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Issa TZ, McCurdy MA, Lee Y, Lambrechts MJ, Sherman MB, Kalra A, Goodman P, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. The Impact of Socioeconomic Status on the Presence of Advance Care Planning Documents in Patients With Acute Cervical Spinal Cord Injury. J Am Acad Orthop Surg 2024; 32:354-361. [PMID: 38271675 DOI: 10.5435/jaaos-d-23-00763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/27/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Patients presenting with spinal cord injury (SCI) often times have notable deficits or polytrauma and may require urgent decision making for early management. However, their presentation may affect decision-making ability. Although advance care planning (ACP) may help guide spine surgeons as to patient preferences, the rate at which they are available and disparities in ACP completion are still not understood. The objective of this study was to evaluate disparities in the completion of ACP among patients with acute SCI. METHODS All patients presenting with cervical SCI to the emergency department at an urban, tertiary level I trauma center from 2010 to 2021 were identified from a prospective database of all consults evaluated by the spine service. Each patient's medical record was reviewed to assess for the presence of ACP documents such as living will, power of attorney, or advance directive. Community-level socioeconomic status was assessed using the Distressed Communities Index. Bivariable and multivariable analyses were performed. RESULTS We identified 424 patients: 104 (24.5%) of whom had ACP. Patients with ACP were older (64.8 versus 56.5 years, P = 0.001), more likely White (78.8% versus 71.9%, P = 0.057), and present with ASIA Impairment Scale grade A SCI (21.2% versus 12.8%, P = 0.054), although the latter two did not reach statistical significance. On multivariable logistic regression, patients residing in at-risk communities were significantly less likely to have ACP documents compared with those in prosperous communities (odds ratio [OR]: 0.29, P = 0.03). Although patients living in distressed communities were less likely to complete ACP compared with those in prosperous communities (OR 0.50, P = 0.066), this did not meet statistical significance. Female patients were also less likely to have ACP (OR: 0.43, P = 0.005). CONCLUSION Female patients and those from at-risk communities are markedly less likely to complete ACP. Attention to possible disparities during admission and ACP discussions may help ensure that patients of all backgrounds have treatment goals documented.
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Affiliation(s)
- Tariq Z Issa
- From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA (Issa, McCurdy, Lee, Sherman, Kalra, Goodman, Canseco, Hilibrand, Vaccaro, Schroeder, and Kepler), the Feinberg School of Medicine, Northwestern University, Chicago, IL (Issa), and the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO (Lambrechts)
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Van Scoy LJ, Levi BH, Bramble C, Calo W, Chinchilli VM, Currin L, Grant D, Hollenbeak C, Katsaros M, Marlin S, Scott AM, Tucci A, VanDyke E, Wasserman E, Witt P, Green MJ. Comparing two advance care planning conversation activities to motivate advance directive completion in underserved communities across the USA: The Project Talk Trial study protocol for a cluster, randomized controlled trial. Trials 2022; 23:829. [PMID: 36180899 PMCID: PMC9523194 DOI: 10.1186/s13063-022-06746-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is a process involving conversations between patients, loved ones, and healthcare providers that consider patient preferences for the types of medical therapies received at the end of life. Underserved populations, including Black, Hispanic, rural, and low-income communities are less likely to engage in ACP than other communities, a health inequity that results in lower-quality care and reduced hospice utilization. The purpose of this trial is to compare efficacy of two interventions intended to motivate ACP (particularly advance directive completion) for those living in underserved communities. METHODS This 3-armed cluster, randomized controlled mixed methods design is being conducted in 75 community venues in underserved communities across the USA. The goal of the trial is to compare the efficacy of two interventions at motivating ACP. Arm 1 uses an end-of-life conversation game (Hello); Arm 2 uses a nationally utilized workshop format for ACP conversations (The Conversation Project); and Arm 3 uses an attention control game (TableTopics). Events are held in partnership with 75 local community-based host organizations and will involve 1500 participants (n=20 per event). The primary outcome is completion of a visually verified advance directive at 6 months post-event. Primary analyses compare efficacy of each intervention to each other and the control arm. Secondary mixed methods outcomes include (a) other ACP behaviors and engagement; (b) communication quality; (c) impact of sociocultural environment on ACP (via qualitative interviews); and (d) implementation and sustainability. Subgroup analyses examine outcomes for Black, Hispanic, and rural groups in particular. DISCUSSION This trial will add to the evidence base behind various conversational ACP interventions, examine potential mechanisms of action for such interventions, and provide qualitative data to better understand the sociocultural environment of how community-based ACP interventions are experienced by underserved populations. Results will also provide important data for future researchers to learn whether visual verification of advance directives is necessary or whether reliance on self-reported outcomes is of comparable value. Data from this study will inform ways to effectively motivate underserved communities to participate in advance care planning. TRIAL REGISTRATION ClinicalTrials.gov NCT04612738. Registered on October 12, 2020. All information from the WHO Trial Registration Data Set can be found within the protocol.
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Affiliation(s)
- Lauren J. Van Scoy
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Benjamin H. Levi
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
- Department of Pediatrics, Penn State College of Medicine, Suite 4400, Mail Code A444, Hershey, PA 17033 USA
| | - Cindy Bramble
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - William Calo
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Lindsey Currin
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Denise Grant
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Christopher Hollenbeak
- Department of Health Policy and Administration, The Pennsylvania State University, 604E Donald H. Ford Bldg., University Park, PA 16802 USA
| | - Maria Katsaros
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Sara Marlin
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Allison M. Scott
- Department of Communication, University of Kentucky, 275 Blazer Dining Hall, University of Kentucky, Lexington, KY 40506 USA
| | - Amy Tucci
- Hospice Foundation of America, 1707 L St. NW, Suite 220, Washington, DC, 20036 USA
| | - Erika VanDyke
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State College of Medicine, 90 Hope Drive, Academic Support Building, Suite 2200, Mail Code A210, Hershey, PA 17033 USA
| | - Pamela Witt
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
| | - Michael J. Green
- Department of Medicine, Penn State College of Medicine, 500 University Dr., H-041, Hershey, PA 17033-0850 USA
- Department of Humanities, Penn State College of Medicine, 500 University Drive, Hershey, PA 17036 USA
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Lin JL, Lipstein EA, Wittenberg E, Tay D, Lundstrom R, Lundstrom GL, Sediqzadah S, Wright DR. Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making. MDM Policy Pract 2021; 6:23814683211039468. [PMID: 34734118 PMCID: PMC8559218 DOI: 10.1177/23814683211039468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.
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Affiliation(s)
- Jody L Lin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | | | - Saadia Sediqzadah
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Van Scoy LJ, Green MJ, Witt PD, Bramble C, Richardson C, Putzig I, Toyobo O, Wasserman E, Chinchilli VM, Tucci A, Levi BH. Low Skepticism and Positive Attitudes About Advance Care Planning Among African Americans: a National, Mixed Methods Cohort Study. J Gen Intern Med 2021; 36:705-712. [PMID: 32948953 PMCID: PMC7947044 DOI: 10.1007/s11606-020-06224-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND African Americans have low engagement in advance care planning (ACP). This has been attributed to healthcare distrust and skepticism about ACP. A better understanding of these attitudes is needed to address health disparities related to end-of-life care. OBJECTIVE To explore the ACP-related values and beliefs of diverse African American communities across the USA and then the perceived value of an inexpensive end-of-life conversational game. DESIGN Prospective, convergent, mixed methods cohort study involving fifteen underserved, African American communities across the USA. PARTICIPANTS Of the 428 who attended events at purposively sampled sites, 90% consented to the research; 37% participated in one of 15 focus groups (n = 141). INTERVENTION An end-of-life conversation game, played in groups of 4-6. MAIN MEASURES The validated, 7-item ACP values and beliefs questionnaire (scaled 7 = least skeptical, 49 = most skeptical) was administered pre-game. Post-game focus groups explored perceptions about ACP and the intervention. KEY RESULTS Participants had positive attitudes (low skepticism) about ACP with a median score of 12.00 (7.00, 20.00). Values and beliefs did not significantly differ by geographical region; however, rural areas were observed to be slightly more skeptical than urban areas (median score 14.00 vs. 11.00, p = 0.002). Themes from focus groups converged with survey data showing participants valued the ACP process and consider further engagement in ACP to be worthwhile. Subthemes emphasized the need for and value of ACP. CONCLUSIONS Skepticism about ACP may contribute to low rates of ACP engagement in underserved African American communities. The positive attitudes uncovered in our study either negate previous findings or suggest reduced skepticism. TRIAL REGISTRATION This study has been registered at clinicaltrials.gov ( NCT03456921 ).
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Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA.
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA.
| | - Michael J Green
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Pamela D Witt
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | | | | | - Irene Putzig
- Hospice Foundation of America, Washington, DC, USA
| | - Olubukola Toyobo
- Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Amy Tucci
- Hospice Foundation of America, Washington, DC, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
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Dressler G, Garrett SB, Hunt LJ, Thompson N, Mahoney K, Sudore RL, Ritchie CS, Harrison KL. "It's Case by Case, and It's a Struggle": A Qualitative Study of Hospice Practices, Perspectives, and Ethical Dilemmas When Caring for Hospice Enrollees with Full-Code Status or Intensive Treatment Preferences. J Palliat Med 2020; 24:496-504. [PMID: 33237830 DOI: 10.1089/jpm.2020.0215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Characterize hospice staff practices and perspectives on discussing end-of-life care preferences with patients/families, including those desiring intensive treatment and/or full code. Background: Patients in the United States can elect hospice while remaining full code or seeking intensive interventions, for example, blood transfusions, or chemotherapy. These preferences conflict with professional norms, hospice philosophy, and Medicare hospice payment policies. Little is known about how hospice staff manage patient/family preferences for full-code status and intensive treatments. Methods: We recruited employees of four nonprofit US hospices with varying clinical and hospice experience for semi-structured, in-depth interviews. Open-ended questions explored participants' practices and perceptions of discussing end-of-life care preferences in hospice, with specific probes about intensive treatment or remaining full code. Interdisciplinary researchers coded and analyzed data using the constant comparative method. Results: Participants included 25% executive leaders, 14% quality improvement administrative staff, 61% clinicians (23 nurses, 21 social workers, 7 physicians, and 2 chaplains). Participants reported challenges in engaging patients/families about end-of-life care preferences. Preferences for intensive treatment or full-code status presented an ethical dilemma for some participants. Participants described strategies to navigate such preferences, including educating about treatment options, and expressed diverse reactions, including accepting or attempting to shift enrollee preferences. Discussion: This study illuminates a rarely studied aspect of hospice care: how hospice staff engage with enrollees choosing full code and/or intensive treatments. Such patient preferences can produce ethical dilemmas for hospice staff. Enhanced communication training and guidelines, updated organizational and federal policies, and ethics consult services may mitigate these dilemmas.
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Affiliation(s)
- Gabrielle Dressler
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Sarah B Garrett
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Lauren J Hunt
- Department of Physiological Nursing, University of California, San Francisco, California, USA
| | - Nicole Thompson
- Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Rebecca L Sudore
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Christine S Ritchie
- The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Krista L Harrison
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
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Van Scoy LJ, Levi BH, Witt P, Bramble C, Richardson C, Putzig I, Levi AR, Wasserman E, Chinchilli V, Tucci A, Green MJ. Association of Participation in an End-of-Life Conversation Game With Advance Care Planning Behavior and Perspectives Among African American Individuals. JAMA Netw Open 2020; 3:e204315. [PMID: 32383747 PMCID: PMC7210487 DOI: 10.1001/jamanetworkopen.2020.4315] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
Abstract
Importance Less than 25% of African American individuals have completed advance directives and are thus vulnerable to poor end-of-life care. Low-cost interventions are needed to increase engagement in advance care planning (ACP). Objectives To investigate whether an end-of-life conversation game motivates African American attendees to engage in ACP and to assess whether the game is well received and endorsed. Exposures Attendance at an end-of-life conversation game (Hello) played in groups of 4 to 6 participants for 60 minutes. Design, Setting, and Participants Prospective, mixed-methods cohort study conducted from 2018 to 2019 with a 3- to 11-month follow-up interview. Game events were held in 53 community venues across the US; 15 were purposively sampled for onsite research procedures. Of 428 attendees at purposively sampled sites, 386 (90%) consented to research procedures (6 attendees were removed from analysis for protocol deviation). Of 367 attendees who provided accurate contact information, 232 (63%) were contacted, and 220 were included in follow-up analyses. Main Outcomes and Measures The primary outcome was advance directive completion rates after the intervention. Secondary outcomes included rates of other ACP behaviors, ACP engagement, conversation satisfaction and realism, and participants' Net Promoter Score (a measure of endorsement). Follow-up telephone interviews explored the game experience and relevant ACP behaviors of attendees. Results Of 380 individuals who participated (mean [SD] age, 62.2 [13.8] years; 304 were female [80%], and 348 were [92%] African American), none withdrew because of an adverse event. After the intervention, 91 of 220 attendees (41%) completed a new advance directive; 176 of 220 attendees (80%) discussed end-of-life wishes with loved ones, and 214 of 219 attendees (98%) completed at least 1 ACP behavior. There was a moderate increase in the self-efficacy domain on the ACP Engagement Survey (mean [SD] change from before to after the game, 0.54 [0.98]; P < .001). The mean (SD) conversation satisfaction score was 6.21 (0.93) (range, 1-7, with 7 being highest satisfaction), and the overall Net Promoter Score was 57.89 (range, -100 to 100, with 100 being highest endorsement). Interviews revealed 5 themes about the game: (1) it was a useful forum for ACP; (2) it provided new information and perspective; (3) it was emotionally beneficial; (4) it increased appreciation for ACP; and (5) it empowered and motivated participants to perform ACP. Mixed-methods integration showed convergence across data sets. Conclusions and Relevance Among a nationwide sample of African American individuals, the end-of-life conversation game appeared to be well received and was associated with high rates of ACP behavior. This low-cost and scalable tool may help reduce health disparities associated with end-of-life care.
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Affiliation(s)
- Lauren Jodi Van Scoy
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Benjamin H. Levi
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Pamela Witt
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | | | - A. Rose Levi
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Emily Wasserman
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vernon Chinchilli
- Department of Public Health Sciences, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - Amy Tucci
- Hospice Foundation of America, Washington, DC
| | - Michael J. Green
- Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Humanities, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
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Rahemi Z, Williams CL. Does ethnicity matter—Cultural factors underlying older adults’ end-of-life care preferences: A systematic review. Geriatr Nurs 2020; 41:89-97. [DOI: 10.1016/j.gerinurse.2019.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/29/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
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Van Scoy LJ, Day AG, Howard M, Sudore R, Heyland DK. Adaptation and Preliminary Validation of the Advance Care Planning Engagement Survey for Surrogate Decision Makers. J Pain Symptom Manage 2019; 57:980-988.e9. [PMID: 30684633 PMCID: PMC6857702 DOI: 10.1016/j.jpainsymman.2019.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/09/2019] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Abstract
CONTEXT Although measures that assess patient engagement in the advance care planning (ACP) process exist, there are no validated tools to assess surrogate decision makers' (SDMs') role in ACP. OBJECTIVES The objective of this study was to adapt and begin to validate a patient-oriented questionnaire for use with SDMs of patients with chronic illness. METHODS Questions from the 55-item patient-oriented ACP engagement survey were adapted for SDMs and assessed for face validity. The resultant 47-item questionnaire was administered to 65 SDMs of patients with chronic illness. Responses were assessed and items were flagged for removal based on item redundancy, nonresponses, and ceiling effects. A preliminary exploratory factor analysis was performed, internal consistency was assessed, and domains were constructed based on findings. RESULTS The 47-item questionnaire was administered to 65 participants (mean age 51.8; 81% female; 96% Caucasian). Seventeen items were removed owing to redundancy (r > 0.80), and 13 items lacking face validity were removed. In a preliminary exploratory factor analysis of the resultant 17-item questionnaire, a three-factor solution was deemed most statistically and conceptually sound. Items were organized into domains: 1) serving as an SDM (seven items); 2) contemplation (four items); 3) readiness (six items). Internal consistency for each domain was high (Cronbach alpha 0.90-0.91). CONCLUSION The 17-item ACP engagement survey for SDMs (ACP-17-SDM) is a conceptually sound and reliable questionnaire adaptation of the original ACP engagement survey. This questionnaire may be used by researchers in parallel with the patient-oriented ACP engagement survey to more fully understand the impact of ACP interventions on SDMs. Larger studies are needed to more closely examine construct validity.
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Affiliation(s)
- Lauren J Van Scoy
- Medicine, Humanities and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
| | - Andrew G Day
- Kingston General Health Research Institute and Clinical Evaluation Unit, Kingston, Ontario, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Rebecca Sudore
- Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - Daren K Heyland
- Department of Critical Care Medicine, Clinical Evaluation Research Unit, Kingston General Health Research Institute, Queen's University, Kingston, Ontario, Canada
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Strategies used to facilitate the discussion of advance care planning with older adults in primary care settings: A literature review. J Am Assoc Nurse Pract 2018; 30:270-279. [DOI: 10.1097/jxx.0000000000000025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
We investigated the influence of sociodemographic factors, acculturation, ethnicity, health status, and spirituality on older adults' health-related decisions when confronted with a choice between competing options. The sample included 451 participants: African Americans (15.74%), Afro-Caribbeans (25.5%), European Americans (36.36%), and Hispanic Americans (22.4%). Compared with others, European Americans and Hispanic Americans favored quality of life over a lengthy life. Sociodemographic factors, acculturation, ethnicity, health status, and spirituality accounted for variations of decisions. The variability of decisions calls for multiple care options to explore the value of different trade-offs in order to avoid predetermined clinical practice guidelines, especially in nursing.
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Van Scoy LJ, Reading JM, Hopkins M, Smith B, Dillon J, Green MJ, Levi BH. Community Game Day: Using an End-of-Life Conversation Game to Encourage Advance Care Planning. J Pain Symptom Manage 2017; 54:680-691. [PMID: 28743662 DOI: 10.1016/j.jpainsymman.2017.07.034] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
CONTEXT Advance care planning (ACP) is an important process that involves discussing and documenting one's values and preferences for medical care, particularly end-of-life treatments. OBJECTIVES This convergent, mixed-methods study assessed whether an end-of-life conversation card game is an acceptable and effective means for performing ACP for patients with chronic illness and/or their caregivers when deployed in a community setting. METHODS Twenty-two games (n = 93 participants) were held in community settings surrounding Hershey, PA in 2016. Participants were recruited using random sampling from patient databases and also convenience sampling (i.e., flyers). Quantitative questionnaires and qualitative focus group interviews were administered to assess the game experience and subsequent performance of ACP behaviors. RESULTS Both quantitative and qualitative data found that Community Game Day was a well-received, positive experience for participants and 75% of participants performed ACP within three months post-intervention. CONCLUSIONS These findings suggest that using a conversation game during community outreach is a useful approach for engaging patients and caregivers in ACP. The convergence of quantitative and qualitative data strongly supports the continued investigation of the game in randomized controlled trials.
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Affiliation(s)
- Lauren J Van Scoy
- Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA.
| | - Jean M Reading
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Margaret Hopkins
- Department of Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Brandi Smith
- Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Judy Dillon
- Department of Nursing, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Michael J Green
- Department of Medicine and Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Benjamin H Levi
- Department of Pediatrics and Humanities, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
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Ankuda CK, Fonger E, O'Neil T. Electing Full Code in Hospice: Patient Characteristics and Live Discharge Rates. J Palliat Med 2017; 21:297-301. [PMID: 28872978 DOI: 10.1089/jpm.2017.0276] [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: 11/12/2022] Open
Abstract
BACKGROUND It is unknown how many hospice enrollees elect to be full code and if this is associated with higher hospice live discharge rates. OBJECTIVE To measure the rates of hospice enrollees electing full code, the characteristics predicting full code status, and the association of full code status with various hospice live discharge patterns. DESIGN Retrospective cohort study of electronic medical record data. SETTING/SUBJECTS A total of 25,636 decedents enrolled in two Michigan hospices between 2009 and 2014. MEASUREMENTS Code status was defined as full code versus do-not-resuscitate (DNR) orders. Covariates include demographics, location (home, hospice facility, nursing home, and hospital), primary diagnosis, and length of stay. Hospice live discharge was defined as short (0-14 days), medium (15-179 days), and long (>179 days). RESULTS A total of 12.9% of hospice enrollees elected full code status. This was significantly (p < 0.05) predicted by male sex, younger age, nonwhite race, home setting of care, and cancer diagnosis. Those with full code status had 1.76 times the adjusted odds of hospice live discharge compared with those with DNR orders (95% confidence interval [CI] 1.44-2.16) and 2.47 times the odds of short live discharge (95% CI 1.69-3.62) with no significant difference in long live discharge. The association of full code orders with hospice live discharge was stronger for nonwhite enrollees, with a live discharge rate of 23.8% versus 11.6% for African Americans with full code versus DNR orders. CONCLUSIONS Those electing full code status on admission to hospice are at high risk of live hospice discharge after short enrollments, particularly nonwhite enrollees.
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Affiliation(s)
- Claire K Ankuda
- 1 Robert Wood Johnson Clinical Scholars Program, University of Michigan , Ann Arbor, Michigan.,2 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Evan Fonger
- 3 Hospice of Michigan , Detroit, Michigan.,4 Arbor Hospice , Ann Arbor, Michigan
| | - Thomas O'Neil
- 4 Arbor Hospice , Ann Arbor, Michigan.,5 Department of Geriatric and Palliative Medicine, University of Michigan , Ann Arbor, Michigan
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13
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Kuchinad KE, Strowd R, Evans A, Riley WA, Smith TJ. End of life care for glioblastoma patients at a large academic cancer center. J Neurooncol 2017; 134:75-81. [PMID: 28528421 DOI: 10.1007/s11060-017-2487-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
Glioblastoma (GBM) is a universally fatal disease, complicated by significant cognitive and physical disabilities, inherent to the disease course. The purpose of this study was to retrospectively analyze end-of-life care for GBM patients at an academic center and compare utilization of these services to national quality of care guidelines, with the goal of identifying opportunities to improve end-of-life care. Single center retrospective cohort study of GBM patients at Johns Hopkins Hospital (JHH) between 2009 and 2014, using electronic medical records and hospice records. Comprehensive medical record review of 100 randomly selected patients with GBM, who were actively treated at JHH. Secondary analysis of all JHH GBM patients (n = 45) who received hospice care at Gilchrist Services, our largest provider, during this time period. Of 100 patients, 76 were referred to hospice. Despite the poor survival and changes in mental capacity associated with this disease, only 40% of individuals had documentation of code status and only 17% had any documentation of advance directives (ADs). None had documentation by a health care provider of a formal symptom, psychosocial, or spiritual assessment at greater than 50% of clinic visits. Only 17% used chemotherapy in their last month of life. 37% were hospitalized in the last month of life for an average of 9 days. Of the Gilchrist Services patients, the median length of stay in hospice was 21 days and 64% of these patients died in their residence with hospice services. Documentation of palliative care and end-of-life measures could improve quality of care for GBM patients, especially in the use of ADs, symptom, spiritual, and psychosocial assessments, with earlier use of hospice to prevent end-of-life hospitalizations.
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Affiliation(s)
| | - Roy Strowd
- Brain Tumor Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | | - Thomas J Smith
- Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Harry J. Duffey Family Professor of Palliative Medicine, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Blalock 369, Baltimore, MD, 21287-0005, USA.
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14
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Lindley LC, Nageswaran S. Pediatric Primary Care Involvement in End-of-Life Care for Children. Am J Hosp Palliat Care 2017; 34:135-141. [PMID: 26430133 PMCID: PMC5037050 DOI: 10.1177/1049909115609589] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To examine the relationship between pediatric primary care involvement and hospice and home health care use at end of life. METHODS California Medicaid data were used to estimate the relationship between pediatric primary care involvement and use of hospice and home health care using generalized estimating equations. RESULTS Of the 2037 children who died between 2007 and 2010, 11% used hospice and 23% used home health. Among all children, primary care was not related to hospice use and was associated with home health use, usual source of care (OR = 1.83, P < .05), comprehensive care (OR = 1.60, P < .05), and continuous care (low: OR = 1.49, P < .05; moderate: OR = 2.57, P < .05; high: OR = 2.12, P < .05). Primary care for children aged 15 to 20 years was related to hospice use, usual source of care (OR = 4.06, P < .05) and continuous care (low: OR = 4.92, P < .05; moderate OR = 4.09, P < .05; high OR = 3.92, P < .05). Primary care for children under 5 years was associated with home health use, usual source of care (OR = 2.59, P < .05), comprehensive care (OR = 2.49, P < .05), and continuous care (low: OR = 2.22, P < .05; moderate: OR = 3.64, P < .05; high: OR = 3.62, P < .05). For children aged 6 to 14 years, this association was seen with continuous care (moderate: OR = 2.38, P < .05; high: OR = 2.13, P < .05). Home health for children aged 15 to 20 years was related to continuous care (moderate: OR = 2.32, P < .05). CONCLUSION Primary care involvement affected hospice use among older age-groups and home health use among younger age-groups. These findings underscore the need for clinical knowledge about end-of-life care for children of all ages among primary care providers.
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Affiliation(s)
- Lisa C Lindley
- 1 College of Nursing, University of Tennessee, Knoxville, TN, USA
| | - Savithri Nageswaran
- 2 Maya Angelou Center for Health Equity Social Sciences & Health Policy, Wake Forest Baptist Medical Center, Wake Forest, NC, USA
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15
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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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16
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Older Adults of Underrepresented Populations and Their End-of-Life Preferences: An Integrative Review. ANS Adv Nurs Sci 2016; 39:E1-E29. [PMID: 27677181 DOI: 10.1097/ans.0000000000000148] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This integrative review was conducted to examine the evidence for understanding diversity in end-of-life preferences among older adults of underrepresented groups. Findings from 21 studies were critically examined, grouped, and compared across studies, populations, and settings. Five major themes emerged: advance directives, hospice and palliative care, communication, knowledge and information, and home and family. Despite multidisciplinary attention, content and methodological limitations narrowed understanding of what matters most to these groups when making decisions at end of life. Rigorous longitudinal studies with more ethnically diverse samples are needed to detect modifiable factors related to disparities at the end of life.
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17
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Lindley LC, Mixer SJ, Mack JW. Home care for children with multiple complex chronic conditions at the end of life: The choice of hospice versus home health. Home Health Care Serv Q 2016; 35:101-111. [PMID: 27383451 PMCID: PMC5218989 DOI: 10.1080/01621424.2016.1208133] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Families desire to bring their children home at end of life, and this creates a variety of unique care needs at home. This study analyzed the child and family factors associated with hospice versus home health care use in the last year of life among children with multiple complex chronic conditions. Using the Andersen Behavioral Healthcare Utilization Model, the predisposing, enabling, and need factors of the child and family were shown to be significant predictors of hospice and home health care use. Hospice and home health care have advantages, and families may wish to use the service that best fits their needs.
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Affiliation(s)
- Lisa C Lindley
- a College of Nursing , University of Tennessee , Knoxville , Tennessee , USA
| | - Sandra J Mixer
- a College of Nursing , University of Tennessee , Knoxville , Tennessee , USA
| | - Jennifer W Mack
- b Department of Pediatric Oncology and the Division of Population Science's Center for Outcomes and Policy Research, Harvard Medical School , Dana-Farber Cancer Institute , Boston , Massachusetts , USA
- c Division of Pediatric Hematology/Oncology , Children's Hospital Boston , Boston , Massachusetts , USA
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18
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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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19
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Hayek S, Nieva R, Corrigan F, Zhou A, Mudaliar U, Mays D, Massoomi M, Ilksoy N. End-of-Life Care Planning: Improving Documentation of Advance Directives in the Outpatient Clinic Using Electronic Medical Records. J Palliat Med 2014; 17:1348-52. [DOI: 10.1089/jpm.2013.0684] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Salim Hayek
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Ria Nieva
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Frank Corrigan
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Amy Zhou
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Uma Mudaliar
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - David Mays
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Michael Massoomi
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
| | - Nurcan Ilksoy
- Emory University School of Medicine, Department of Medicine, Atlanta, Georgia
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20
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Butler J, Binney Z, Kalogeropoulos A, Owen M, Clevenger C, Gunter D, Georgiopoulou V, Quest T. Advance directives among hospitalized patients with heart failure. JACC-HEART FAILURE 2014; 3:112-21. [PMID: 25543976 DOI: 10.1016/j.jchf.2014.07.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/28/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the frequency and correlates of documented advance directives (ADs) among patients hospitalized for heart failure (HF). BACKGROUND Discussing ADs with patients with HF is critical for identifying treatment goals consistent with patients' values and preferences and for facilitating health care team communication. METHODS We retrospectively identified electronic medical records of adult patients admitted to 2 large tertiary care hospitals with either the primary or secondary discharge diagnosis of HF from September 2008 to August 2013 to assess the presence of ADs in electronic medical records. We performed analyses including HF as either the primary or secondary admission diagnosis and HF as the primary admission diagnosis only. Multivariable models were constructed to investigate independent predictors of documented ADs. RESULTS Data included 44,768 admissions from 24,291 individual patients over 5 years. Mean age of patients at admission was 64.8 ± 15.9 years; 47.9% of these patients were female, 51.8% were black. The median length of stay for all admissions was 5 (3 to 10) days; 12.7% of patients had documented ADs. Older age, female sex, white race, higher socioeconomic status, higher risk for adverse in-hospital outcomes, length of stay ≥5 days, hospice discharge, palliative care consultation, and a do-not-resuscitate order were all associated with a significantly higher chance of having documented ADs. A significant increase in ADs over time was noted, but more than 80% of patients did not have ADs in medical records at the end of the study period. CONCLUSIONS In a diverse population of hospitalized patients with HF, most did not have a documented AD in the medical records. Although several factors were associated with a higher probability, major opportunities exist for all subgroups of patients with HF to improve documentation of ADs.
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Affiliation(s)
- Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, New York.
| | - Zachary Binney
- Emory Cardiovascular Clinical Research Institute, Emory University, Atlanta, Georgia
| | | | - Melissa Owen
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Carolyn Clevenger
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Debbie Gunter
- Emory Cardiovascular Clinical Research Institute, Emory University, Atlanta, Georgia
| | | | - Tammie Quest
- Emory Cardiovascular Clinical Research Institute, Emory University, Atlanta, Georgia; Atlanta Veterans Administration Medical Center, Department of Veterans Affairs, Atlanta, Georgia
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21
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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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22
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Matsui M, Capezuti E. Differences in Perceived Autonomy Among American and Japanese Older Adults. J Gerontol Nurs 2014; 40:36-44. [DOI: 10.3928/00989134-20140211-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 11/12/2013] [Indexed: 11/20/2022]
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23
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Baughman KR, Ludwick R, Palmisano B, Hazelett S, Sanders M. The Relationship Between Organizational Characteristics and Advance Care Planning Practices. Am J Hosp Palliat Care 2014; 32:510-5. [DOI: 10.1177/1049909114530039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Organizational characteristics may impede the uniform adoption of advance care planning (ACP) best practices. We conducted telephone interviews with site directors of a Midwestern state’s Medicaid waiver program administered by the Area Agencies on Aging and surveyed the 433 care managers (registered nurses and social workers) employed within these 9 agencies. Care managers at 2 agencies reported more frequent ACP discussions and higher levels of confidence. Both sites had ACP training programs, follow-up protocols, and informational packets available for consumers that were not consistently available at the other agencies. The findings point to the need for consistent educational programs and policies on ACP and more in depth examination of the values, beliefs, and resources that account for organizational differences in ACP.
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Affiliation(s)
- Kristin R. Baughman
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Barbara Palmisano
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Susan Hazelett
- Health Services Research and Education Institute, Summa Health System, Akron, OH, USA
| | - Margaret Sanders
- Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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24
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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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Ko E, Lee J. Completion of Advance Directives Among Low-Income Older Adults. Am J Hosp Palliat Care 2013; 31:247-53. [DOI: 10.1177/1049909113486170] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the prevalence of completion of advance directives (ADs) and the effects of race/ethnicity on AD completion using a cross-sectional design. Low-income older adults (n = 256) who were residents of supportive housing facilities or members of a senior center were interviewed in person. About 20% of the participants had completed ADs. Knowledge and attitudes toward ADs, income, and previous experience in an intensive care unit significantly predicted the completion of ADs after controlling for other factors. Those with higher levels of knowledge, positive attitudes, or those with higher incomes were more likely to complete ADs than their counterparts. Findings suggest that as a proxy for multiple socioeconomic, social and cultural factors, race, and ethnicity need to be considered in planning end-of-life care.
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Affiliation(s)
- Eunjeong Ko
- School of Social Work, San Diego State University, San Diego, CA, USA
| | - Jaehoon Lee
- Center for Research Methods and Data Analysis, University of Kansas, Lawrence, KS, USA
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