Low Rates of Advance Care Planning (ACP) Discussions Despite Readiness to Engage in ACP Among Liver Transplant Candidates

Wang, Connie W.; Lebsack, Adrienne; Sudore, Rebecca L.; Lai, Jennifer C.

doi:10.1007/s10620-020-06369-1

Cited by 25 publications

(23 citation statements)

References 22 publications

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“…In addition, they wanted to avoid end-of-life decision-making conflicts. This is consistent with the research findings of Wang et al 30 However, not all elderly AIDS patients considered it necessary to have an ACP discussion at this stage. This was a result of their misunderstanding of the ACP concept and lack of AIDS knowledge.…”

Section: Strengthen Public Education To Promote the Acp Cognitionsupporting

confidence: 91%

Advance Care Planning Among Elderly Acquired Immunodeficiency Syndrome Patients

Yang

Chen

Hou

et al. 2021

J Hosp Palliat Nurs

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Complications arising from human immunodeficiency virus may affect the ability of elderly AIDS patients to communicate and make decisions about future medical care. It is important for elderly AIDS patients to be able to express effectively their preferences for future treatments and care. This study explored preferences and influencing factors of advance care planning among elderly AIDS patients. A semistructured interview outline was developed based on the theory of planned behavior. A qualitative preference interview was conducted among 16 eligible elderly AIDS patients. Using thematic analysis, the data were analyzed and categorized into 3 themes and 9 subthemes that were classified under the theory of planned behavior framework. The 3 themes were as follows: a positive attitude toward advance care planning, a strong desire for family and social support, and some obstacles to discussing advance care planning in the current environment. These themes provided valuable insights to advance care planning educators and practitioners from different work environments and units to aid them in constructing future ACP intervention models for elderly AIDS patients.

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Section: Strengthen Public Education To Promote the Acp Cognitionsupporting

confidence: 91%

Advance Care Planning Among Elderly Acquired Immunodeficiency Syndrome Patients

Yang

Chen

Hou

et al. 2021

J Hosp Palliat Nurs

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“…This low frequency of performing ACP is not unique to our institution. 17,18 Nationally, less than 50% of older adults have any form of an AD, and rates of ACP may be even lower for patients undergoing surgery. 4,5 Our results are consistent with the existing literature by demonstrating low rates of adherence with multiple aspects of ACP.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Advance Care Planning for Older Adults Undergoing Major Abdominal Surgery

Bleicher

McGuire

Robbins

et al. 2021

Am J Hosp Palliat Care

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Background: Advance care planning (ACP) is recommended for older patients undergoing surgery. ACP consists of creating advance directives (ADs), identifying surrogate decision makers (SDMs), and documenting goals of care. We identified factors associated with documentation of preoperative ACP to identify opportunities to optimize ACP for older surgical patients. Methods: This was a retrospective study of surgical patients ≥70 years old who underwent elective, high-risk abdominal procedures between 01/2015-08/2019. Clinical data were obtained from our institution’s National Surgical Quality Improvement Project database. ACP metrics were extracted from the electronic medical record. We analyzed the data to identify patient factors associated with ACP metrics. We also analyzed whether ACP was more frequent for patients who experienced postoperative complications or death. Results: 267/1,651 patients were included. 97 patients (36%) had an AD available on the day of surgery, 57 (21%) had an SDM identified, and 31 (12%) had a documented goals of care conversation. On multivariable analysis, older age and white race were associated with an increased likelihood of having an AD available on the day of surgery. Women were 1.7 times more likely to have an SDM (p = 0.02). No patient or surgeon factors were significantly associated with goals of care documentation. ACP was not performed more frequently in patients who experienced postoperative complications or death. Conclusion: In this series, ACP was not routinely documented for older patients undergoing major surgery. ACP was not more frequent in patients who experienced complications or death, demonstrating the importance of universal preoperative ACP in older patients.

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“…Advance care planning (ACP) with patients on the LT waiting list One qualitative (34), two quantitative (21, 35) and one quasi-experimental (29) study contributed to the theme of ACP with patients on the LT waiting list (Table 4). These studies highlighted that although patients report that they are ready to engage in the process of ACP (34,35), there is little evidence of this taking place with one study showing that 9% of these patients reported completing an ACP prior to their LT evaluation, and only 10% reporting having a Durable Power of Attorney written in their medical notes (35). Patient participants remember receiving information about the risk of death whilst they were on the LT waiting list but were not aware of receiving information about making a decision about a Goals of Care Designation i.e.…”

Section: Study Participantsmentioning

confidence: 99%

Palliative Care for Patients with End-Stage Liver Disease on the Liver Transplant Waiting List: An International Systematic Review

et al. 2021

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Background and Aim. People with end stage liver disease on the liver transplant waiting list have high symptom burden, which can successfully be addressed by specialist palliative care. Potential tensions with the perceived curative nature of liver transplant make delivering specialist palliative care challenging. This systematic review seeks to establish what is known on the impact of specialist palliative care for patients on liver transplant waiting lists, healthcare professionals' perspectives of providing specialist palliative care for this population, and uptake of advance care planning (ACP).Medline, Embase and CINAHL were searched to 5th May 2020. Qualitative and quantitative findings were grouped together according to main relevant themes.Results: Eight studies of mixed quality and mainly quantitative, were identified. Findings suggest early palliative care intervention improve patients' symptoms and prompt ACP conversations, but patients on the waiting list receive limited palliative care input. Liver physicians' lack of clarity on referral criteria and liver transplant patients' concerns of being abandoned, were reasons for reluctance to refer to specialist palliative care. They felt referral to specialist palliative care is appropriate only for patients receiving hospice or end of life care. Uptake and understanding of ACP and Goals of Care designation by patients is poor.Conclusions: This review found evidence of benefit of specialist palliative care for patients on liver transplant waiting lists, but found in a limited understanding of their role. Evidence is limited to studies from North America. Future research is needed to understand better how palliative care could be provided into this clinical environment.

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Low Rates of Advance Care Planning (ACP) Discussions Despite Readiness to Engage in ACP Among Liver Transplant Candidates

Cited by 25 publications

References 22 publications

Advance Care Planning Among Elderly Acquired Immunodeficiency Syndrome Patients

Advance Care Planning Among Elderly Acquired Immunodeficiency Syndrome Patients

Preoperative Advance Care Planning for Older Adults Undergoing Major Abdominal Surgery

Palliative Care for Patients with End-Stage Liver Disease on the Liver Transplant Waiting List: An International Systematic Review

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