Knowledge Of Advance Care Planning Research Articles

Factors Influencing Advance Care Planning Among Older Adults in Two Socioeconomically Diverse Living Communities.

Advance care planning (ACP) is an iterative, complex, and dynamic process of discussion, decision-making, and documentation about end-of-life care. The extent to which this process takes place in older adults in diverse socioeconomic settings is not well documented. The aim of this study was to assess the knowledge, attitudes, and beliefs about ACP among older adults in two socioeconomically diverse settings to identify the individual and contextual factors that influence behaviors regarding end-of-life care. A cross-sectional survey design was used. An affordable independent continuing care retirement community and a high-income eligible (HIE) independent continuing care retirement community. Individuals aged 55 years and older who resided in independent living. A 61-item survey was administered. Simple descriptive statistics were used to examine the responses, and inferential statistics were used to evaluate which items were associated with key outcomes between the 2 settings. Seventy-seven older adults completed the survey. Significant differences in familiarity of terminology and knowledge of ACP, as well as significant differences in completion of advance directives and communication, were found between the 2 communities. No differences were found in attitudes and beliefs about end-of-life issues. Higher levels of knowledge and engagement in ACP were reported at the HIE community as compared to the affordable housing community. These findings provide insight into the influence of the contextual forces that encourage and support ACP.

High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study.

Many patients with chronic illnesses report a desire for increased involvement in medical decision-making. This pilot study aimed to explore how patients with exacerbation-prone disease trajectories such as advanced heart failure or chronic obstructive pulmonary disease experience advance care planning using an online decision aid and to compare whether patients with different types of exacerbation-prone illnesses had varied experiences using the tool. Pre-intervention questionnaires measured advance care planning knowledge. Post-intervention questionnaires measured: (1) advance care planning knowledge; (2) satisfaction with tool; (3) decisional conflict; and (4) accuracy of the resultant advance directive. Comparisons were made between patients with heart failure and chronic obstructive pulmonary disease. Over 90% of the patients with heart failure (n = 24) or chronic obstructive pulmonary disease (n = 25) reported being "satisfied" or "highly satisfied" with the tool across all satisfaction domains; over 90% of participants rated the resultant advance directive as "very accurate." Participants reported low decisional conflict. Advance care planning knowledge scores rose by 18% (p < 0.001) post-intervention. There were no significant differences between participants with heart failure and chronic obstructive pulmonary disease. Patients with advanced heart failure and chronic obstructive pulmonary disease were highly satisfied after using an online advance care planning decision aid and had increased knowledge of advance care planning. This tool can be a useful resource for time-constrained clinicians whose patients wish to engage in advance care planning.

Development of a Scale to Assess Physician Advance Care Planning Self-Efficacy.

Although patients prefer that physicians initiate advance care planning (ACP) conversations, few physicians regularly do so. Physicians may be reluctant to initiate ACP conversations because they lack self-efficacy in their skills. Yet, no validated scale on self-efficacy for ACP exists. Our objective was to develop a scale that measures physicians' ACP self-efficacy (ACP-SE) and to investigate the validity of the tool. Electronic questionnaires were administered to a random sample of family medicine physicians (n = 188). Exploratory factor analysis was performed to determine whether the scale was multidimensional. An initial assessment of the scale's validity was also conducted. The exploratory factor analysis indicated that a single factor was appropriate using all 17 items. A single, unidimensional scale was created by averaging the 17 items, yielding good internal consistency (Cronbach α = 0.95). The average scale score was 3.94 (standard deviation = 0.71) on a scale from 1 to 5. The scale was moderately correlated with a global single-item measure of self-efficacy for ACP ( r = .79, P < .001), and the scale differentiated between physician groups based on how much ACP they were doing, how recently they had an ACP conversation, formal training on ACP, and knowledge of ACP. In a multivariate analysis, the ACP-SE scale was a strong predictor of the percentage of patients with chronic life-limiting diseases with whom the physician discussed ACP. The final ACP-SE scale included 17 items and demonstrated high internal consistency.

Advance Care Planning for Older Australians Living in the Community

To evaluate the impact of advance care planning (ACP) education with people aged ≥60 years living in the community. The interactive workshop explored all aspects of ACP—legal, emotional, physical, spiritual, role of significant others—and allowed reflection time, questions, and group discussion. Evaluation of knowledge and attitudes toward ACP were completed pre- and post-training. Readiness-to-change and feedback about the workshop quality were collected post-training. Eleven workshops were delivered in Queensland (132 matched pre- and post-questionnaires compared for analysis). Participant’s ACP knowledge and confidence increased significantly (12/13 statements, p&lt;0.05) alongside some shift in attitudes (4/12 statements, p&lt;0.05) after training. Participants were engaged and rated the workshop positively. Single ACP workshops are an effective intervention for healthy older people in the community. Training should focus on demystifying legislation and documentation, the importance of planning and communicating wishes while still healthy, and the need to regularly review and update plans. Follow-up is required to assess translation of education into ACP action.

Knowledge, attitudes, and preferences of healthy young adults regarding advance care planning: a focus group study of university students in Pittsburgh, USA.

BackgroundTo date, research and promotion regarding advance care planning (ACP) has targeted those with serious illness or the elderly, thereby ignoring healthy young adults. The purpose of this study was to explore young adults’ knowledge, attitudes, and preferences regarding advance care planning (ACP) and medical decision-making. Further, we aimed to understand the potential role of public health to encourage population-based promotion of ACP.MethodsBetween February 2007 and April 2007, we conducted six focus groups comprising 56 young adults ages 18–30. Topics explored included (1) baseline knowledge regarding ACP, (2) preferences for ACP, (3) characteristics of preferred surrogates, and (4) barriers and facilitators to completing ACP specific to age and individuation. We used a qualitative thematic approach to analyze transcripts.ResultsAll participants desired more information regarding ACP. In addition, participants expressed (1) heterogeneous attitudes regarding triggers to perform ACP, (2) the opinion that ACP is a marker of individuation, (3) the belief that prior exposure to illness plays a role in prompting ACP, and (4) an appreciation that ACP is flexible to changes in preferences and circumstances throughout the life-course.ConclusionYoung adults perceive ACP as a worthwhile health behavior and view a lack of information as a major barrier to discussion and adoption. Our data emphasize the need for strategies to increase ACP knowledge, while encouraging population-level, patient-centered, healthcare decision-making.

Evaluation of an advance care planning education programme for nursing homes: A Longitudinal study

To evaluate the success of a programme of Advance Care Planning education for nursing homes by examining the effect on staff knowledge, Advance Care Planning practice within the home and end-of-life hospital admission rates. Three longitudinal questionnaires assessing staff knowledge, Advance Care Planning Practice and hospital deaths completed before and after the initiation of the Advance Care Planning education programme by homes that had completed the training and those yet to undergo the training. Superior Advance Care Planning knowledge was evident in those staff that had completed the training. There was an increase of 85% in the number of Advance Care Plans completed in the training homes and an overall reduction in hospital deaths of 25% for residents from training homes. A programme of Advance Care Planning education for nursing homes is successful in improving nursing home staff knowledge, increasing Advance Care Planning practice and reducing hospital deaths.

The Effect of Educational Intervention regarding Advance Care Planning for Advance Directives

This study aimed to examine the effects of empowerment and education intervention to promote Advance Care Planning (ACP) for residents in a highly aged and depopulated region. The study utilized a single-group pre- and post-test design and was conducted in Osakikamijima, Hiroshima, Japan. The researchers and town officials together formed an ACP committee and created an intervention framework. An ACP workshop was held for the participants and a self-administered questionnaire was carried out before, immediately after, and 3 months after the workshop. A total of 125 residents participated in the workshop and 87 of them completed more than 80% of the questionnaire items, whose responses were analyzed as valid responses. The number of participants who completed the AD increased significantly three months after the workshop (p = 0.008). There was a slight increase in the frequency of consultation with the family, but no change was observed in terms of consultation with healthcare providers. The educational intervention in-creased the respondents’ awareness and knowledge of ACP but did not affect the autonomous decision-making process regarding end-of-life care. This strategic process of ACP empowered the residents’ awareness and attitude towards end-of-life care with an increased completion rate of AD. On the other hand, cognitive barriers remained toward communication and decision-making shared with healthcare providers. Insufficient consultation with family members also became evident. Therefore, a new intervention strategy which helps increase communication with healthcare providers needs to be formulated and guidelines for consultation with the family and others need to be prepared.

Teaching general practitioners and doctors-in-training to discuss advance care planning: evaluation of a brief multimodality education programme

ObjectiveTo develop and evaluate an interactive advance care planning (ACP) educational programme for general practitioners and doctors-in-training.DesignDevelopment of training materials was overseen by a committee; informed by literature and previous...

A Systematic Review of Advance Directives and Advance Care Planning in Chinese People From Eastern and Western Cultures

There is increasing interest in the role of advance care planning (ACP) and advance directives (ADs) in eliciting patient preferences for future medical care. Whereas Americans from many cultures embrace the concept of autonomy and AD, elements of the Chinese culture may lead to disagreement with ACP. Filial piety, an important concept in Chinese culture, may hinder truth-telling, discussion of poor prognosis, and ACP. The purpose of this systematic review was to examine the empirical evidence about ACP and AD in Chinese people from Eastern and Western cultures. Databases searched were PubMed, EMBASE, CINAHL, PsychInfo, and Cochrane Database of Systematic Reviews. Fifteen publications met the inclusion criteria. Narrative analysis was used and five major themes were extracted: (a) factors predicting preferences for ACP/AD, (b) Chinese-specific considerations related to ACP, (c) decision making in ACP, (d) ACP and AD knowledge, and (e) Chinese cultural aspects of ACP. There was little difference in results from Eastern versus Western countries. Culturally sensitive ACP must be approached with compassion and respect and provide a sense of dignity. A family decision-making model may be more appropriate for discussions with Chinese people about ACP and AD.

EMPOWERING CARE HOME STAFF TO DELIVER QUALITY END OF LIFE CARE: THE IMPACT OF THE SIX STEPS TO SUCCESS PROGRAMME ON END OF LIFE CARE IN CARE HOMES IN NORTH WEST ENGLAND

BackgroundInappropriate admissions to hospital from care homes at the end-of-life (EoL), identified within the UK Department of Health's End-of-Life Care (EoLC) Strategy resulted in the call for improved education surrounding...

ADVANCE CARE PLANNING TRAINING IN NURSING HOMES: A SUCCESS STORY?

BackgroundThe number of older frail nursing home residents is increasing in the UK. Advance Care Planning (ACP) for this population provides an opportunity to empower older people by discussing and...

Advance care planning for Māori, Pacific and Asian people: the views of New Zealand healthcare professionals

Despite the benefits of advance care planning (ACP), international research has suggested that in pluralistic and multicultural societies such as New Zealand, significant differences exist in the uptake of ACP between European-based populations and other cultural groups [Crawley (2005)]. The purpose of this study was to therefore explore the views of generalist palliative care providers in both the community and hospital settings regarding the barriers to ACP adoption as well as methods to increase knowledge about ACP among Māori, Pacific and Asian cultural groups within New Zealand society. Eleven individual interviews, two joint interviews and three focus groups were conducted with health and social care professionals with a wide range of knowledge and experience in palliative care. Challenges were related to a number of issues based on culture, including family decision-making style, a need to 'do everything' and a reluctance to discuss issues surrounding dying and death. Suggestions to increase the knowledge of ACP included techniques to improve information access and the utilisation of shared norms and values to assist with discussions between Māori, Pacific and Asian health professionals and their patients and families/whānau. Findings indicate a need for more family/whānau-centred models of ACP, addressed much earlier in the healthcare process and within the community setting.

Advance Care Planning Knowledge and Documentation in a Hospitalized Cancer Population

To have a better understanding of our patients' knowledge of advance directive planning and execution, as well as communication with their oncologists regarding their wishes, we conducted a survey on our inpatient hematology-oncology services. A total of 68 unique hospitalized patients with a diagnosis of cancer completed surveys. Surveys were given to all oncology patients regardless of their reason for admission. Overall, 29% of the patients reported having had a discussion with their oncologist regarding their wishes if they became seriously ill or near death. Of those who did have this conversation, the majority said that they, rather than their physician, initiated it. Although the vast majority of patients (97%) knew what a living will was, only 54% had one in place. Twenty patients had a discussion with their oncologist, and 14 of them (70%) had a living will. This percentage was higher than in the group that did not have a conversation with their physician (48%; 23 of 48 patients), but the difference was not statistically significant. Most cancer patients admitted to an inpatient oncology unit either did not have or did not recall having a discussion with their oncologist regarding end-of-life issues. This study gives us a baseline of information in evaluating future interventions directed to improve the quality of patient-physician communication regarding end-of-life planning.

UNDERSTANDING HOW CANCER PATIENTS ACTUALISE, RELINQUISH, AND REJECT ADVANCE CARE PLANNING: IMPLICATIONS FOR PRACTICE

BackgroundAlthough advance care planning (ACP) is recognised as intégral to quality cancer care, it remains poorly integrated in many settings. Given cancer patients' unpredictable disease trajectories and equivocal treatment options,...

Evaluation of novel multimedia education to train doctors to discuss advance care planning (ACP)

Despite evidence of significant benefits of ACP for patients and relatives, many doctors lack the confidence to have ACP discussions with patients. To improve the ability of doctors to undertake...

Final evaluation of the “Making Health Choices” advance care planning in aged care project

Published literature suggests that advance care planning (ACP) activity in aged-care homes is inconsistent and often of poor quality. There are few published reports of the effectiveness of formal training...

Advance care planning in life limiting illness

In the Spanish advance care planning (ACP) Program ‘KAYRÓS- Helping Conversations’, inspired in Respecting Choices philosophy, we developed an innovative cluster research, NEURO-KAYRÓS, applied to two neurodegenerative diseases with contrasting...

Making health choices: advance care planning in aged care. Perception versus reality

IntroductionThe Making Health Choices pilot project being undertaken within Residential Aged Care Facilities in Victoria (Australia) by the Respecting Patient Choices team is currently undergoing evaluation. This presentation will provide...

Making health choices; Part 1. Advance Care planning in aged care project. Setting the scene

IntroductionThe (2009) Australian National Health & Hospital Reform Commission Report highlighted the need for advance care planning (ACP) for older persons in residential aged care facilities (RACFs). Using knowledge gained...