Feasibility and acceptability of introducing advance care planning on a thoracic medicine inpatient ward: an exploratory mixed method study

Abstract

Background and aimsAdvance care planning (ACP) is communication about wishes and preferences for end-of-life care. ACP is not routinely used in any Norwegian hospitals. We performed a pilot study (2014–2017) introducing ACP on a thoracic medicine ward in Norway. The aims of this study were to explore which topics patients discussed during ACP conversations and to assess how patients, relatives and clinicians experienced the acceptability and feasibility of performing ACP.MethodsConversations were led by a study nurse or physician using a semistructured guide, encouraging patients to talk freely. Each conversation was summarised in a report in the patient’s medical record. At the end of the pilot period, clinicians discussed their experiences in focus group interviews. Reports and transcribed interviews were analysed using systematic text condensation.ResultsFifty-one patients participated in ACP conversations (41–86 years; 9 COPD, 41 lung cancer, 1 lung fibrosis; 11 women); 18 were accompanied by a relative. Four themes emerged: (1) disturbing symptoms, (2) existential topics, (3) care planning and (4) important relationships. All participants appreciated the conversations. Clinicians (1 physician and 7 nurses) participated in two focus group interviews. Reports from ACP conversations revealed patient values previously unknown to clinicians; important information was passed on to primary care. Fearing they would deprive patients of hope, clinicians acted as gatekeepers for recruitment. Although they reported barriers during recruitment, many clinicians saw ACP as pertinent and called for time and skills to integrate it into their daily clinical practice.ConclusionsPatients, relatives and clinicians showed a positive attitude towards ACP. Focusing on present and future symptom control may be an acceptable way to introduce ACP. Important aspects for implementing ACP in this patient group are management support, education, training, feasible routines and allocated time to perform the conversations.

Psychological resilience among palliative patients with advanced cancer: A systematic review of definitions and associated factors

“…The 10 qualitative studies in the present review explored palliative patients' perspectives on their sources of resilience as they live with advanced cancer (Table 4). Spirituality, 26–28 social support from friends and family, 27–29 and prior experience dealing with illness and life adversity 30–32 were the most common sources. Meaning‐making (or positive reframing), 30,33 reconciling with life's finiteness (by focusing on past experiences and the present with a positive orientation towards a limited future), 28,31 acceptance of illness, 28,29 and a sense of control and determination 26 were also commonly cited sources of psychological resilience in palliative patients.…”

“…Spirituality, 26–28 social support from friends and family, 27–29 and prior experience dealing with illness and life adversity 30–32 were the most common sources. Meaning‐making (or positive reframing), 30,33 reconciling with life's finiteness (by focusing on past experiences and the present with a positive orientation towards a limited future), 28,31 acceptance of illness, 28,29 and a sense of control and determination 26 were also commonly cited sources of psychological resilience in palliative patients. Other possible sources of resilience included having a positive attitude, 26 hope, 31 dignity, 34 engagement with palliative care, 26 and quality of life being supported by palliative care 29 .…”

“…Meaning‐making (or positive reframing), 30,33 reconciling with life's finiteness (by focusing on past experiences and the present with a positive orientation towards a limited future), 28,31 acceptance of illness, 28,29 and a sense of control and determination 26 were also commonly cited sources of psychological resilience in palliative patients. Other possible sources of resilience included having a positive attitude, 26 hope, 31 dignity, 34 engagement with palliative care, 26 and quality of life being supported by palliative care 29 . Only one study 35 also looked at psychological resilience as a source instead, suggesting that it enhances or contributes to a sense of dignity in palliative patients with advanced cancer.…”

“…Corresponding to the respective study designs, the JBI critical appraisal checklists for analytical cross sectional (four studies), 11–13,22 qualitative research (10 studies), 26–35 and randomised controlled trials (one study) 21 were utilised. Appraisal scores were calculated as a proportion of the number of items each study fulfilled on its respective checklist, after excluding non‐applicable items.…”

How Do Patients with Life-Limiting Illness and Caregivers Want End-Of-Life Prognostic Information Delivered? A Pilot Study

“…A previous attempt to raise sensitive conversations using vignette techniques in Australia yielded a high acceptability and low level of missing data [ 19 ]. Another recent pilot in Norway also demonstrated the feasibility of initiating difficult conversations on advance care planning with hospitalized patients [ 20 ].…”