Advance care decision making and planning

Tran, Michael; Grant, Matthew; Clayton, Josephine M; Rhee, Joel

doi:10.31128/ajgp-06-18-4613

Cited by 17 publications

(15 citation statements)

References 16 publications

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“…Contrary to the misconception that they indicate a patient's imminent death to clinicians 9 potentially compromising their care, 10 these vital documents address patient goals of care and preferences and provide a basis for clinical and ethical decision-making. 11,12 Although age and primary diagnosis has relevance for initiating a goal of care document (GOC), 10 it is good practice for patients to have such discussions with their general practitioners 13 (advance care plans) and then to have those plans reviewed early in the admission and prior to discharge. However, when patients are admitted to hospital, physicians do not routinely initiate such discussions until late in the course of an illness.…”

Section: Introductionmentioning

confidence: 99%

Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients

Subramaniam

Tiruvoipati

Green

et al. 2021

Internal Medicine Journal

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Section: Introductionmentioning

confidence: 99%

Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients

Subramaniam

Tiruvoipati

Green

et al. 2021

Internal Medicine Journal

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“…To avoid becoming a burden to their family members like their patient, the caregivers are more willing to discuss and even actively plan or sign advance directives for their EOL care wishes, and express their wishes to their immediate family members or medical staff. Scholars mentioned that it is an extremely stressful and burdensome process for family members to speculate whether the patient has a do not resuscitate order or life-sustaining therapy decisions [24]. Through the ACP process, family members will be better able to understand the patient's wishes, values, and EOL care decisions, assisting them in having a peaceful death, and thus feeling consoled.…”

Section: Discussionmentioning

confidence: 99%

Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

Chiang

Hsieh

Fan

et al. 2020

IJERPH

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The aging of the Taiwanese population has become a major issue. Previous research has focused on the burden and stress faced by caregivers, but has not explored how the experience of these caregivers influences decisions of advance care planning (ACP). Semi-structured and in-depth interviews were conducted. Qualitative content analysis was used to identify important themes. Five themes and fourteen sub-themes were identified: (1) Past experiences: patient wishes, professional recommendations, and expectation about disease progress; (2) Impact of care on family members: positive affirmation, open-minded life, social isolation and health effects, and financial and life planning effects; (3) Attitude toward life: not forcing to stay, and not becoming a burden, (4) Expected proxy dilemmas: torment between doing or not, seeing the extension of suffering and toil, and remorse and self-blame; (5) Expectation of end of life (EOL) care: caregiver’s experience and EOL care decisions, and practicality of EOL decision making. After making multiple medical decisions for their disabled relatives, caregivers are able to calmly face their own medical decisions, and “not becoming a burden” is their primary consideration. It’s suggested that implementation of shared decision-making on medical care for patients with chronic disability will not only improve the quality of their medical care but also reduce the development of remorse and guilty feelings of caregivers after making medical decisions.

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“…It is recommended that PAA-and ACP-related training be included in annual mandatory continuing education for HPs [20,24]. Particularly, HPs with managerial roles must undergo educational training of coordination or multidisciplinary consultations [24,25].…”

Section: Characteristics Of Participantsmentioning

confidence: 99%

Knowledge of and barriers to palliative care perceived by healthcare providers before and after promotion of the Patient Autonomy Act: A cross-sectional study

Chen

Kuo

Lin

et al. 2020

Preprint

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Background: During the period of 2016~2018, many efforts were put into promoting the Patient Autonomy Act (PAA) in Taiwan, such as nationally sponsoring advertisements, promoting campaigns, and conducting in-service training programs for healthcare providers. However, no study has examined the impacts of promoting the PAA on healthcare providers. This study was designed to investigate healthcare providers’ knowledge of palliative care and perceptions of palliative care barriers before and after promoting the PAA. Methods: A cross-sectional design was conducted in 2013 and 2018 respectively that used a self-reporting questionnaire to examine healthcare providers’ knowledge of palliative care and perceived barriers to providing palliative care. One hospital recruited 277 healthcare providers in 2013 and 222 healthcare providers in 2018 in another hospital. Statistical analyses involved descriptive statistics for demographic characters. Multivariate linear regression analyses were used to identify predictors of knowledge of and perceived barriers to palliative care. A principal component analysis was to identify the most appropriate factorial structure for the contents of knowledge and perceived barriers to palliative care. Results: Three factors related to knowledge of palliative care were identified in both 2013 and 2018 data: ‘policy, regulation, and promotion’, ‘philosophy and treatments’, and ‘myths and misunderstandings’. Study findings in the two periods were similar. As for barriers to providing palliative care, three factors were identified in 2013 of ‘quality palliative care’, ‘palliative care difficulties’ and ‘messaging and communication’, and in 2018 of ‘messaging and information’, ‘knowledge and attitudes’ and ‘quality palliative care’ were identified. Study findings differed between the two periods. Conclusion: After implementation of the PAA, perceived barriers changed. Policies can better reinforce mitigating strategies—including opportunities for education, shared decision-making, and changes in institutions and care systems. Also, assessing barriers creates important opportunities for further research to address the most critical aspects to improving end-of-life care for patients and their families.

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Advance care decision making and planning

Cited by 17 publications

References 16 publications

Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients

Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients

Does the Experience of Caring for a Severely Disabled Relative Impact Advance Care Planning? A Qualitative Study of Caregivers of Disabled Patients

Knowledge of and barriers to palliative care perceived by healthcare providers before and after promotion of the Patient Autonomy Act: A cross-sectional study

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