Educating Healthcare Employees about Advance Care Planning

Glennon, Catherine; Thomas, Wendy; Black, Katherine; Herrig, Madison; J, Ishikawa; Reedy, Isabel

doi:10.4103/apjon.apjon_27_19

Cited by 5 publications

(9 citation statements)

References 10 publications

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“…Lastly, the influences of family members on patients's process of ACP decision-making ought to be taken into account by including family members (dyads) in future studies, to reflect the family-bond phenomena in the Chinese culture. The results from our study support nascent efforts to educate health providers in ACPrelated knowledge, to strengthen their communication skills, to provide the ACP-knowledge and skill-set needed to educate patients and their families, and to embrace a multidisciplinary approach-thus ensuring efficient ACPrelated decision-making [55].…”

Section: Conclusion and Recommendationssupporting

confidence: 65%

The decisional balance, attitudes, and practice behaviors, its predicting factors, and related experiences of advance care planning in Taiwanese patients with advanced cancer

et al. 2022

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Background Patients with advanced cancer are prone to experience burdensome physical, psychological, and financial consequences. Healthcare providers may not fully appreciate advanced cancer patients’ medical care autonomy, such as at that emboded by Advance Care Planning (ACP), and by doing so may compromise their quality of end-of-life (EOL). Hence, it is essential for healthcare providers to effectively assess and communicate with patients’ regarding their medical decisions before their patients are incapacitated by their disease progression. The purpose of this investigation was to describe the decisional balance, attitudes, and practice behaviors of ACP and its predictors of ACP-related experiences in Taiwanese patients with advanced cancer. Methods This cross-sectional, descriptive study employed a mixed-methodsquantitative and qualitative design with a sample of 166 patients that were purposely recruited from in-patient oncology units at a regional teaching hospital in southern Taiwan. Study data consisted of patient replies to a 34-item self-report tool, Decisional Balance, Attitudes, Practice Behaviors of ACP (DAP-ACP) and 4 semi-structured questions. Result Findings indicated that, in general, study participants exhibited favorable ACP-decisional balance and positive ACP-attitudes & practice behaviors. The results also indicated that gender, educational level, and cancer diagnosis were associated with significant differences on the “ACP-decisional balance” and “ACP-attitudes” scales. In addition, our findings documented that the participants’ gender and educational level were significant predictors of both ACP-decisional balance and ACP-attitudes. Furthermore the participants’ ACP-practice behaviors were predicted by ACP-decisional balance, but not with their ACP-attitudes. The qualitative analysis of the semi-structured questions identified six themes in responses to current medical decision making (e.g., compliance with physician instructions, family engagement in treatment decision-making); and eight themes pertaining to future ACP-related concerns were identified (e.g., family conflict, effectiveness of time-limited trials). Conclusion To promote patients’ engagement in ACP, the healthcare professional need to assess and advocate patients’ concerns or attitudes regarding ACP in a timely manner. In addition, factors or concerns that might influence patients’ responses to ACP derived from both the quantitative and qualitative findings of this current study need to be considered especially in initiating the dialogue regarding ACP with patients with advanced cancer. Trial registration No. CYCH 2,019,072, Date of registration 5 Dec 2019.

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Section: Conclusion and Recommendationssupporting

confidence: 65%

The decisional balance, attitudes, and practice behaviors, its predicting factors, and related experiences of advance care planning in Taiwanese patients with advanced cancer

et al. 2022

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“…Our sampling strategy also inhibits broad generalizations to other populations; however, we would argue that the present study offers an important contribution to knowledge about the reasoning and considerations leading to prioritized EoL preferences. While the GoWish cards have been used in several recent studies of different contexts and populations ( Banner et al, 2019 ; Delgado-Guay et al, 2016 ; Glennon et al, 2019 ; Kuramoto et al, 2015 ; Zachariah, Klein, Clifton-Hawkins, Andrews, & Gross, 2015 ), we have found few other studies reporting on how GoWish items have been reasoned about and negotiated by users. The study by Lee, Hinderer, and Alexander (2018) on EoL preferences for Chinese Americans is a rare exception, also involving community-dwelling older adults, as they briefly report on how participants commented card items.…”

Section: Discussionmentioning

confidence: 91%

Exploring Community-Dwelling Older Adults’ Considerations About Values and Preferences for Future End-of-Life Care: A Study from Sweden

2020

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Background and Objectives There is a substantial body of research on advance care planning (ACP), often originating from English-speaking countries and focused on health care settings. However, studies of content of ACP conversations in community settings remain scarce. We therefore explore community-dwelling, older adults’ reasoning about end-of-life (EoL) values and preferences in ACP conversations. Research Design and Methods In this participatory action research project, planned and conducted in collaboration with national community-based organizations, we interviewed 65 older adults without known EoL care needs, about their values and preferences for future EoL care. Conversations were stimulated by sorting and ranking statements in a Swedish version of GoWish cards, called the DöBra cards, and verbatim transcripts were analyzed inductively. Results While participants shared some common preferences about EoL care, there was great variation among individuals in how they reasoned. Although EoL preferences and prioritizations could be identical, different individuals explained these choices very differently. We exemplify this variation using data from four participants who discussed their respective EoL preferences by focusing on either physical, social, existential, or practical implications. Discussion and Implications A previously undocumented benefit of the GoWish/DöBra cards is how the flexibility of the card statements support substantial discussion of an individual’s EoL preferences and underlying values. Such in-depth descriptions of participants’ reasoning and considerations are important for understanding the very individual nature of prioritizing EoL preferences. We suggest future users of the DöBra/GoWish cards consider the underlying reasoning of individuals’ prioritizations to strengthen person-centeredness in EoL conversations and care provision.

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“…Knowledge gaps revealed by the initial findings guided the project team to search for methods of ACP-focused education and narrow the topics that would be taught. 4,6,7,[11][12][13] Change strategies were developed in response to follow-up surveys using the GRiP matrix. 14 This facilitated the group process to explore barriers to best practices and to identify, develop, and implement strategies to increase compliance with audit criteria.…”

Section: Phase 2: Design and Implementation Of Strategies To Improve ...mentioning

confidence: 99%

“…Guided by the literature, the project lead educated the staff regarding AD, Durable Power of Attorney (DPOA), Physicians Orders for Life-Sustaining Treatment (POLST), and Living Wills. 1,7,11 During a virtual meeting with 28 nurses, the project lead delivered a presentation discussing a review of the literature, scope of practice, definitions of common ACP terms, conversation prompts, and policies specific to the medical center. This was recorded, a QR code was made available in the charting room, a weblink was emailed, and 16 additional views were counted.…”

Section: Inadequate Knowledgementioning

confidence: 99%

“…In contrast, nurses’ low confidence can be attributed to a lack of education regarding the topic 1 . Glennon et al posited that HCPs are not prepared to facilitate ACP conversations if they are unable to grasp the purpose and importance of the topic 7 . Therefore, nurses need to be primed with appropriate skills, as they are responsible for establishing decision-making processes to facilitate ACP and advocate for patients 8…”

Section: Introductionmentioning

confidence: 99%

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Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project

Garcia

Kim

Barbour

et al. 2023

JBI Evidence Implementation

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Introduction and objective: Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients’ preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses’ capacity to engage in ACP. Methods: This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability. Results: Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients’ treatment preferences. Conclusions: Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.

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Educating Healthcare Employees about Advance Care Planning

Abstract: The objective of this descriptive article is to provide a background of current research and data on advance care planning. Additionally, a proposed and detailed education initiative for increasing completion and understanding of advance care planning documents is presented.

Cited by 5 publications

References 10 publications

The decisional balance, attitudes, and practice behaviors, its predicting factors, and related experiences of advance care planning in Taiwanese patients with advanced cancer

The decisional balance, attitudes, and practice behaviors, its predicting factors, and related experiences of advance care planning in Taiwanese patients with advanced cancer

Exploring Community-Dwelling Older Adults’ Considerations About Values and Preferences for Future End-of-Life Care: A Study from Sweden

Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project

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