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Van Scoy LJ, Green MJ, Dimmock AE, Bascom R, Boehmer JP, Hensel JK, Hozella JB, Lehman EB, Schubart JR, Farace E, Stewart RR, Levi BH. High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study. Chronic Illn 2016; 12:227-35. [PMID: 27055468 DOI: 10.1177/1742395316633511] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Many patients with chronic illnesses report a desire for increased involvement in medical decision-making. This pilot study aimed to explore how patients with exacerbation-prone disease trajectories such as advanced heart failure or chronic obstructive pulmonary disease experience advance care planning using an online decision aid and to compare whether patients with different types of exacerbation-prone illnesses had varied experiences using the tool. METHODS Pre-intervention questionnaires measured advance care planning knowledge. Post-intervention questionnaires measured: (1) advance care planning knowledge; (2) satisfaction with tool; (3) decisional conflict; and (4) accuracy of the resultant advance directive. Comparisons were made between patients with heart failure and chronic obstructive pulmonary disease. RESULTS Over 90% of the patients with heart failure (n = 24) or chronic obstructive pulmonary disease (n = 25) reported being "satisfied" or "highly satisfied" with the tool across all satisfaction domains; over 90% of participants rated the resultant advance directive as "very accurate." Participants reported low decisional conflict. Advance care planning knowledge scores rose by 18% (p < 0.001) post-intervention. There were no significant differences between participants with heart failure and chronic obstructive pulmonary disease. DISCUSSION Patients with advanced heart failure and chronic obstructive pulmonary disease were highly satisfied after using an online advance care planning decision aid and had increased knowledge of advance care planning. This tool can be a useful resource for time-constrained clinicians whose patients wish to engage in advance care planning.
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Affiliation(s)
- Lauren J Van Scoy
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Michael J Green
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Anne Ef Dimmock
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rebecca Bascom
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - John P Boehmer
- Division of Cardiology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jessica K Hensel
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Joshua B Hozella
- Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
| | - Erik B Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jane R Schubart
- Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Elana Farace
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Renee R Stewart
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Benjamin H Levi
- Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA
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