scholarly journals Rural health professionals‘ experiences in implementing advance care planning: a focus group study

2016 ◽  
Vol 22 (5) ◽  
pp. 423 ◽  
Author(s):  
Sophie Fletcher ◽  
Craig Sinclair ◽  
Joel Rhee ◽  
Desiree Goh ◽  
Kirsten Auret
Keyword(s):  
Rural Health ◽  
Advance Care Planning ◽  
Western Australia ◽  
Health Professionals ◽  
Care Planning ◽  
Focus Group Study ◽  
Future Health ◽  
Practice Nurses ◽  
Future Health Care ◽  
Advance Care

Advance care planning (ACP) is described as an ongoing discussion between a patient, their family and healthcare professionals (HCPs) to understand a patient’s wishes for future health care. Legislation supporting ACP in Western Australia is relatively new and HCPs are still learning about the process and implementation. This study aimed to provide a rich description of rural health professionals’ perceptions and experiences with ACP within the context of their professional role and to identify systemic issues and training needs. Ten focus groups were conducted throughout 2014 with a total of 55 rural participants including general practitioners (n=15), general practice registrars (n=6), practice nurses (n=18), community nurses (n=4) and hospital nurses (n=12) in the south-western regions of Western Australia. Thematic analysis has identified the following themes regarding ACP: benefits to patients and families; professional roles in ACP; barriers and enablers; and systems for communicating ACP. HCPs have self-determined their roles in the ACP process, which currently leaves some components of the process unaccounted for, suggesting that collaboration between HCPs working together in a rural health setting and a standardised system for distributing these documents may assist with the implementation of ACP.

scholarly journals How do Lawyers Assist Their Clients With Advance Care Planning? Findings From a Cross-Sectional Survey of Lawyers in Alberta

2018 ◽  
Author(s):  
Nola M. Ries ◽  
Maureen Douglas ◽  
Jessica Simon ◽  
Konrad Fassbender
Keyword(s):  
Advance Care Planning ◽  
Care Plan ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Future Health ◽  
Cross Sectional ◽  
Legal Professionals ◽  
Advance Care Plan ◽  
Future Health Care ◽  
Advance Care

Advance care planning (ACP) is the process of thinking about, discussing and documenting one’s preferences for future health care. ACP has important benefits: people who have a written directive are more likely to receive care that accords with their preferences, have fewer hospitalizations, and die in their preferred location. This article focuses on the important role that legal professionals have in advising and assisting clients with ACP. Studies report that people who have a written advance care plan are more likely to have received assistance in preparing the document from a lawyer than from a doctor. Yet virtually no research engages with the legal profession to understand lawyers’ attitudes, beliefs, and practices in this important area. This article starts to fill this gap by reporting the findings of a survey of lawyers in the province of Alberta. The results reveal lawyers’ practices in relation to ACP, their perceptions of their professional role and factors that support or hinder lawyers in working with clients on ACP, and their preferences for resources to assist them in helping their clients. To the authors’ knowledge, this is the first survey of lawyers on their practices in relation to ACP.

Advance care planning in Australia: what does the law say?

2016 ◽  
Vol 40 (4) ◽  
pp. 405 ◽  
Author(s):  
Rachel Z. Carter ◽  
Karen M. Detering ◽  
William Silvester ◽  
Elizabeth Sutton
Keyword(s):  
Health Care ◽  
Advance Care Planning ◽  
Legal Status ◽  
Care Planning ◽  
Future Health ◽  
Substitute Decision Maker ◽  
The Status ◽  
Future Health Care ◽  
Advance Care ◽  
The Law

Advance care planning (ACP) assists people to plan for their future health and personal care. ACP encourages a person to legally appoint a substitute decision maker (SDM) and to document any specific wishes regarding their future health care in an advance care directive (ACD). Formal documentation of wishes increases the chances that a person’s wishes will be known and followed. However, one of the biggest impediments for doctors following the person’s wishes is uncertainty surrounding the law, which is complicated and varies between the states and territories of Australia. SDM legislation varies regarding who can be appointed, how they are appointed, the powers that an SDM can be given and the decision-making principles that the SDM needs to follow. In circumstances where an SDM has not been appointed, the hierarchy for determining the default SDM for a person also varies between states. Although many states have legislated ACD forms allowing for documentation of a person’s health care wishes, these forms allow for different things to be documented and have different requirements to be valid. The Australian population is mobile, with patients frequently moving between states. The status of ACP documentation created in a state other than the state in which a patient requires treatment also varies, with some states recognising interstate ACDs whereas others do not. This article outlines the legal status of ACDs, within Australian jurisdictions, including the legal validity of interstate ACDs, and argues that uniform laws and documents would assist with awareness and understanding of, and compliance with, ACDs.

Advance care planning: what do patients want?

2019 ◽  
Vol 80 (5) ◽  
pp. 263-267 ◽  
Author(s):  
Lucy Owen ◽  
Anna Steel
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Care Planning ◽  
Care Planning ◽  
Shared Decision ◽  
Future Health ◽  
Final Study ◽  
Future Health Care ◽  
Advance Care

Introduction: Advance care planning is the process by which patients can make decisions about their future health care should they lose capacity. Such conversations are shown to improve quality of life and reduce institutionalization. This article explores the preferences and wishes of patients in terms of advance care planning. Methods: CINAHL, Medline, Embase and Pubmed were searched. Key words included ‘elderly’, ‘advance care planning’, ‘advance directive’, ‘views’ and ‘opinions’. Results: A total of 64 abstracts were screened and 20 full text articles read; 11 articles were included in the final study. Individual and cultural differences influence the level of decision making that patients want. Most studies agreed that conversations should be carried out opportunistically by a trained health-care professional. Patients value honest and open conversations, without which they may make misinformed decisions. Conclusions: The level of shared decision making that individuals personally want should be established. Open and honest conversations should be initiated at the earliest opportunity.

COVID-19 and advance care planning: A unique opportunity.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 32-32
Author(s):  
Aliya Gessling ◽  
Mary Rank ◽  
Deborah Larson ◽  
Ann Soloway ◽  
Jessica Langston ◽  
...  
Keyword(s):  
Health Care ◽  
High Risk ◽  
Advance Care Planning ◽  
Healthcare Providers ◽  
Cost Effective ◽  
Care Planning ◽  
Future Health ◽  
Care Assessment ◽  
Future Health Care ◽  
Advance Care

32 Background: Advance Care Planning (ACP) is a process to document patient preferences for future health care. Conversations between healthcare providers, patients, and loved-ones are required to reflect a patient’s values, goals, and ultimately their choices for life-sustaining treatments (LST). The COVID-19 pandemic has highlighted the critical importance of these discussions and the need for improved patient engagement. Methods: As COVID-19 infections surged, the VA Northern California Health Care System (VA NCHCS) Hospice and Palliative Care Section (HPCS) partnered with Patient Aligned Care Teams to expand urgent outreach to high-risk patients needing LST documentation. High risk was defined as age > 80, COPD or asthma diagnosis, or Care Assessment Need Score > 80 (CAN Score models risk of hospitalization or death within 1 year). An experienced HPCS Nurse Practitioner (NP) contacted these identified patients to 1.) provide COVID-19 education, 2.) conduct a high-quality goals of care conversation, and 3.) complete LST documentation and other ACP needs. A representative cohort was then followed up to evaluate concordance of treatment with their documented preferences. Results: Between March 2020 and September 2020, 910 patients were identified as high risk. Of these patients, 294 agreed to participate in the telehealth visit and complete LST documentation. Importantly, 108 (37%) patients chose DNR and other LST limitations. In addition, 142 (48%) patients created POLST documentation and 128 (43%) completed Advance Directives. Over 70% of patients who were hospitalized in the VA received care concordant with the newly documented LST preferences. A follow up survey of 29 participants found the outreach impactful and their preferences documented correctly. Conclusions: Prior studies have demonstrated success at educating primary providers to conduct ACP discussions, but given the limitations imposed by COVID-19 restrictions, this novel and highly cost-effective process of coupling a highly trained HPCS NP with a primary care team to perform ACP was piloted with success. After only a single ACP discussion, patients were able to formalize their limits to treatment and subsequent care aligned with these preferences. Patients also found this focused ACP discussion meaningful. This pathway will be integrated within the VA NCHCS as a long-term approach to continued ACP outreach.

scholarly journals ‘Traversing difficult terrain’. Advance care planning in residential aged care through multidisciplinary case conferences: A qualitative interview study exploring the experiences of families, staff and health professionals

2021 ◽  
pp. 026921632110132
Author(s):  
Suzanne Rainsford ◽  
Sally Hall Dykgraaf ◽  
Rosny Kasim ◽  
Christine Phillips ◽  
Nicholas Glasgow
Keyword(s):  
Advance Care Planning ◽  
Health Professionals ◽  
Aged Care ◽  
Shared Responsibility ◽  
Care Staff ◽  
Residential Aged Care ◽  
Care Planning ◽  
Qualitative Interview Study ◽  
Case Conferences ◽  
Advance Care

Background: Advance care planning improves the quality of end-of-life care for older persons in residential aged care; however, its uptake is low. Case conferencing facilitates advance care planning. Aim: To explore the experience of participating in advance care planning discussions facilitated through multidisciplinary case conferences from the perspectives of families, staff and health professionals. Design: A qualitative study (February–July 2019) using semi-structured interviews. Setting: Two residential aged care facilities in one Australian rural town. Participants: Fifteen informants [family ( n = 4), staff ( n = 5), health professionals ( n = 6)] who had participated in advance care planning discussions facilitated through multidisciplinary case conferences. Results: Advance care planning was like navigating an emotional landscape while facing the looming loss of a loved one. This emotional burden was exacerbated for substitute decision-makers, but made easier if the resident had capacity to be involved or had previously made their wishes clearly known. The ‘conversation’ was not a simple task, and required preparation time. Multidisciplinary case conferences facilitated informed decision-making and shared responsibility. Opportunity to consider all care options provided families with clarity, control and a sense of comfort. This enabled multiple stakeholders to bond and connect around the resident. Conclusion: While advance care planning is an important element of high quality care it involves significant emotional labour and burden for families, care staff and health professionals. It is not a simple administrative task to be completed, but a process that requires time and space for reflection and consensus-building to support well-considered decisions. Multidisciplinary case conferences support this process.

Enabling Advance Care Planning in Dementia Care: A Primary Care Approach

2020 ◽  
pp. 082585972097393
Author(s):  
Linda Lee ◽  
Loretta M. Hillier ◽  
Stephanie K. Lu ◽  
Donna Ward
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Health Professionals ◽  
Online Survey ◽  
Ease Of Use ◽  
Depth Information ◽  
Care Planning ◽  
Care Approach ◽  
Memory Clinics ◽  
Advance Care

Background: Lack of tools to support advance care planning (ACP) has been identified as a significant barrier to implementing these discussions. Aim: We pilot tested an ACP framework tool for use with persons living with dementia (PLWD) in primary care-based memory clinics and an Adult Day Program; this study describes user and recipient experiences with this framework. Methods: We used a mixed methods approach. Health professionals completed an online survey following pilot testing and PLWD and substitute decision makers (SDM) completed survey immediately following the ACP discussion assessing their satisfaction (5-point scale) with the framework and exploring potential outcomes. Interviews with health professionals, PLWD, and SDM were conducted to gather more in-depth information on their perceptions of the ACP framework/ discussion. Results: Surveys were completed by 12 health professionals, 13 PLWD, and 16 SDM. While PLWD and SDM were satisfied with the ACP discussion (M = 4.0/5), health professionals were minimally satisfied with the ease of use of the framework (M = 2.0/5), acceptability for patients (M = 2.4/5) and feasibility in practice (M = 1.9/5). Sixteen interviews were completed with 8 health professionals, 1 PLWD, and 7 SDM. While health professionals valued ACP, lack of time and training were identified barriers to framework use. SDM felt better prepared for future decisions and PLWD were put at ease, knowing that their wishes for care were understood. Conclusion: PLWD and SDM value the opportunity for ACP, and although health professionals identified some concerns with framework administration, they acknowledge the value and importance of ACP. Continuing efforts to refine ACP processes are justified.

scholarly journals Prevalence of Advance Care Planning Practices Among People with Chronic Diseases in Hospital and Community Settings: A Quasi-Experimental Design

2020 ◽  
Author(s):  
Sarah Yeun-Sim Jeong ◽  
Tomiko Barrett ◽  
Se Ok Ohr ◽  
Peter Cleasby ◽  
Ryan Davey
Keyword(s):  
Health Care ◽  
Chronic Diseases ◽  
Advance Care Planning ◽  
Healthcare Professionals ◽  
Community Setting ◽  
Care Planning ◽  
Community Settings ◽  
Future Health ◽  
Number Of Patients ◽  
Advance Care

Abstract Background: Advance Care Planning (ACP) enables healthcare professionals to embrace the important process where patients think about their values in life and goals for health care, and discuss their future health care preferences with family members for a time when they are not able to make health care decisions. Despite the promotion of ACP last two decades, and well-known benefits of ACP and a written Advance Care Directive (ACD), they are still underutilised in Australia and across the world. Previous studies have provided some insights, however, an uptake of ACP and prevalence of ACDs in community setting is rarely reported.Methods: The aim of this study was to determine the uptake of ACP and prevalence of ACDs among people with chronic diseases in hospital and community settings. A retrospective medical record audit of eligible patients looking for evidence of ACP was conducted in 16 research sites (eight intervention and eight control) in hospital and community care settings. Participants included those who were admitted to one of the research sites, and who were aged 18 years and over with at least one of nine nominated chronic diseases. The primary outcome measures included the number of patients with evidence of ACP through the following practices: completion of an ACD, appointment of an Enduring Guardian (EG), or completion of a resuscitation plan. Results: The overall prevalence of ACD was 2.8% (n=28) out of 1006 audited records, and only 10 of them were legally binding. The number of EGs legally appointed was 39 (3.9%) across the sites. A total of 151 (15.4%) resuscitation plans were found across the eight hospital sites. 95% (n=144) of the resuscitation plans advised ‘Not-for-resuscitation’. Conclusions: The uptake of ACP is very low. Current medical recording system reveals the challenges in ACP lie in the process of storage, access and execution of the ACDs. Given that having an ACD or EG in place is only useful if the treating physician knows how and where to access the information, it has implications for policy, information system, and healthcare professionals’ education. Trial registration: The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246). The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx

Is This ACP? A Focus Group Study of Patient Experiences of Advance Care Planning

2022 ◽  
Author(s):  
Amanda J. Reich ◽  
Stephen Perez ◽  
Priscilla Gazarian ◽  
Noah D’Arcangelo ◽  
Kristina Gonzales ◽  
...  
Keyword(s):  
Focus Group ◽  
Advance Care Planning ◽  
Patient Experiences ◽  
Care Planning ◽  
Focus Group Study ◽  
Advance Care

scholarly journals Implantable cardioverter defibrillator deactivation and advance care planning: a focus group study

Heart ◽  
2019 ◽  
pp. heartjnl-2019-315721 ◽  
Author(s):  
Rik Stoevelaar ◽  
Arianne Brinkman-Stoppelenburg ◽  
Anne Geert van Driel ◽  
Rozemarijn L van Bruchem-Visser ◽  
Dominic AMJ Theuns ◽  
...  
Keyword(s):  
Focus Groups ◽  
Implantable Cardioverter Defibrillator ◽  
Advance Care Planning ◽  
Comparative Method ◽  
Disease Stage ◽  
Care Planning ◽  
Best Interest ◽  
Focus Group Study ◽  
Cardioverter Defibrillator ◽  
Advance Care

ObjectiveImplantable cardioverter defibrillators can treat life-threatening arrhythmias, but may negatively influence the last phase of life if not deactivated. Advance care planning conversations can prepare patients for future decision-making about implantable cardioverter defibrillator deactivation. This study aimed at gaining insight in the experiences of patients with advance care planning conversations about implantable cardioverter defibrillator deactivation.MethodsIn this qualitative study, we held five focus groups with 41 patients in total. Focus groups were audio-recorded and transcribed. Transcripts were analysed thematically, using the constant comparative method, whereby themes emerging from the data are compared with previously emerged themes.ResultsMost patients could imagine deciding to have their implantable cardioverter defibrillator deactivated, for instance because the benefits of an active device no longer outweigh the harm of unwanted shocks, when having another life-limiting illness, or when relatives would think this would be in their best interest. Some patients expressed a need for advance care planning conversations with a healthcare professional about deactivation, but few had had these. Others did not, saying they solely focused on living. Some patients were hesitant to record their preferences about deactivation in advance care directives, because they were unsure whether their current preferences would reflect future preferences.ConclusionsAlthough patients expressed a need for more information, advance care planning conversations about implantable cardioverter defibrillator deactivation seemed to be uncommon. Deactivation should be more frequently addressed by healthcare professionals, tailored to the disease stage of the patient and readiness to discuss this topic.

Sign in / Sign up

Export Citation Format

Share Document