Advance Care Plans: Planning for Critical Healthcare Decisions

2021 ◽  
Author(s):  
Nazli Gurdamar-Okutur ◽  
Simona Botti ◽  
Vicki G. Morwitz
Keyword(s):  
Care Plans ◽  
Advance Care

Advance care plans for CPR or mechanical ventilation in patients with dementia

2010 ◽  
Vol 35 (12) ◽  
pp. 38-42 ◽  
Author(s):  
Teresa F. Westenhaver ◽  
Teresa J. Krassa ◽  
Gloria J. Bonner ◽  
Diana J. Wilkie
Keyword(s):  
Mechanical Ventilation ◽  
Care Plans ◽  
Advance Care

Fidelity is fundamental: intervention predictors in advance care plans in terminal cancer

2019 ◽  
pp. bmjspcare-2019-001917
Author(s):  
Lisa Vaccaro ◽  
Phyllis N Butow ◽  
Deborah Lee ◽  
Stephanie B Johnson ◽  
Melanie Bell ◽  
...  
Keyword(s):  
Family Caregiver ◽  
Skills Training ◽  
Audit Tool ◽  
Advanced Cancer Patients ◽  
Care Plans ◽  
Registration Number ◽  
Advance Care ◽  
Caregiver Involvement ◽  
Caregiver Report ◽  
General Communication

ObjectivesAssessing whether interventions are implemented as intended (fidelity) is critical to establishing efficacy in clinical research yet rarely applied in advance care planning (ACP) interventions. We aimed to develop and implement a fidelity audit tool for an ACP intervention.MethodsWe developed a fidelity audit tool assessing: (A) content; (B) quality (general communication, eliciting EOL preferences and prognostic communication); and (C) family/caregiver involvement. We audited (double-coded) 55 audio-recordings of ACP discussions delivered to advanced cancer patients and caregivers, within a clinical trial.ResultsFidelity to content was high: mean=9.38/11 but lower for the quality of general communication (mean=12.47/20), discussion of patient preferences (mean=4.67/7), prognosis (mean=3.9/6) and family/caregiver involvement (mean=2.67/4). Older patient age and caregiver religiosity were associated with higher fidelity. Higher fidelity to content was associated with the trial primary outcome of family caregiver report of patient wishes being discussed and met.ConclusionsFidelity to content, but not quality, of the ACP intervention is strong. Communication skills training is critical for ACP interventionists. Adherence was higher with older patients and religious carers, factors that may influence acceptance of death and readiness to undertake ACP, making the discussion easier.Trial registration numberACTRN12613001288718.

scholarly journals Clinician barriers and facilitators to heart failure advance care plans: a systematic literature review and qualitative evidence synthesis

2019 ◽  
pp. bmjspcare-2018-001747 ◽  
Author(s):  
Markus Schichtel ◽  
Bee Wee ◽  
John I MacArtney ◽  
Sarah Collins
Keyword(s):  
Heart Failure ◽  
Healthcare Professionals ◽  
Evidence Synthesis ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Emotional Impact ◽  
Qualitative Evidence Synthesis ◽  
Care Plans ◽  
Advance Care ◽  
Disease Specific

BackgroundClinicians hesitate to engage with advance care planning (ACP) in heart failure. We aimed to identify the disease-specific barriers and facilitators for clinicians to engage with ACP.MethodsWe searched Medline, Embase, CINAHL, PubMed, Scopus, the British Nursing Index, the Cochrane Library, the EPOC register, ERIC, PsycINFO, the Science Citation Index and the Grey Literature from inception to July 2018. We conducted the review according to Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Two reviewers independently assessed original and empirical studies according to Critical Appraisal Skills Programme criteria. The SURE framework and thematic analysis were used to identify barriers and facilitators.ResultsOf 2308 articles screened, we reviewed the full text of 42 studies. Seventeen studies were included. The main barriers were lack of disease-specific knowledge about palliative care in heart failure, high emotional impact on clinicians when undertaking ACP and lack of multidisciplinary collaboration between healthcare professionals to reach consensus on when ACP is indicated. The main facilitators were being competent to provide holistic care when using ACP in heart failure, a patient taking the initiative of having an ACP conversation, and having the resources to deliver ACP at a time and place appropriate for the patient.ConclusionsTraining healthcare professionals in the delivery of ACP in heart failure might be as important as enabling patients to start an ACP conversation. This twofold approach may mitigate against the high emotional impact of ACP. Complex interventions are needed to support clinicians as well as patients to engage with ACP.

Synchronizing advance directives among patients across a health system.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 233-233
Author(s):  
Sherri Rauenzahn Cervantez ◽  
Sadiyah Hotakey ◽  
Amanda Hernandez ◽  
Stephanie Warren ◽  
Jennifer Quintero ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health System ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Care Planning ◽  
Care Clinic ◽  
Care Plans ◽  
Palliative Oncology ◽  
Advance Care

233 Background: Advance directives (ADs) are legal tools that direct treatment or decision making and appoint a surrogate decision-maker (health care proxy). The presence of ADs is associated with decreased rates of hospitalization, use of life-sustaining treatment, and deaths in a hospital setting. Additionally, completed ADs lead to increased use of hospice or palliative care, more positive family outcomes, improved quality of life for patients, and reduced costs for healthcare. Despite the benefits of advance care planning, only 18-36% of adults have completed advance care plans. The aims of our pilot study were to 1) implement a synchronized system for advance care planning across the UT Health San Antonio health system and 2) improve advance care planning rates in a primary care clinic and palliative oncology clinic. Methods: During a 10-month prospective period, system processes for advance care planning were reviewed with identification of three primary drivers for advance care plan completion: a) electronic/EMR processes, b) clinical workflows and training, and c) patient resources and education. As a result of this quality improvement initiative, standardized forms, resources, and processes for obtaining advance care plans were implemented in the selected clinics. Results: At baseline, the primary care clinic had 84/644 (13%) patients and the palliative oncology clinic had 25/336(7%) with completed advance care plans. With the implementation of a standardized process, 108 patients (23% increase in rate of completion) in the primary clinic and 56 patients (71% increase in rate of completion) in the palliative oncology setting completed advance care planning (ACP). Additionally, there was a 5-fold increase in billing of ACP CPT codes within the clinics during the first 6 months compared to the prior full year. Conclusions: While this quality improvement pilot initiative was limited to two clinics, the synchronized modifications suggest that the system changes could be expanded to other clinics in our UT health system to promote ACP discussions, completion of plans, and ultimately improved patient care.

Engaging College Undergraduates in Advance Care Planning

2016 ◽  
Vol 74 (3) ◽  
pp. 329-344 ◽  
Author(s):  
Sara Sanders ◽  
Erin L. Robinson
Keyword(s):  
Advance Care Planning ◽  
End Of Life Care ◽  
Care Planning ◽  
Life Care ◽  
Health Care Planning ◽  
Medical Decisions ◽  
Care Plans ◽  
Life Threatening ◽  
Advance Care

Advance care planning (ACP) is a critical part of long-term health-care planning, as no one knows when the ability to make personal medical decisions may be impaired. Many assume ACP is only necessary for older adults or those with life-threatening health conditions; however, there are growing discussions about healthy, young adults also engaging in ACP, as they too suffer from unexpected medical events that limit their ability to make medical decisions. The current study examined the reactions of college students following the completion of their advance care plans and then sharing these plans with friends and family. The students reported that while completing their advance care plans created many emotions, they found the experience to be valuable and facilitated conversations with family and friends about end-of-life care that may not have occurred otherwise.

scholarly journals ‘It’s a hard conversation to have’. Healthcare professionals’ views concerning advance care discussions with young people affected by life-limiting neuromuscular diseases: an interview study

2017 ◽  
Vol 9 (1) ◽  
pp. e9-e9
Author(s):  
Andy Hiscock ◽  
Stephen Barclay
Keyword(s):  
Young People ◽  
End Of Life ◽  
End Of Life Care ◽  
Healthcare Professionals ◽  
Neuromuscular Diseases ◽  
Individual Case ◽  
Life Care ◽  
Care Plans ◽  
Advance Care ◽  
The Uk

ObjectiveLife-limiting neuromuscular disease, such as some of the muscular dystrophies, are often diagnosed in early childhood: when death comes, commonly in the second or third decade of life, patients rarely have advance care plans in place or documented end-of-life care preferences. There is very limited literature concerning the discussions about end-of-life plans healthcare professionals have with young people affected by life-limiting neuromuscular diseases. The aim of this study was to investigate the views and experiences of healthcare professionals concerning having discussions about advance care plans and end-of-life care with teenagers and young adult patients affected by life-limiting neuromuscular diseases.MethodsSemistructured interviews with a maximum variety sample of nine professionals involved in the care of young people with life-limiting neuromuscular diseases in one region of the UK.ResultsWhile recognising the inevitable progression of the conditions, there was no consensus among interviewees concerning best approaches to discuss end-of-life care plans. Several environmental and personal barriers were identified that lead to avoidance of the emotionally challenging and difficult conversations.ConclusionsCommunity-based professionals with well-established relationships with patients and families may be best placed to take the lead and coordinate discussions, but individual case-by-case preferences need to be carefully considered.

scholarly journals Clinicians’ consent law knowledge: The case for education

2020 ◽  
Vol 21 (3) ◽  
pp. 65-77
Author(s):  
Denise Patricia Craig ◽  
Fintan Thompson
Keyword(s):  
Decision Making ◽  
Potential Benefit ◽  
Legal Education ◽  
Education Session ◽  
Short Term ◽  
Care Plans ◽  
Patients Rights ◽  
Before And After ◽  
Advance Care ◽  
Supported Education

Introduction: The short-term objectives of this study were to investigate clinicians’ confidence with, and knowledge of, consent laws, their behaviour regarding familiarisation with patients’ advance care plans and the potential benefit of brief education. Education covered patients’ rights to refuse treatment, including via advance directive, and the legislated hierarchy of decision-making authority.Methods: Throughout 2018, all clinicians at one Queensland Hospital and Health Service were invited to attend a 1-hour legal education session. The study used a crosssectional survey to measure clinicians’ knowledge before and after education. Responses from 316 pre- and 319 post-education questionnaires were analysed.Results: A 1-hour legal education session improved clinicians’ understanding of legislated consent hierarchy and patients’ rights. Pre education, 4.1% of participants correctly identified the lawful consent hierarchy, rising to 65.5% after education. Accuracy increased significantly after education; however, substantial errors persisted.Conclusions: The potential benefit of education to increase multidisciplinary clinicians’ legal knowledge was supported. Education can ensure that clinicians are made aware of patients’ rights and the potential complexity of lawful substitute decision making.

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