Assessment of Surrogates’ Knowledge of Patients’ Treatment Goals and Confidence in Their Ability to Make Surrogate Treatment Decisions

Fried, Terri R.; Zenoni, Maria; Iannone, Lynne; OʼLeary, John R.

doi:10.1001/jamainternmed.2018.5299

Cited by 31 publications

(26 citation statements)

References 11 publications

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“…41 The ACP intervention had a significant effect on both surrogates' longitudinal preparedness and confidence in decision-making and their understanding of the patients' treatment preferences, compared to controls. Consistent with prior research, 42 African American surrogates felt better prepared and confident in their ability to make treatment decisions, but had decreased odds of being in the high congruence class, independent of the intervention effect. Trial findings confirm ACP is beneficial 43 and support African Americans' desire to have family participate in decision-making.…”

Section: Discussionsupporting

confidence: 76%

Advance Care Planning—Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT

Lyon

Caceres

Scott

et al. 2021

Am J Hosp Palliat Care

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Context: The effect of advance care planning (ACP) interventions on the trajectory of end-of-life treatment preference congruence between patients and surrogate decision-makers is unstudied. Objective: To identify unobserved distinctive patterns of congruence trajectories and examine how the typology of outcome development differed between ACP and controls. Methods: Multisite, assessor-blinded, intent-to-treat, randomized clinical trial enrolled participants between October 2013 to March 2017 from 5 hospital-based HIV clinics. Persons living with HIV(PLWH)/surrogate dyads were randomized to 2 weekly 60-minute sessions: ACP (1) ACP facilitated conversation, (2) advance directive completion; or Control (1) Developmental/relationship history, (2) Nutrition/Exercise. Growth Mixed Modeling was used for 18-month post-intervention analysis. Findings: 223 dyads (N = 449 participants) were enrolled. PLWH were 56% male, aged 22 to 77 years, and 86% African American. Surrogates were 56% female, aged 18 to 82 years, and 84% African American. Two latent classes (High vs. Low) of congruence growth trajectory were identified. ACP influenced the trajectory of outcome growth (congruence in all 5 AIDS related situations) by latent class. ACP dyads had a significantly higher probability of being in the High Congruence latent class compared to controls (52%, 75/144 dyads versus 27%, 17/62 dyads, p = 0.001). The probabilities of perfect congruence diminished at 3-months post-intervention but was then sustained. ACP had a significant effect (β = 1.92, p = 0.006, OR = 7.10, 95%C.I.: 1.729, 26.897) on the odds of being in the High Congruence class. Conclusion: ACP had a significant effect on the trajectory of congruence growth over time. ACP dyads had 7 times the odds of congruence, compared to controls. Three-months post-intervention is optimal for booster sessions.

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Section: Discussionsupporting

confidence: 76%

Advance Care Planning—Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT

Lyon

Caceres

Scott

et al. 2021

Am J Hosp Palliat Care

View full text Add to dashboard Cite

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“…30–32 However, the lasting power of attorney (surrogates for decisions about health care and treatment should the person lose the capacity to decide for themselves) 17 appointment rate in our study was low ( n = 1/10, 10%) when compared to Detering et al’s 30 research ( n = 56/154, 36%). This might be explained by (1) the small sample recruited; (2) patients believed that physicians or family members would make the best decisions for them ( contextual moderator – theme 4 ), therefore it was not necessary to officially appoint a surrogate; (3) the surrogates were not psychologically ready to play this role; 31–33 (4) the patient’s preferences and views change over time; 14 and (5) a misunderstanding of the legal framework regarding advance care planning among stakeholders (e.g. patients, family members and healthcare professionals).…”

Section: Discussioncontrasting

confidence: 69%

Feasibility and acceptability of a culturally adapted advance care planning intervention for people living with advanced cancer and their families: A mixed methods study

et al. 2020

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Background: Increasing evidence shows that advance care planning is effective in improving outcomes. However, its applicability and acceptability outside Western cultures remain unknown. Examination of relevant cultural adaptations is required prior to wider adoption. Aim: To examine the feasibility and acceptability of a culturally adapted advance care planning intervention in a Taiwanese inpatient hospital for advanced cancer patients, family members and healthcare professionals. Methods: A single-group, non-controlled, mixed methods feasibility study guided by a previously developed logic model. The culturally adapted advance care planning intervention represented a one-time intervention, comprising pre-advance care planning preparation and follow-up consultation. Qualitative interviews explored participants’ view on their involvement in the study. Patients’ medical records were examined to assess intervention fidelity. Findings from both data sets were integrated following analysis. Results: N = 29 participants ( n = 10 patients; n = 10 family members and n = 9 healthcare professionals) participated in the intervention, of who 28 completed follow-up interviews. Of the 10 advance care planning interventions delivered, most components ( n = 10/13) were met. Key contextual moderators influencing the intervention feasibility included: (1) resource constraints resulting in increased workload; (2) care decisions informed by relatives’ experiences of care; (3) the requirement for financial and policy support; and (4) a presumption for end-of-life care provision and surrogate decision-making. Six areas of intervention refinement were identified for future research. Conclusion: Implementing a culturally adapted advance care planning intervention in an inpatient hospital setting in Taiwan is possible. The participants reported the intervention to be acceptable. However, careful attention to the conceptual underpinning using local primary data is imperative for its success.

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“…Palliative care providers are experts in supporting family members by facilitating critical conversations, discussing goals of care, and working to identify patient’s desires. When surrogates are more quickly identifiable, surrogate confidence in knowing the patient’s wishes can be a barrier to advance care planning discussions [ 105 ] and this should be addressed in providers communication resources for COVID-19 care. Infection-control policies for COVID-19 often present barriers to communication with surrogate decision makers, and most surrogates will not be physically present when discussing treatment options with clinicians.…”

Section: Discussionmentioning

confidence: 99%

Opportunities to improve COVID-19 provider communication resources: A systematic review

Wittenberg

Goldsmith

Chen

et al. 2021

Patient Education and Counseling

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Assessment of Surrogates’ Knowledge of Patients’ Treatment Goals and Confidence in Their Ability to Make Surrogate Treatment Decisions

Cited by 31 publications

References 11 publications

Advance Care Planning—Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT

Advance Care Planning—Complex and Working: Longitudinal Trajectory of Congruence in End-of-Life Treatment Preferences: An RCT

Feasibility and acceptability of a culturally adapted advance care planning intervention for people living with advanced cancer and their families: A mixed methods study

Opportunities to improve COVID-19 provider communication resources: A systematic review

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