Advance Health Care Planning Research Articles

EMPOWERING END-OF-LIFE CONVERSATIONS: The Role of Specialized Nursing Teams in Facilitating Code Status Changes at Discharge.

Objectives: Hospitalized patients may require goals of care (GOC) or Advance Health Care Planning (ACP), which can be time-consuming and emotionally tolling for providers. A nursing team specializing in code status (CODE), GOC, and ACP was developed to provide meaningful support for patients and families and decrease provider burden. Interest in CODE, GOC, ACP, and effectiveness of a nursing team to lead these conversations prompted this study. Methods: A collaborative nursing team was trained to address CODE, GOC, and ACP with patients demonstrating illness or geriatric syndrome. This team conducted 3 visits per patient on average during hospitalization using structured CODE templates to establish longer term goals and document what matters in the healthcare journey. Comprehensive narratives for ACP and GOC were included in charting, syncing the medical team, nursing, patient, and family. Consults were tracked over nine months with data reviewed retrospectively from medical charts. Descriptive analyses of cohort demographics, CODE and outcomes were completed. Results: The study group comprised 3342 patients between October 2022 and June 2023. Patients ranged in age from 18-106 years, with majority (88%) age 65 years and older. Mean length of stay (LOS) was 6.8 days with CODE documented for 91% upon admission. Of the 3166 older adults with known CODE on admission, 946 (30%) changed CODE by discharge, of which 95% were de-escalated. 83% of older patients arriving with limited CODE maintained limitations at discharge, with a small portion converting to comfort (16%). Conclusion: Employing a focused nursing team to conduct CODE, GOC, and ACP conversations may be an effective use of time and resources and result in de-escalation of resuscitation orders for patients demonstrating illness or geriatric syndrome.

Improving Advance Healthcare Planning Documentation in Nursing Home Medical Records

Improving Advance Healthcare Planning Documentation in Nursing Home Medical Records

The Factors associated with death in hospitalized patients with severe acute respiratory syndrome by Covid-19: a retrospective longitudinal study in a city in southeastern Brazil

The COVID-19 pandemic represents a challenge for health systems. Considering the importance of determining possible risk groups, this study aimed to describe the epidemiological profile and to evaluate the factors associated with death in hospitalized patients with Severe Acute Respiratory Syndrome caused by SARS-Cov-2 (COVID-19), in Contagem, Minas Gerais, during the year of 2020. A bivariate logistic regression was performed for each explanatory variable, followed by step-by-step backward selection. Only adjusted variables showing a significant association remained in the final model. This study demonstrates that the chances of death in hospitalized patients were higher in men; people aged 60 years or older; that presented respiratory distress as a symptom; that were obese or immunocompromised; that had cardiac, hepatic, renal, pulmonary or neurologic chronic diseases; and that required intensive care unit admission or invasive respiratory support. We conclude that COVID-19 represents an enormous challenge for health systems, demanding the need for specialized hospital services. Therefore, knowing the risk profile is a necessary tool to optimize treatment and to prevent worse outcomes. KEY WORDS: Severe acute respiratory syndrome; coronavirus infection; advance health care planning; health correlates; risk factor; covid-19.

Engagement in steps of advance health care planning by homeless veterans.

Communicating health care preferences in advance, so that wishes can be honored if the person becomes unable to participate in decision-making, is especially important for vulnerable populations such as homeless veterans. Hospitals are required to inform patients of their rights to document their preferences, but completion rates for advance directives are low. Conceptualizing advance health care planning as a series of health behavior steps emphasizing communication is recommended for improving engagement in advance health care planning. The authors used program evaluation data from psychoeducational groups with 288 homeless veterans to learn about their previous experience with different steps of advance health care planning and their personal goals for future steps. Results revealed a significant discrepancy between what these veterans reported they have done and information available to health care providers in the medical record: Only 26% had an advance directive in the medical record, but 70% reported they had thought about the care they would want, and almost half reported they had talked with a trusted other or named someone to make decisions for them. The most frequent goal endorsed by veterans attending groups was discussing advance health care planning with family or trusted others and/or naming someone to be a decision maker. These findings indicate a need for improved communication and documentation of veteran preferences about emergency and end of life care. Results are also consistent with interventions tailored to varying readiness for different steps of advance health care planning. (PsycINFO Database Record

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement

ContextThe Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. ObjectivesTo better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. MethodsExamination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. ResultsOf veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. ConclusionsOur clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers.

Legal Aspects of Oncology Care for Dying Patients

Patients with cancer who are approaching the end of their lives, as well as the patients’ families and professional caregivers, often confront difficult decisions regarding the initiation, continuation, withholding, or withdrawal of various forms of medical care. Those clinical choices must be made and implemented within the prevailing legal environment. The legal environment in the United States surrounding and shaping medical decision making and care for dying cancer patients is explored in this chapter. Specific topics addressed include distinguishing living patients from dead bodies, informed consent and refusal, informational confidentiality in medical care, advance health care planning, medical decision making in the absence of advance planning, standards of care and medical malpractice liability, limits on the rights of patients and families, and postmortem rights and responsibilities.

Documentation of Advance Healthcare Planning in the Electronic Health Records of Elderly Out-Patients with Dementia or Cognitive Impairment (P7.340)

Documentation of Advance Healthcare Planning in the Electronic Health Records of Elderly Out-Patients with Dementia or Cognitive Impairment (P7.340)

Systematic Review of Research Literature on African Americans’ End-of-Life Healthcare Preferences

The goals of this systematic review are to summarize what research has revealed about patterns of African Americans’ preferences for of end-of-life (EOL) healthcare services and to uncover as possible explanations for differences compared to those of White, non-Hispanic individuals. The first portion of this article summarizes the patterns uncovered over the past 10 years of research about EOL healthcare preferences associated with African Americans’ culture. The focus will then turn to research findings regarding possible explanations for the patterns of hospice usage, written evidence of advance healthcare planning, and preferences for so-called life-saving therapies (LSTs). Four factors emerged most often in both the qualitative and quantitative research as strongly associated with preferences and decisions made regarding EOL healthcare: trust of the healthcare providers, religion/religiosity/spirituality, social organization and dynamics, and education/healthcare literacy. Throughout the article, attention will be drawn to implications for the science of caring and nursing practice.

Handbook for health care ethics committees

Preface Acknowledgments I. Curriculum for Ethics Committees 1. Ethical Foundations of Clinical Practice The Role of Ethics in Clinical Medicine Ethics Committees in the Health Care Setting Fundamental Ethical Principles Principlism and Alternative Approaches The Role of Culture, Race, and Ethnicity in Health Care Conflicting Obligations and Ethical Dilemmas 2. Decision Making and Decisional Capacity in Adults Health Care Decisions and Decision Making Decision-Making Capacity Assessment and Determination of Capacity Deciding for Patients without Capacity 3. Informed Consent and Refusal Evolution of the Doctrine of Informed Consent Elements of Informed Consent and Refusal The Nature of Informed Consent Exceptions to the Consent Requirement 4. Truth Telling Justifications Disclosure Disclosure of Adverse Outcomes and Medical Error Privacy and Confidentiality Genomic Testing and Control of Information 5. Special Decision-Making Concerns of Minors Decisional Capacity and Minors Consent for and by Minors Confidentiality and Disclosure Special Problems of Functionally Alone Adolescents 6. Ethical Issues in Reproduction The Ethics and Politics of Reproductive Choice Assisted Reproductive Technologies Surrogacy and Gestational Carriers Termination of Pregnancy Maternal-Fetal Issues Prenatal/Newborn Genetic Testing and Genomic Newborn Screening Special Decision-Making Concerns of the Elderly The Other Side of the Mountain Diminishing Autonomy and Decisional Capacity Promise that you won't ever put me in a nursing home Independence, Dependence, and Role Reversals Prior Wishes and Current Needs Intimacy and Security Transition from Hospital to Home or Nursing Home 8. Ethical Issues in the Care of Disabled Persons Disability and Its Place in Bioethics Defining Disability The Medical and Social Models of Disability The Disability Rights Critique of Prenatal Genetic Testing Special Challenges in the Care of Persons with Severe Cognitive Impairment Medical Decision Making and the Disabled 9. End-of-Life Issues Decision Making at the End of Life Defining Death Organ Donation Advance Health Care Planning Honoring Patients' End-of-Life Decisions Goals of Care at the End of Life Forgoing Life-Sustaining Treatment Protecting Patients from Treatment Rejection of Recommended Treatment and Requests to Do Everything Medical Futility 10. Palliation From Caring to Curing and Back Again The Experience of and Response to Pain The Moral Imperative to Relieve Pain Assisted and Permitted Dying Pediatric Palliative Care Palliative Care and Hospice Palliative Care 11. Justice, Health, and Access to Health Care Access to Health Care in the United States Justice and Health Disparities Health Care as a Requirement of Justice Health Care and Health Theories of Justice Rationing Health Care Reform 12. Organizational Ethics From Bioethics to Health Care Organizational Ethics Moral Responsibilities of Health Care Organizations Organizational Ethics and Compliance Ethics and the Allocation of Resources Ethics Committees and Organizational Issues Developing an Organizational Ethics Service II. The Creation, Nature, and Functioning of Ethics Committees 13. Profile of Ethics Committees Origins Committee Functions Membership Expertise in Ethics Leadership Securing a Foothold Clinical Ethics Consultation Overview of Ethics Consultation Three Models of Clinical Ethics Consultation Services Building an Ethics Consultation Service Credentialing and Privileging Clinical Ethics Consultants Analytic Approaches to Clinical Ethics Consultation Selecting the Best Clinical Ethics Consultation Service Model for Your Institution Access to Clinical Ethics Consultation Policies 15. Ethics Education Brown Bag Lunches Journal Clubs Case Conferences Ethics Grand Rounds Ethics Modules in Residency Training and Medical School Programs Ethics Symposia White Papers, Memoranda, Guidelines, and Protocols Additional Education Opportunities 16. Sample Clinical Cases Adolescent Decision Making Advance Directives Autonomy in Tension with Best Interest Confidentiality Decisional Capacity Disclosure and Truth Telling End-of-Life Care Forgoing Life-Sustaining Treatment Goals of Care Informed Consent and Refusal Medical Futility Parental Decision Making Surrogate Decision Making 17. Sample Policies and Procedures III. Organizational Codes of Ethics Regional Medical Center Code of Conduct Metropolitan Medical Center Code of Ethics University Health Network Code of Ethics IV. Key Legal Cases Informed Consent Privacy Confidentiality Health Care Decision Making Medical Decision Making for Minors Reproductive Rights State Action to Protect Public Health State Action to Control What Practitioners Must or Must Not Discuss with Their Patients Health Care Reimbursement V. An Ethics Committee Meeting Index

Attitudes of Long-Term Care Social Workers Toward Physician-Assisted-Suicide

Abstract Previous studies about attitudes toward physician-assisted-suicide focused little on attitudes of social workers despite their prominent role in work with the dying. This study, conducted in 2001, through a mail survey to long-term care social workers, examined attitudes toward physician-assisted-suicide (PAS) and the factors that impact on their attitudes. It also examined their knowledge and involvement in the PAS debate, and their involvement with end-of-life issues. The sample included 312 social workers, employed in not-for-profit long-term care facilities across New York State. The findings suggest that social workers are experienced with end-of-life issues and assume a leading role in the area of advance healthcare planning in their facilities. The findings also suggest that social workers in long-term care have diverse attitudes toward PAS, with the majority tending to agree with PAS under certain circumstances. Respondents to this survey do not feel educationally prepared for the issues ...

Living wills and the Mental Capacity Act: a postal questionnaire survey of UK geriatricians

To determine geriatricians' experience of and views on living wills, National Health Service Trusts' support of advance end-of-life health care planning and geriatricians' views on related legal changes in the Mental Capacity Act. Anonymous postal questionnaire survey of all 1,426 British Geriatrics Society members in England, Wales and Northern Ireland. A total of 842 (59%) questionnaires were returned. Of 811 geriatricians, 454 (56%) had cared for patients with living wills. Of the 280 who cared for patients when the living will had come into effect, 108 (39%) had changed treatment because of the living will and 84 (78%) of those felt that decisions had been easier to make. Living wills not already in effect made discussions with patients [171 of 178 (96%)] and families [135 of 178 (76%)] easier. Of 779 geriatricians, 713 (92%) saw advantages of older people using living wills; 467 of these also expressed concerns. Only 16 (2%) geriatricians who had concerns said that there were no advantages. A total of 214 (27%) were aware that their Trust had a form to help with discussions about cardiopulmonary resuscitation. Fewer [126 of 781 (16%)] were aware of a Trust policy on living wills. The proposal, in the Mental Capacity Bill, for advance refusals of treatment was supported by 59% (476 of 801), yet the proposal for a lasting power of attorney (LPA) covering health care was only supported by 47% (382 of 806). Many geriatricians have positive experiences of caring for patients with living wills. Despite recognising potential problems, most geriatricians support the use of living wills by older people. However, most believe that their Trust does not have a policy to support advance health care planning. Geriatricians have reservations about LPAs covering health care.

Advance health care planning: taking a "medical future".

This article describes the living will and durable power of attorney as legal mechanisms for advance health care planning, and discusses the role of the physician in health care planning. The concept of a "medical future" is a new but not radically different device for furthering the objectives of advance health care planning.