How to increase public participation in advance care planning: findings from a World Café to elicit community group perspectives

Background

In 2014, Alberta, Canada broke new ground in having the first provincial healthcare policy and procedure for advance care planning (ACP), the process of communicating and documenting a person’s future healthcare preferences. However, to date public participation and awareness of ACP remains limited. The aim of this initiative was to elicit community group perspectives on how to help people learn about and participate in ACP.

Methods

Targeted invitations were sent to over 300 community groups in Alberta (e.g. health/disease, seniors/retirement, social/service, legal, faith-based, funeral planning, financial, and others). Sixty-seven participants from 47 community groups attended a “World Café”. Participants moved between tables at fixed time intervals, and in small groups discussed three separate ACP-related questions. Written comments were captured by participants and facilitators. Each comment was coded according to Michie et al.’s Theoretical Domains Framework, and mapped to the Capability, Opportunity and Motivation behavior change system (COM-B) in order to identify candidate intervention strategies.

Results

Of 800 written comments, 76% mapped to the Opportunity: Physical COM-B component of behavior, reflecting a need for access to ACP resources. The most common intervention functions identified pertained to Education, Environmental Restructuring, Training, and Enablement. We synthesized the intervention functions and qualitative comments into eight recommendations for engaging people in ACP. These pertain to access to informational resources, group education and facilitation, health system processes, use of stories, marketing, integration into life events, inclusion of business partners, and harmonization of terminology.

Conclusions

There was broad support for the role of community groups in promoting ACP. Eight recommendations for engaging the public in ACP were generated and have been shared with stakeholders.

Characterization of anatomically compliant linear cardiac lesions created by the CARDIMA radiofrequency surgical ablation system

This study investigated anatomical cardiac linear lesion characteristics created by the CARDIMA RF surgical ablation system. We developed an in vitro porcine cardiac model that simulates cardiac tissue during an on-pump open chest procedure. We used the INTELLITEMP energy management device to deliver RF energy to an 8 electrode, 8 thermocouple deflectable linear surgical probe, to form curvilinear and linear lesions on porcine myocardium. Ablations were at two target temperatures (70 degrees C and 80 degrees C) and durations (60 sec. and 90 sec.). The results show that this system is capable of forming clinically relevant deep and contiguous lesions of desired length.