Stages of Change for the Component Behaviors of Advance Care Planning

Fried, Terri R.; Redding, Colleen A.; Robbins, Mark L.; Paiva, Andrea L.; OʼLeary, John R.; Iannone, Lynne

doi:10.1111/j.1532-5415.2010.03184.x

Cited by 154 publications

(151 citation statements)

References 35 publications

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“…22,23 The facilitators aim to support an interactive discussion that affords opportunities for patients to learn from the experiences and perspectives of others. To support the facilitators' role, we developed a "Facilitators' Communication Guide" (Table 2), which is similar to other patient/provider communication guides.…”

Section: Cpt = Current Procedural Terminologymentioning

confidence: 99%

“…The discussions include sharing experiences related to advance care planning, considering values related to serious illness, choosing surrogate decision makers, deciding how much flexibility to allow decision makers, and having conversations with decision makers and clinicians. 22,23 The facilitators aim to support an interactive discussion that affords opportunities for patients to learn from the experiences and perspectives of others. To support the facilitators' role, we developed a "Facilitators' Communication Guide" (Table 2), which is similar to other patient/provider communication guides.…”

Section: Conversation Group Medical Visitmentioning

confidence: 99%

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Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

et al. 2016

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PURPOSE Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care-based group visit model focused on advance care planning. METHODSWe conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project. RESULTSTen of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics.CONCLUSION A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system. 2016;14:125-132. doi: 10.1370/afm.1906. Ann Fam Med INTRODUCTIOND espite the benefits of advance care planning for patients, primary care clinicians face barriers to effective counseling on the issue, including their limited time and a lack of clinic-based support. [1][2][3][4] The Dying in America report 5 emphasized the need to integrate advance care planning into clinical care, and the Centers for Medicare and Medicaid Services recently approved reimbursement for counseling on advance care planning. 6 Advance care planning is an ongoing process that involves multiple conversations among individuals, family members, and health care professionals. 1,7 Studies show that many US decedents had not discussed preferences for end-of-life care with someone close to them, completed a living will, or established a durable power of attorney for health care. 8,9 Primary care clinics are uniquely positioned to implement new models that engage patients in advance care planning. 10 The American Academy of Family Physicians recognizes group medical visits (GMVs) as a strategic approach within the patient-centered medical home. 11,12 GMVs, also called shared medical appointments, engage patients in health promotion and disease management. [13][14][15][16][17][18] care, a...

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Section: Cpt = Current Procedural Terminologymentioning

confidence: 99%

Section: Conversation Group Medical Visitmentioning

confidence: 99%

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

et al. 2016

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“…Patients progressing one SoC during the first 1 month of treatment can double their chances of action (13). The SoC model has been used in multiple disciplines to aid patients in making difficult decisions about many conditions, including renal transplantation (14)(15)(16)(17)(18)(19)(20). The aims of this study were to (1) develop an SoC tool to measure patient readiness for dialysis modality decision-making, (2) determine associations between SoC and dialysis modality decision-making, and (3) determine additional factors associated with both SoC and dialysis decision-making.…”

Section: Introductionmentioning

confidence: 99%

Behavioral Stage of Change and Dialysis Decision-Making

Prakash

McGrail

Lewis

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Behavioral stage of change (SoC) algorithms classify patients' readiness for medical treatment decision-making. In the precontemplation stage, patients have no intention to take action within 6 months. In the contemplation stage, action is intended within 6 months. In the preparation stage, patients intend to take action within 30 days. In the action stage, the change has been made. This study examines the influence of SoC on dialysis modality decision-making.Design, setting, participants, & measurements SoC and relevant covariates were measured, and associations with dialysis decision-making were determined. In-depth interviews were conducted with 16 patients on dialysis to elicit experiences. Qualitative interview data informed the survey design. Surveys were administered to adults with CKD (eGFR#25 ml/min/1.73 m 2 ) from August, 2012 to June, 2013. Multivariable logistic regression modeled dialysis decision-making with predictors: SoC, provider connection, and dialysis knowledge score.Results Fifty-five patients completed the survey (71% women, 39% white, and 59% black), and median annual income was $17,500. In total, 65% of patients were in the precontemplation/contemplation (thinking) and 35% of patients were in the preparation/maintenance (acting) SoC; 62% of patients had made dialysis modality decisions. Doctors explaining modality options, higher dialysis knowledge scores, and fewer lifestyle barriers were associated with acting versus thinking SoC (all P,0.02). Patients making modality decisions had doctors who explained dialysis options (76% versus 43%), were in the acting versus the thinking SoC (50% versus 10%), had higher dialysis knowledge scores (1.4 versus 0.5), and had lower eGFR (13.9 versus 16.8 ml/min/1.73 m 2 ; all P,0.05). In adjusted analyses, dialysis knowledge was significantly associated with decision-making (odds ratio, 4.2; 95% confidence interval, 1.4 to 12.9; P=0.01), and SoC was of borderline significance (odds ratio, 5.8; 95% confidence interval, 1.0 to 32.6; P=0.05). The model C statistic was 0.87.Conclusions Dialysis decision-making was associated with SoC, dialysis knowledge, and physicians discussing treatment options. Future studies determining ways to assist patients with CKD in making satisfying modality decisions are warranted.

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“…Barriers to completing an advanced directive included lack of time or completion not being a priority and lack of knowledge or denial of health status knowledge (Aw et al, 2012;Barnes, Jones, Tookman & King, 2007;Fried et al, 2010;Jezewski & Meeker, 2005). Thorevska et al (2005) described subjects who had completed a living will as more likely to be white, Protestant and highly educated.…”

Section: Synthesis Of Evidencementioning

confidence: 99%

Cardio Pulmonary Resuscitation Decisions in Nursing Home Residents

Bennett

Moddeman²,

Gaspar³

et al. 2013

Journal of the American Medical Directors Association

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Objective: Cardiopulmonary resuscitation (CPR) performed on nursing home residents, consistently demonstrates poor outcomes with less than 5% survival rate (AMDA, January 30, 2011). Study participants overestimate CPR survival based on television and lack of accurate information (Adams & Snedden, 2006;van Mil et al., 2000). This project evaluated use of a video decision tool on CPR choices in nursing home residents over three months. Methods:A CPR video decision tool was added to advance care planning discussions as an audiovisual component to educate nursing home residents and their decision makers.Nurse Practitioners (NPs) documented the resident's choices in the electronic health record (EHR). Clinical metric reports, based on the EHR, were used to measure the change in CPR decisions over three months in seven nursing homes.Significance: Health care spending is disproportionate at the end of life-30% of Medicare expenditures are attributed to 5% of beneficiaries who die annually and 78% of costs are incurred in the final 30 days of life (Yu, 2008). Studies indicate a reduction in hospitalizations by increasing the use of advanced directives, surrogate decision makers and do not resuscitate decisions (Levy, Morris & Kramer, 2008;Molloy et al. 2000;and Nicholas, Langa, Iwashyna & Weir, 2011). Integration of a CPR video tool (Nous Foundation, 2010) into advance care planning, has the potential to reduce hospitalizations and health care costs, and ensure end of life care is consistent with resident wishes (Aw et al., 2012). Results:The mean percentage change following implementation of the CPR video tool was 5.5% with p=.226. One facility closed during the pilot, one facility with a new NP showed an increase in residents requesting CPR and one of the eight facilities showed no change. The decrease in residents requesting CPR was not statistically signficant following integration of the CPR video tool. Despite the lack of statistical significance, a 5.5% reduction in residents selecting CPR with an equivalent reduction in hospitalizations would reduce medical expenses by $56,987.Keywords: CPR; Nursing Home; Video Decision Tool -3 - Appendix J Post Implementation Call Log 88-5 - Tables Table 1 Critical Apprisal of Evidence 16 Table 2 AGREE Guideline Evaluation 16 Table 3 Rapid Critical Appraisal of Systematic Review 18 Table 4 Recommendations with Levels of Effectiveness 27 Table 5 Evidence Synthesis 30 Table 6 Timeline for Project Implementation 32 Table 7 Descriptive Statistics 38 Table 8 Tests of Between Subjects Effects 38 List of List of Figures SummaryThe proposed integration of a video CPR decision tool into the existing advance care planning discussions between the nurse practitioners, nursing home residents and their decision makers is projected to reduce the number of residents requesting CPR to less than the current 36.7% as a primary direct outcome measurement. Theoretical Framework-Organizational Process ChangeThe Rosswurm and Larrabee (1999) model for evidence-based practice change em...

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Stages of Change for the Component Behaviors of Advance Care Planning

Cited by 154 publications

References 35 publications

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

Behavioral Stage of Change and Dialysis Decision-Making

Cardio Pulmonary Resuscitation Decisions in Nursing Home Residents

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