM To understand how advance care planning can be better implemented for community-dwelling frail elders and to develop a conceptual model to underpin intervention development. DESIGN A structured integrative review of relevant literature. DATA SOURCES CINAHL, Embase, Ovid Medline, PsycINFO, Cochrane Library, and University of York Centre for Reviews and Dissemination. Further strategies included searching for policy and clinical documents, grey literature, and hand-searching reference lists. Literature was searched from 1990 until October 2018. RESULTS From 3043 potential papers, 42 were included. Twenty-nine were empirical, six expert commentaries, four service improvements, two guidelines and one theoretical. Analysis revealed nine themes: education and training, personal ability, models, recognising triggers, resources, conversations on death and dying, living day to day, personal beliefs and experience, and relationality. CONCLUSION Implementing advance care planning for frail elders requires a system-wide approach, including providing relevant resources and clarifying responsibilities. Early engagement is key for frail elders, as is a shift from the current advance care planning model focussed on future ceilings of care to one that promotes living well now alongside planning for the future. The proposed conceptual model can be used as a starting point for professionals, organisations and policymakers looking to improve advance care planning for frail elders.
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Affiliation(s)
- Sarah Combes
- Florence Nightingale Faculty of Nursing,
Midwifery and Palliative Care, King’s College London, London, UK
- St Christopher’s Hospice, London,
UK
| | - Caroline Jane Nicholson
- Florence Nightingale Faculty of Nursing,
Midwifery and Palliative Care, King’s College London, London, UK
- St Christopher’s Hospice, London,
UK
| | - Karen Gillett
- Florence Nightingale Faculty of Nursing,
Midwifery and Palliative Care, King’s College London, London, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing,
Midwifery and Palliative Care, King’s College London, London, UK
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18
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Hemsley B, Meredith J, Bryant L, Wilson NJ, Higgins I, Georgiou A, Hill S, Balandin S, McCarthy S. An integrative review of stakeholder views on Advance Care Directives (ACD): Barriers and facilitators to initiation, documentation, storage, and implementation. PATIENT EDUCATION AND COUNSELING 2019; 102:1067-1079. [PMID: 30799141 DOI: 10.1016/j.pec.2019.01.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/05/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To examine the views and experiences of patients and their health care providers on developing advance care planning (ACP) and advance care directives (ACD); and determine barriers and facilitators to ACD development, storage, and use, including implications for people with communication disability. METHOD An integrative review of 93 studies, analysed according to their content themes. RESULTS Content themes encapsulated the initiation, documentation, and implementation stages of ACP/ACD. Lack of guidance for initiating and supporting ACP/ACD impedes discussions, and both patients and healthcare providers avoid discussions owing to fear of dying and reluctance to think about end-of-life. CONCLUSIONS There are several barriers and facilitators to the initiation of ACP discussions, documentation and implementation of ACD, and little research exploring the views of legal professionals on the development, storage, or use of ACP documents. Further research is needed to explore the timing and responsibility of both legal and health professionals in initiating and supporting ACP discussions. PRACTICE IMPLICATIONS It is important for healthcare providers to raise ACP discussions regularly so that patients have time to make informed advance care decisions. Storage of the document in an electronic health record might facilitate better access to and implementation of patients' end-of-life care decisions.
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Affiliation(s)
- Bronwyn Hemsley
- The University of Technology Sydney, Building 7, Faculty of Science and Graduate School of Health Building, 67 Thomas Street, Ultimo, Australia @BronwynHemsley.
| | - Jacqueline Meredith
- The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| | - Lucy Bryant
- The University of Technology Sydney, Building 7, Faculty of Science and Graduate School of Health Building, 67 Thomas Street, Ultimo, Australia @BronwynHemsley.
| | - Nathan J Wilson
- Western Sydney University, Building G10/Office 10, Hawkesbury Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Isabel Higgins
- The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| | - Andrew Georgiou
- Macquarie University, Room L6 36, Level 6, 75 Talavera Road, NSW, 2109, Australia.
| | - Sophie Hill
- La Trobe University, School of Psychology and Public Health, College of Science, Health and Engineering, VIC, 3086, Australia.
| | - Susan Balandin
- Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Shaun McCarthy
- The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
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Hansen ED, Mitchell MM, Cruz Oliver DM, Alghanim FA, Walter M, Case AA, Smith T, Knowlton AR. Chronic Pain, Functional Status, and Life Satisfaction Are Associated With Patients Living With HIV Discussing Advance Care Planning With Their Family or Friends. J Pain Symptom Manage 2019; 57:961-965. [PMID: 30818027 PMCID: PMC6486419 DOI: 10.1016/j.jpainsymman.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 02/06/2023]
Abstract
CONTEXT In the era of effective antiretroviral therapy, persons living with HIV/AIDS (PLWHA) are living longer, transforming HIV from a universally fatal disease to a serious chronic illness, warranting discussions between patients and their loved ones about advance care planning (ACP). Evidence is needed on factors associated with patients' likelihood to discuss ACP with loved ones. OBJECTIVES To further characterize factors associated with successful ACP in PLWHAs with their loved ones, we examined associations between patients having ACP discussions with the need for assistance with personal care, chronic pain, life satisfaction, prior family disagreements over health care decisions, sex, age, and interference in daily routines due to memory problems. METHODS Data were from the Affirm Care study (N = 370), which examined social and environmental factors associated with health outcomes among PLWHAs and their informal caregivers. RESULTS Slightly more than half of respondents discussed ACP with loved ones (57%). In adjusted analysis, higher levels of chronic pain (odds ratio [OR] = 2.09, P = 0.045), needing assistance with personal care (OR = 1.63, P = 0.023), greater life satisfaction (OR = 1.02, P = 0.002), prior family arguments over health care decisions (OR = 2.80, P < 0.001), and female sex (OR = 2.22, P = 0.001) were associated with higher odds of discussing ACP with loved ones, whereas age, drug use, education level, depression, and memory problems were nonsignificant. CONCLUSION These results suggest that interventions to increase ACP among PLWHAs and their loved ones should target males. The findings also suggest PLWHAs with chronic pain, the need for assistance with personal care, and those with a history of prior family arguments over health care decisions may be primed for ACP.
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Affiliation(s)
- Eric D Hansen
- Department of Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA.
| | | | - Dulce M Cruz Oliver
- Palliative Medicine Program, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Fahid A Alghanim
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Michelle Walter
- Department of Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Amy A Case
- Department of Supportive Care, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Tom Smith
- Palliative Medicine Program, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amy R Knowlton
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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20
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Choi S, McDonough IM, Kim M, Kim G. The association between the number of chronic health conditions and advance care planning varies by race/ethnicity. Aging Ment Health 2018; 24:453-463. [PMID: 30593253 PMCID: PMC6599541 DOI: 10.1080/13607863.2018.1533521] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Although a national consensus exists on the need to increase the rates of advance care planning (ACP) for all adults, racial/ethnic differences in ACP have been consistently observed. This study investigated the intersection of racial/ethnic differences and the number of chronic health conditions on ACP among middle-aged and older adults in the United States.Method: Responses from 8,926 adults from the 2014 wave of the Health and Retirement Study were entered into multilevel hierarchical logistic regression analyses with generalized linear mixed models to predict ACP focused on assigning a durable power of attorney for healthcare (DPOAHC) and having a written living will after adjusting for covariates.Results: We found a significant positive relationship between the number of chronic health conditions and ACP. Non-Hispanic Blacks/African Americans and Hispanics were less likely to engage in ACP than non-Hispanic Whites/Caucasians. Racial/ethnic disparities were even starker for completing a living will. The number of chronic health conditions had a greater effect for Hispanics than non-Hispanic Whites/Caucasians on ACP through assigning a DPOAHC and having a living will. The initial disparity in ACP among Hispanics with no chronic health conditions decreased as the number of chronic health conditions increased.Conclusion: Our findings suggest that more chronic health conditions increase the likelihood that Hispanics will complete ACP documents. These ACP differences should be highlighted to researchers, policymakers, and healthcare professionals to reduce stark racial/ethnic disparities in ACP. A comprehensive and culturally caring decision-making approach should be considered when individuals and families engage in ACP.
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Affiliation(s)
- Shinae Choi
- Department of Consumer Sciences, The University of Alabama,
304 Adams Hall, Box 870158, Tuscaloosa, AL 35487, USA, Phone: 205-348-9173,
,Associate, Alabama Research Institute on Aging, The
University of Alabama, Tuscaloosa, AL 35487,Correspondence concerning this article should be
addressed to Shinae Choi
| | - Ian M. McDonough
- Associate, Alabama Research Institute on Aging, The
University of Alabama, Tuscaloosa, AL 35487,Department of Psychology, The University of Alabama, 410A
Gordon Palmer Hall, Box 870348, Tuscaloosa, AL 35487, USA, Phone: 205-737-3442,
| | - Minjung Kim
- Department of Educational Studies, The Ohio State
University, Ramseyer Hall, 29 W Woodruff Ave, Columbus, OH 43210, USA, Phone:
614-247-1858,
| | - Giyeon Kim
- Department of Psychology, Chung-Ang University, 84
Heukseok-Ro, Dongjak-Gu, Seoul 06974, South Korea, Phone: 82-2-820-5165,
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21
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Piers R, Albers G, Gilissen J, De Lepeleire J, Steyaert J, Van Mechelen W, Steeman E, Dillen L, Vanden Berghe P, Van den Block L. Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliat Care 2018; 17:88. [PMID: 29933758 PMCID: PMC6014017 DOI: 10.1186/s12904-018-0332-2] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual’s preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. Methods Following the Belgian Centre for Evidence-Based Medicine’s procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). Results Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. Conclusion No high-quality guidelines are available for ACP in dementia care. By combining evidence with expert and user opinions, we have defined a unique set of recommendations for ACP in people living with dementia. These recommendations form a valuable tool for educating healthcare professionals on how to perform ACP across settings.
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Affiliation(s)
- Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium.,End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Gwenda Albers
- Flanders Federation for Palliative Care, Vilvoorde, Belgium
| | - Joni Gilissen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - Jan Steyaert
- Department of Sociology, University of Antwerp, Antwerp, Belgium.,Flemish Expertise Centre on Dementia Care, Antwerp, Belgium
| | - Wouter Van Mechelen
- Department of Public Health and Primary Care, ACHG, KU Leuven, Leuven, Belgium
| | - Els Steeman
- Academic Centre for Nursing and Midwifery, KULeuven, Leuven, Belgium
| | - Let Dillen
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium.
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Addressing personal barriers to advance care planning: Qualitative investigation of a mindfulness-based intervention for adults with cancer and their family caregivers. Palliat Support Care 2018; 17:276-285. [PMID: 29880064 DOI: 10.1017/s1478951518000354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Advance care planning (ACP) increases quality of life and satisfaction with care for those with cancer and their families, yet these important conversations often do not occur. Barriers include patients' and families' emotional responses to cancer, such as anxiety and sadness, which can lead to avoidance of discussing illness-related topics such as ACP. Interventions that address psychological barriers to ACP are needed. The purpose of this study was to explore the effects of a mindfulness intervention designed to cultivate patient and caregiver emotional and relational capacity to respond to the challenges of cancer with greater ease, potentially decreasing psychological barriers to ACP and enhancing ACP engagement. METHOD The Mindfully Optimizing Delivery of End-of-Life (MODEL) Care intervention provided 12 hours of experiential training to two cohorts of six to seven adults with advanced-stage cancer and their family caregivers (n = 13 dyads). Training included mindfulness practices, mindful communication skills development, and information about ACP. Patient and caregiver experiences of the MODEL Care program were assessed using semistructured interviews administered immediately postintervention and open-ended survey questions delivered immediately and at 4 weeks postintervention. Responses were analyzed using qualitative methods.ResultFour salient themes were identified. Patients and caregivers reported the intervention (1) enhanced adaptive coping practices, (2) lowered emotional reactivity, (3) strengthened relationships, and (4) improved communication, including communication about their disease.Significance of resultsThe MODEL Care intervention enhanced patient and caregiver capacity to respond to the emotional challenges that often accompany advanced cancer and decreased patient and caregiver psychological barriers to ACP.
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Cottingham AH, Cripe LD, Rand KL, Frankel RM. "My Future is Now": A Qualitative Study of Persons Living With Advanced Cancer. Am J Hosp Palliat Care 2017; 35:640-646. [PMID: 28992715 DOI: 10.1177/1049909117734826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Advance care planning (ACP) enables individuals to deliberate about future preferences for care based upon their values and beliefs about what is important in life. For many patients with advanced cancer, however, these critical conversations do not occur. A growing body of literature has examined the end-of-life wishes of seriously ill patients. Few studies have explored what is important to persons as they live with advanced cancer. The aim of the current study was to address this gap and to understand how clinicians can support patients' efforts to live in the present and plan for the future. METHODS Transcriptions of interviews conducted with 36 patients diagnosed with advanced cancer were analyzed using immersion-crystallization, a qualitative research technique. RESULTS Four overarching themes were identified: (I) living in the face of death, (II) who I am, (III) my experience of cancer, and (IV) impact of my illness on others. Twelve subthemes are also reported. SIGNIFICANCE OF RESULTS These findings have significant implications for clinicians as they partner with patients to plan for the future. Our data suggest that clinicians consider the following 4 prompts: (1) "What is important to you now, knowing that you will die sooner than you want or expected?" (2) "Tell me about yourself." (3) "Tell me in your own words about your experience with cancer care and treatment." (4) "What impact has your illness had on others?" In honoring patients' lived experiences, we may establish the mutual understanding necessary to providing high-quality care that supports patients' priorities for life.
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Affiliation(s)
- Ann H Cottingham
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,2 Department of Medicine and Psychology, Regenstrief Institute, Inc, Indianapolis, IN, USA
| | - Larry D Cripe
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,3 Department of Medicine and Psychology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA
| | - Kevin L Rand
- 4 Department of Medicine and Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Richard M Frankel
- 1 Department of Medicine and Psychology, Indiana University School of Medicine, Indianapolis, IN, USA.,5 Department of Medicine and Psychology, Cleveland Clinic, Cleveland, OH, USA
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Genewick JE, Lipski DM, Schupack KM, Buffington ALH. Characteristics of Patients With Existing Advance Directives: Evaluating Motivations Around Advance Care Planning. Am J Hosp Palliat Care 2017; 35:664-668. [PMID: 28925295 DOI: 10.1177/1049909117731738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Although 80% of patients endorse an advance directive (AD), less than 35% of American adults have a documented AD. Much research has been done on barriers to creating ADs; however, there is a paucity of research addressing motivations for creating ADs. Previous research has identified 4 categories of influence for engaging in advance care planning (ACP). This study aimed to quantify the influence of these 4 motivating categories in creating an AD. METHODS Participants included 238 adults with documented ADs. Participants completed an 11-item questionnaire addressing 1 of the 4 hypothesized categories of influence in addressing ACP: concern for self; concern for others; expectations about the impact of ACP; and anecdotes, stories, and experiences. RESULTS Principle component analysis yielded 2 factors representing dignity and personal control (intrinsic factors) and societal and familial influence (extrinsic factors). Intrinsic factors were the primary and most influential motivating factors among participants. A regression analysis of individual motivating factors showed that prior to age 50, the desire to provide guidance about personal preferences for end-of-life care significantly predicted the creation of an AD, whereas after age 50, the urging of family members significantly predicted the creation of an AD. DISCUSSION Results indicated that intrinsic factors were the most influential motivator among participants of all ages. Extrinsic factors appeared to be less influential in the decision to create an AD. Motivating factors were also found to vary by age. These results may help physicians be more targeted in discussions surrounding ADs, thus saving time, which physicians identify as the main barrier in engaging in such discussions, while meeting patients' wishes for their physicians to bring up the topic of ADs.
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Affiliation(s)
| | | | | | - Angela L H Buffington
- 1 Mayo Clinic Health System, Mankato, MN, USA.,3 University of Minnesota Medical School, Minneapolis, MN, USA
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25
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Ke LS, Huang X, Hu WY, O'Connor M, Lee S. Experiences and perspectives of older people regarding advance care planning: A meta-synthesis of qualitative studies. Palliat Med 2017; 31:394-405. [PMID: 27515975 DOI: 10.1177/0269216316663507] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. AIM To understand the experiences and perspectives of older people regarding advance care planning. DESIGN A systematic review of qualitative studies and meta-synthesis was conducted. DATA SOURCES CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. RESULTS A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care. CONCLUSION Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.
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Affiliation(s)
- Li-Shan Ke
- 1 Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.,2 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Xiaoyan Huang
- 3 School of Nursing, Fudan University, Shanghai, China.,4 Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, VIC, Australia
| | - Wen-Yu Hu
- 2 School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Margaret O'Connor
- 4 Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, VIC, Australia.,5 Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan Lee
- 4 Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, VIC, Australia
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Galambos C, Starr J, Rantz MJ, Petroski GF. Analysis of Advance Directive Documentation to Support Palliative Care Activities in Nursing Homes. HEALTH & SOCIAL WORK 2016; 41:228-234. [PMID: 29206978 DOI: 10.1093/hsw/hlw042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/03/2015] [Indexed: 06/07/2023]
Abstract
As part of an intervention to improve health care in nursing homes with the goal of reducing potentially avoidable hospital admissions, 1,877 resident records were reviewed for advance directive (AD) documentation. At the initial phases of the intervention, 50 percent of the records contained an AD. Of the ADs in the resident records, 55 percent designated a durable power of attorney for health care, most often a child (62 percent), other relative (14 percent), or spouse (13 percent). Financial power of attorney documents were sometimes found within the AD, even though these documents focused on financial decision making rather than health care decision making. Code status was the most prevalent health preference documented in the record at 97 percent of the records reviewed. The intervention used these initial findings and the philosophical framework of respect for autonomy to develop education programs and services on advance care planning. The role of the social worker within an interdisciplinary team is discussed.
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Affiliation(s)
- Colleen Galambos
- Graduate Certificate in Gerontological Social Work Program, School of Social Work, University of Missouri, Columbia, MO
| | - Julie Starr
- Urogynecology, University of Missouri Women's Health Center, Columbia
| | - Marilyn J Rantz
- Sinclair School of Nursing, University of Missouri, Columbia
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The Role of Spirituality in Coping With Chronic Illness: What Health Care Providers Need to Know for Advance Directive Decision Making. J Dr Nurs Pract 2016; 9:194-198. [PMID: 32750989 DOI: 10.1891/2380-9418.9.2.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spirituality is recognized by health care providers as having a significant influence on an individual's ability to cope. The role of spirituality in coping with chronic illness as well as what providers need to know about spirituality in advance directive decision making (ADDM), however, are poorly understood phenomena. With the growing population of people with chronic illness combined with escalating costs and disease burden, providers must understand and use the role of spirituality in the care of their patients who have demanding states of health and illness. Research has demonstrated the power of spirituality in managing chronic illness as well as the importance of spirituality during end-of-life care planning. The purpose of this case study is to illustrate the necessity of recognizing and understanding an individual's spiritual beliefs and values during chronic illness and how this knowledge, or lack of knowledge, affects ADDM.
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Markham SA, Levi BH, Green MJ, Schubart JR. Use of a Computer Program for Advance Care Planning with African American Participants. J Natl Med Assoc 2015; 107:26-32. [PMID: 27282525 DOI: 10.1016/s0027-9684(15)30006-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ACKNOWLEDGMENTS The authors wish to acknowledge the support and assistance of Dr. William Lawrence for his contribution to the M.A.UT model used in the decision aid, Making Your Wishes Known: Planning Your Medical Future (MYWK), Dr. Cheryl Dellasega for her leadership in focus group activities, Charles Sabatino for his review of legal aspects of MYWK, Dr. Robert Pearlman and his collaborative team for use of the advance care planning booklet "Your Life, Your Choices," Megan Whitehead for assistance in grant preparation and project organization, and the Instructional Media Development Center at the University of Wisconsin as well as JPL Integrated Communications for production and programming of MYWK. BACKGROUND For various cultural and historical reasons, African Americans are less likely than Caucasians to engage in advance care planning (ACP) for healthcare decisions. PURPOSE This pilot study tested whether an interactive computer program could help overcome barriers to effective ACP among African Americans. METHODS African American adults were recruited from traditionally Black churches to complete an interactive computer program on ACP, pre-/post-questionnaires, and a follow-up phone interview. RESULTS Eighteen adults (mean age =53.2 years, 83% female) completed the program without any problems. Knowledge about ACP significantly increased following the computer intervention (44.9% → 61.3%, p=0.0004), as did individuals' sense of self-determination. Participants were highly satisfied with the ACP process (9.4; 1 = not at all satisfied, 10 = extremely satisfied), and reported that the computer-generated advance directive accurately reflected their wishes (6.4; 1 = not at all accurate, 7 = extremely accurate). Follow-up phone interviews found that >80% of participants reported having shared their advance directives with family members and spokespeople. CONCLUSION Preliminary evidence suggests that an interactive computer program can help African Americans engage in effective advance care planning, including creating an accurate advance directive document that will be shared with loved ones.
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Affiliation(s)
- Sarah A Markham
- Department of Humanities, The Pennsylvania State University, College of Medicine
| | - Benjamin H Levi
- Department of Humanities, The Pennsylvania State University, College of Medicine
| | - Michael J Green
- Department of Humanities, The Pennsylvania State University, College of Medicine
| | - Jane R Schubart
- Departments of Surgery and Medicine, The Pennsylvania State University, College of Medicine.
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Tay SY, Davison J, Jin NC, Yap PLK. Education and Executive Function Mediate Engagement in Advance Care Planning in Early Cognitive Impairment. J Am Med Dir Assoc 2015; 16:957-62. [PMID: 26130078 DOI: 10.1016/j.jamda.2015.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/01/2015] [Accepted: 05/27/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Advance care planning (ACP) is an important component to holistic care for people with early cognitive impairment (ECI) who are generally still mentally capable of making rational decisions. This study explores the willingness of people with ECI to engage in ACP and how clinical and behavioral variables shape their decisions. METHODS Ninety-eight persons with ECI (mild cognitive impairment or early dementia, Clinical Dementia Rating = 0.5/1.0) and assessed to have adequate insight (Clinical Insight Rating Scale) underwent an ACP information session. They were assessed on their knowledge of dementia (Knowledge of Alzheimer Disease) and willingness to engage in ACP, and were interviewed on their beliefs and attitudes toward ACP (Perceived Barriers and Benefits Scale to ACP). Univariate analysis and logistic regression identified factors that predicted persons willing or unwilling to engage in ACP based on their responses to the perceived barriers and benefits of ACP as well as sociodemographic and clinical variables. RESULTS Fifty-two persons (54%) were keen on ACP. On univariate analysis, persons with better executive function [Frontal Assessment Battery (FAB)] (t = -3.63, P < .0001), were more educated (t = -2.11, P = .038) and had lower barriers to ACP (t = 2.47, P = .015), particularly less "passive coping" (t = 2.83, P = .006), were more keen on ACP. Logistic regression revealed that the combined predictive model comprising FAB, education, and passive coping as a whole reliably differentiated those unwilling to engage in ACP from those who were willing (χ(2) = 18.995, P = .001 with df = 4). Wald criterion showed that FAB (P = .016) and passive coping (P = .023) contributed most to prediction. CONCLUSIONS Better education and executive function predict willingness to engage in ACP, and these factors are instrumental in a person's ability to acquire knowledge and process information. Initiating ACP discussions early, increasing efforts at education, and providing tailored information are important interventions that facilitate completion of ACP.
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Affiliation(s)
- Sze Yan Tay
- Department of Neurology, Singapore General Hospital, Singapore
| | - John Davison
- Department of Psychology, National University of Singapore, Singapore
| | - Ng Chong Jin
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
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Abstract
Cognitively impaired and cognitively intact older adults seemingly differ regarding engagement in aspects of advance care plans (ACPs). Through informant reports in the Canadian Study on Health and Aging, we examined differences between deceased cognitively impaired and intact older adults in components of ACPs: (1) discussions/arrangements for end-of-life care; (2) creation of legal documents; and in ACP outcomes, (3) location of death; and (4) dying in accordance with wishes. Cognitively impaired older adults were more likely to have made arrangements for a substitute decision-maker (OR = 1.90) and to have created legal documents (OR = 2.64 for health care preferences, OR = 2.00 for naming a decision-maker). They were less likely to have discussed preferences for end-of-life care (OR = 0.62). These findings suggest that ACPs differ for cognitively impaired persons, indicating a need for further investigation. This is a step towards understanding this complex process in a particularly vulnerable population.
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Kossman DA. Prevalence, Views, and Impact of Advance Directives Among Older Adults. J Gerontol Nurs 2014; 40:44-50. [DOI: 10.3928/00989134-20140310-01] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/18/2013] [Indexed: 11/20/2022]
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Amjad H, Towle V, Fried T. Association of experience with illness and end-of-life care with advance care planning in older adults. J Am Geriatr Soc 2014; 62:1304-9. [PMID: 24934237 DOI: 10.1111/jgs.12894] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine whether experiences with illness and end-of-life care are associated with readiness to participate in advance care planning (ACP). DESIGN Observational cohort study. SETTING Community. PARTICIPANTS Persons aged 60 and older recruited from physician offices and a senior center. MEASUREMENTS Participants were asked about personal experience with major illness or surgery and experience with others' end-of-life care, including whether they had made a medical decision for someone dying, knew someone who had a bad death due to too much or too little medical care, or experienced the death of a loved one who made end-of-life wishes known. Stages of change were assessed for specific ACP behaviors: completion of living will and healthcare proxy, communication with loved ones regarding life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same topics. Stages of change included precontemplation, contemplation, preparation, and action or maintenance, corresponding to whether the participant was not ready to complete the behavior, was considering participation in the next 6 months, was planning participation within 30 days, or had already participated. RESULTS Of 304 participants, 84% had one or more personal experiences or experience with others. Personal experiences were not associated with greater readiness for most ACP behaviors. In contrast, having one or more experiences with others was associated with greater readiness to complete a living will and healthcare proxy, discuss life-sustaining treatment with loved ones, and discuss quantity versus quality of life with loved ones and with physicians. CONCLUSION Older individuals who have experience with end-of-life care of others demonstrate greater readiness to participate in ACP. Discussions with older adults regarding these experiences may be a useful tool in promoting ACP.
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Affiliation(s)
- Halima Amjad
- Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
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Levi BH, Wilkes M, Der-Martirosian C, Latow P, Robinson M, Green MJ. An Interactive Exercise in Advance Care Planning for Medical Students. J Palliat Med 2013; 16:1523-7. [DOI: 10.1089/jpm.2013.0039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Benjamin H. Levi
- Departments of Humanities and Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
| | - Michael Wilkes
- Office of the Dean, University of California, Davis, California
- School of Medicine, University of California, Davis, California
| | | | - Polly Latow
- Department of Internal Medicine, University of California, Davis, California
| | - Mark Robinson
- Department of Internal Medicine, University of California, Davis, California
| | - Michael J. Green
- Departments of Humanities and Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania
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Moorman SM, Inoue M. Persistent problems in end-of-life planning among young- and middle-aged American couples. J Gerontol B Psychol Sci Soc Sci 2012; 68:97-106. [PMID: 23149430 DOI: 10.1093/geronb/gbs103] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Guided by the transtheoretical model of health behavior change, this study sought to explain why (a) rates of advance care planning remain low in the general population and (b) surrogate decision makers are often inaccurate about patients' end-of-life preferences. METHODS The study used quantitative data from a cross-sectional internet survey conducted between July and October 2010. The 2,150 participants aged 18-64 belonged to 1,075 married or cohabiting heterosexual couples. Participants included members of a nationally representative internet panel and a convenience sample from online advertisements. RESULTS Older age was associated with a greater likelihood of having executed a living will and/or appointed a durable power of attorney for health care. Both older age and poorer health were independently associated with a greater likelihood of having discussed end-of-life health care treatment preferences. Completion of one's own end-of-life planning was unrelated to one's ability to accurately report one's partner's treatment preferences. DISCUSSION Readiness to plan for end of life appears to differ across planning behaviors. Age and health are related to aspects of one's own advance care planning, but none of these factors are related to accuracy as a partner's surrogate.
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Affiliation(s)
- Sara M Moorman
- Department of Sociology, Boston College, McGuinn Hall 426, 140 Commonwealth Avenue, Chestnut Hill, MA 02467-3807, USA.
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Volker DL, Zolnierek C, Harrison T, Walker J. End of life and women aging with a disability. J Palliat Med 2012; 15:667-71. [PMID: 22536990 DOI: 10.1089/jpm.2011.0506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Approximately 21 million noninstitutionalized Americans with physical disabilities will ultimately face end-of-life [EOL] issues. Studies have documented disparate care and poorer outcomes for persons with preexisting disabilities who have life-limiting illnesses, which raises the question of how EOL experiences may differ for these individuals. The aim of this qualitative, descriptive study was to explore how EOL issues might emerge within the life stories of women aging with functional disabilities. Interview data were obtained from a larger, ongoing ethnographic study focused on the creation of an explanatory model of health disparities of disablement in women with mobility impairment. Each participant was interviewed three to four times using a life-course perspective that captures life trajectories and transitions experienced over time. For this analysis, 41 interviews were selected from 20 participants who discussed issues related to death and dying. Content analysis of the data revealed five analytic categories: death as a signpost, impact of others' deaths, deaths that affected personal insights and choice, EOL possibilities, and a personal brush with death. EOL issues were manifested in a variety of ways that revealed both determination to remain as independent as possible within the context of declining functional ability and uncertainty regarding the future.
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Affiliation(s)
- Deborah L Volker
- The University of Texas at Austin School of Nursing, Austin, Texas, 78701, USA.
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Abstract
BACKGROUND Few people with dementia have made advance plans for their health care. Advance care planning (ACP) is a process of discussion between an individual and their care providers that takes account of wishes and preferences for future care. We aimed to examine the facilitators and inhibitors to ACP in people with dementia. We also aimed to identify key themes in the literature and critically review the methodologies used. METHODS We systematically searched the English language literature including PubMed, CINAHL, AMED, PsychINFO, EMBASE and BNI. We included empirical studies which reported the characteristics of the patient population, the type of advance care planning used and the study setting, and which involved people with dementia, family members or professional carers. RESULTS We identified 17 studies (11 quantitative methods, one qualitative and five mixed methods). We found one ACP intervention which changed outcomes for people with dementia. Key themes were identified: there is a point at which cognition decreases critically so that an advanced care plan can no longer be made; factors present in family carers and professionals can influence decision-making and the ACP process; ACPs are affected by preferences for life sustaining treatments; ACP in dementia may differ from other illness groups; and there is a need for education relating to ACP. CONCLUSION The current evidence base for ACP in dementia is limited. Since UK government policy recommends that all people should engage in ACP, more evidence is needed to understand the feasibility and acceptability of advanced care plans for people with dementia.
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