scholarly journals 7 The Elephant in the Room: An Innovative and Effective Approach to Multidisciplinary Advance Care Planning Training

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i1-i6
Author(s):  
L Owen ◽  
A Steele ◽  
K Goffe ◽  
J Pleming
Keyword(s):  
Cultural Values ◽  
Advance Care Planning ◽  
Discharge Planning ◽  
Group Discussion ◽  
Care Planning ◽  
Allied Health Professionals ◽  
Change In Practice ◽  
Sustained Change ◽  
Advance Care ◽  
Multidisciplinary Simulation

Abstract Background Exploring patients’ preferences for future care is known to reduce adverse health outcomes, limit transfers between care settings institutionalisation and improve quality of life. Patients value opportunities to have honest conversations. In the recent “Talking about Dying” report from the Royal College of Physicians (RCP), it was found that healthcare professionals (HCPs) find it challenging to start conversations with patients and families. Yet the report highlights a need for HCPs to be equipped with the skills and confidence to provide opportunities for advance care planning in primary care, inpatient and outpatient settings. Methods A multi-disciplinary faculty delivered simulation sessions to 115 candidates (50.4% doctors, 33% nurses and 16.5% allied health professionals) from primary and secondary care. Eight half-day sessions have taken place across North London. Each session started with an introductory lecture, followed by simulated scenarios between a professional actor and candidate within small multi-disciplinary groups. Group discussion was facilitated and feedback given. We focused on acknowledging the progressive, complex and unpredictable nature of frailty. Scenarios included resuscitation, re-admission to hospital, risk feeding, complex discharge planning and cultural values in older adults. Results 100% would recommend this multidisciplinary simulation to teach advance care planning. Only 15.6% of candidates felt confident or very confident with conversations; this improved to 90.5% following the simulation and was maintained at 69.5% three months later. Understanding when advance care planning is appropriate improved from 70% to 100%. Three months after the training, 86% stated they had a sustained change in practice in ACP as a result of the course. Conclusion We have demonstrated that our multidisciplinary simulation is an effective format of improving understanding and confidence in having advance care planning conversations. These results are evident both immediately after and at the three month follow up stage demonstrating a sustained change in practice.

scholarly journals STARTING THE CONVERSATION: RESULTS FROM AN INTERPROFESSIONAL WORKSHOP ABOUT ADVANCE CARE PLANNING

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S969-S969
Author(s):  
Stacy L Barnes ◽  
Susan Breakwell ◽  
Jordan Cannon
Keyword(s):  
Advance Care Planning ◽  
Low Cost ◽  
Group Discussion ◽  
Health Professions ◽  
Physician Assistants ◽  
Speech Pathology ◽  
Care Planning ◽  
Biomedical Sciences ◽  
Advance Care ◽  
Case Presentations

Abstract Advance care planning is more than documenting end of life medical decisions; it should be the beginning of an important and ongoing conversation about personal values, goals, and preferences. Health profession students must be prepared to have these conversations and overcome any existing barriers to effective patient-provider communication. To this end, a multidisciplinary planning team from Marquette University and the Medical College of Wisconsin developed a 2-hour workshop directed at students in the health professions. It was designed to be highly interactive, including guided self-reflection, drawing, writing, videos, small group work, case presentations, and large group discussion. The workshop was scheduled to coincide with National Healthcare Decisions Day (April 16th). A total of 149 students participated, representing the disciplines of medicine, nursing, physician assistants, counseling psychology, speech pathology, and biomedical sciences. Feedback from both students and faculty was overwhelmingly positive, indicating interest and need for this type of program. A post-event questionnaire, which included a retrospective pre/post-test, assessed learners’ gains in knowledge and self-efficacy. Significant (< 0.001) gains were found on all measured items. Data from an electronic follow-up survey suggested the majority of participants took additional actions steps related to advance care planning in the month following the workshop. In conclusion, this is a low-cost, replicable workshop that aligns with current recommendations for advanced care planning (IOM, 2015), is well received by students and faculty in the health professions, and may serve as a springboard for increasing the number of advance care planning conversations.

scholarly journals Culturally Adapting an Advance Care Planning Communication Intervention With American Indian and Alaska Native People in Primary Care

2019 ◽  
Vol 31 (2) ◽  
pp. 178-187
Author(s):  
Kate M. Lillie ◽  
Lisa G. Dirks ◽  
J. Randall Curtis ◽  
Carey Candrian ◽  
Jean S. Kutner ◽  
...  
Keyword(s):  
Primary Care ◽  
American Indian ◽  
Cultural Values ◽  
Advance Care Planning ◽  
Alaska Native ◽  
Native People ◽  
Care Planning ◽  
Primary Care Settings ◽  
Patient Provider Communication ◽  
Advance Care

Introduction: Advance care planning (ACP) is a process in which patients, families, and providers discuss and plan for desired treatment goals. American Indian and Alaska Native people (AI/AN) have higher prevalence of many serious, life-limiting illnesses compared with the general population; yet AI/ANs use ACP considerably less than the overall population. Method: We conducted a qualitative study to culturally adapt an existing ACP intervention for AI/ANs in two primary care settings. Results: We found that it is important to incorporate patients’ cultural values and priorities into ACP, determine who the patient wants involved in ACP conversations, and consider the culturally and locally relevant barriers and facilitators when developing an ACP intervention with AI/AN communities. Discussion: At the core, ACP interventions should be clear and understandable across populations and tailored to facilitate culturally appropriate and meaningful patient–provider communication. Our results and methodology of culturally adapting an intervention may be applicable to other underrepresented populations.

Advance care planning in community: Evaluation of a two-session workshop.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 14-14
Author(s):  
Michael Rabow ◽  
Marilyn McGowan ◽  
Rebecca Small ◽  
Redwing Keyssar ◽  
Hope S. Rugo
Keyword(s):  
Family Caregivers ◽  
Advance Care Planning ◽  
Group Discussion ◽  
Care Physician ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Planning ◽  
Community Evaluation ◽  
Advance Care ◽  
Workshop Evaluation

14 Background: Engaging patients in advance care planning (ACP) is challenging. Group visits and multiple patient-clinician interactions appear to promote advance directive (AD) completion. We evaluated the effectiveness of a two-session ACP workshop. Methods: We conducted a nurse-led ACP workshop for patients and their family caregivers in a comprehensive cancer center. Patients were invited by their outpatient palliative care physician and an assistant helped coordinate attendance. Monthly sessions were 2 hours long and 2 weeks apart. The first session detailed the ACP process, featured the “Go Wish” card game, and introduced the “Five Wishes” AD. In the time between sessions, patients were encouraged to play Go Wish with family and to begin filling out their AD. The second session included questions and discussion, and helped patients complete, notarize, and scan their AD into the EMR. Workshop evaluation included the validated 4-question Sudore ACP Readiness Survey as well as semi-structured participant interviews. Results: Ten of 11 participants from 4 workshop offerings completed surveys. Median age was 48 years (range 41-72). Most patients (10/11, 90.9%) had breast cancer. Mean pre-workshop ACP readiness was 4.0 out of 5; post-workshop readiness increased nearly significantly to 4.325 (p = .057). Eight of the workshop participants (72.7%) had a new notarized AD scanned into the EMR. Participants most appreciated the chance to talk with other patients (“The most important thing was having a group there. I don’t think I ever would have read that packet if it had just been handed to me.”) and the chance to include their family caregivers (“My family and I had a rich and bonding talk, which was helpful for their own thinking about the AD for themselves as well.”). Two family caregivers completed their own AD. Patients who declined a workshop invitation most commonly reported they “did not have time” because of medical appointments. Conclusions: The ACP workshop was well received by participants and increased ACP readiness, discussion, and completion. The opportunities for group discussion and inclusion of family caregivers were important to participants. Barriers to attending workshops must be explored.

Advance Care Planning in Community: An Evaluation of a Pilot 2-Session, Nurse-Led Workshop

2018 ◽  
Vol 36 (2) ◽  
pp. 143-146 ◽  
Author(s):  
Michael W. Rabow ◽  
Marilyn McGowan ◽  
Rebecca Small ◽  
Redwing Keyssar ◽  
Hope S. Rugo
Keyword(s):  
Family Caregivers ◽  
Advance Care Planning ◽  
Group Discussion ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Care Group ◽  
Care Planning ◽  
Patients With Cancer ◽  
Semistructured Interviews ◽  
Advance Care

Background: Engaging patients in advance care planning (ACP) is challenging but crucial to improving the quality of end-of-life care. Group visits and multiple patient–clinician interactions may promote advance directive (AD) completion. Objective: Facilitate ACP discussions with patients and caregivers and the creation of notarized AD’s at a comprehensive cancer center. Design: Two-session, nurse-led ACP workshops for patients and their family caregivers. Setting/Participants: The workshop was offered to patients with cancer at a comprehensive cancer center and their family caregivers. Measurements: Validated 4-question ACP engagement survey, creation of a notarized AD by end of the workshop, and semistructured interviews. Results: Thirty-five patients participated in 10 workshops held March 2017 to February 2018. Median age was 52. Of 35, 24 (68.5%) patients completed pre- and postworkshop evaluation surveys. Mean preworkshop ACP readiness was 3.64 of 5; postworkshop readiness increased to 4.26 of 5 ( P = .001). Of 26, 17 (65.4%) of the patients who attended both workshop sessions had a new notarized AD scanned into the electronic medical record at the completion of the workshop series. Three family caregivers completed and had their own ADs notarized. Patient and family member response was overwhelmingly positive, with participants citing opportunities for group discussion and inclusion of family caregivers as important. Conclusions: The ACP workshop was well received by participants and increased ACP readiness, discussion, and completion. Attendance at the workshop was low and barriers to attending workshops must be explored.

The Medical Treatment Planning and Decisions Act 2016: what is the role for allied health professionals?

2020 ◽  
Vol 26 (5) ◽  
pp. 383
Author(s):  
Aidan Borthwick ◽  
Peter Higgs
Keyword(s):  
Primary Care ◽  
Medical Treatment ◽  
Advance Care Planning ◽  
Health Professionals ◽  
Allied Health ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Planning ◽  
Allied Health Professionals ◽  
Advance Care

Advance care planning is increasingly common practice in contemporary health care for individuals living with a chronic condition. Currently, limited research has been conducted into how newly adopted legislation in Victoria, Australia, facilitates advance care planning. The purpose of this study was to explore the uptake of the Medical Treatment Planning and Decisions Act 2016 in the primary care setting. The study also aimed to explore barriers that allied health professionals encounter when practicing advance care planning with patients. Four interdisciplinary focus groups and two in-depth interviews with participants were conducted and thematically analysed using an interpretivist inquiry paradigm. Analysis revealed two key themes: promoting client wellbeing and scope of practice. The data suggest that advance care planning by allied health professionals in the primary care setting is limited. Focussing on enhancing clients’ wellbeing was more important than the development of advanced care directives. Attempting to promote the wellbeing of patients may foster hesitation to commence advance care planning in primary care. This study demonstrated that knowledge of the fundamental legislative changes are evident among allied health professionals which provides a foundation for successful development of advance care planning post implementation of the new Act.

Advance Care Planning

2016 ◽  
Vol 34 (1) ◽  
pp. 26-33 ◽  
Author(s):  
Laurence Tan ◽  
Lai Kiow Sim ◽  
Lynnette Ng ◽  
Hui Jin Toh ◽  
James Alvin Low
Keyword(s):  
Quality Of Life ◽  
End Of Life ◽  
Advance Care Planning ◽  
Treatment Options ◽  
Group Discussion ◽  
Spiritual Needs ◽  
Care Planning ◽  
Spiritual Community ◽  
Advance Care

There has been a growing trend in addressing spiritual needs in caring for the person, especially nearing the end of one’s life. Advance care planning (ACP) facilitates understanding of preferences and explores the spiritual and existential aspects of care. This study explores the views and preferences of a group of Catholic nuns in Singapore, specifically looking at what was meaningful and valuable to them when determining treatment options at the end of life. Twenty-three nuns were purposively recruited in July 2012. A focus group discussion was conducted after administration of a questionnaire and attendance at a 1-hour talk on ACP. Slightly more than half had heard of ACP prior to the talk. The majority agreed that ACP was not against their religious beliefs” and that quality of life was important to them. The themes that emerged from this study were autonomy and freedom, spirituality and quality of life, and the meaning of ACP. The findings of this study suggested that spirituality and faith define the way the participants lived their lives, including their views and preferences on end-of-life care. Integrating spirituality into an essential domain of care will help the spiritual community honor a crucial part of end-of-life discussions and afford a greater discernment of the deep meaning that ACP holds.

Demenz aus palliativmedizinischer Perspektive: warum ein krankheitsspezifisches Advance Care Planning wichtig ist

2018 ◽  
Vol 75 (2) ◽  
pp. 105-111 ◽  
Author(s):  
Ralf J. Jox ◽  
Francesca Bosisio ◽  
Eve Rubli Truchard
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care ◽  
Menschen Mit Demenz

Zusammenfassung. Die Palliative Care muss sich im Zuge des demographischen Wandels vieler Gesellschaften rund um den Globus tiefgreifend wandeln. Sie muss mehr und mehr mit der Geriatrie zusammenarbeiten und geriatrische Expertise integrieren. Eine der zentralen Herausforderungen Geriatrischer Palliative Care ist die ethisch angemessene Therapieentscheidung für Menschen, die nicht mehr urteilsfähig sind. Nachdem der bisherige Ansatz herkömmlicher Patientenverfügungen erwiesenermassen enttäuscht hat, wird aktuell, gerade auch in deutschsprachigen Ländern, das systemische Konzept des Advance Care Planning (ACP) verfolgt. In diesem Artikel wird zunächst ACP mit seinen Zielen, Elementen und Effekten vorgestellt. Sodann wird gezeigt, weshalb es für Menschen mit Demenz eines adaptierten ACP-Programms bedarf und was ein solches demenzspezifisches ACP beinhalten muss.

Die Patientenverfügung «Plus» – das Konzept des Advance Care Planning (ACP)

Praxis ◽  
2017 ◽  
Vol 106 (25) ◽  
pp. 1369-1375 ◽  
Author(s):  
Barbara Loupatatzis ◽  
Tanja Krones
Keyword(s):  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

Zusammenfassung. Advance Care Planning ist ein begleiteter, strukturierter Prozess, der es Patienten und ihren Angehörigen ermöglicht, sich mit ihren Einstellungen zu Leben und Sterben sowie möglichen Behandlungen für den Fall einer Urteilsunfähigkeit mit Hilfe eines ausgebildeten Beraters auseinander zu setzen. Das Konzept kombiniert die individuelle Beratung des Patienten mit einem regionalen, systemischen Ansatz, der sicherstellt, dass alle Beteiligten die verwendeten Dokumente kennen und auch in einer Notfallsituation korrekt anwenden können. Ziel ist es, die Behandlung von urteilsunfähigen Patienten besser im Sinne ihrer Wünsche und Bedürfnisse zu koordinieren und dadurch die Patientenautonomie zu stärken.

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