Montgomery et al's Response to Morrison: Advance Directives/Care Planning: Clear, Simple, and Wrong (DOI: 10.1089/jpm.2020.0272)

Montgomery, Carole; Hickman, Susan E.; Wilkins, Christine; Fromme, Erik K.; Anderson, Stephanie

doi:10.1089/jpm.2020.0523

Cited by 5 publications

(2 citation statements)

References 4 publications

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“…In the middle of a debate where the benefit of continuing ACP research is coming into question, 16 this is especially concerning. In a response to Dr Morrison’s notes from the editor, 16 Montgomery et al 23 call for further work to develop evidence-based conceptual models of ACP. This response further notes that the intervention logic must also be considered within the system where the intervention is implemented.…”

Section: Introductionmentioning

confidence: 99%

Complex advance care planning interventions for chronic serious illness: how do they work? a scoping review

Stevens

Deliëns

Pype

et al. 2021

BMJ Support Palliat Care

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ContextAdvance care planning (ACP) interventions have the potential to improve outcomes for patients with chronic serious illness. Yet the rationale for outcome choices and the mechanisms by which outcomes are achieved are not always clear.ObjectivesTo identify and map proposed mechanisms on how complex ACP interventions can impact outcomes for patients with chronic serious illness and to explore factors that might explain intervention outcomes.MethodsThis is a scoping review of randomised controlled trials of complex ACP interventions for patients with chronic serious illness which explicitly stated the mechanism(s) by which the intervention was thought to work. We searched six databases and hand-searched key journals and reference lists.ResultsInclusion yielded 16 articles. Inclusion procedures and mapping of mechanisms and outcomes indicated that causality between components and outcomes was not always clearly described. Tailoring intervention content to patients’ needs was linked to the greatest number of different outcome categories, while promoting competence and confidence to engage in ACP was most often explicitly linked to a primary outcome. Three main factors which might have affected intended outcomes were identified: participant characteristics, such as illness experience or cultural differences; the setting of implementation; or methodological limitations of the study.ConclusionFindings highlighted two main points of consideration for future ACP intervention studies: the need for clearly stated logic in how interventions are expected to impact primary outcomes and the importance of considering how an intervention may function for patients with chronic serious illnesses within a specific setting.

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Section: Introductionmentioning

confidence: 99%

Complex advance care planning interventions for chronic serious illness: how do they work? a scoping review

Stevens

Deliëns

Pype

et al. 2021

BMJ Support Palliat Care

View full text Add to dashboard Cite

show abstract

“…The STAMP outcomes reflect person-centered process and action advance care planning outcomes but do not address other key categories of advance care planning outcomes, including quality of care, health status, and health care 3 utilization, as well as surrogate decision-maker preparation (4,5). The STAMP team's selection of person-centered outcomes reflects increased attention to the issue of measurement and broader range of outcomes in advance care planning, rather than being exclusively focused on goal-concordant care, which is a difficult outcome to measure and may not be realistic given the intervention focus (6,7). Moving forward, there are real challenges to overcome to implement STAMP.…”

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confidence: 99%

Preparation Matters: What We Can Learn From an Olympic Swimmer About the Value of Advance Care Planning Interventions

Hickman

Lum

2021

Ann Intern Med

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In 2008, Olympic swimmer Michael Phelps broke a world record under unthinkably challenging circumstances-his goggles filled with water early in the race, and he was unable to see. When asked how he did it, he shared that he had grown bored with his coach's advice to mentally practice the perfect race and had instead begun to imagine what he would do if something went awry. When "swimming blind" unexpectedly became his reality, he already had a well-rehearsed strategy in his head for what he needed to do, enabling him to win his 10th gold medal (1).Michael Phelps' success shows the value of "mental contrasting," a well-established behavior change

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Implementing advance care planning in Swedish healthcare settings – a qualitative study of professionals’ experiences

Beck

Lundblad

Göras

et al. 2022

Scandinavian Journal of Primary Health Care

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Background Advance care planning (ACP) is a process involving conversations about values and preferences regarding future care at the end-of-life. ACP has led to positive outcomes, both in relation to quality of life and with increased use of palliative care, less life-sustaining treatment and fewer hospital admissions. Sweden has yet to embrace the practice systematically, but scattered initiatives exist. Aim To study implementation of a routine for ACP in NH settings in Sweden by exploring healthcare professionals’ experiences of engaging in ACP following this implementation. Methods The study followed a qualitative inductive design with convenience and snowball sampling. Semi-structured group and individual interviews with registered healthcare professionals were analysed using qualitative content analysis. Findings Organisational support for sustainable ACP implementation was found to be essential. This included sufficient training, facilitation, collaboration and uniform work routines across providers and professionals. Engaging in ACP conversations following the implemented routine was found to be a process of preparing, being, talking, deciding and sharing. Conclusions Successful implementation of ACP in NHs requires a carefully planned implementation strategy. ACP in NHs tend to be medically focused at the expense of residents’ psychosocial care-planning needs. Widespread uptake of ACP in Sweden could be useful in the national effort to adopt more person-centred care in Swedish healthcare. KEY POINTS While advance care planning has been implemented in many other countries, Sweden lacks a national strategy on advance care planning and Swedish healthcare settings have yet to systematically implement this practice. • This study is the first to report on professionals’ experiences of engaging in sustainable advance care planning, following top-down implementation of the practice in one Swedish region. • Successful implementation of advance care planning in nursing homes requires a system-level approach, and shortcomings of the implementation process are highlighted.

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Montgomery et al's Response to Morrison: Advance Directives/Care Planning: Clear, Simple, and Wrong (DOI: 10.1089/jpm.2020.0272)

Cited by 5 publications

References 4 publications

Complex advance care planning interventions for chronic serious illness: how do they work? a scoping review

Complex advance care planning interventions for chronic serious illness: how do they work? a scoping review

Preparation Matters: What We Can Learn From an Olympic Swimmer About the Value of Advance Care Planning Interventions

Implementing advance care planning in Swedish healthcare settings – a qualitative study of professionals’ experiences

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