Care Discussions Research Articles

Barriers and Facilitators to End-of-Life Care Delivery in ICUs: A Qualitative Study.

To understand frontline ICU clinician's perceptions of end-of-life care delivery in the ICU. Qualitative observational cross-sectional study. Seven ICUs across three hospitals in an integrated academic health system. ICU clinicians (physicians [critical care, palliative care], advanced practice providers, nurses, social workers, chaplains). None. In total, 27 semi-structured interviews were conducted, recorded, and transcribed. The research team reviewed all transcripts inductively to develop a codebook. Thematic analysis was conducted through coding, category formulation, and sorting for data reduction to identify central themes. Deductive reasoning facilitated data category formulation and thematic structuring anchored on the Systems Engineering Initiative for Patient Safety model identified that work systems (people, environment, tools, tasks) lead to processes and outcomes. Four themes were barriers or facilitators to end-of-life care. First, work system barriers delayed end-of-life care communication among clinicians as well as between clinicians and families. For example, over-reliance on palliative care people in handling end-of-life discussions prevented timely end-of-life care discussions with families. Second, clinician-level variability existed in end-of-life communication tasks. For example, end-of-life care discussions varied greatly in process and outcomes depending on the clinician leading the conversation. Third, clinician-family-patient priorities or treatment goals were misaligned. Conversely, regular discussion and joint decisions facilitated higher familial confidence in end-of-life care delivery process. These detailed discussions between care teams aligned priorities and led to fewer situations where patients/families received conflicting information. Fourth, clinician moral distress occurred from providing nonbeneficial care. Interviewees reported standardized end-of-life care discussion process incorporated by the people in the work system including patient, family, and clinicians were foundational to delivering end-of-life care that reduced both patient and family suffering, as well as clinician moral distress. Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.

Good or Great: Which One Are You?

Clinicians caring for patients, especially those with chronic diseases or older adults, need to recognize the value of being able to transition away from aggressive care when appropriate and focus on a more palliative approach. Research has shown that patients want to have goals of care discussions and maintain autonomy at the end of life. These goals of care discussions can be challenging, and clinicians must prioritize and develop this skill in order to provide their patients with what they may need most. Being able to treat patients aggressively and prolong life is undoubtedly vital; however, so is the ability to recognize suffering and provide a patient and their family with the opportunity to find peace at the end of life. This skill ensures a more whole person focus and sets the great clinician apart from the good.

Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

BackgroundPersons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation.MethodsThirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study.ResultsSix themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making.ConclusionsFamily and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders’ perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.

A text analytics approach for mining public discussions in online cancer forum: Analysis of multi-intent lung cancer treatment dataset

BackgroundOnline cancer forums (OCF) are increasingly popular platforms for patients and caregivers to discuss, seek information on, and share opinions about diseases and treatments. This interaction generates a substantial amount of unstructured text data, necessitating deeper exploration. Using time series data, our study exploits topic modeling in the novel domain of online cancer forums (OCFs) to identify meaningful topics and changing dynamics of online discussion across different lung cancer treatment intent groups. MethodsFor this purpose, a dataset comprising 27,998 forum posts about lung cancer was collected from three OCFs: lungcancer.net, lungevity.org, and reddit.com, spanning the years 2016 to 2018. ResultsThe analysis reflects the public discussion on multi-intent lung cancer treatment over time, taking into account seasonal variations. Discussions on cancer symptoms and prevention garnered the most attention, dominating both curative and palliative care discussions. There were distinct seasonal peaks: curative care topics surged from winter to late spring, while palliative care topics peaked from late summer to mid-autumn. Keyword analysis highlighted that lung cancer diagnosis and treatment were primary topics, whereas cancer prevention and treatment outcomes were predominant across multi-care contexts. For the study period, curative care discussions predominantly revolved around informational support and disease syndromes. In contrast, social support and cancer prevention prevailed in the palliative care context. Notably, topics such as cancer screening and cancer treatment exhibit pronounced seasonal variations in curative care, peaking in frequency during the summers (May to August) of the study period. Meanwhile, the topic of tumor control within palliative care showed significant seasonal influence during the winters and summers of 2017 and 2018. ConclusionOur text analysis approach using OCF data shows potential for computational methods in this novel domain to gain insights into trends in public cancer communication and seasonal variations for a better understanding of improving personalized care, decision support, treatment outcomes, and quality of life.

Aging With Grace: The Quest for Integrated, Compassionate Care for Older Adults.

This Practice Update discusses the potential for implementation of the 4M model for care of older adults in Israel, to complement the medical-centric model that exists today. The older adult population in Israel is increasing. However, efficient and sufficient care that takes patient's wishes into consideration is lacking. Care of older adults, particularly palliative patients, is complex and requires multidisciplinary efforts. There are numerous challenges to caring for older adults. These include fragmentation of care, unclear boundaries between palliative and geriatric care, and the preservation of patient autonomy, indicating a need to adopt new care frameworks. The authors suggest implementing the 4M model as a new care framework in addition to the current medical-centric model. This framework considers important care aspects during discussions of care: what matters to the patient, medication, mentation, and mobility. Implementation of this model can promote better-integrated care, thus improving the quality of life for older adults.

Do-not-attempt-resuscitation orders, end-of-life care discussions, and advance care planning for deteriorating patients in Japan.

Do-not-attempt-resuscitation orders, end-of-life care discussions, and advance care planning for deteriorating patients in Japan.

Abstract WP143: Towards What Goal? Palliative Care Utilization for the Post Endovascular Therapy Patient

Introduction: AHA Guidelines call for utilization of Palliative Care (PC) for all patients with serious, life-threatening stroke. The purpose of this study was to assess factors associated with change in Code Status and PC utilization for patients with large vessel occlusion undergoing EVT. Methods: We retrospectively reviewed prospectively collected data in an IRB-approved stroke registry at two large, academic Comprehensive Stroke Centers. Subjects who received EVT for acute ischemic stroke (AIS) between 2014-2022 were included. Patients were grouped by change in code status during hospitalization. Baseline demographics were compared between groups with frequencies, chi-squared or t-test as appropriate. A correlation matrix was constructed and regression was performed. Results: Of the 411 included patients, 88 had code status changes. There was a significant difference in age, history of diabetes, last known well to hospital arrival, groin puncture to recanalization, and sICH within 36 hours between groups (Table 1). Goals of care (GOC) discussion was documented in only 36% of patients, with a mean of 4 days from stroke onset to code status change. Code status change was significantly associated with female sex (p=0.04), history of diabetes (p=0.01), sICH at 36 hours post rt-PA (p<0.001), PC consult (p<0.001), and rt-PA treatment (p=0.004). Code status change was best predicted with a model including age, DM, Initial NIHSS, and sICH within 36 hours. Conclusions: Despite undergoing acute intervention, few AIS patients had documented GOC discussions or code status change during hospitalization. Biases must be addressed in utilizing PC in AIS to provide comprehensive care. Standardized GOC discussions result in caregivers being more informed of prognosis and ensuring that patient’s GOC are honored. Further research is needed to determine barriers to GOC discussions and PC utilization in AIS.

Improving health education through a patient-clinician partnered intervention in the patient with genitourinary cancer.

TPS525 Background: Health literacy is associated with health equity, acts as a cornerstone in optimizing patient care and is associated with improved quality of life. The objective of this project is to improve health literacy in patients with genitourinary cancer through a patient-clinician partnered education intervention. Synthesis of Literature Utilization of a targeted education program delivered in-person using voice instruction demonstrated the greatest significant effect on health-related quality of life; the additional of illustration and text further improved this metric. Optimal health related quality of life is associated with greater comprehension of disease and adherence to treatment plan, heightened self-efficacy, and improvement in patient-provider communication. Methods: The intervention is a patient-clinician partnered written form used in conjunction with verbal instruction. The patient documents reasons for the visit and primary concerns to be addressed prior to the provider encounter during the visit. The Action Plan then records the treatment plan and next steps discussed during the visit. A Confidence Ruler acts as a visual representation of patient confidence in the plan of care, acting as a prompt to the provider to ensure adequate information transfer at conclusion of the visit. The patient then retains the written form highlighting the care discussion for reference and recall as needed. Evaluation A five-point Likert test will measure change pre/post intervention; data will be analyzed in a cohort looking at improvement in overall mean. The HRQOL-14 and the CHLT-6 modified will be used to assess baseline health related quality of life and health literacy respectively followed by cohort analysis of the means to determine efficacy outcomes. The primary outcome is to improve health literacy in all patients within a genitourinary oncology clinic population using is a written tool in concurrence with verbal instruction with secondary focus on improving health-related quality of life in the same population. Recommendation Health literacy must be assessed each visit to optimize patient care outcomes and quality of life. Targeted health education must be patient specific and titrated to individual health literacy needs.

Battling Alone on Multiple Fronts - How Gender Norms Affect the Soldiers' Wife as Caregiver in India.

Women form the backbone of caregiving in palliative home care throughout the world. They put in more intense care for longer hours, perform more intimate tasks, and face more physical and mental strain, comorbidities, anxiety, and depression. However, gender norms that perceive caregiving as a natural part of femininity dismiss this as part of their duty toward their family, thus making their care work invisible, taken for granted, and devalued. This results in women bearing more burden with less support and no appreciation and suffering more negative mental and physical health outcomes than men. Globally, women perform 76.2% of unpaid care work. India ranks a dismal - 135 out of 146 countries in the 2022 Gender Gap report. Less than 10% of Indian men participate in household work. Women in rural India continue to be less educated; the majority are not allowed to travel alone and are culturally not involved in decision-making, which is done by the males. Wives of armed forces personnel are forced to live without their husbands for long periods. This leads to even more challenges when they also need to take care of patients with life-limiting illnesses. No study has been done on this population till now. This study aimed to explore the experiences of the women in armed forces families, caring at home for patients with palliative needs. This was a qualitative study based on a thematic analysis of semi-structured interviews with adult caregivers - either serving personnel or their dependent family members. Female relatives were the main caregivers in 13 cases; the majority belonged to rural areas, were between 22 and 47 years of age, most were married, had young children, and reported health issues of their own. Major themes that emerged include lack of information, the expectation of being a caregiver irrespective of ability/needs, physical and psychological burden, neglected emotional needs, difficulty in traveling alone, social isolation, loss of employment with the financial burden, stigmatisation and ill-treatment of widows by in-laws. 'Soldier's wives, who must stay alone, face increased burdens as they face not only the physical and emotional burden of caregiving but also the additional challenges of living alone, mostly in rural Indian society, where gender norms are still deeply ingrained. Creating awareness about this vulnerable community among palliative care providers is required to improve services for them. There is also an urgent need for identifying, challenging, and addressing stereotyped roles and disparities in healthcare systems, practices, care goals, and policies by sensitising staff, educating families, developing gender-sensitive resources and support systems, initiating care discussions, and undertaking more gender-related research.

Dialysis decision-making process by Chinese American patients at an urban, academic medical center: a retrospective chart review

BackgroundClinical practice guidelines emphasize shared decision-making for kidney replacement treatment, yet little is known about the influence of cultural differences on that process. We undertook a retrospective chart review to explore the process and timing of dialysis decision making and initiation in Chinese American patients to provide quality kidney care for this population.DesignParticipants received outpatient care at Tufts Medical Center and dialysis at Dialysis Clinic, Inc. Boston or Somerville, MA from 2001–2021. Clinic chart review sourced demographic, clinical, and end-of-life care information from 180 participants (82 Chinese American, 98 other) from stage 4 chronic kidney disease (CKD) and dialysis initiation.ResultsChinese American participants were older (mean 70 vs. 59, p < 0.0001), less likely to speak English (12% vs. 87%, p < 0.0001), and used interpreter services more (80% vs. 11%, p < 0.0001). Chinese American participants had more visits (median 14 vs. 10, p = 0.005); were more often accompanied by family members (75% vs. 40%, p < 0.001); and had significantly lower rates of healthcare proxy documentation (35% vs. 55%, p = 0.006). There was no statistical difference in months between first CKD 4 visit and first dialysis. Both groups started dialysis at the same average eGFR and with similar rates of permanent dialysis access. Chinese American participants had significantly lower serum albumin at dialysis initiation (mean 3.3 g/dL vs 3.7 g/dL, p = 0.0003). Documentation reflected a low number of conversations about non-dialytic care, end-of-life planning, or palliative care in both groups across all visits.ConclusionThe time between CKD 4 and dialysis initiation was the same in both groups, suggesting a similar overall outcome of care. Chart documentation suggests that Chinese American participants had a significantly higher number of visits with nephrologists where discussion about dialysis was noted and were more likely to have a family member present at the visit. Fewer Chinese American participants completed healthcare proxies. Among all study participants, healthcare proxy, code status, and palliative care discussions were reported less frequently than expected. These findings highlight opportunities for collaboration between palliative care clinicians and nephrologists.

Piloting a Patient Tool to Aid Palliative Care Referrals during Advanced Lung Cancer Treatment

ContextPatient misperceptions are a strong barrier to early palliative care discussions and referrals during advanced lung cancer treatment. ObjectivesWe developed and tested the acceptability of a web-based patient-facing palliative care education and screening tool intended for use in a planned multilevel intervention (i.e., patient, clinician, system-level targets). MethodsWe elicited feedback from advanced lung cancer patients (n = 6), oncology and palliative care clinicians (n = 4), and a clinic administrator (n = 1) on the perceived relevance of the intervention. We then tested the prototype of a patient-facing tool for patient acceptability and preliminary effects on patient palliative care knowledge and motivation. ResultsPartners agreed that the intervention—clinician palliative care education and an electronic health record-integrated patient tool—is relevant and their feedback informed development of the patient prototype. Advanced stage lung cancer patients (n = 20; age 60 ± 9.8; 40% male; 70% with a technical degree or less) reviewed and rated the prototype on a five-point scale for acceptability (4.48 ± 0.55), appropriateness (4.37 ± 0.62), and feasibility (4.43 ± 0.59). After using the prototype, 75% were interested in using palliative care and 80% were more motivated to talk to their oncologist about it. Of patients who had or were at risk of having misperceptions about palliative care (e.g., conflating it with hospice), 100% no longer held the misperceptions after using the prototype. ConclusionThe palliative care education and screening tool is acceptable to patients and may address misperceptions and motivate palliative care discussions during treatment.

A conceptual model of the nurse's role as primary palliative care provider in goals of care communication

ObjectiveNurses have opportunities to engage in goals of care conversations that can promote palliative care communication. The purpose of this study was to describe nurses' experiences in goals of care communication as summarized in the literature and to present a conceptual model of communication pathways for nurses. MethodsAn integrative review of the literature (2016–2022) addressing nurses' experiences in goals of care communication was conducted using PubMed, CINAHL, and PsychInfo databases. A total of 92 articles were retrieved. A total of 12 articles were included for this review after applying the inclusion and exclusion criteria. ResultsOf the 12 articles, the majority were qualitative studies (n = 8). Qualitative analysis of findings from all articles revealed three dominant themes: nurses' ambiguous role responsibilities, goals of care as end-of-life communication, and the need for nurse communication training. ConclusionThis article suggests an innovative conceptual model for advancing nurse communication about goals of care to facilitate primary palliative care. InnovationThe framework characterizes two communication pathways for Advanced Practice Nurses who direct goals of care discussions and Registered Nurses who support goals of care communication. The model informs future communication training aimed at supporting primary palliative care.

Evaluating the transition of adolescents and young adults with palliative care needs from pediatric to adult care

BackgroundThe transition from pediatric to adult healthcare poses significant challenges for adolescents and young adults (AYA), especially those with chronic conditions, yet most children receive inadequate transition preparation. Research on the transition for patients receiving palliative care services is particularly limited. We sought to address this gap in the literature. MethodsYoung adults aged 18 to 35 years who transitioned from the pediatric setting and received adult palliative care services at an urban academic medical center between the dates of February 1st, 2020 and July 1st, 2022 were identified retrospectively via electronic medical record. Chart review was used to investigate outcomes of interest, including use of pediatric palliative care services and timing of care conversations. ResultsOnly 23 % of patients interfaced with pediatric palliative care, despite all having childhood diagnoses. Pediatric palliative care exposure was associated with a significantly earlier median age of first adult palliative care encounter (19.63 versus 25.06, p = <0.001). Goals of care discussions, code status conversations, and healthcare proxy documentation occurred earlier if pediatric palliative care was involved (18.9 years versus 25.7 years, p < 0.001; 20.9 years versus 30.0 years, p < 0.001; 20.7 versus 28.9, p < 0.001). ConclusionsPediatric palliative care services were underutilized in AYA patients, but when used, were associated with earlier adult palliative care encounters, goals of care discussions, code status decisions, and health care proxy identification.

Understanding Potentially Preventable 7-day Readmission Rates in Hospital Medicine Patients at a Comprehensive Cancer Center.

This study aimed to describe the potentially preventable 7-day unplanned readmission (PPR) rate in medical oncology patients. A retrospective analysis of all unplanned 7-day readmissions within Hospital Medicine at MD Anderson Cancer Center from September 1, 2020 to February 28, 2021, was performed. Readmissions were independently analyzed by 2 randomly selected individuals to determine preventability. Discordant reviews were resolved by a third reviewer to reach a consensus. Statistical analysis included 138 unplanned readmissions. The estimated PPR rate was 15.94%. The median age was 62.50 years; 52.90% were female. The most common type of cancer was noncolon GI malignancy (34.06%). Most patients had stage 4 cancer (69.57%) and were discharged home (64.93%). Premature discharge followed by missed opportunities for goals of care discussions were the most cited reasons for potential preventability. These findings highlight areas where care delivery can be improved to mitigate the risk of readmission within the medical oncology population.

HEALTH CARE SETTINGS: A MISSED OPPORTUNITY TO ADDRESS HEARING LOSS

Abstract Background Identifying hearing loss (HL) within the healthcare system is essential to mitigate its risk for associated negative psychosocial and health conditions, including isolation and depression yet is rarely assessed. This qualitative study sought to gain in-depth understandings of how HL affects communication regarding care preferences within the older adult-partner dyad in the context of chronic illness. Its premise was that older adults with HL may not be able to participate effectively in care discussions and are at risk of not receiving patient centered care. Method: Planned as in-person, pandemic restrictions mandated transition to zoom. 15 older adults (≥60) with HL and 13 partners participated. Results One key story line evolving from the data is “Compulsory Self-Advocacy”. Almost uniformly, participants reported that healthcare practitioners “Never Asked” about HL. During one-on-one communication, HL wasn’t necessarily brought to the surface and often went unnoted because participants didn’t see it as pertinent to issues discussed. Still, they were unsure the practitioner was aware of their HL. Rather, they asked that information be repeated or noted they had trouble hearing or understanding when they realized problems. Reporting their HL didn’t generally result in on-going consideration of their specific communication needs. They had to self-advocate to obtain accurate information or bring their partner to appointments to help. Some commented on the value of policies mandating access to notes or written reports. Conclusions Healthcare settings provide unique opportunities to identify HL and initiate interventions that may mitigate its negative effects, including social isolation and loneliness.

IMPLEMENTING AND TESTING THE EFFICACY OF A GERIATRIC GOALS OF CARE TOOL IN AN ACUTE HOSPITAL SETTING

Abstract Goals of care (GOC) discussions, which focus on patient values and preferences, are associated with improved outcomes for older adults, including lower hospital readmission rates, increased adherence to advanced care plans, and improved patient satisfaction. GOC discussions do not occur consistently and a reliable method of documentation has yet to be established. The Geriatrics Goals of Care (GGOC) tool was developed to easily review and document GOC discussions for geriatric patients (65 years and older) in the electronic medical record, focusing on pre-hospital function and hospitalization goals. The study objective was to evaluate the GGOC tool’s impact on 30-day hospital readmission. Using an experimental design, the GGOC tool was implemented in one hospital unit and a second comparative unit served as a control. The GGOC tool was administered to a total of 82 patients and 162 control unit patients received standard care (N= 244). A logistic regression of patient-level data revealed that the odds of having a hospital readmission within 30 days were approximately 65% lower for patients who received the GGOC tool compared to those in the control unit (OR = .344, SE = .40, p = .008, 95% CI [.156, .759]). The readmission rate for the unit utilizing the GGOC tool yielded a cost savings of $185,019.12. Applying the same readmission rate to the control unit, the expected cost savings was $365,625 for the control group. Results suggest that the GGOC tool may be effective for documenting GOC discussions, reducing the burden of readmissions with their associated costs.

AN EDUCATIONAL PROGRAM IN ASSISTED LIVING TO INCREASE STAFF SELF-EFFICACY IN PROVISION OF DEMENTIA PALLIATIVE CARE

Abstract Advance care planning among persons with dementia, their family members and staff in assisted living (AL) communities can facilitate meeting care preferences. In a recent NIH Stage 1a feasibility cluster randomized trial in AL communities (N=118 residents with dementia, 23 staff; k=10 ALs). The Palliative Care Education in Assisted Living for Dementia Care Providers (PCEAL-DCP) intervention showed an increase in documentation of ACP discussions (e.g., completion of advance directives, having goals of care discussions with family) in the treatment group from 12% to 51% compared to control group (8% to 23%) from baseline to six-months (effect size 0.86, Cohen’s d statistic). The current study is an NIH Stage 1b pilot using the same sample to test staff self-efficacy as a mechanism and if staff self-efficacy mediates the effects of increased documentation of ACP discussions. The measure of staff self-efficacy includes two self-reported survey items at pre- and post-intervention (baseline and one-month) that asks them how much they agree with their ability to provide care for terminally ill persons and terminally ill persons with dementia (completely agree, somewhat agree, completely disagree). Descriptive results indicate a larger increase for the treatment AL staff from baseline to one month for the percentage who completely agreed with both items. For the item specific to providing care for terminally ill persons with dementia, the treatment group was 47% baseline to 84.6% one-month compared to 66% baseline and 50% control group. Results for mediation between staff-self efficacy and ACP will be discussed.

ADVANCE CARE PLANNING IN PRIMARY CARE: ENGAGING ACCOMPANIED OLDER ADULTS WITH COGNITIVE IMPAIRMENT

Abstract Alzheimer’s Disease and Related Dementias (ADRD) are among the most profoundly disabling and costly of all health conditions, and persons living with dementia are at heightened risk for high utilization of burdensome and costly end-of-life care. Family caregivers are at the forefront of managing ADRD, however, they are not routinely engaged in primary care discussions about prognosis and the healthcare preferences of the people for whom they care. Advance care planning (ACP) is a longitudinal communication process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Early initiation of ACP, communication with the primary care team, and the inclusion of associated caregivers is imperative in ADRD care due to progressive and devastating effects on decision-making capacity connected with the disease. SHARE, a multicomponent communication intervention, engaged 273 patient-family caregiver dyads in a randomized-controlled trial collecting baseline and six-month survey data related to experiences in the primary care setting. 145 patient-caregiver dyads assigned to the intervention received an offer for a facilitated advance care planning conversation. This symposium will highlight 6-month outcomes from caregiver-reported surveys. Attendees will gain a perspective on ACP considerations in a cognitively impaired population including ethical considerations and the factors influencing preparedness for medical decision making for involved family caregivers. Additional attention concerning the quality and content of ACP conversations with patient-caregiver dyads and the development of a fidelity tool for usage with audio-recorded ACP conversations will be presented.

A CHECKLIST-BASED INTERVENTION TO SUPPORT FAMILY CAREGIVERS IN PRIMARY CARE

Abstract Family caregivers commonly accompany older adults to their routine medical visits, but caregivers’ own needs and concerns are not systematically identified or addressed in clinical practice. Collaborative Healthcare Encounters with Caregivers (CHEC) is a checklist-based intervention that uses a prioritization approach to help caregivers efficiently identify and communicate their most salient concerns to primary care providers. This presentation will report findings from a pilot randomized controlled trial of N=37 patient-caregiver dyads who were randomized to CHEC (N=21) or usual care (n=16). The goals of the pilot trial were to evaluate CHEC’s impact on medical visit duration and communication (using time-stamped audio-recordings and a structured coding system) and caregivers’ perceptions of CHEC’s utility (using questionnaires and interviews). Total visit duration was comparable across treatment groups (CHEC: 29.3 minutes vs. UC: 32.8 minutes; p=0.55), but a greater proportion of the visit time was spent addressing caregivers’ concerns among CHEC group participants, as compared to usual care participants (25% vs. 6%; p&amp;lt;.001). In post-visit interviews, caregivers commented that CHEC was useful in helping them to prepare for the visit by thinking about their questions in advance and prompting providers to acknowledge their concerns. Findings from this study explicitly address the RAISE Act’s recommendation for integrating evidence-based caregiver assessment instruments into clinical care delivery (Outcome 2.2) and indicate CHEC’s potential as an efficient, clinically feasible intervention that can support greater inclusion of caregivers in primary care discussions.

Neuropalliative care in a tertiary-level hospital.

Palliative care in neurology is a recent specialty to improve the quality of life of patients with severe neurological diseases. This study aims to determine the frequency of neurological inpatients who had indication of palliative care, and evaluate the symptomatology, demographic profile, the need for supportive measures, advance directives for life and medical history of patients in a tertiary hospital in Brazil. This cross-sectional analytical study evaluated all patients admitted to the neurological semi-intensive care unit (ICU) at Hospital Israelita Albert Einstein with neurological conditions from February through August 2022. The Palliative Performance Scale (weight loss greater than 5% associated with body changes and a negative response to the question: 'Would you be surprised if the patient died within 1 year?') was used to indicate palliative care. Patients were divided into three groups: patients with palliative care needs (groupindication), patients without palliative care needs (groupwithout indication) and patients who received at least one assessment of a palliative care team (grouppalliative). Demographic data were analysed using the Χ2 test for qualitative and Kruskal-Wallis test for quantitative variables. Of the 198 patients included in the study, 115 (58%) had palliative care needs. Only 6.9% received assessment by the palliative care team, and 9.56% had advance directives in their medical records. Patients in groupindication had a higher prevalence of symptoms, such as fatigue, depression, shortness of breath and lack of appetite, and required more supportive measures, such as oxygen therapy, enteral/parenteral nutrition, admissions at ICU and days in hospital. Despite the high demand for palliative care in neurology, few patients receive this treatment, resulting in decreased quality of care. Therefore, greater integration and discussion of palliative care in neurology are needed.