Quality Measures for Symptoms and Advance Care Planning in Cancer: A Systematic Review

2006 ◽  
Vol 24 (30) ◽  
pp. 4933-4938 ◽  
Author(s):  
Karl A. Lorenz ◽  
Joanne Lynn ◽  
Sydney Dy ◽  
Anne Wilkinson ◽  
Richard A. Mularski ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Cancer Care ◽  
English Language ◽  
Basic Research ◽  
Quality Measures ◽  
Self Report ◽  
Care Planning ◽  
Cancer Management ◽  
Patient Goals ◽  
Advance Care

Purpose Measuring quality of care for symptom management and ascertaining patient goals offers an important step toward improving palliative cancer management. This study was designed to identify systematically the quality measures and the evidence to support their use in pain, dyspnea, depression, and advance care planning (ACP), and to identify research gaps. Methods English-language documents were selected from MEDLINE, Cumulative Index to Nursing and Allied Health, PsycINFO (1995 to 2005); Internet-based searches; and contact with measure developers. We used terms for each domain to select studies throughout the cancer care continuum. We included measures that expressed a normative relationship to quality, specified the target population, and specified the indicated care. Dual data review and abstraction was performed by palliative care researchers describing populations, testing, and attributes for each measure. Results A total of 4,599 of 5,182 titles were excluded at abstract review. Of 537 remaining articles, 19 contained measures for ACP, six contained measures for depression, five contained measures for dyspnea, and 20 contained measures for pain. We identified 10 relevant measure sets that included 36 fully specified or fielded measures and 14 additional measures (16 for pain, five for dyspnea, four for depression, and 25 for ACP). Most measures were unpublished, and few had been tested in a cancer population. We were unable to describe the specifications of all measures fully and did not search for measures for pain and depression that were not cancer specific. Conclusion Measures are available for assessing quality and guiding improvement in palliative cancer care. Existing measures are weighted toward ACP, and more nonpain symptom measures are needed. Additional testing is needed before the measures are used for accountability, and basic research is required to address measurement when self-report is impaired.

The Role and Activities of Board-Certified Chaplains in Advance Care Planning

2021 ◽  
pp. 104990912198999
Author(s):  
Jung Kwak ◽  
Soyeon Cho ◽  
George Handzo ◽  
Brian P. Hughes ◽  
Sami S. Hasan ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Self Report ◽  
Healthcare Team ◽  
Care Planning ◽  
Cross Sectional ◽  
Team Members ◽  
Roles And Responsibilities ◽  
Healthcare Settings ◽  
Academic Medical ◽  
Advance Care

Background: Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. Objectives: To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. Methods: A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains’ organizations in the U.S. The survey data included chaplains’ demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. Results: More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. Conclusion: Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

Quality Improvement Initiatives to Reduce Mortality: An Opportunity to Engage Palliative Care and Improve Advance Care Planning

2018 ◽  
Vol 36 (2) ◽  
pp. 97-104 ◽  
Author(s):  
Signe Peterson Flieger ◽  
Erica Spatz ◽  
Emily J. Cherlin ◽  
Leslie A. Curry
Keyword(s):  
Palliative Care ◽  
Quality Improvement ◽  
End Of Life ◽  
Advance Care Planning ◽  
Secondary Analysis ◽  
Care Quality ◽  
Care Planning ◽  
Goals Of Care ◽  
Patient Goals ◽  
Advance Care

Background: Despite substantial efforts to integrate palliative care and improve advance care planning, both are underutilized. Quality improvement initiatives focused on reducing mortality may offer an opportunity for facilitating engagement with palliative care and advance care planning. Objective: In the context of an initiative to reduce acute myocardial infarction (AMI) mortality, we examined challenges and opportunities for engaging palliative care and improving advance care planning. Methods: We performed a secondary analysis of qualitative data collected through the Leadership Saves Lives initiative between 2014 and 2016. Data included in-depth interviews with hospital executives, clinicians, administrators, and quality improvement staff (n = 28) from 5 hospitals participating in the Mayo Clinic Care Network. Focused analysis examined emergent themes related to end-of-life experiences, including palliative care and advance care planning. Results: Participants described challenges related to palliative care and advance care planning in the AMI context, including intervention decisions during an acute event, delivering care aligned with patient and family preferences, and the culture around palliative care and hospice. Participants proposed strategies for addressing such challenges in the context of improving AMI quality outcomes. Conclusions: Clinicians who participated in an initiative to reduce AMI mortality highlighted the challenges associated with decision-making regarding interventions, systems for documenting patient goals of care, and broader engagement with palliative care. Quality improvement initiatives focused on mortality may offer a meaningful and feasible opportunity for engaging palliative care. Primary palliative care training is needed to improve discussions about patient and family goals of care near the end of life.

scholarly journals Association Between Region of Birth and Advance Care Planning Documentation Among Older Australian Migrant Communities: A Multicenter Audit Study

2020 ◽  
Vol 76 (1) ◽  
pp. 109-120
Author(s):  
Craig Sinclair ◽  
Marcus Sellars ◽  
Kimberly Buck ◽  
Karen M Detering ◽  
Ben P White ◽  
...  
Keyword(s):  
Health Professional ◽  
Language Proficiency ◽  
Family Involvement ◽  
Advance Care Planning ◽  
English Language ◽  
Care Facility ◽  
Care Planning ◽  
Cross Sectional ◽  
Term Care ◽  
Advance Care

Abstract Objectives This study explored associations between birth region, sociodemographic predictors, and advance care planning (ACP) uptake. Methods A prospective, multicenter, cross-sectional audit study of 100 sites across 8 Australian jurisdictions. ACP documentation was audited in the health records of people aged 65 years or older accessing general practice (GP), hospital, and long-term care facility (LTCF) settings. Advance care directives (ACDs) completed by the person (“person completed ACDs”) and ACP documents completed by a health professional or other person (“health professional or someone else ACP”) were counted. Hierarchical multilevel logistic regression assessed associations with birth region. Results From 4,187 audited records, 30.0% (1,152/3,839) were born outside Australia. “Person completed ACDs” were less common among those born outside Australia (21.9% vs 28.9%, X2 (1, N = 3,840) = 20.3, p < .001), while “health professional or someone else ACP” was more common among those born outside Australia (46.4% vs 34.8%, X2 (1, N = 3,840) = 45.5, p < .001). Strongest associations were found for those born in Southern Europe: “person completed ACD” (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.36–0.88), and “health professional or someone else ACP” (OR = 1.41, 95% CI = 1.01–1.98). English-language proficiency and increased age significantly predicted both ACP outcomes. Discussion Region of birth is associated with the rate and type of ACP uptake for some older Australians. Approaches to ACP should facilitate access to interpreters and be sensitive to diverse preferences for individual and family involvement in ACP.

Integrative Palliative Care

2018 ◽  
Author(s):  
Angela Lee ◽  
Stephanie Cheng ◽  
Dale Lupu
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
End Of Life ◽  
Integrative Medicine ◽  
Advance Care Planning ◽  
Palliative Medicine ◽  
Geriatric Patients ◽  
Care Planning ◽  
Patient Goals ◽  
Advance Care

Integrative medicine and palliative medicine share many tenets. This chapter reviews integrative approaches to the most common symptoms needing palliation among geriatric patients at the end of life, including pain, nausea and vomiting, constipation, dyspnea, and fatigue. Several palliative care approaches to communication about patient goals and advance care planning for a time when the patient is unable to make decisions are described. Resources to support advance care planning are provided. Finally, issues that need to be addressed by either primary care geriatrics or in consultation with palliative care in the last weeks, days, and hours of life are described.

Advance-care planning quality improvement plan: A Cancer Care Ontario toolkit to support primary care teams to implement advance care plans in practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 76-76
Author(s):  
Jeff Myers ◽  
Suzanne Strasberg ◽  
Kathi Carroll ◽  
Zabin Dhanji ◽  
Ingrid Harle ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Advance Care Planning ◽  
Cancer Care ◽  
Care Planning ◽  
Advance Care ◽  
Care Practices ◽  
Primary Care Practices ◽  
Eol Care

76 Background: In Ontario, the Ministry of Health and Long Term Care’s (MOHLTC) uses Quality Improvement Plans (QIPs) to drive system improvement aimed at providing high value, high quality care for all. To support the introduction of QIPs into the primary care sector, Cancer Care Ontario has developed an Advance Care Planning (ACP) toolkit for practices that include ACP as part of their annual QIP. ACP is an ongoing and dynamic process that involves a capable individual reflecting on their current values and beliefs for their health care, communicating their personal wishes for future health care and identifying an individual who will make decisions on their behalf in the event that they are unable to provide informed consent. The process is iterative and wishes may change over time with changes in health status. Methods: The ACP QIP was developed based on the Plan, Do, Study, Act cycle of continuous quality improvement. The ACP QIP provides primary care practices with detailed instructions on how to implement, monitor and report on an ACP Quality Improvement initiative. Importantly, the ACP QIP provides guidance and practical tools for developing objectives, establishing targets, and identifying measures and baselines for performance. CCO is actively promoting the ACP QIP in an effort to encourage uptake and broad adoption across Ontario. Results: There is now evidence that with ACP there is a greater likelihood EOL wishes will be both known and followed resulting in improved EOL care. ACP is also associated with decreased distress among the family members. Conclusions: Creating an ACP QIP supports primary care’s focus on advancing quality patient care. Importantly, implementing the ACP QIP into primary care practices has the potential to improve EOL care and secondarily reduce health care costs ultimately working towards achieving the triple aim of “better care, better health, and lower costs”.

The acceptability to African-Americans of a structured conversation guide to improve advance care planning in the setting of cancer: A focus-group study.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 11-11 ◽  
Author(s):  
Justin J Sanders ◽  
Katherine W. Sterba ◽  
Dee Ford ◽  
Susan Block
Keyword(s):  
African Americans ◽  
Advance Care Planning ◽  
Community Outreach ◽  
Care Planning ◽  
Focus Group Study ◽  
Serious Illness ◽  
Patient Goals ◽  
Advance Care ◽  
The Individual ◽  
The Impact

11 Background: African-Americans are less likely than whites to participate in advance care planning (ACP), which may contribute to disparities in the receipt of goal-concordant care. Literature points to multiple factors: the impact of religion, mistrust, different preferences for life-sustaining measures, family-decision making styles and poor knowledge about ACP. Early ACP conversations are associated with improved outcomes at the end of life, including goal-concordant care. A systematically-developed, serious illness conversation guide (“guide”) for oncologists, embedded in a systems-based approach to improving illness care, has demonstrated more frequent, higher-quality, and earlier ACP conversations in a predominantly white and middle class cohort of cancer patients. This study aimed to explore the acceptability and need for modification of the guide in more diverse populations. Methods: We conducted a series of focus groups with panels of clinicians and researchers, African-American church members, and seriously ill patients and their caregivers to assess barriers to ACP and preferences concerning modifications to the guide. We used template analysis to code themes at the individual, interpersonal and systems levels. Results: At the individual level, participants confirmed the importance of religion and the impact of perceived discrimination (e.g., receipt of inferior care) and superstition (e.g., talking about death may make it happen). Interpersonal-level factors influencing ACP included family, trust, and concerns about provider abandonment. Participants confirmed systems-level barriers of access and mistrust in the healthcare system and highlighted community outreach as a key part of the process. Participants reported positive responses to the tone and content of the guide and found the guide to be acceptable when it included a question that elicited coping mechanisms, including religion. Conclusions: Participants in our study found the use of a serious illness conversation guide to identify patient goals and priorities acceptable, and emphasized the importance of adding a question focused on coping and religion.

scholarly journals A07-B Goals of Care and Advance Care Planning Initiative in the Cancer Care Setting

2016 ◽  
Vol 52 (6) ◽  
pp. e9
Author(s):  
Louise Hanvey ◽  
Savanah Ashton ◽  
Ruth Barker ◽  
Mireille Lecours ◽  
Tara Carpenter-Kellett ◽  
...  
Keyword(s):  
Advance Care Planning ◽  
Cancer Care ◽  
Care Setting ◽  
Care Planning ◽  
Goals Of Care ◽  
Advance Care

scholarly journals Practice and Perceived Importance of Advance Care Planning and Difficulties in Providing Palliative Care in Geriatric Health Service Facilities in Japan: A Nationwide Survey

2017 ◽  
Vol 35 (3) ◽  
pp. 464-472 ◽  
Author(s):  
Shoji Yokoya ◽  
Yoshiyuki Kizawa ◽  
Takami Maeno
Keyword(s):  
Palliative Care ◽  
Health Service ◽  
Advance Care Planning ◽  
Nationwide Survey ◽  
Self Report ◽  
Care Planning ◽  
Care Education ◽  
Perceived Importance ◽  
Advance Care ◽  
Eol Care

Background: The provision of end-of-life (EOL) care by geriatric health service facilities (GHSFs) in Japan is increasing. Advance care planning (ACP) is one of the most important issues to provide quality EOL care. This study aimed to clarify the practice and perceived importance of ACP and the difficulties in providing palliative care in GHSFs. Methods: A self-report questionnaire was mailed to head nurses at 3437 GHSFs nationwide. We asked participants about their practices regarding ACP, their recognition of its importance, and their difficulties in providing palliative care. We also analyzed the relationship between these factors and EOL care education. Results: Among 844 respondents (24.5% response rate), approximately 69% to 81% of head nurses confirmed that GHSF residents and their families understood disease conditions and goals of care. There was a large discrepancy between the actual practice of ACP components and the recognition of their importance (eg, asking residents about existing advance directive [AD; 27.5% practiced it, while 79.6% considered it important]; recommending completion of an AD [18.1% vs 68.4%], and asking for designation of a health-care proxy [30.4% vs 76.8%]). The EOL care education was provided at 517 facilities (61.3%). Head nurses working at EOL care education–providing GHSFs practiced ACP significantly more frequently and had significantly fewer difficulties in providing palliative care. Conclusion: A large discrepancy was found between GHSF nurses’ practice of ACP and their recognition of its importance. Providing EOL care education in GHSFs may increase ACP practices and enhance respect for resident’s preferences concerning EOL care.

Evidence-Based Recommendations for Information and Care Planning in Cancer Care

2008 ◽  
Vol 26 (23) ◽  
pp. 3896-3902 ◽  
Author(s):  
Anne Walling ◽  
Karl A. Lorenz ◽  
Sydney M. Dy ◽  
Arash Naeim ◽  
Homayoon Sanati ◽  
...  
Keyword(s):  
Cancer Care ◽  
Evidence Based ◽  
Care Planning ◽  
Clinical Practices ◽  
High Quality ◽  
Quality Cancer Care ◽  
Patient Goals ◽  
Sentinel Events ◽  
Advance Care ◽  
Physician Patient

The practice of oncology is characterized by challenging communication tasks that make it difficult to ensure optimal physician-patient information sharing and care planning. Discussions of diagnosis, prognosis, and patient goals are essential processes that inform decisions. However, data suggest that there are deficiencies in this area. We conducted a systematic review to identify the evidence supporting high-quality clinical practices for information and care planning in the context of cancer care as part of the RAND Cancer Quality–Assessing Symptoms, Side Effects, and Indicators of Supportive Treatment Project. Domains of information and care planning that are important for high-quality cancer care include integration of palliation into cancer care, advance care planning, sentinel events as markers for the need to readdress a patient's goals of care, and continuity of care planning. The standards presented here for information and care planning in cancer care should be incorporated into care pathways and should become the expectation rather than the exception.

Disrupting end-of-life cancer care delivery: Results from the engagment of patients with advanced cancer trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6525-6525
Author(s):  
Manali I. Patel ◽  
Vandana Sundaram ◽  
Manisha Desai ◽  
VJ Periyakoil ◽  
James Kahn ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Healthcare Utilization ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Cancer Care ◽  
Care Planning ◽  
Patient Reported ◽  
Advance Care

6525 Background: Sustainable approaches to improve quality and safety of care of patients with advanced cancer while concurrently reducing costs is a growing national need. As part of the Veterans Administration Engagement of Patients with Advanced Cancer (EPAC) trial, we trained a lay health worker (LHW) to engage patients with stage 3 and 4 cancer in early advance care planning (ACP). The goal of this follow-up study was to examine the effect of the LHW intervention on patient-reported care experiences, healthcare utilization, and costs in the last 30 days of life for patients who died within 15 months of enrollment. Methods: We evaluated patient-reported experiences with decision-making, healthcare utilization, and total healthcare costs 30 days prior to death. A T-test was used to compare patient experiences with decision-making. To compare ED use and hospitalizations, we utilized an exact Poisson regression. A generalized linear model with gamma link-log function was used to compare total costs. The latter methods adjusted for length of follow-up. Results: In the 30 days prior to death, 60 patients died in each arm within 15 months of enrollment (difference not statistically significant). Patients in the intervention had significantly improved rates of ACP documentation (98% versus 18% p < 0.001), improved experiences with decision-making as measured by an index ranging from 0-5 with higher values representing more favorable experience (4.73 (SD 0.61) vs 4.15 (SD 1.02)) p < 0.001), higher utilization of hospice (77% vs 52%, p < 0.005), lower rates of any emergency department use (5% versus 45% p < 0.001) and any hospitalization (5% versus 43% p < 0.001), and significantly lower total costs of care ($1,048 versus $23,482 p < 0.001) compared to the patients randomized to the usual care arm. Conclusions: Integrating a LHW into oncology care to engage patients in early advance care planning resulted in significantly improved patient experience, decreased utilization and decreased total costs in the last month of life. LHWs may represent a sustainable resource to facilitate optimal patient-centered cancer care at the end-of-life. Clinical trial information: NCT02966509.

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