Willingness of family caregivers of people with dementia to undertake Advance Care Planning: Examining an extended model of the Theory of Planned Behavior

Barriers to Advance Care Planning in Older Adults With Dementia, Their Families and Healthcare Professionals: An Umbrella Review of Qualitative Evidence

This umbrella review aimed to examine and synthesize qualitative studies that explored the barriers and facilitators of advance care planning for persons with dementia, their families, and their healthcare professionals and caregivers. The modified umbrella review approach developed by the Joanna Briggs Institute was followed. Five major English databases were searched. Four reviews based on 38 primary qualitative studies were included. The methodological quality of the included reviews was moderate to high. The synthesis yielded 16 descriptive themes and five analytical themes: making the wishes/preferences of persons with dementia visible; constructive collaboration based on stakeholders having positive relationships; emotional chaos in facing end-of-life substitute decision-making; initiating the advance care planning process; and preparedness and commitment of healthcare providers to advance care planning. Comprehensive and workable strategies are required to overcome complex and interrelated barriers involving not only healthcare professionals but also organizational and systemic challenges.

Defining the content of a website on advance care planning in dementia: a focus group study with family and health professionals

BACKGROUND

Advance care planning (ACP) is a process that enables individuals to define goals and preferences for their future care. It is particularly relevant for people with dementia and their family. Interactive tools, such as websites, that encourage reflection, communication and/or documentation, may support this group in the ACP process. However, considering the specific needs of people with dementia, it is important to develop adapted tools for this population. This study was conducted to define the content of an interactive website for people with dementia and their family caregivers to support them in ACP and to assess the barriers and facilitators for potential users in finding and using such a website from the perspective of family caregivers and healthcare professionals.

METHODS

Online focus groups with family caregivers (serving both as potential users and proxies for people with dementia) and healthcare professionals caring for people with dementia, using a semi-structured topic guide. To analyse the data, we used thematic framework analysis with a combination of deductive and inductive approaches to coding.

RESULTS

We conducted 4 focus groups with family caregivers of people with dementia (n = 18) and 3 with healthcare professionals (n = 17). Regarding the content of the website, participants highlighted that information on ACP (what and why) and guidance on how to start talking about ACP throughout the dementia trajectory should be included on the website. To increase the usability of the website, most participants considered a text-to-speech and a print option as important functionalities. A lack of computer literacy was found to be the most significant barrier to finding and using the website.

CONCLUSION

A website for people with dementia and their family caregivers to support them in ACP should focus on comprehensive content on ACP, peer testimonials, and interactive communication tools. Moreover, there should be certain flexibility in navigating through the website so people with dementia and their family caregivers can use it at their own pace. As the next step, we will include people with dementia in developing the website.

Support from healthcare professionals in empowering family carers to discuss advance care planning: A population-based survey

BACKGROUND

Family carers have a prominent role in end-of-life care for seriously ill persons. However, most of the Advance Care Planning literature is focused on the role of healthcare professionals.

AIMS

To investigate (1) what proportion of family carers discussed advance care planning with their relative and associated socio-demographic and clinical characteristics (2) what proportion received support from healthcare professionals for these conversations, (3) what type of support they received and (4) to what extent the type of support received was considered sufficient.

DESIGN/PARTICIPANTS

Population-based cross-sectional survey in Belgium of bereaved family carers of persons with a serious chronic illness (N = 3000) who died 2-6 months before the sample was drawn, identified through three sickness funds. The survey explored support from healthcare professionals for family carers during the last 3 months of the patient's life.

RESULTS

Response rate was 55%. The proportion of family carers that engaged in an advance care planning conversation with their relative was 46.9%. Of these family carers, 78.1% received support from a healthcare professional, mostly by doing the advance care planning conversation together (53.8%). Of family carers receiving support from a healthcare professional, 57.4% deemed the support sufficient.

CONCLUSION

Many family carers engage in advance care planning conversations with their dying relative. Healthcare professionals often support them by performing the advance care planning conversations together. More insight into how family carers can be supported to conduct these advance care planning conversations, both with and without involvement of healthcare professionals, is necessary.

"It Encourages Family Discussion": A Mixed-Methods Examination of the This Is Us Alzheimer's Disease & Caregiving Storyline

The average United States (U.S.) adult spends approximately one hour interacting directly with a healthcare professional but 2,000 hours watching primetime television annually. Thus, television storylines may be a powerful vehicle for promoting awareness about Alzheimer's disease and caregiving, which affect an estimated 9 million U.S. adults. We used a mixed-methods approach consisting of an online survey of U.S. adult This Is Us viewers (n = 720) and 4 focus groups (n = 12) with a subset of survey respondents to systematically assess viewer perceptions of an Alzheimer's disease and caregiving storyline from the This Is Us television show and the storyline's influence on viewer behavioral intent toward planning for aging. Triangulation of survey and focus group results suggests the storyline may motivate viewers to discuss plans for aging with their family because of a reduction in stigma and seeing on-screen family tensions related to senior care. Results suggest investments in collaborative partnerships between public health and the entertainment industry may be a valuable way to positively impact those affected by Alzheimer's disease and caregiving. Clips from this storyline could also be used as part of health communication campaigns to encourage advanced care planning discussions.

A qualitative study with people with young-onset dementia and their family caregivers on advance care planning: A holistic, flexible, and relational approach is recommended

BACKGROUND

Broad consensus exists on the relevance of advance care planning in dementia. Although people with young-onset dementia and their family are hypothesized to have distinct needs and preferences in this area, they are hardly ever included in studies.

AIM

We aim to explore the experiences with and views on advance care planning of people with young-onset dementia and their family caregivers.

DESIGN

A qualitative study was conducted, analyzing semi-structured interviews through the method of constant comparative analysis.

SETTING/PARTICIPANTS

We included 10 people with young-onset dementia and 10 of their family caregivers in Flanders.

RESULTS

Participants lacked awareness about the concept of advance care planning, especially as a communication process. They had not or barely engaged in planning future care yet pointed out possible benefits of doing so. Initially, people with young-onset dementia and their caregivers directly associated advance care planning with planning for the actual end of life. When discussing advance care planning as a communication process, they paid ample attention to non-medical aspects and did not distinguish between medical, mental, and social health. Rather, respondents thought in the overarching framework of what is important to them now and in the future.

CONCLUSIONS

Engagement in advance care planning might be hindered if it is too medicalized and exclusively patient-centered. To accommodate advance care planning to people with young-onset dementia's and their caregivers' needs, it should be presented and implemented as a holistic, flexible, and relational communication process. Policy and practice recommendations are provided on how to do so.

Using Multilevel Structural Equation Modeling (MSEM) to Identify the Predictors and Influencing Mechanism of Technology Use Among Chinese Physicians: An Example from Des-Gamma-Carboxy Prothrombin (DCP)

Background

Since expanding the use of appropriate and effective health technologies will greatly benefit the diagnosis and treatment of some major diseases at an early stage, understanding the mechanism of technology use is crucial for its successful implementation. Few previous studies focused on the healthcare providers and involved multi-facets factors at individual, technical, organizational, and environmental levels.

Purpose

To examine the influencing mechanism of technology use among Chinese physicians by integrating multilevel factors, Des-gamma-Carboxy Prothrombin (DCP) was taken as an example.

Methods

Through multistage random sampling, a cross-sectional questionnaire survey was conducted among physicians in charge of direct use of DCP of sampled secondary and tertiary hospitals. Since the sample data comprised two hierarchical levels (physicians and hospitals), multilevel structural equation modeling was used to link five aspects of factors with physicians’ technology use and estimate the effects.

Results

Totally, 229 physicians completed the investigation. The use of DCP appears to be at a relatively low level. Intra-class coefficients of the null model (unadjusted baseline model) suggested that physicians’ DCP use has a significant variation between hospitals. The final model identified that value cognition (B = 0.447, P < 0.01), experienced organizational practice (B = 0.203, P < 0.05), and perceived organizational atmosphere (B = −0.237, P < 0.01) contributed directly to physicians’ DCP use. Additionally, technical assessment, perceived organizational atmosphere, and perceived environmental pressure had indirect impacts on physicians’ DCP use that were mediated by value cognition and experienced organizational practice (P < 0.05).

Conclusion

This study incorporated and determined the significant direct or indirect role of value cognition, technical assessment, experienced organizational practice, perceived organizational atmosphere, and perceived environmental pressure. This influencing mechanism with integrated multilevel factors could serve as a theoretical basis for tailoring interventions to promote technology use among Chinese physicians.

Practitioners' perceptions of acceptability of a question prompt list about palliative care for advance care planning with people living with dementia and their family caregivers: a mixed-methods evaluation study

OBJECTIVES

In oncology and palliative care, patient question prompt lists (QPLs) with sample questions for patient and family increased patients' involvement in decision-making and improved outcomes if physicians actively endorsed asking questions. Therefore, we aim to evaluate practitioners' perceptions of acceptability and possible use of a QPL about palliative and end-of-life care in dementia.

DESIGN

Mixed-methods evaluation study of a QPL developed with family caregivers and experts comprising a survey and interviews with practitioners.

SETTING

Two academic medical training centres for primary and long-term care in the Netherlands.

PARTICIPANTS

Practitioners (n=66; 73% woman; mean of 21 (SD 11) years of experience) who were mostly general practitioners and elderly care physicians.

OUTCOMES

The main survey outcome was acceptability measured with a 15-75 acceptability scale with ≥45 meaning 'acceptable'.

RESULTS

The survey response rate was 21% (66 of 320 participated). The QPL was regarded as acceptable (mean 51, SD 10) but 64% felt it was too long. Thirty-five per cent would want training to be able to answer the questions. Those who felt unable to answer (31%) found the QPL less acceptable (mean 46 vs 54 for others; p=0.015). We identified three themes from nine interviews: (1) enhancing conversations through discussing difficult topics, (2) proactively engaging in end-of-life conversations and (3) possible implementation.

CONCLUSION

Acceptability of the QPL was adequate, but physicians feeling confident to be able to address questions about end-of-life care is crucial when implementing it in practice, and may require training. To facilitate discussions of advance care planning and palliative care, families and persons with dementia should also be empowered to access the QPL themselves.