Cancer Patient Characteristics Related to Prognosis in Patients with Metastatic Cancer Admitted to Intensive Care: The Importance of Advance Care Planning and Shared Decision Making

2018 ◽  
Vol 21 (12) ◽  
pp. 1681-1682 ◽  
Author(s):  
Aart Osinski ◽  
Gerard Vreugdenhil
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Cancer Patient ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Metastatic Cancer ◽  
Patient Characteristics ◽  
Care Planning ◽  
Shared Decision ◽  
Advance Care

scholarly journals Advance Care Planning (ACP) vs. Advance Serious Illness Preparations and Planning (ASIPP)

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 218 ◽  
Author(s):  
Daren K. Heyland
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Older Persons ◽  
Clinical Decision Making ◽  
Past Research ◽  
Care Planning ◽  
Shared Decision ◽  
Serious Illness ◽  
Advance Care

COVID-19 has highlighted the reality of an impending serious illness for many, particularly for older persons. Those faced with severe COVID-19 infection or other serious illness will be faced with decisions regarding admission to intensive care and use of mechanical ventilation. Past research has documented substantial medical errors regarding the use or non-use of life-sustaining treatments in older persons. While some experts advocate that advance care planning may be a solution to the problem, I argue that the prevailing understanding and current practice of advance care planning perpetuates the problem and results in patients not receiving optimal patient-centered care. Much of the problem centers on the framing of advance care planning around end of life care, the lack of use of decision support tools, and inadequate language that does not support shared decision-making. I posit that a new approach and new terminology is needed. Advance Serious Illness Preparations and Planning (ASIPP) consists of discrete steps using evidence-based tools to prepare people for future clinical decision-making in the context of shared decision-making and informed consent. Existing tools to support this approach have been developed and validated. Further dissemination of these tools is warranted.

Integrating Palliative Care in Ambulatory Care of Noncancer Serious Chronic Illness: A Systematic Review

2020 ◽  
Author(s):  
Sydney M. Dy ◽  
Julie M. Waldfogel ◽  
Danetta H. Sloan ◽  
Valerie Cotter ◽  
Susan Hannum ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Usual Care ◽  
Ambulatory Care ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Advance Directive ◽  
Care Planning ◽  
Shared Decision ◽  
Advance Care

Objectives. To evaluate availability, effectiveness, and implementation of interventions for integrating palliative care into ambulatory care for U.S.-based adults with serious life-threatening chronic illness or conditions other than cancer and their caregivers We evaluated interventions addressing identification of patients, patient and caregiver education, shared decision-making tools, clinician education, and models of care. Data sources. We searched key U.S. national websites (March 2020) and PubMed®, CINAHL®, and the Cochrane Central Register of Controlled Trials (through May 2020). We also engaged Key Informants. Review methods. We completed a mixed-methods review; we sought, synthesized, and integrated Web resources; quantitative, qualitative and mixed-methods studies; and input from patient/caregiver and clinician/stakeholder Key Informants. Two reviewers screened websites and search results, abstracted data, assessed risk of bias or study quality, and graded strength of evidence (SOE) for key outcomes: health-related quality of life, patient overall symptom burden, patient depressive symptom scores, patient and caregiver satisfaction, and advance directive documentation. We performed meta-analyses when appropriate. Results. We included 46 Web resources, 20 quantitative effectiveness studies, and 16 qualitative implementation studies across primary care and specialty populations. Various prediction models, tools, and triggers to identify patients are available, but none were evaluated for effectiveness or implementation. Numerous patient and caregiver education tools are available, but none were evaluated for effectiveness or implementation. All of the shared decision-making tools addressed advance care planning; these tools may increase patient satisfaction and advance directive documentation compared with usual care (SOE: low). Patients and caregivers prefer advance care planning discussions grounded in patient and caregiver experiences with individualized timing. Although numerous education and training resources for nonpalliative care clinicians are available, we were unable to draw conclusions about implementation, and none have been evaluated for effectiveness. The models evaluated for integrating palliative care were not more effective than usual care for improving health-related quality of life or patient depressive symptom scores (SOE: moderate) and may have little to no effect on increasing patient satisfaction or decreasing overall symptom burden (SOE: low), but models for integrating palliative care were effective for increasing advance directive documentation (SOE: moderate). Multimodal interventions may have little to no effect on increasing advance directive documentation (SOE: low) and other graded outcomes were not assessed. For utilization, models for integrating palliative care were not found to be more effective than usual care for decreasing hospitalizations; we were unable to draw conclusions about most other aspects of utilization or cost and resource use. We were unable to draw conclusions about caregiver satisfaction or specific characteristics of models for integrating palliative care. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were seen as barriers to implementation. Conclusions. For integrating palliative care into ambulatory care for serious illness and conditions other than cancer, advance care planning shared decision-making tools and palliative care models were the most widely evaluated interventions and may be effective for improving only a few outcomes. More research is needed, particularly on identification of patients for these interventions; education for patients, caregivers, and clinicians; shared decision-making tools beyond advance care planning and advance directive completion; and specific components, characteristics, and implementation factors in models for integrating palliative care into ambulatory care.

scholarly journals Understanding patients' and doctors' attitudes about shared decision making for advance care planning

2014 ◽  
Vol 18 (6) ◽  
pp. 2054-2065 ◽  
Author(s):  
Negin Hajizadeh ◽  
Lauren M. Uhler ◽  
Rafael E. Pérez Figueroa
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Care Planning ◽  
Shared Decision ◽  
Advance Care

scholarly journals Shared decision making and advance care planning-underpinnings, similarities and differences

2012 ◽  
Vol 2 (2) ◽  
pp. 173.1-173
Author(s):  
T Krones ◽  
N Biller Andorno ◽  
J in der Schmitten ◽  
C Mitchell ◽  
R Spirig ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Care Planning ◽  
Shared Decision ◽  
Advance Care ◽  
Similarities And Differences

scholarly journals Shared Decision Making Between Older Adult Home Health Patients and Their Caregivers: A Dyadic Coping Perspective

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 359-359
Author(s):  
Djin Tay ◽  
Lee Ellington ◽  
Gail Towsley ◽  
Katherine Supiano ◽  
Cynthia Berg
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Older Adult ◽  
Advance Care Planning ◽  
Home Health ◽  
Illness Representations ◽  
Dyadic Coping ◽  
Care Planning ◽  
Shared Decision ◽  
Advance Care

Abstract Older adult Home health (HH) patients comprise a medically frail population with increased inpatient and emergency department utilization. Despite the need for advance care planning among this population, rates are suboptimal. Patients rely increasingly on caregivers to advocate and coordinate their care particularly at the end of life; however surrogate decision makers are often underprepared for their roles in end-of-life decision making. This study examined shared decision making processes among older adult HH patients and caregivers during a shared decision making intervention guided by the Developmental-Contextual Model of dyadic coping (DCM). Purposive recruitment of N=18 HH patient-caregiver dyads was conducted. Patients were 55 years and above and participated with a family or non-family caregiver they nominated to the study. A 10-41 minute long video-recorded advance care planning intervention was conducted in patients’ homes and analyzed for non-verbal and verbal interactions using Noldus Observer XT 14.0. Theoretically-derived codes were applied deductively in a content analysis to examine dyadic processes associated with interactions suggesting agreement (convergent interactions) and disagreement (divergent interactions). Convergent interactions demonstrated greater alignment in illness representations and shared appraisals, and processes involving support, negotiation, and confirmation of preferences were noted. Convergent interactions also facilitated joint planning for future decisions. Disagreement on illness representations and/or shared appraisals, and overriding another’s preference was observed with divergent interactions. This study builds the groundwork for intervention refinement to promote constructive decision making and address non-constructive decision making among patient and caregivers for advance care planning.

Advance Care Planning and Shared Decision-Making: Paving the Way

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 39-39
Author(s):  
Francesca Bosisio ◽  
◽  
Daniela Ritzenthaler ◽  
Eve Rubli Truchard ◽  
Ralf J. Jox ◽  
...  
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Advance Care Planning ◽  
Care Quality ◽  
University Hospital ◽  
Care Planning ◽  
Shared Decision ◽  
Goals Of Care ◽  
Decision Making Capacity ◽  
Advance Care

"Advance care planning (ACP) has become widely used in medical care in order to plan ahead of a loss of decision-making capacity. Since ACP aim is to promote anticipatory and substitute autonomy by engaging people ‒ and possibly their relatives ‒ in deciding about future goals of care and treatments, scientific literature in this field often posits that ACP involve shared decision-making. This assumption however is rarely backed up by an in-depth reflection on how shared decision-making might operate within ACP and which shared decision-making template is more likely to foster ACP. Our ACP tool, based on a model created at the Zurich University Hospital (Krones et al, 2019), engages patients in a structured communicational process about their values and preferences for care. In this tool, ACP facilitators help patients set goals of care and document treatments decisions in three paradigmatic situations of loss of decision-making capacity. Because our ACP tool entails discussions about goals of care, quality of life, and options in terms of disease- or symptom-management, we turned to Elwyn and al.’s three talk’s model (2012) and Vermunt et al.’s three level goal model (2018) in order to incorporate elements of shared decision-making in our ACP tool. In this presentation we discuss how these models might be combined in order to foster shared decision-making within our ACP tool and, by then, broaden its scope and eventually improve its effectiveness, strengthen its theoretical foundations and uphold the ethics of care in the event of a loss of decision-making capacity. "

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