Barriers and Strategies to an Iterative Model of Advance Care Planning Communication

Ahluwalia, Sangeeta C.; Bekelman, David B.; Huynh, Alexis K.; Prendergast, Thomas J.; Shreve, Scott; Lorenz, Karl

doi:10.1177/1049909114541513

Cited by 42 publications

(55 citation statements)

References 43 publications

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“…Many reported helping factors are in fact ways to deal with this challenge and to find team consensus in decision-making. In line with some of the existing literature, our study shows that factors to overcome obstacles are mostly situated in communication with patients [23,[49][50][51] or in personal attitudes of professionals [52][53][54][55].…”

Section: Discussionsupporting

confidence: 83%

What do hospital professionals report as helping in overcoming obstacles for ACP decision-making? A qualitative study

Vanderhaeghen¹,

Bossuyt²,

Menten³

et al. 2017

Int Clin Med

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Background: Advance Care Planning (ACP) can be defined as an ongoing process of communication between patients and (in-) formal caregivers to help an individual identify, reflect upon, discuss, and express her or his values, beliefs, goals, and priorities to guide individual care and treatment decision making when nearing end of life. Studies suggest ACP is not well implemented in the hospital setting. This contrast sharply to the necessity of those conversations in hospitals: treatment decisions are made which potentially have a big impact on the patient's and families quality of life. AIMS: In order to facilitate the implementation of the ACP decision making process in hospital, it might be interesting to know what helps hospital professionals to overcome challenges.

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Section: Discussionsupporting

confidence: 83%

What do hospital professionals report as helping in overcoming obstacles for ACP decision-making? A qualitative study

Vanderhaeghen¹,

Bossuyt²,

Menten³

et al. 2017

Int Clin Med

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show abstract

“…The value of a systematic approach to orchestrating the process of ACP for complex patients-who are typically cared for by multiple different providers in a range of settings during the course of illness-has received relatively little attention in the literature (30)(31)(32). The comments of providers who care for patients with advanced kidney disease interviewed for this study speak to the complex and fragmented patterns of care experienced by these patients and spotlight both the need for and the challenges to an interdisciplinary approach to ACP for this population.…”

Section: Discussionmentioning

confidence: 99%

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

O’Hare

Szarka

McFarland

et al. 2016

CJASN

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Background and objectives There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease.Design, setting, participants, & measurements Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory.Results The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. ConclusionsThe comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease.

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“…In one study, primary care providers described barriers such as variation in how providers approach Advance Care Planning ACP, lack of useful information about patient values to guide decision making, and ineffective communication between providers across settings. 21 Although patients infrequently initiate these discussions, clinicians missed opportunities to engage in ACP discussions when patients expressed concerns regarding their future care. 22 Health care systems often lack the personnel or work flow processes to systematically approach ACP.…”

Section: Clinician and Health Care System Barriers To Advance Care Plmentioning

confidence: 99%

Advance Care Planning in the Elderly

Lum

Sudore

Bekelman

2015

Medical Clinics of North America

Self Cite

130

107

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Barriers and Strategies to an Iterative Model of Advance Care Planning Communication

Abstract: Greater attention to connecting providers across the continuum, maximizing the potential of the electronic health record, and linking patient experiences to their values may help to connect ACP communication across the continuum.

Cited by 42 publications

References 43 publications

What do hospital professionals report as helping in overcoming obstacles for ACP decision-making? A qualitative study

What do hospital professionals report as helping in overcoming obstacles for ACP decision-making? A qualitative study

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

Advance Care Planning in the Elderly

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