A Hospital-Based Advance Care Planning Intervention for Patients with Heart Failure: A Feasibility Study

Sadeghi, Bahman; Walling, Anne M.; Romano, Patrick S.; Ahluwalia, Sangeeta C.; Ong, Michael

doi:10.1089/jpm.2015.0269

Cited by 24 publications

(24 citation statements)

References 14 publications

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“…This has come about in order to break down taboos concerning death and dying. A systematized way to address EOL matters has been demonstrated in the Advanced Care Planning (ACP) [9, 10], which is a well-known approach to talking about EOL, also for chronic diseases [11, 12] and in hospital settings [13]. However, this approach has not been adopted systematically in hospitals, indicating that there are barriers to its implementation [14].…”

Section: Introductionmentioning

confidence: 99%

Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

2019

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Background End-of-life (EOL) conversations in hospital should serve to give patients the opportunity to consider future treatment options and help them clarify their values and wishes before it becomes relevant to make decisions about treatment. However, it is known that EOL conversations are not performed systematically in hospital. This may mean that patients and their relatives do not address EOL issues. There is a lack of knowledge about who is responsible for conducting these conversations, and when and under what circumstances they are conducted. The aim of this study was to explore the existing practices regarding EOL conversations in an acute care hospital setting. Methods The design was Interpretive Description and the methods for the data collection included: 1. Participatory observational studies in a pulmonary medical and surgical ward (a total of 66 h); 2. Four focus group interviews with healthcare professionals ( n = 14) from the wards. The analysis followed Spradley’s ethnosemantic analysis. Results The results revealed three cultural categories related to: 1. The physical and organizational setting; 2. The timing of EOL conversations and competencies and roles in addressing EOL issues and 3. Topics addressed in EOL conversations. The EOL conversations were part of daily clinical practice, but there was a lack of competencies, roles were unclear and the physical and organizational environment was not conducive to the conversations. The topics of the EOL conversations revolved around a “here-and-now” status of the patient’s disease progression and decisions about the level of treatment. To a lesser extent, the conversations included the patient’s and relatives’ thoughts and wishes concerning EOL, which allowed long-term care planning. Conclusion This study demonstrates that there are several barriers to talking about EOL in an acute care hospital setting, and future strategies must address an overall approach. In order to provide patients and their relatives with better opportunities to express their EOL wishes, there is a need for clearer roles and guidelines in an interdisciplinary approach to EOL conversations, alongside improved staff competencies and changes to the organizational and physical environment.

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Section: Introductionmentioning

confidence: 99%

Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

2019

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“…The Johns Hopkins Nursing Evidence-Based Practice Evidence Rating Scale was used to evaluate the level and quality of the evidence as specified in Table 1. 12 Two articles were level I with a quality rating of B, 13,14 3 articles were level III with a quality rating of B, [15][16][17] and 1 article was level IV with a quality rating of B. 18 Five studies included heart failure patients with sample sizes ranging from 36 patients to 313 patients.…”

Section: Resultsmentioning

confidence: 99%

“…The third theme focused on a strengthened connection between preferred and delivered care. 13,14,16,18 Two studies looked at care preferences for heart failure patients. 14,16 The populations were similar in nature; however, Kirchoff et al 14 also included end-stage renal disease patients.…”

Section: Strengthened Connection Between Preferred and Delivered Carementioning

confidence: 99%

“…When effective communication occurs with patients and surrogates willing to engage in conversation, their preferred care preferences closely align with the actual care they receive, regardless of formal documentation. 13,14,16,18 Increased Patient Involvement in ACP The fourth theme identified was increased patient involvement in ACP. [16][17][18] Patients with heart failure and COPD show interest in available treatment options but have a decreased understanding of their disease trajectories, which can impact discussions of their treatment preferences.…”

Section: Strengthened Connection Between Preferred and Delivered Carementioning

confidence: 99%

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Advance Care Planning in Chronically Ill Persons Diagnosed With Heart Failure or Chronic Obstructive Pulmonary Disease: An Integrative Review

Williams

Kozachik

Karlekar

et al. 2020

Am J Hosp Palliat Care

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Introduction: Advance care planning (ACP) discussions help guide future medical care consistent with patient wishes. These discussions should be a part of routine care and should be readdressed frequently as a patient’s medical condition changes. Limited literature exists supporting structured processes for identifying persons who may benefit from these conversations. The purpose of this integrative review was to understand whether targeting patients with episodic disease trajectories in the acute care setting will increase their willingness to participate in ACP discussions. Methods: Using the Johns Hopkins Nursing Evidence-Based Practice Model as a guideline, this integrative review focused on the research query “In the acute care setting, does targeting patients with heart failure or chronic obstructive pulmonary disease for ACP lead to increased willingness to participate in these discussions.” Articles from 2009 to September 2019 were considered for review. Results: Six articles met inclusion criteria for final analysis. Articles outside of the United States were excluded. Four themes emerged from the literature: (1) improved patient attitudes toward ACP, (2) effective communication surrounding care preferences, (3) strengthened connection between preferred and delivered care, and (4) increased patient involvement in ACP. Conclusion: Chronic diseases such as heart failure and COPD have a high symptom burden punctuated by exacerbations, making it difficult to know when introduction of ACP discussions would be most beneficial. Future research should focus on a deeper evaluation of when to introduce ACP conversations in this population and which ACP interventions are effective to facilitate these discussions.

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“…Practitioners of this program, before discharging the patient, discuss individualized prognosis and specific treatment options through videos and booklets, and at the end of the meetings patients are encouraged to discuss care in the home setting. 10 We also identified a secondary prevention program conducted by nurses to limit the evolution of the disease, with patients admitted to the hospital unit for ACS, who are evaluated, interviewed and followed by the study nurses through contact, phone counseling and advice on healthy living and drug titration to achieve target values for blood pressure and blood lipids. 11 Another educational intervention found in the articles analyzed is the Basic Educational Program for the prevention of cardiovascular disease that uses AsuRiesgo (acronym for Asuncion modificacion de factores de Riesgo cardiovascular -Modification of Cardiovascular Risk Factors) with cardiac patients.…”

Section: Discussionmentioning

confidence: 99%

Educational technologies for cardiopathy

Farias

Silva

et al. 2020

R.pesq.:cuid.fundam.Online

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Objetivo: identificar as tecnologias utilizadas por enfermeiros no processo educativo de pessoas com cardiopatia no ambiente hospitalar. Método: trata-se de uma revisão integrativa realizada nas bases de dados virtuais Pubmed, Scielo e Lilacs. Foram selecionados dez publicações e ao final, foi realizado uma análise dos estudos selecionados a fim de identificar sua relevância e aplicabilidade. Resultados: verifica-se a grande diversidade de tecnologias elaboradas e implementadas, variando entre programas educativos com a utilização de vídeos, questionários e instrumentos, programas de rastreamento, de acompanhamento após alta hospitalar, encontros grupais e momentos educativos direcionados aos pacientes no ambiente da pesquisa. Conclusão: foi identificado uma grande variedade de tecnologias utilizadas por enfermeiros no processo educativo de pessoas com cardiopatia no ambiente hospitalar, o que contribui para diminuição do tempo de internação hospitalar, menores índices de reinternações e reincidências por Doenças Cardiovasculares, atuando ainda na reabilitação cardiovascular do paciente.

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A Hospital-Based Advance Care Planning Intervention for Patients with Heart Failure: A Feasibility Study

Abstract: A hospital-based ACP intervention using nonclinician health educators is feasible to implement and has the potential to facilitate the ACP process.

Cited by 24 publications

References 14 publications

Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

Talking about end of life in general palliative care – what’s going on? A qualitative study on end-of-life conversations in an acute care hospital in Denmark

Advance Care Planning in Chronically Ill Persons Diagnosed With Heart Failure or Chronic Obstructive Pulmonary Disease: An Integrative Review

Educational technologies for cardiopathy

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