Making medical decisions for an incompetent older adult when both a proxy and an advance directive are available: which is more likely to reflect the older adult’s preferences?

Bravo, Gina; Sene, Modou; Arcand, Marcel

doi:10.1136/medethics-2017-104203

Cited by 12 publications

(7 citation statements)

References 24 publications

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“…93.4% of were reported by their caregivers to have an advance directive and 96.1% of decedents with advance directives were reported to have assigned a health care agent. Our high rates of advance directive possession and health care agent designation are concordant with recent studies in community-dwelling populations of people with dementia in the United States [27,37,38] . To our knowledge, there have been two previous studies assessing goals of care conversations between people with dementia and their caregivers [27,28] .…”

Section: Discussionsupporting

confidence: 86%

“…Those with dementia may discuss wishes with lawyers in the course of drafting directives, but such conversations and documents are not always revealed to caregivers, sometimes due to attorneyclient confidentiality [33] . As a result, surrogate decision-makers often poorly predict the preferences of people with dementia [34][35][36] and lack concordance with advance directives [37,38] .…”

Section: Introductionmentioning

confidence: 99%

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Goals of Care Conversations and Subsequent Advance Care Planning Outcomes for People with Dementia

Kiekhofer

Hooper

et al. 2021

JAD

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Background: Advance care planning has been shown to improve end of life decision-making for people with dementia. However, the impact of goals of care conversations between people with dementia and their caregivers has not been characterized. Objective: In this study, we evaluate the association between goals of care conversations and advance care planning outcomes. Methods: Retrospective advance care planning measures were collected via a questionnaire administered to 166 caregivers after the death of the person with dementia for whom they provided care. Results: At time of death, the majority of decedents with dementia had advance directives, health care agents, and previous goals of care conversations with their caregiver. Goals of care conversations were significantly associated with the perceived usefulness of advance directives, the perceived adherence to advance directives, and decedent dying at their desired place of death, but not with disagreements around end-of-life care. Conclusion: Our findings suggest that goals of care conversations are an important component of advance care planning. These findings support the development of interventions that facilitate such conversations between people with dementia and their caregivers.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Goals of Care Conversations and Subsequent Advance Care Planning Outcomes for People with Dementia

Kiekhofer

Hooper

et al. 2021

JAD

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“…5 Further, other studies have found preliminary evidence that patients' preferences documented in LWs better reflect their wishes and preferences than the predictions made by their designated surrogates. 6 This is additionally supported by research in recent years that has found that the majority of patients (especially those with advance directives) do have stable end-of-life preferences over time. 2,7 Thus, when these findings are combined with the additional concerns regarding the accuracy of surrogate decision-making, there does not seem to be justification for prioritizing patients' HcPOAs over their LWs based upon this concern regarding the reliability of the documented preferences in LWs.…”

mentioning

confidence: 81%

When Advance Directives Collide

Potter

Lee

2020

J GEN INTERN MED

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“…Three (8.8%) articles tested interventions aimed at improving dementia care dyad ACP concordance ( Matheis-Kraft & Roberto, 1997 ; Towsley et al 2022 ; Volandes et al 2009 ). Two (5.8%) articles tested whether surrogate decision makers were more accurate than a written advance directive ( Bravo et al, 2018 ) or an actuarial model ( Smucker et al, 2000 ). One (2.9%) intervention tested whether older adults with dementia could effectively communicate their end-of-life wishes ( Song et al, 2019 ).…”

Section: Part 1: Scoping Reviewmentioning

confidence: 99%

Advance Care Planning in the Context of Dementia: Defining Concordance

Clayton,

Supiano,

Aruscavage

et al. 2024

The Gerontologist

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Background and Objectives Individuals with dementia may require a surrogate decision-maker as their disease progresses. To prepare for this potential role, dementia care partners need to develop a thorough understanding of their care recipient’s end-of-life values and preferences, or care dyad ACP concordance. As part of our pilot study implementing the LEAD intervention with dementia care dyads, we conducted a multi-method investigation to define care dyad ACP concordance. Research Design and Methods We conducted a scoping review of peer-reviewed studies published after 1991 in English focusing on care dyad ACP concordance in dementia care and included 34 articles. Concurrently, we used descriptive qualitative analysis to analyze seven dyadic ACP conversations from a pilot study about dyadic dementia ACP. Results The scoping review demonstrated 1) no definition of care dyad ACP concordance was reported; 2) surrogate accuracy in end-of-life decisions varies widely; and 3) best practices for ACP in dementia may aid in achieving ACP concordance, but do not prioritize it as an outcome. Qualitative analysis identified seven elements for achieving concordance: Respect/Regard; use of Clarifying Processes; Conveying Health Care Scenarios; Affirmation of Understanding; Recognizing Uncertainty; Expression of Positive Emotions; and Trust. Discussion and Implications Care dyad ACP concordance occurs when care recipients and care partners both understand a care recipient’s end-of-life values, understand the end-of-life preferences informed by those values, and the care partner expresses a willingness to accomplish the care recipient’s wishes to the best of their ability. ACP concordance can be further operationalized for research and clinical care.

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Making medical decisions for an incompetent older adult when both a proxy and an advance directive are available: which is more likely to reflect the older adult’s preferences?

Abstract: ISRCTN89993391; Post-results.

Cited by 12 publications

References 24 publications

Goals of Care Conversations and Subsequent Advance Care Planning Outcomes for People with Dementia

Goals of Care Conversations and Subsequent Advance Care Planning Outcomes for People with Dementia

When Advance Directives Collide

Advance Care Planning in the Context of Dementia: Defining Concordance

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