scholarly journals Reflections on a Real‐Time Advance Care Planning Discussion During Our First Virtual Teaching Rounds in Post‐Acute Care

2020 ◽  
Author(s):  
Hunter Carlock ◽  
Ryan Meyer ◽  
Stacy Young ◽  
Leonardo Villarroel ◽  
Sanya Diaz ◽  
...  
Keyword(s):  
Real Time ◽  
Acute Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care ◽  
Virtual Teaching ◽  
Teaching Rounds ◽  
Post Acute Care

Advance care planning in an Asian country

2018 ◽  
Author(s):  
Irwin Clement ◽  
Alphonsus Wai ◽  
Hoong Chung
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
Acute Care ◽  
Advance Care Planning ◽  
Social Care ◽  
Asian Country ◽  
Care Planning ◽  
Care Continuum ◽  
Health And Social Care ◽  
Advance Care

Advance care planning (ACP) was introduced to Singapore in the late 2000s in the form of local projects that encouraged conversations on end-of-life concerns, beginning first with residents in several nursing homes. High patient receptivity to the concept of planning ahead for care and death was encouraging, which prompted Ministry of Health to approve an S$18.1m effort to develop and promote ACP nationally in 2011. Since then, the practice of ACP has gradually spread throughout the country’s public acute care hospitals, most community hospitals, and all nursing homes, as well as a handful of eldercare providers, with close to 5,000 plans lodged electronically, 2,000 ACP conversation facilitators trained across the health and social care continuum and more than 1,000 community ACP advocates activated.

scholarly journals Documenting plans for care: advance care directives and the 7-step pathway in the acute care context

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Gregory Brian Crawford ◽  
Katherine Hodgetts ◽  
Teresa Burgess ◽  
Jaklin Eliott
Keyword(s):  
End Of Life ◽  
Acute Care ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Hospital Setting ◽  
South Australia ◽  
Care Plan ◽  
Care Planning ◽  
Life Care ◽  
Advance Care

Abstract Background Advance care planning involves the discussion and documentation of an individual’s values and preferences to guide their future healthcare should they lose capacity to make or communicate treatment decisions. Advance care planning can involve the individual’s completion of an Advance Care Directive (ACD), a legislated and common-law instrument which may include appointment of a substitute decision-maker and binding refusals of treatment. In South Australia, ACDs intersect in the acute-care context with the Resuscitation Plan 7-Step Pathway (7-SP), an integrated care plan written for and by clinicians, designed to organise and improve patients’ end-of-life care through the use of structured documentation. Here, we examine the perspectives of healthcare professionals (HCPs) within a hospital setting on the practical integration of ACDs and the 7-SP, exploring the perceived role, function, and value of each as they intersect to guide end-of-life care in an Australian hospital setting. Methods Qualitative data were collected via eight focus groups with a total of 74 HCPs (acute care, and oncology specialists; medical intern; general and emergency nurses; social workers) across two hospitals. Audio recordings were transcribed and thematically analysed. Results HCPs viewed ACDs as a potentially valuable means of promoting patient autonomy, but as rarely completed and poorly integrated into hospital systems. Conversely, the process and documentation of the 7-SP was perceived as providing clarity about clinicians’ responsibilities, and as a well-understood, integrated resource. Participants sometimes exhibited uncertainty around which document takes precedence if both were present. Sometimes, the routinisation of the 7-SP meant it was understood as the ‘only way’ to determine patient wishes and provide optimal end-of-life care. When this occurs, the perceived authority of ACDs, or of patients’ choice not to participate in end-of-life discussions, may be undermined. Conclusions The intersection of ACDs and the 7-SP appears problematic within acute care. Clinicians’ uncertainty as to whether an ACD or 7-SP takes precedence, and when it should do so, suggests a need for further clarity and training on the roles of these documents in guiding clinical practice, the legislative context within which specific documentation is embedded, and the dynamics associated with collaborative decision-making in end-of-life care.

scholarly journals When do Physicians and Nurses Start Communication about Advance Care Planning? A Qualitative Study at an Acute Care Hospital in Japan

2020 ◽  
Vol 12 (3) ◽  
pp. 289-305 ◽  
Author(s):  
Mari Tsuruwaka ◽  
Yoshiko Ikeguchi ◽  
Megumi Nakamura
Keyword(s):  
Qualitative Study ◽  
Acute Care ◽  
Advance Care Planning ◽  
Healthcare Professionals ◽  
Medical Condition ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Care Planning ◽  
Care Hospital ◽  
Advance Care

Abstract Although advance care planning (ACP) can lead to more patient-centered care, the communication around it can be challenging in acute care hospitals, where saving a life or shortening hospitalization is important priorities. Our qualitative study in an acute care hospital in Japan revealed when specifically physicians and nurses start communication to facilitate ACP. Seven physicians and 19 nurses responded to an interview request, explaining when ACP communication was initiated with 32 patients aged 65 or older. Our qualitative approach employed descriptive analysis to identify major themes, which included “initiation by patients” and “initiation by healthcare professionals.” In the latter case, seven specific triggers were identified: (1) when the patients’ medical condition changed in terms of symptom relief, (2) when the patients’ medical condition changed in terms of prognostic prediction, (3) when serious events occurred, (4) when a choice of treatment was presented, (5) when the location for end-of-life care was chosen, (6) when the patients’ cognitive function deteriorated, and (7) when serious events settled down. Within this group of healthcare professionals, physicians were more focused on changes in their patients’ medical condition, whereas nurses focused more on their patients’ desire for a long-term perspective. Nurses encouraged patients to consider ACP themselves, which developed into an approach to respect patients’ autonomy. In acute care hospitals, it appeared to be desirable to have an early discussion where patients could understand the significance ACP, which would matter even after their discharge from the hospital.

Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting

2020 ◽  
Vol 23 (1) ◽  
pp. 59-68
Author(s):  
Monica Fliedner ◽  
Ruud J. G. Halfens ◽  
Cynthia R. King ◽  
Steffen Eychmueller ◽  
Christa Lohrmann ◽  
...  
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Advance Care Planning ◽  
Care Setting ◽  
Care Planning ◽  
Acute Care Setting ◽  
Roles And Responsibilities ◽  
Advance Care

Advance Care Planning in Chronically Ill Patients With an Episodic Disease Trajectory in the Acute Care Setting: A Quality Improvement Project

2021 ◽  
pp. 104990912110367
Author(s):  
Molly T. Williams ◽  
Mohana Karlekar ◽  
Anne Coogan ◽  
Megan Shifrin ◽  
Judy Ascenzi
Keyword(s):  
Quality Improvement ◽  
Acute Care ◽  
Advance Care Planning ◽  
Care Setting ◽  
Comparison Group ◽  
Chronically Ill ◽  
Care Planning ◽  
Acute Care Setting ◽  
Disease Trajectory ◽  
Advance Care

Introduction: Advance care planning (ACP) is a fluid discussion between patients and providers to define preferences for future medical care. In the acute care setting, ACP is limited due to lack of structured process for identifying persons who may benefit from ACP. This quality improvement (QI) project aimed to increase the frequency of ACP discussions and documentation of preferences by targeting geriatric patients with an episodic disease trajectory for ACP. Methods: This project used an intervention and comparison group design to target English-speaking, geriatric adults at a large academic medical center with a diagnosis of NYHA class III/IV HF and/or GOLD criteria III/IV COPD for ACP discussions. The intervention group was compared to a group with a range of diagnoses who were approached in a non-systematic way. Results: Thirteen (n = 13) participants completed all aspects of the QI project. Results showed a non-significant increase in the number of patients with a diagnosis of HF and/or COPD who participated in an ACP discussion when compared to the comparison group (n = 20, p = 0.131), as well as a non-significant increase in the number of ACP tools documented in the HER (53.8% compared to 30%) (x = 1.877, p = 0.171). Conclusion: While this project demonstrated non-significant statistical results in the incidence and documentation of an ACP tool, this project increased the number of ACP discussions had, which is clinically significant.

Patient and nurse perspectives on advance care planning in acute care

2019 ◽  
Vol 50 ◽  
pp. 151203
Author(s):  
Priscilla K. Gazarian ◽  
Julie Cronin ◽  
Kayla M. Baker ◽  
Barbara J. Friel
Keyword(s):  
Acute Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

Advance Care Planning Needs in Idiopathic Pulmonary Fibrosis: A Qualitative Study

2021 ◽  
pp. 104990912110417
Author(s):  
Meena Kalluri ◽  
Sara Orenstein ◽  
Nathan Archibald ◽  
Charlotte Pooler
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Home Care ◽  
Acute Care ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Care Planning ◽  
Advance Care

Introduction: Advance care planning is recommended in chronic respiratory diseases, including Idiopathic Pulmonary Fibrosis. In practice, uptake remains low due to patient, physician and system-related factors, including lack of time, training and guidance on timing, components and content of conversations. Our aim was to explore perspectives, experiences and needs to inform a framework. Methods: We conducted a qualitative study in western Canada, using semi-structured interviews and inductive analysis. Patient, caregiver and health care professional participants described advance care planning experiences with Idiopathic Pulmonary Fibrosis. Results: Twenty participants were interviewed individually: 5 patients, 5 caregivers, 5 home care and 5 acute care health care professionals. Two categories, perceptions and recommendations, were identified with themes and subthemes. Participant perceptions were insufficient information and conversations occur late. Recommendations were: have earlier conversations; have open conversations; provide detailed information; and plan for end-of-life. Patients and caregivers wanted honesty, openness and clarity. Professionals related delayed timing to poor end-of-life care and distressing deaths. Home care professionals described comfort with and an engaged approach to advance care planning. Acute care professionals perceived lack of clarity of roles and described personal, patient and caregiver distress. Interpretation: Analysis of diverse experiences provided further understanding of advance care planning in Idiopathic Pulmonary Fibrosis. Advance care planning is desired by patients and caregivers early in their illness experience. Health care professionals described a need to clarify role, scope and responsibility. Practical guidance and training must be available to care providers to improve competency and confidence in these conversations.

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.

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