Advance care planning in primary care, only for severely ill patients? A structured review

Glaudemans, Jolien J; Charante, Eric P. Moll van; Willems, Dick L.

doi:10.1093/fampra/cmu074

Cited by 88 publications

(84 citation statements)

References 27 publications

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“…Empirical evidence reporting the prevalence of ACP discussion or AD documentation has largely come from Western countries. Despite the benefits of ACP or AD use and recommendations that it be administered early before a disease crisis (Brinkman‐Stoppelenburg et al, ; Detering & Silveira, ; Silveira et al, ), ACP discussions and AD documentation remain underused (Glaudemans et al, ). The utilisation rates vary by healthcare context (Glaudemans et al, ), with the completion of ADs ranging from 26.3% of the general adult population aged 18 years or older in the United States (Rao, Anderson, Lin, & Laux, ) to 71% among deceased American adults (Enguidanos & Ailshire, ).…”

Section: Discussionmentioning

confidence: 99%

“…Today, the early integration of ACP or ADs into standard care is highly recommended, as it has beneficial effects on patient and family outcomes (Brinkman‐Stoppelenburg, Rietjens, & van der Heide, ; Detering & Silveira, ; Silveira, Kim, & Langa, ), and their use is common among severely ill patients, such as those with cancer or lung disease (Enguidanos & Ailshire, ; Vanbutsele et al, ). However, the broader application of ACP or ADs to the primary care population and its effects on this population need further investigation (Glaudemans, Moll van Charante, & Willems, ; Hinders, ). Access to such care is limited, and its use varies by population (Glaudemans et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…However, the broader application of ACP or ADs to the primary care population and its effects on this population need further investigation (Glaudemans, Moll van Charante, & Willems, ; Hinders, ). Access to such care is limited, and its use varies by population (Glaudemans et al, ). Documentation of an AD is relatively low in patients with severe chronic diseases (Diestre, Gonzalez, Collell, Perez, & Hernando, ), which can lead to unnecessary aggressive treatments.…”

Section: Introductionmentioning

confidence: 99%

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Correlates of advance directive treatment preferences among community‐dwelling older people with chronic diseases

Kim

Heo

Hong

et al. 2019

Int J Older People Nursing

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Background: Concerns over the creation of advance directives (ADs) and the factors associated with treatment directive decisions among Korean community-dwelling older people with chronic diseases have rarely been addressed. Objectives:This study aimed to examine knowledge, attitudes and barriers/benefits regarding ADs and their associations with AD treatment preferences among chronically ill, low-income, community-dwelling older people.Methods: Using a descriptive, correlational design, older people who were recipients of home visiting service for chronic disease management participated in this study.Home visiting nurses collected data on knowledge, attitudes and perceived barriers/ benefits and treatment directives using questionnaires during home visits. Results:Older people (N = 112, mean age = 74.9 years, women = 83.9%) who had chronic diseases such as hypertension (56.3%), diabetes mellitus (40.2%) and cardiovascular disease/stroke (22.3%) participated. Approximately half of the participants preferred hospice care (54.5%), while a few of them preferred aggressive treatments: cardiopulmonary resuscitation (CPR) (14.3%), ventilation support (9.8%) and haemodialysis (8.9%). Being married was associated with the likelihood of preferring CPR (odds ratio [OR] = 11.79) and ventilation support (OR = 9.99), higher education with CPR (OR = 1.23) and haemodialysis (OR = 1.16), and having a cardiovascular disease (CVD)/stroke with CPR (OR = 6.46) and hospice care (OR = 3.06). Among the modifiable factors, greater perceived barriers increased the likelihood of CPR preference (OR = 1.12) but decreased the likelihood of hospice care preference (OR = 0.96).Greater perceived benefits decreased the likelihood of CPR preference (OR = 0.81) and ventilation support (OR = 0.89), and AD knowledge decreased the likelihood of haemodialysis preference (OR = 0.23). Conclusion:The multidimensional factors were differently associated with each of the AD treatment preferences. Modifiable factors, including perceived barriers and benefits and knowledge, should be improved to help low-income, community-dwelling older people select adequate AD treatment preferences.Implications for practice: Additional information regarding AD treatments and some modifiable and non-modifiable correlates can be integrated into primary and palliative/supportive care in public health. The current home visitation service may also

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Correlates of advance directive treatment preferences among community‐dwelling older people with chronic diseases

Kim

Heo

Hong

et al. 2019

Int J Older People Nursing

View full text Add to dashboard Cite

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“…Systematic and narrative reviews of ACP interventions in primary care settings emphasize the need for sustainable interventions. 41 Simultaneously, there is an increased focus on ACP as a measure of patient-directed, high-quality health care. The National Committee for Quality Assurance’s 2014 patient-centered medical home standards include a quality metric related to advance directive documentation.…”

Section: Discussionmentioning

confidence: 99%

A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

et al. 2017

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Introduction Group visits for advance care planning (ACP) may help patients document preferences for decision makers and future care. We assessed the impact of a primary care-based ACP group visit (ACP-GV) intervention on older adults’ ACP documentation and why patients participated. Methods Older adults (>65 years) in primary care participated in a 2-session ACP-GV intervention that promotes group dynamics, peer-based learning, and goal setting. Charts were reviewed at baseline, 3 months, and 12 months for documentation of decision makers and ACP forms. We described patients’ reasons for participating through analysis of transcripts. Results 118 patients (mean age 76 years; 62% female and 82% white) participated in 16 ACP-GV cohorts. From baseline to 3-month follow-up, documentation of decision maker preferences increased from 39% to 81%, and was 89% at 12-month follow-up. Patients with completed ACP forms increased from 20% to 57% at 3 months, and was 67% at 12 months. Reasons for participating included recognizing the importance of ACP, curiosity, participation recommended by primary care provider, desire to talk with family/friends, and desire to complete advance directives. Conclusions This ACP-GV intervention increased ACP documentation among patients with diverse reasons for participating. This is a patient-centered approach to ACP in primary care.

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“…Currently, this is not done in a systematic way [40, 41]. Undertaking ACP in the community may allow preferences to be discussed and decisions made outside the context of a health crisis [42].…”

Section: Discussionmentioning

confidence: 99%

Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness

et al. 2017

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BackgroundAs in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings.MethodsMedline, EMBASE and Cochrane databases were searched between 1995 and 2015 for data-based papers. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were categorised according to whether the primary aim was to improve: (a) end of life processes (i.e. end-of-life documentation and discussions, referrals); or (b) end-of-life outcomes (i.e. perceived quality of life, health status, health care use, costs). Intervention studies were assessed against the Effective Practice and Organisation of Care methodological criteria for research design, and their effectiveness examined.ResultsA total of 416 papers met eligibility criteria. The number increased by 13% each year (p < 0.001). Most studies were descriptive (n = 351, 85%), with fewer measurement (n = 17) and intervention studies (n = 48; 10%). Only 18 intervention studies (4%) met EPOC design criteria. Most reported benefits for end-of-life processes including end-of-life discussions and documentation (9/11). Impact on end-of-life outcomes was mixed, with some benefit for psychosocial distress, satisfaction and concordance in care (3/7).ConclusionMore methodologically robust studies are needed to evaluate the impact of interventions on end-of-life processes, including whether changes in processes translate to improved end-of-life outcomes. Interventions which target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-017-0204-1) contains supplementary material, which is available to authorized users.

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Advance care planning in primary care, only for severely ill patients? A structured review

Cited by 88 publications

References 27 publications

Correlates of advance directive treatment preferences among community‐dwelling older people with chronic diseases

Correlates of advance directive treatment preferences among community‐dwelling older people with chronic diseases

A Group Visit Initiative Improves Advance Care Planning Documentation among Older Adults in Primary Care

Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness

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