Serious Illness Conversations in advanced kidney disease: a mixed-methods implementation study

Thamcharoen, Natanong; Nissaisorakarn, Pitchaphon; Cohen, Robert A.; Schonberg, Mara A.

doi:10.1136/bmjspcare-2020-002830

Cited by 12 publications

(27 citation statements)

References 24 publications

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“…Of these, 11 were randomized controlled trials (RCTs) using different methods, 28–30,47,53,55,60,61,63,64,66 1 was a secondary analysis of data from an RCT, 65 and 2 studies also had an experimental design but were not RCTs 43,51 . Seven studies had a prospective study design, 41,42,46,48,49,56,68 3 studies were intervention development and piloting studies, 44,45,69 1 study was a mixed methods implementation study, 67 3 studies were retrospective observational studies, 40,57,59 1 study was an economic evaluation based on data from one of the retrospective studies, 58 1 was a cross-sectional study with a pre- and post-test survey, 50 1 was an evaluation of the procedure of a multidisciplinary deliberation clinic through an Ethics Committee in Nephrology, 54 1 was a case review and guide for nephrologists, 52 and 1 was a qualitative interview study with thematic analysis 62 . Patient involvement interventions were mostly evaluated in clinical settings 28–30,40–45,47–51,53–55,57–67 or simulation centers 46,56,68,69 .…”

Section: Resultsmentioning

confidence: 99%

Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review

Buur

Bekker

Madsen

et al. 2023

JBI Evidence Synthesis

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Objective: The objective of this review was to investigate and map empirical evidence of patient involvement interventions to support patients with kidney failure making end-of-life care decisions in kidney services. Introduction: Clinical guidance integrating end-of-life care within kidney failure management pathways varies. Advance care planning interventions aimed at involving patients with kidney failure in their end-of-life care planning are established in some countries. However, there is limited evidence of the other types of patient involvement interventions integrated within services to support patients with kidney failure in making decisions about their end-of-life care. Inclusion criteria: This scoping review included studies exploring patient involvement interventions evaluated for patients with kidney failure considering end-of-life care, their relatives, and/or health professionals in kidney services. Studies of children under the age of 18 years were excluded. Methods: The review was informed by JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. MEDLINE, Scopus, Embase, and CINAHL were searched for full-text studies in English, Danish, German, Norwegian, or Swedish. Two independent reviewers assessed the literature against the inclusion criteria. A relational analysis framework was used to synthesize the data extracted from the included studies, and to investigate and map different patient involvement interventions. Results: The search identified 1628 articles, of which 33 articles met the inclusion criteria. A total of 23 interventions were described. Interventions targeted patients (n=3); health professionals (n=8); patients and health professionals (n=5); and patients, relatives, and health professionals (n=7). Intervention components included patient resources (eg, information, patient decision aids), consultation resources (eg, advance care planning, shared decision-making), and practitioner resources (eg, communication training). Patient involvement interventions were delivered within hospital-based kidney services. Conclusions: The review identified several ways to support patients with kidney failure to be involved in end-of-life care decisions. Future interventions may benefit from adopting a complex intervention framework to engage multiple stakeholders in the research and design of an intervention for shared decision-making between patients with kidney failure, their relatives, and health professionals about integrating end-of-life care options into their kidney disease management pathway.

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Section: Resultsmentioning

confidence: 99%

Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review

Buur

Bekker

Madsen

et al. 2023

JBI Evidence Synthesis

View full text Add to dashboard Cite

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“…One barrier for implementation was the physicians' fear of taking away patients' hope when talking about what might happen. However, a recent study showed that patients felt SIC helped them to reflect on their prognosis and goals of care, and did not decrease their hope or provoke anxiety [41]. Another study described that the conversations were useful, and although they did not find any differences in patients' experiences of peacefulness or hopefulness, they found that the patients experienced better planning for future care with a focus on their personal priorities [22].…”

Section: Discussionmentioning

confidence: 97%

Organizational readiness to implement the Serious Illness Care Program in hospital settings in Sweden

Andersson

Sandgren

2022

BMC Health Serv Res

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Background The Serious Illness Care Program (SICP) is a model developed for structured communication, identifying patients, and training physicians to use a structured guide for conversations with patients and family members. However, there is a lack of knowledge regarding the sustainable implementation of this conversation model. Therefore, the aim of this study was to identify barriers and enablers during the implementation of the SICP in hospital settings. Methods The SICP was implemented at 20 units in two hospitals in Sweden. During the implementation process, seven individual interviews and two group interviews were conducted with seven facilitators (five physicians, one behavioral therapist, and one administrator). Data were analyzed using qualitative content analysis, first inductively, and then deductively using the organizational readiness for change as a theoretical framework. Result The analysis resulted in three factors acting as enablers and eight factors acting as enablers and/or barriers during the implementation of the SICP. The three factors considered as enablers were preliminaries, identifying patients, and facilitator’s role. The eight factors considered as enablers and/or barriers were broad implementation, leadership, time, confidence, building foundation, motivation to work change, motivation for training in serious illness conversations, and attitudes. Conclusion This study indicates limited readiness to implement the SICP in hospital settings due to considerable variation in organizational contextual factors, change efficacy, and change commitment. The identified enablers and barriers for implementation of the SICP could guide and support future implementations to be sustainable over time.

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“… Staff = 14 10 (71.4%) The shifts in processes employed by inter-professional clinicians revealed comprehensive models for prognostic communication and creative workflows to ensure that patients with complex illnesses had proactive, longitudinal, and patient-centered SICs and care planning. Thamcharoen et al (2021) [ 54 ] U.S. This pilot study aimed to explore whether use of the SICG to aid early ACP is acceptable, and to evaluate the information gained from these conversations. Mixed-methods implementation study.…”

Section: Table A1mentioning

confidence: 99%

Patient Identification for Serious Illness Conversations: A Scoping Review

Baxter

Fromme

Sandgren

2022

IJERPH

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Serious illness conversations aim to align medical care and treatment with patients’ values, goals, priorities, and preferences. Timely and accurate identification of patients for serious illness conversations is essential; however, existent methods for patient identification in different settings and population groups have not been compared and contrasted. This study aimed to examine the current literature regarding patient identification for serious illness conversations within the context of the Serious Illness Care Program and/or the Serious Illness Conversation Guide. A scoping review was conducted using the Joanna Briggs Institute guidelines. A comprehensive search was undertaken in four databases for literature published between January 2014 and September 2021. In total, 39 articles met the criteria for inclusion. This review found that patients were primarily identified for serious illness conversations using clinical/diagnostic triggers, the ’surprise question’, or a combination of methods. A diverse assortment of clinicians and non-clinical resources were described in the identification process, including physicians, nurses, allied health staff, administrative staff, and automated algorithms. Facilitators and barriers to patient identification are elucidated. Future research should test the efficacy of adapted identification methods and explore how clinicians inform judgements surrounding patient identification.

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Serious Illness Conversations in advanced kidney disease: a mixed-methods implementation study

Cited by 12 publications

References 24 publications

Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review

Patient involvement interventions for patients with kidney failure making end-of-life care decisions: a scoping review

Organizational readiness to implement the Serious Illness Care Program in hospital settings in Sweden

Patient Identification for Serious Illness Conversations: A Scoping Review

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