“Advance” Care Planning Reenvisioned

Moody, Sandra

doi:10.1111/jgs.16903

Cited by 17 publications

(27 citation statements)

References 6 publications

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“…As suggested also by our previous work [ 35 ] and other studies [ 38 , 39 ], these findings provide further support for an iterative process of ACP, focusing on conversations about individuals’ anchor values rather than solely documenting medical treatment preferences. Others in the field [ 40 , 41 ] argue for the importance of timely and repeated ACP discussions to allow for both advance as well as in the moment decisions.…”

Section: Discussionmentioning

confidence: 99%

Same, same, but different? A longitudinal, mixed-methods study of stability in values and preferences for future end-of-life care among community-dwelling, older adults

2021

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Background End-of-life preferences may change over time, e.g. due to illness progression or life events. Research on stability of end-of-life preferences has largely focused on life-sustaining treatments in seriously ill patients or medical decision-making based on hypothetical illness scenarios and possible treatment options. Few studies focus on community-dwellers in natural settings. The aim of this study was thus to explore if and how community-dwelling, older adults’ prioritizations and reasoning about values and preferences for future end-of-life care change over time. Methods Using a mixed-methods design, we explored stability of end-of-life preferences in older community-dwelling adults without imminent end-of-life care needs. At two timepoints (T1 and T2), 5.5–12 months apart, 52 individuals discussed what would be important to them at the end-of-life, through open conversations and while using DöBra cards, a Swedish version of GoWish cards. Participants ranked their most important card statements from 1 to 10. Stability in card rankings, i.e. a card recurring in the top-10 ranking at T2 regardless of position, was explored using descriptive statistics and non-parametric analyses. Participants’ reasoning about card choices were explored with longitudinal qualitative analysis. Results Stability between T1 and T2 in the top-10 priorities ranged from 20 to 80%, median 60%. Stability in cards rankings could not be explained by changes in participants’ health status, extent of card use (no/little/frequent use) between interviews, or days between T1 and T2, nor was it related to demographic variables. Qualitative analysis showed that consistent reasoning was not always paired with consistency in card choices and changed card choices were not always related to changes in reasoning. Conclusions Longitudinal exploration combining DöBra card rankings with underlying reasoning about end-of-life preferences over time furthers knowledge on the dynamics between values and preferences in end-of-life decision-making. Individuals’ end-of-life preferences in form of card choices were relatively stable over time albeit with large variation between different individuals. However, the values and underlying reasoning that participants used to motivate their choices appeared more stable than ranking of card choices. We thus conclude that concurrent conversation-based exploration is a more comprehensive indicator of end-of-life values and preferences over time than ranking of cards alone.

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Section: Discussionmentioning

confidence: 99%

Same, same, but different? A longitudinal, mixed-methods study of stability in values and preferences for future end-of-life care among community-dwelling, older adults

2021

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“…10 Taken together, this highlights the current state of the scientific discourse around ACP in terms of its conceptualisation and its goals. [11][12][13][14] Indeed, questions have been posed about whether ACP has the capacity to address what has been defined by a Delphi panel as its most important outcome, namely goal-concordant care, leading to discussions regarding what the focus of ACP research ought to be. [15][16][17] The workings of ACP as a process are complex, 18 19 but this complexity may not always be addressed in the research literature and may be overlooked when interventions and outcomes are considered discretely.…”

Section: Introductionmentioning

confidence: 99%

Complex advance care planning interventions for chronic serious illness: how do they work? a scoping review

Stevens

Deliëns

Pype

et al. 2021

BMJ Support Palliat Care

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ContextAdvance care planning (ACP) interventions have the potential to improve outcomes for patients with chronic serious illness. Yet the rationale for outcome choices and the mechanisms by which outcomes are achieved are not always clear.ObjectivesTo identify and map proposed mechanisms on how complex ACP interventions can impact outcomes for patients with chronic serious illness and to explore factors that might explain intervention outcomes.MethodsThis is a scoping review of randomised controlled trials of complex ACP interventions for patients with chronic serious illness which explicitly stated the mechanism(s) by which the intervention was thought to work. We searched six databases and hand-searched key journals and reference lists.ResultsInclusion yielded 16 articles. Inclusion procedures and mapping of mechanisms and outcomes indicated that causality between components and outcomes was not always clearly described. Tailoring intervention content to patients’ needs was linked to the greatest number of different outcome categories, while promoting competence and confidence to engage in ACP was most often explicitly linked to a primary outcome. Three main factors which might have affected intended outcomes were identified: participant characteristics, such as illness experience or cultural differences; the setting of implementation; or methodological limitations of the study.ConclusionFindings highlighted two main points of consideration for future ACP intervention studies: the need for clearly stated logic in how interventions are expected to impact primary outcomes and the importance of considering how an intervention may function for patients with chronic serious illnesses within a specific setting.

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“…Currently there is much debate and controversies around these areas. The use of the term advance care planning has been questioned, with a suggestion to replace 'advance' with 'adaptive' to take into account unexpected diagnoses with rapid deterioration (8). A series of studies in palliative care in the UK questioned the perceived conventional wisdom around best medical practices in hospital and general practice settings (9)(10)(11).…”

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confidence: 99%

Implementing Advance Care Planning in ‘The Age of Deferred Death' - the Hong Kong Experience over 4 Years

Woo

2021

The Journal of nutrition, health and aging

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Objectives: To plan, implement and evaluate a series of initiatives to improve patient centred quality of end of life care through raising public awareness, promoting the concept that all health and social care professionals should be engaged in this practice, and carrying out pilot of community care models. Design: Pilot studies of community models of care, training programs for health and social care professionals, public education programmes. Setting: Selected hospitals, residential care homes for the elderly, and community centres in Hong Kong. Participants: Patients and their families at the end of life stage. Measurements: Combination of quantitative and qualitative studies according to different components of the initiative. Results: Effective training for professional staff occurred using training videos, role play, rather than lectures, and when concepts are integrated into daily practice and quality assurance programmes. Members of the public welcomed end of life care discussions and the implementation of advance care planning. The pilot community care program was found to reduce anxiety, depression, physical symptoms, improve communication within the family as well as promoting a feeling of peace among recipients of the service. It also reduced care giver strain and anxiety, as well as hospital visits and duration of stay. Similar findings were also observed among recipients of care in the residential care setting. Conclusion: A sustainable model would require uptake by policy makers and chief executives of Social Welfare and Health Bureaus, supported by amendments of relevant legal ordinances, which is in progress after public consultation.

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“Advance” Care Planning Reenvisioned

Cited by 17 publications

References 6 publications

Same, same, but different? A longitudinal, mixed-methods study of stability in values and preferences for future end-of-life care among community-dwelling, older adults

Same, same, but different? A longitudinal, mixed-methods study of stability in values and preferences for future end-of-life care among community-dwelling, older adults

Complex advance care planning interventions for chronic serious illness: how do they work? a scoping review

Implementing Advance Care Planning in ‘The Age of Deferred Death' - the Hong Kong Experience over 4 Years

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