Despite efforts to improve uptake of advance care planning (including AD), barriers remain. One likely trigger for completing an AD and advance care planning is undertaking a wider future planning process (e.g. making a will or financial enduring power of attorney). This presents opportunities to increase advance care planning, but steps are needed to ensure that planning, which occurs outside the health system, is sufficiently informed and supported by health information so that it is useful in the clinical setting. Variations by state could also suggest that redesign of regulatory frameworks (such as a user-friendly and well-publicised form backed by statute) may help improve uptake of AD.
A review of the literature has been undertaken to examine health-related quality-of-life (HRQoL) of children and adolescents with speech and language difficulties (SaLD), with a particular focus on evidence regarding the domains of HRQoL most affected by SaLD. Twelve electronic databases were searched for articles on this topic published from 1966 to January 2011. Seven studies suitable for inclusion were identified. These papers were reviewed in relation to their participants, sample size, study design, and outcome measures, which differed considerably across studies. From the studies reviewed, there is emerging evidence that HRQoL can be compromised for children and adolescents with SaLD relative to their peers, and some consensus that the social domain of HRQoL is most impacted. Overall, the review highlights a paucity of research in this area and recommendations are made as to how research may advance. Most importantly, studies examining the effect of child and family factors in mediating or moderating the relationship between SaLD and HRQoL are required. This knowledge will support the identification of children with SaLD at risk of poorer HRQoL outcomes and inform intervention strategies through the identification of relevant risk and protective factors.
Several parent and child factors were consistently linked with functional disability, whereas better family functioning was associated with functional ability. Applying an ecological framework, assisted identification of areas for further research, and provides direction for treatments that may be more effective in optimizing long-term functional outcomes, extending current psychological approaches.
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