1
|
Gross J, Koffman J. Examining how goals of care communication are conducted between doctors and patients with severe acute illness in hospital settings: A realist systematic review. PLoS One 2024; 19:e0299933. [PMID: 38498549 PMCID: PMC10947705 DOI: 10.1371/journal.pone.0299933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Patient involvement in goals of care decision-making has shown to enhance satisfaction, affective-cognitive outcomes, allocative efficiency, and reduce unwarranted clinical variation. However, the involvement of patients in goals of care planning within hospitals remains limited, particularly where mismatches in shared understanding between doctors and patients are present. AIM To identify and critically examine factors influencing goals of care conversations between doctors and patients during acute hospital illness. DESIGN Realist systematic review following the RAMESES standards. A protocol has been published in PROSPERO (CRD42021297410). The review utilised realist synthesis methodology, including a scoping literature search to generate initial theories, theory refinement through stakeholder consultation, and a systematic literature search to support program theory. DATA SOURCES Data were collected from Medline, PubMed, Embase, CINAHL, PsychINFO, Scopus databases (1946 to 14 July 2023), citation tracking, and Google Scholar. Open-Grey was utilized to identify relevant grey literature. Studies were selected based on relevance and rigor to support theory development. RESULTS Our analysis included 52 papers, supporting seven context-mechanism-output (CMO) hypotheses. Findings suggest that shared doctor-patient understanding relies on doctors being confident, competent, and personable to foster trusting relationships with patients. Low doctor confidence often leads to avoidance of discussions. Moreover, information provided to patients is often inconsistent, biased, procedure-focused, and lacks personalisation. Acute illness, medical jargon, poor health literacy, and high emotional states further hinder patient understanding. CONCLUSIONS Goals of care conversations in hospitals are nuanced and often suboptimal. To improve patient experiences and outcome of care interventions should be personalised and tailored to individual needs, emphasizing effective communication and trusting relationships among patients, families, doctors, and healthcare teams. Inclusion of caregivers and acknowledgment at the service level are crucial for achieving desired outcomes. Implications for policy, research, and clinical practice, including further training and skills development for doctors, are discussed.
Collapse
Affiliation(s)
- Jamie Gross
- Northwick Park and Central Middlesex Hospitals, London North West University Healthcare NHS Trust, Harrow, United Kingdom
- King’s College London, Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, United Kingdom
| | - Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, University of Hull, Hull, United Kingdom
| |
Collapse
|
2
|
Yang L, Zhu N, Wang X, Tan J, Chen L, Su C, Dong T, Long B, Qiu Y, Deng R. Experiences and perspectives of healthcare professionals, patients and caregivers toward the serious illness conversation guide: protocol for a qualitative meta-synthesis. BMJ Open 2023; 13:e073171. [PMID: 38011974 PMCID: PMC10685960 DOI: 10.1136/bmjopen-2023-073171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Exploring the experiences and perspectives of healthcare professionals, patients and caregivers toward serious illness conversations based on the Serious Illness Care Program is vital for improving communication with patients who are seriously ill, as has been shown in previous studies. However, few studies have carried out a systematic review to examine common themes, strengthen conclusions and identify gaps in the literature, the findings of which could help steer further research, policies and practice to improve more timely and person-centred conversations about the values and priorities of patients with serious illnesses. The objective of this qualitative meta-synthesis is to explore how healthcare professionals, patients and caregivers described their own experiences of the processes of serious illness communication through a secondary analysis of published qualitative data. METHODS AND ANALYSIS Meta-aggregation will be used to conduct a systematic review of qualitative studies. We conducted an initial search on 10 October 2023; papers published in English will be searched using electronic databases, including PubMed (MEDLINE), Web of Science, Embase, Ovid and CINAHL. Studies that satisfy the eligibility criteria will be evaluated for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. The meta-aggregative review will consist of the following: (1) extraction of findings of all included studies; (2) categorisation of the findings, with at least two findings per category; and (3) synthesis of one or more findings from at least two categories. Study eligibility screening, data extraction, analysis and JBI Critical Appraisal Checklist and Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research assessments will be undertaken independently by two authors. ETHICS AND DISSEMINATION Secondary data analysis of published literature does not require ethical approval. The results will be disseminated in peer-reviewed journals and presented in conference papers and elsewhere. PROSPERO REGISTRATION NUMBER CRD42022330859.
Collapse
Affiliation(s)
- Liu Yang
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Nanxi Zhu
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Neonatal Medicine Center, Xiamen Children's Hospital, Xiamen, China
| | - Xianlin Wang
- Department of Nursing, Zunyi Medical University, Zunyi, China
| | - Jin Tan
- Department of Nursing, Zunyi Medical University, Zunyi, China
| | - Liuliu Chen
- School of Health, Zhuhai College of Science and Technology, Zhuhai, China
| | - Cui Su
- Department of Nursing, Zunyi Medical University, Zunyi, China
| | - Tiaoxia Dong
- Department of Nursing, Zunyi Medical University, Zunyi, China
| | - Bingjie Long
- Department of Neonatal Medicine Center, Xiamen Children's Hospital, Xiamen, China
| | - Yeyin Qiu
- Fifth Affiliated Hospital of Zunyi Medical University, Zhuhai, China
| | - Renli Deng
- Department of Emergency, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Nursing, Zunyi Medical University, Zunyi, China
| |
Collapse
|
3
|
da Silva MDAP, Corradi-Perini C. The Mapping of Influencing Factors in the Decision-Making of End-of-Life Care Patients: A Systematic Scoping Review. Indian J Palliat Care 2023; 29:234-242. [PMID: 37700891 PMCID: PMC10493695 DOI: 10.25259/ijpc_292_2022] [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: 12/08/2022] [Accepted: 01/27/2023] [Indexed: 09/14/2023] Open
Abstract
Decisions in end-of-life care are influenced by several factors, many of which are not identified by the decision maker. These influencing factors modify important decisions in this scenario, such as in decisions to adapt to therapeutic support. This presented scoping review aims to map the factors that influence end-of-life care decisions for adult and older adult patients, by a scoping review. The review was carried out in 19 databases, with the keyword 'clinical decision-making' AND 'terminal care' OR 'end-of-life care' and its analogues, including publications from 2017 to 2022. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The search resulted in 3474 publications, where the presence of influencing factors in end-of-life decision-making for adults and the elderly was applied as a selection criterion. Fifty-four (54) of them were selected, which means 1.5% of all the results. Among the selected publications, 89 influencing factors were found, distributed in 54 (60.6%) factors related to the health team, 18 (20.2%) to patients, 10 (11.2%) related to family or surrogates and 7 (7.8%) factors related to the decision environment. In conclusion, we note that the decision-making in end-of-life care is complex, mainly because there is an interaction of different characters (health team, patient, family, or surrogates) with a plurality of influencing factors, associated with an environment of uncertainty and that result in a critical outcome, with a great repercussion for the end of life, making it imperative the recognition of these factors for more competent and safe decision-making.
Collapse
Affiliation(s)
| | - Carla Corradi-Perini
- Bioethics Graduate Program, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| |
Collapse
|
4
|
Weber DE, Kadden D, Herbst L. A Novel Curriculum to Improve Medical Student Preparedness to have Advance Care Planning Discussions. Am J Hosp Palliat Care 2023; 40:416-422. [PMID: 35655330 DOI: 10.1177/10499091221106692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Physicians report inadequate training in advance care planning (ACP) discussions despite the importance of these skills for practicing physicians including new residents. Objectives: To evaluate the effectiveness of a novel curriculum to prepare graduating medical students to have ACP discussions. Design: An ACP curriculum was implemented within a new fourth-year medical student elective with a focus on interactive educational methods and simulated experiences. Setting/Subjects: Forty-seven students received the curriculum over 3 years at a medium-sized, urban medical school. Measurements: Students were surveyed regarding attitudes and comfort related to ACP discussions and end-of-life (EOL) topics before and after the course. Additionally, students were asked about baseline experiences in the pre-course survey and perceived effectiveness of the educational methods in the post-course survey. Results: Comfort discussing EOL care decisions without supervision rose from 4% to 36% after the course with none of the students feeling they needed maximal help from a supervisor after the course compared to 51% before the course. All students agree or strongly agreed (Likert 4 or 5) that they felt prepared to discuss patient's wishes and values in EOL care with a real patient or family after the course. Conclusions: An ACP curriculum can increase student comfort and preparedness to have these conversations as residents. Students found small group discussions and the chance for direct practice with simulated patients to be most helpful. These findings can help guide implementation of ACP curricula in medical education.
Collapse
Affiliation(s)
- Danielle E Weber
- Department of Internal Medicine, University of Cincinnati Medical Center, 2518University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 2518University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel Kadden
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 2518University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lori Herbst
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 2518University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Family and Community Medicine, Palliative Medicine Team, University of Cincinnati Medical Center, 2518University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
5
|
Hendry A, Pottle J, Johnstone R, Poolman M, Hiscock J. The intricacy of interactions: qualitative exploration of preferences
and perceptions of advance care planning among healthcare professionals,
patients and those close to them. Palliat Care Soc Pract 2022; 16:26323524221139879. [PMCID: PMC9716444 DOI: 10.1177/26323524221139879] [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: 05/27/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives: Advance care planning (ACP) is a way of documenting preferences in case of a
change or decline in health via verbal discussion and may
include a written document. ACP relates not only to treatment preferences
but to all aspects of future care such as place of death, plans for
dependents and spiritual beliefs. Research has shown that ACP can have a
positive impact but needs further understanding to enhance communication and
increase uptake. This article focusses on the importance and intricacy of
interactions and why a preference-based approach may be beneficial for the
future. Methods: This article reports two separate, but related, pieces of qualitative
research. First, focus groups to evaluate perspectives of healthcare
professionals (HCPs) following their attendance at a North Wales ACP
training workshop. The second study comprised interviews exploring the views
of patients, those close to them and HCPs regarding ACP. Results: ACP interactions are complex and intricate. There is an association with end
of life rather than changes in health among patients and HCPs often view
discussions as akin to ‘breaking bad news’. Good communication between
patients, loved ones and HCPs is essential to reduce distress and ensure
preferences are understood. Trust between patients and HCPs is of high
importance and often a patient will have a preferred HCP who they feel
comfortable discussing ACP with. Conclusion: A preference-based approach to ACP has potential to widen participation in
ACP, relieve anxiety and ease burden for patients and carers. Further
research is needed to identify ways to increase inclusivity.
Collapse
Affiliation(s)
| | | | | | - Marlise Poolman
- Bangor Institute for Health and Medical
Research, Bangor University, Wrexham, UK,Betsi Cadwaladr University Health Board, North
Wales, UK
| | - Julia Hiscock
- Bangor Institute for Health and Medical
Research, Bangor University, Wrexham, UK
| |
Collapse
|
6
|
Malhotra C, Ramakrishnan C. Complexity of implementing a nationwide advance care planning program: results from a qualitative evaluation. Age Ageing 2022; 51:6770073. [PMID: 36273345 DOI: 10.1093/ageing/afac224] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/18/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND We evaluated Singapore's national advance care planning (ACP) program to understand challenges to its implementation within multiple clinical settings. METHODS We conducted focus group discussions (FGDs) with a purposive sample of health care professionals (HCPs) involved in ACP program delivery within acute care hospitals, primary care clinics and nursing homes. FGDs were stratified into three categories based on HCPs' role within the ACP framework-leaders versus facilitators and advocates versus nursing home heads. Using NVivo 11, we analysed data using thematic analysis and Conceptual Framework for Implementation Research. RESULTS A total of 107 HCPs from 25 organisations participated in 22 FGDs. Findings revealed wide variation in ACP implementation among organisations and identified 12 themes organized within four domains-outer setting (lack of public awareness, shortcomings in inter-organisational partnerships, performance driven policies), inner setting (lack of commitment from organisational leadership, paucity of dedicated resources, absence of an institution-wide ACP culture, lack of physician engagement), characteristics of HCPs (language barriers) and process (inadequate training, complexity of conversations and documentations, challenges to retrieving ACP documents, absence of comprehensive monitoring and evaluation). CONCLUSION ACP program implementation is complex and faces multiple health care system challenges. To integrate ACP within routine clinical care, ACP processes should be simplified, training framework be strengthened, physicians be engaged and an ACP supportive culture be created within and outside organisations. Findings will be used to guide ACP implementation within the country and globally.
Collapse
Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore 169857.,Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857
| | | |
Collapse
|
7
|
van Lummel EVTJ, Savelkoul C, Stemerdink ELE, Tjan DHT, van Delden JJM. The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention. BMC Palliat Care 2022; 21:119. [PMID: 35794617 PMCID: PMC9258045 DOI: 10.1186/s12904-022-01005-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients still receive non-beneficial treatments when nearing the end of life. Advance care planning (ACP) interventions have shown to positively influence compliance with end of life wishes. Hospital physicians seem to miss opportunities to engage in ACP, whereas patients visiting the outpatient clinic usually have one or more chronic conditions and are at risk for medical emergencies. So far, implemented ACP interventions have had limited impact. Structural implementation of ACP may be beneficial. We hypothesize that having ACP conversations more towards the end of life and involving the treating physician in the ACP conversation may help patient wishes and goals to become more concrete and more often documented, thus facilitating goal-concordant care. Aim To facilitate timely shared decision making and increase patient autonomy we aim to develop an ACP intervention at the outpatient clinic for frail patients and determine the feasibility of the intervention. Methods The United Kingdom’s Medical Research Council framework was used to structure the development of the ACP intervention. Key elements of the ACP intervention were determined by reviewing existing literature and an iterative process with stakeholders. The feasibility of the developed intervention was evaluated by a feasibility study of 20 ACP conversations at the geriatrics and pulmonology department of a non-academic hospital. Feasibility was assessed by analysing evaluation forms by patients, nurses and physicians and by evaluating with stakeholders. A general inductive approach was used for analysing comments. The developed intervention was described using the template for intervention description and replication (TIDieR). Results We developed a multidisciplinary timely undertaken ACP intervention at the outpatient clinic. Key components of the developed intervention consist of 1) timely patient selection 2) preparation of patient and healthcare professional 3) a scripted ACP conversation in a multidisciplinary setting and 4) documentation. 94.7% of the patients, 60.0% of the nurses and 68.8% of the physicians agreed that the benefits of the ACP conversation outweighed the potential burdens. Conclusion This study showed that the developed ACP intervention is feasible and considered valuable by patients and healthcare professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01005-3.
Collapse
|
8
|
Vemuri S, Hynson J, Williams K, Gillam L. Conceptualising paediatric advance care planning: a qualitative phenomenological study of paediatricians caring for children with life-limiting conditions in Australia. BMJ Open 2022; 12:e060077. [PMID: 35577468 PMCID: PMC9115011 DOI: 10.1136/bmjopen-2021-060077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/04/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES Advance care planning (ACP) helps families and paediatricians prepare and plan for end-of-life decision-making. However, there remains inconsistency in its practice with the limited literature describing what this preparation involves, and whether paediatricians recognise a difference between the process of ACP and its outcomes, such as resuscitation plans. This study aims to understand how paediatricians conceptualise ACP when caring for children with life-limiting conditions (LLC) who are unable to participate in decision-making for his/herself. DESIGN Individual, semistructured, vignette-based qualitative interviews. SETTING Acute inpatient and long-term outpatient paediatric care in three secondary and two tertiary centres in Victoria, Australia. PARTICIPANTS 25 purposively sampled paediatricians who treat children with LLC, outside the neonatal period. Paediatricians were excluded if they worked within specialist palliative care teams or assisted in this study's design. RESULTS Four key themes were identified when approaching end-of-life decision-making discussions: (1) there is a process over time, (2) there are three elements, (3) the role of exploring parental values and (4) the emotional impact. The three elements of this process are: (1) communicating the child's risk of death, (2) moving from theoretical concepts to practice and (3) documenting decisions about resuscitation or intensive technologies. However, not all paediatricians recognised all elements as ACP, nor are all elements consistently or intentionally used. Some paediatricians considered ACP to be only documentation of decisions in advance. CONCLUSION There is a preparatory process of discussions for end-of-life decision-making, with elements in this preparation practised within therapeutic relationships. Complexity in what constitutes ACP needs to be captured in guidance and training to include intentional exploration of parental values, and recognition and management of the emotional impact of ACP could increase its consistency and value.
Collapse
Affiliation(s)
- Sidharth Vemuri
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Jenny Hynson
- Victorian Paediatric Palliative Care Program, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katrina Williams
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Lynn Gillam
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Children's Bioethics Centre, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
9
|
A good death from the perspective of healthcare providers from the internal medicine department in Shanghai: A qualitative study. Int J Nurs Sci 2021; 9:236-242. [PMID: 35509698 PMCID: PMC9052265 DOI: 10.1016/j.ijnss.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022] Open
|
10
|
Sævareid TJL, Pedersen R, Magelssen M. Positive attitudes to advance care planning - a Norwegian general population survey. BMC Health Serv Res 2021; 21:762. [PMID: 34334131 PMCID: PMC8327435 DOI: 10.1186/s12913-021-06773-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Authorities recommend advance care planning and public acceptance of it is a prerequisite for widespread implementation. Therefore, we did the first study of the Norwegian public with an aim of getting knowledge on their attitudes to issues related to advance care planning. Methods An electronic survey to a nationally representative web panel of Norwegian adults. Results From 1035 complete responses (response rate 40.7%), we found that more than nine out of ten of the general public wanted to participate in advance care planning, believed it to be useful for many, and wanted to make important healthcare decisions themselves. Almost nine out of ten wanted to be accompanied by next of kin during advance care planning. Most (69%) wanted health care personnel to initiate advance care planning and preferred it to be timed to serious illness with limited lifetime (68%). Only about 9% stated that health care personnel should have the final say in healthcare decisions in serious illness. Conclusions Developing and implementing advance care planning as a public health initiative seems warranted based on the results of this study. Patient perspectives should be promoted in decision-making processes. Nevertheless, training of health care personnel should emphasise voluntariness and an individual approach to initiating, timing and conducting advance care planning because of individual variations.
Collapse
Affiliation(s)
| | - Reidar Pedersen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166, Frederik Holsts hus, 0450, Oslo, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, University of Oslo, Kirkeveien 166, Frederik Holsts hus, 0450, Oslo, Norway
| |
Collapse
|
11
|
Islam I, Nelson A, Longo M, Byrne A. Before the 2020 Pandemic: an observational study exploring public knowledge, attitudes, plans, and preferences towards death and end of life care in Wales. BMC Palliat Care 2021; 20:116. [PMID: 34284754 PMCID: PMC8290392 DOI: 10.1186/s12904-021-00806-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding public attitudes towards death and dying is important to inform public policies around End of Life Care (EoLC). We studied the public attitudes towards death and dying in Wales. METHODS An online survey was conducted in 2018. Social media and the HealthWiseWales platform were used to recruit participants. Data were analysed using descriptive statistics and thematic analysis. RESULTS 2,210 people participated. Loss of independence (84%), manner of death, and leaving their beloved behind were the biggest fears around death and dying. In terms of EoLC, participants sought timely access to care (84%) and being surrounded by loved ones (62%). Being at home was less of a priority (24%). Only 50% were familiar with Advance Care Planning (ACP). A lack of standard procedures as well as of support for the execution of plans and the ability to revisit those plans hindered uptake. The taboo around death conversations, the lack of opportunities and skills to initiate discussion, and personal fear and discomfort inhibited talking about death and dying. 72% felt that we do not talk enough about death and dying and advocated normalising talking by demystifying death with a positive approach. Health professionals could initiate and support this conversation, but this depended on communication skills and manageable workload pressure. Participants encouraged a public health approach and endorsed the use of: a) social media and other public platforms, b) formal education, c) formal and legal actions, and d) signposting and access to information. CONCLUSIONS People are ready to talk about death and dying and COVID-19 has increased awareness. A combination of top-down and bottom-up initiatives across levels and settings can increase awareness, knowledge, and service-utilisation-drivers to support health professionals and people towards shared decisions which align with people's end of life wishes and preferences.
Collapse
Affiliation(s)
- Ishrat Islam
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.
| | - Mirella Longo
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.,Department of Palliative Medicine, Velindre NHS Trust, Cardiff, CF15 7QZ, UK
| |
Collapse
|
12
|
Dujardin J, Schuurmans J, Westerduin D, Wichmann AB, Engels Y. The COVID-19 pandemic: A tipping point for advance care planning? Experiences of general practitioners. Palliat Med 2021; 35:1238-1248. [PMID: 34041987 DOI: 10.1177/02692163211016979] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2020, the COVID-19 pandemic caused an acute risk of deterioration and dying for many, and an urgent need to start advance care planning. AIM To explore how general practitioners (GPs) experienced discussing values, goals and preferences with patients during COVID-19. DESIGN AND SETTING Qualitative research in general practice. METHODS Semi-structured interviews for which Dutch GPs were recruited via purposive sampling. Content analysis was used. RESULTS Fifteen GPs were interviewed. Six themes were identified: (i) urge of advance care planning, (ii) the GP's perceived role in it, (iii) preparations for it, (iv) (proactively) discussing it, (v) essentials for good communication and (vi) advance care planning in the (near) future. Calls for proactively discussing advance care planning in the media and in COVID-guidelines caused awareness of it's importance. GPs envisaged an important role for themselves in initiating it, especially with patients at risk to deteriorate or die from COVID-19. Timing advance care planning appeared difficult but crucial. The recommended digital way of communication was considered problematic due to missing nonverbal communication and difficulties in involving relatives. It was noted that admission to the ICU, which was hardly discussed before the COVID-19 pandemic, should remain a topic during advance care planning. CONCLUSION The COVID-19 pandemic brought advance care planning into a new light, GPs were more experienced with discussing it and patients were more aware of their frailty. Because of the nearing 'grey wave', advance care planning should remain top priority. Therefore, it should be central in GP and post-academic training.
Collapse
Affiliation(s)
- Janneke Dujardin
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical centre, Nijmegen, The Netherlands
| | - Jaap Schuurmans
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical centre, Nijmegen, The Netherlands
| | - Dieke Westerduin
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical centre, Nijmegen, The Netherlands
| | - Anne B Wichmann
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical centre, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical centre, Nijmegen, The Netherlands
| |
Collapse
|
13
|
Lasmarías C, Subirana-Casacuberta M, Mancho N, Aradilla-Herrero A. Spanish Cross-Cultural Adaptation and Psychometric Properties of the Advance Care Planning Self-Efficacy: A Cross-Sectional Study. J Palliat Med 2021; 24:1807-1815. [PMID: 34143670 DOI: 10.1089/jpm.2020.0653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Perceived self-efficacy in advance care planning (ACP) is frequently used to measure the impact of ACP programs for professionals responsible for advanced chronic patients. A validated ACP Self-Efficacy (ACP-SE) scale is not currently available in Spanish. Objective: To culturally adapt and validate Baughman's ACP-SE scale into Spanish (ACP-SEs). Methodology/Design: An instrumental study was performed in two phases: (1) cultural adaptation of the ACP-SE scale and (2) psychometric properties measurement. Setting/Participants: The survey was sent to 5785 professionals: physicians, nurses, psychologists, and social workers, members of scientific associations in the areas of primary care, geriatrics, and palliative care in Catalonia, Spain. Results: Five hundred thirty-eight questionnaires were obtained, respondents were physicians (69.0%) and nurses (28.4%) and mean age was 47 years (standard deviation [SD] = 10.1). Most were women (79.6%), 68% had >15 years of professional experience, and 80.7% worked in primary care. Internal consistency was high (Cronbach's alpha = 0.95) and showed a unidimensional structure explaining 56.2% of total variance. Mean score was 67.37 (SD = 16.1). Variables associated with greater self-efficacy were previous training (t = -3.23, df = 273.76, p = 0.001), previous participation in ACP processes (t = -6.23, df = 521, p < 0.001), and membership in geriatric or palliative care scientific association (p < 0.001). ACP-SEs positively correlated to other compared scales. Conclusion: The ACP-SE scale demonstrates adequate psychometric properties. This is the first self-efficacy scale for ACP in Spanish. It should facilitate a better understanding of implementation processes related to ACP programs for professionals involved in caring for patients with advanced diseases.
Collapse
Affiliation(s)
- Cristina Lasmarías
- Department of Education and Training, Catalan Institute of Oncology, Barcelona, Spain.,Catalonia Chronic Care Research Group, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
| | - Mireia Subirana-Casacuberta
- Nursing Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; Consorci Sanitari Parc Taulí, Sabadell, Spain.,Research Group on Methodology, Methods, Models, and Health and Social Outcomes, Faculty of Health Science and Welfare, Centre for Health and Social Care Research, University of Vic-Central University of Catalonia, Vic, Barcelona, Spain
| | - Núria Mancho
- Department of Statistics, Biomedical Research Institute of Bellvitge (IDIBELL), Barcelona, Spain
| | - Amor Aradilla-Herrero
- Escoles Universitàries Gimbernat (Universitat Autònoma de Barcelona), Sant Cugat del Vallès, Barcelona, Spain
| |
Collapse
|
14
|
Cerulus M, Bossuyt I, Vanderhaeghen B. An integrative literature review of the implementation of advance care planning in hospital settings. J Clin Nurs 2021; 30:3099-3110. [PMID: 34010482 DOI: 10.1111/jocn.15835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To identify and synthesise existing literature about action research in the implementation of advance care planning in a hospital setting. BACKGROUND Despite the proven added value of advance care planning, there is a lack of wide integration of this concept. There are several obstacles known for the implementation but it remains unclear how these can be overcome. Action research is described in the literature as a plausible way to overcome obstacles to the implementation of quality enhancing projects. DESIGN An integrative literature review was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and reported in accordance with the PRISMA statement. METHODS We searched databases MEDLINE, EMBASE, CINAHL and Web of Science to identify executed action research for the implementation of advance care planning programs within a hospital setting, from January 2005 until November 2019. Studies were assessed for comprehensiveness and were supplemented by studies in reference lists of included articles. A quality appraisal and a thematic synthesis were performed on all included studies. RESULTS Five studies met inclusion criteria. Interventions focused on both nurses, physicians and hospitalised patients. Interventions targeted three different themes: identifying at-risk patients, adapting documentation to the local context and using communication improvement tools. CONCLUSIONS A Supportive and Palliative Care Indicators Tool is proposed to identify patients in need of advance care planning to work more efficiently. Furthermore, adapting documentation and instruments to a specific care context are shown to make advance care planning more effective. Communication challenges can be addressed by promoting communication skills and increase stakeholder self-confidence.
Collapse
|
15
|
Abel J, Kellehear A, Millington Sanders C, Taubert M, Kingston H. Advance care planning re-imagined: a needed shift for COVID times and beyond. Palliat Care Soc Pract 2020; 14:2632352420934491. [PMID: 32924012 PMCID: PMC7446254 DOI: 10.1177/2632352420934491] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Julian Abel
- Compassionate Communities UK Trewoon Farm, TR12 6DT
| | | | | | | | | |
Collapse
|
16
|
Rawlings D, Yin H, Devery K, Morgan D, Tieman J. End-of-Life Care in Acute Hospitals: Practice Change Reported by Health Professionals Following Online Education. Healthcare (Basel) 2020; 8:healthcare8030254. [PMID: 32781639 PMCID: PMC7551093 DOI: 10.3390/healthcare8030254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022] Open
Abstract
Providing quality care for those dying in hospital is challenging for health professionals who receive little training in this. “End of Life Essentials” (EOLE) was developed to address gaps in health professionals’ knowledge, skills and confidence in end-of-life care via the provision of online learning modules and practice resources. This study aimed to determine whether respondents could describe clinical practice change as a result of module completion. Deidentified data were collected between October and November 2018 from learners registered for the online learning modules. Both quantitative and qualitative data were extracted and analysed. The survey design and conduct were reviewed, and ethical approval was obtained. Although the response rate was very low, results from n = 122 learners show improvements in knowledge, skills, awareness and confidence as a result of the undertaking of the learning modules. Two thirds self-reported practice changes (71%, n = 59) following the education, with “communication” cited most commonly (n = 19). The findings suggest that the EOLE education modules can help to improve end-of-life care by increasing health professionals’ awareness of good practice as well as their knowledge, skills and confidence. Online learning has also been reinforced as an appropriate forum for end-of-life education. Following education, implementing what has been learned occurs more easily at a personal level rather than at a team and organisational level. Barriers to and enablers of clinical practice change in hospital are described, including the fact that the organisation may not be responsive to changes or have the relevant resources to support change.
Collapse
|
17
|
Greenwald JL, Greer JA, Gace D, Sommer RK, Daubman BR, Rosenberg LB, LaSala C, Jacobsen J. Implementing Automated Triggers to Identify Hospitalized Patients with Possible Unmet Palliative Needs: Assessing the Impact of This Systems Approach on Clinicians. J Palliat Med 2020; 23:1500-1506. [PMID: 32589501 DOI: 10.1089/jpm.2020.0161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Understanding patients' goals and values is important to ensure goal-concordant care; however, such discussions can be challenging. Little is known about the impact of having these discussions on hospitalists. Objective: To assess the impact on hospitalists of a system that reminds them to have serious illness conversations with their patients identified with potential unmet palliative needs. Design: Two group cohort trial. Setting/Subjects: Single academic center. Internal medicine hospitalist physicians, nurse practitioners, and physician's assistants. Measurements: Before the trial, all participants received serious illness conversation training. During the trial, hospitalists on intervention units received verbal notification when their recently admitted patients were identified using a computer algorithm as having possible unmet palliative needs. Hospitalists on the control unit received no notifications. At baseline and three months, hospitalists completed questionnaires regarding communication skill acquisition, perception of the importance of these conversations, and sense of the meaning gained from having them. Results: Both groups had similar improvements in their self-reported communication skills and experienced a small decline in how important they felt the conversations were. Neither group perceived having the discussions as being affectively harmful to patients. The intervention hospitalists, over time, reported a slight reduction in the sense of meaning they achieved from the conversations. Conclusion: Routinely informing hospitalists when their patients were identified as being at increased risk for unmet palliative needs did not increase the sense of meaning these providers achieved. It is likely the pretrial training accounted for many of the positive outcomes in communication skills observed in both arms of the trial.
Collapse
Affiliation(s)
- Jeffrey L Greenwald
- Core Educator Faculty, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph A Greer
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Denisa Gace
- Hospital Medicine Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert K Sommer
- Center for Psychiatric Oncology and Behavioral Sciences, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leah B Rosenberg
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Cynthia LaSala
- Department of Nursing, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juliet Jacobsen
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
18
|
Stegmann ME, Geerse OP, Tange D, Richel C, Brom L, Engelen V, Duijts SFA. Experiences and needs of patients with incurable cancer regarding advance care planning: results from a national cross-sectional survey. Support Care Cancer 2020; 28:4211-4217. [PMID: 31900610 DOI: 10.1007/s00520-019-05285-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 12/23/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients faced with incurable cancer may experience a lack of support from their physician throughout and after treatment. Studies on the needs and experiences of these patients are scarce. In this study, we explored the needs and experiences of patients diagnosed with incurable cancer regarding the conversation, in which they were told that their cancer was incurable, the care received after this conversation, and their preferences regarding end-of-life conversations. METHODS Data were cross-sectionally collected through a national online survey in the Netherlands (September 2018). Descriptive statistics and correlation coefficients were reported and subgroups were compared. RESULTS Six hundred fifty-four patients (mean age 60 years; 58% women) completed the survey. Patients were primarily diagnosed with breast cancer (22%) or a hematological malignancy (21%). Patients reported a strong need for emotional support during the conversation, in which they were told their cancer was incurable (mean score 8.3; scale 1-10). Their experienced satisfaction with received emotional support was mediocre (mean score 6.4; scale 1-10). Of those patients who felt like they did not receive any additional care (37%) after the diagnosis, the majority expressed a clear need for this kind of care (59%). Mostly, support pertained to psychosocial issues. Regarding conversations about the end of life, most patients (62%) expressed a need to discuss this topic, and preferred their healthcare provider to initiate this conversation. CONCLUSION Care for patients with incurable cancer can be further improved by tailoring conversations to specific needs and timely providing appropriate supportive care services.
Collapse
Affiliation(s)
- Mariken E Stegmann
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands.
| | - Olaf P Geerse
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands
- Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dorien Tange
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie van Kankerpatiëntorganisaties, NFK), Utrecht, The Netherlands
| | - Carol Richel
- Dutch Breast Cancer Association (Borstkankervereniging Nederland, BVN), Utrecht, The Netherlands
| | - Linda Brom
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Vivian Engelen
- Dutch Federation of Cancer Patients Organisations (Nederlandse Federatie van Kankerpatiëntorganisaties, NFK), Utrecht, The Netherlands
| | - Saskia F A Duijts
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, FA 21, 9713 AV, Groningen, The Netherlands
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Grossman D, Katz A, Lock K, Caraiscos VB. A Retrospective Study Reviewing Interprofessional Advance Care Planning Group Discussions in Pulmonary Rehabilitation: A Proof-of-Concept and Feasibility Study. J Palliat Care 2019; 36:219-223. [DOI: 10.1177/0825859719896421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Advance care planning (ACP) is a process of reflection and discussion wherein a patient, in consultation with a health-care provider, family, and/or loved ones, clarifies values and treatment preferences and establishes goals, including a plan for end-of-life (EOL) care. Advance care planning encompasses appreciating and understanding illness and treatment options, elucidating patient values and beliefs, and identifying a substitute decision maker (SDM) or designating a power of attorney (POA) for personal care. These discussions have proven to be effective in improving patient–family satisfaction, reducing anxiety regarding EOL care in patients and family members, and improving patient-centered care by empowering patients to direct their care at EOL. However, ACP conversations are often difficult to have due to the sensitive nature of such discussions. Objective: The aim of this study was to determine whether group facilitation for teaching and discussing ACP enhances participants’ understanding of ACP and allows them to feel comfortable and supported when discussing these sensitive issues. Methods: Patients who were registered in North York General Hospital’s (NYGH) pulmonary rehabilitation program from June 2016 until August 2017 were given the opportunity to attend two 1-hour sessions related to ACP. The first session was dedicated to educating patients on ACP, explaining the hierarchy of the SDM and the role of the POA for personal care. The second session, provided a short time later, was devoted to discussions of values, wishes, fears, and trade-offs for future medical and EOL care. These discussions led by the supportive care nurse practitioner and a physician who are members of the NYGH Freeman Palliative Care Team were held in a group-facilitated format. Anonymous feedback forms, including both qualitative and quantitative feedback, were completed by the participants and analyzed. Participants: Analysis of a sample of 30 participants who attended 1 or 2 of the ACP sessions revealed that 21 identified as female and 9 identified as male. The average age of the participants was 76 years. Findings: Participants felt the content was relevant to their needs and were comfortable asking questions with all feedback averages ranging from good to very good. Participants appreciated the opportunity to share their thoughts in an open and interactive format. Conclusion: Discussing issues relevant to ACP, including providing information about ACP, sharing fears, wishes, and tradeoffs, were well-received in a group-support environment. Future studies should assess the impact of ACP group discussion on the individual, such as identifying a POA, having discussions regarding wishes and values with the SDM/POA, and examining the clinical impact of such sessions.
Collapse
Affiliation(s)
- Daphna Grossman
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Katz
- Sackler Faculty of Medicine, Tel Aviv University Israel, Tel Aviv, Israel
| | - Karen Lock
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Valerie B. Caraiscos
- Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
20
|
Zwakman M, Pollock K, Bulli F, Caswell G, Červ B, van Delden JJM, Deliens L, van der Heide A, Jabbarian LJ, Koba-Čeh H, Lunder U, Miccinesi G, Arnfeldt CAM, Seymour J, Toccafondi A, Verkissen MN, Kars MC. Trained facilitators' experiences with structured advance care planning conversations in oncology: an international focus group study within the ACTION trial. BMC Cancer 2019; 19:1026. [PMID: 31672145 PMCID: PMC6822448 DOI: 10.1186/s12885-019-6170-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In oncology, Health Care Professionals often experience conducting Advance Care Planning (ACP) conversations as difficult and are hesitant to start them. A structured approach could help to overcome this. In the ACTION trial, a Phase III multi-center cluster-randomized clinical trial in six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia, United Kingdom), patients with advanced lung or colorectal cancer are invited to have one or two structured ACP conversations with a trained facilitator. It is unclear how trained facilitators experience conducting structured ACP conversations. This study aims to understand how facilitators experience delivering the ACTION Respecting Choices (RC) ACP conversation. METHODS A qualitative study involving focus groups with RC facilitators. Focus group interviews were recorded, transcribed, anonymized, translated into English, and thematically analysed, supported by NVivo 11. The international research team was involved in data analysis from initial coding and discussion towards final themes. RESULTS Seven focus groups were conducted, involving 28 of in total 39 trained facilitators, with different professional backgrounds from all participating countries. Alongside some cultural differences, six themes were identified. These reflect that most facilitators welcomed the opportunity to participate in the ACTION trial, seeing it as a means of learning new skills in an important area. The RC script was seen as supportive to ask questions, including those perceived as difficult to ask, but was also experienced as a barrier to a spontaneous conversation. Facilitators noticed that most patients were positive about their ACTION RC ACP conversation, which had prompted them to become aware of their wishes and to share these with others. The facilitators observed that it took patients substantial effort to have these conversations. In response, facilitators took responsibility for enabling patients to experience a conversation from which they could benefit. Facilitators emphasized the need for training, support and advanced communication skills to be able to work with the script. CONCLUSIONS Facilitators experienced benefits and challenges in conducting scripted ACP conversations. They mentioned the importance of being skilled and experienced in carrying out ACP conversations in order to be able to explore the patients' preferences while staying attuned to patients' needs. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number registry 63110516 ( ISRCTN63110516 ) per 10/3/2014.
Collapse
Affiliation(s)
- M Zwakman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - K Pollock
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - F Bulli
- Oncological network, research and prevention Institute - ISPRO, Florence, Italy
| | - G Caswell
- Faculty of Medicine and Health Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - B Červ
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - J J M van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - A van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - L J Jabbarian
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Koba-Čeh
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - U Lunder
- University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - G Miccinesi
- Oncological network, research and prevention Institute - ISPRO, Florence, Italy
| | - C A Møller Arnfeldt
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, The Research Unit, Copenhagen, Denmark
| | - J Seymour
- University of Sheffield, Sheffield, UK
| | - A Toccafondi
- Oncological network, research and prevention Institute - ISPRO, Florence, Italy
| | - M N Verkissen
- End-of-life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.,Ghent University, Brussels, Belgium
| | - M C Kars
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | | |
Collapse
|
21
|
Estimating the Impact of Words Used by Physicians in Advance Care Planning Discussions: The "Do You Want Everything Done?" Effect. Crit Care Explor 2019; 1:e0052. [PMID: 32166233 PMCID: PMC7063893 DOI: 10.1097/cce.0000000000000052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. To estimate the probability of a substitute decision maker choosing to withdraw life-sustaining therapy after hearing an affirmative patient response to the phrase “Do you want everything done?”
Collapse
|
22
|
Hamayoshi M, Goto S, Matsuoka C, Kono A, Miwa K, Tanizawa K, Evans C, Ikenaga M. Effects of an advance care planning educational programme intervention on the end-of-life care attitudes of multidisciplinary practitioners at an acute hospital: A pre- and post-study. Palliat Med 2019; 33:1158-1165. [PMID: 31257989 DOI: 10.1177/0269216319860707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Advance care planning is a crucial end-of-life care practice. However, an advance care planning educational programme for practitioners in an acute care setting has not yet been established. Consequently, we examined the effects of an advance care planning educational programme in an acute hospital in the hope of achieving increased awareness of end-of-life care. DESIGN A mixed-methods, pre- and post-design was employed to evaluate the change in attitudes of practitioners post-programme. The intervention programme was conducted thrice over 3 months in 90-min sessions. SETTING/PARTICIPANTS This study included 85 participants in the baseline assessment working at B acute hospital in Osaka. RESULTS Participants' scores on the 'Positive attitude for end-of-life care' subscale on the short version of the Frommelt Attitude Toward Care of Dying scale significantly increased after the 6-month intervention. A 'Positive attitude for end-of-life-care' implies that participants would not be afraid to practice end-of-life care. Further, participants' scores on the 'Death relief' subscale of the Death Attitude Inventory also significantly increased. The term 'Death relief' means that death helps in ending suffering. It means participants are not afraid of death. Qualitative results implied that participants believed advance care planning implementation and communicating with patients and patients' families were critical. CONCLUSIONS Six months post-intervention, participants displayed sustained positive attitudes towards end-of-life care. These results suggest that the present programme was effective at improving practitioners' attitudes towards patients' end-of-life care.
Collapse
Affiliation(s)
| | | | | | | | - Kyoko Miwa
- Yodogawa Christian Hospital, Osaka, Japan
| | | | | | | |
Collapse
|