Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure

Chandar, Manisha; Brockstein, Bruce; Zunamon, Alan; Silverman, Irwin; Dlouhy, Sarah; Ashlevitz, Kathryn; Tabachow, Cory; Lapin, Brittany; Ewigman, Bernard; Mazzone, Theodore; Obel, Jennifer

doi:10.1177/1049909116636614

Cited by 57 publications

(51 citation statements)

References 12 publications

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“…Negative social influences were addressed by preparing patients through brochures or public awareness campaigns (Glaudemans, de Jong, Onwuteaka Philipsen, Wind, & Willems, 2019;Howard et al, 2018;Wissow et al, 2004) and using patient video decision aids (Volandes et al, 2016). Positive social influences were created by promoting collaboration between primary care providers and specialists (Chandar et al, 2017) and using practice champions (Wissow et al, 2004). Motivation was increased by offering incentives-primarily in fee-for-service environments-to promote conversation (Fulmer et al, 2018) or performance feedback (Wissow et al, 2004).…”

Section: Adaptationsmentioning

confidence: 99%

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Nelson-Brantley

Buller

Befort

et al. 2019

J of Nursing Scholarship

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Section: Adaptationsmentioning

confidence: 99%

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Nelson-Brantley

Buller

Befort

et al. 2019

J of Nursing Scholarship

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“…The guide allowed clinicians to obtain important information more efficiently, which has implications in a busy clinical practice. 15,62 The qualitative learnings also revealed enhanced confidence and comfort in initiating conversations and an intention to try the guide in practice. Although we were able to observe significant self-reported improvements, we express caution with these findings, given that these are subjective measures and numerous systematic reviews have concluded that training alone is insufficient to drive lasting improvements in practice.…”

Section: Discussionmentioning

confidence: 93%

“…4,13,14 Many barriers to communication have been identified: lack of knowledge about how to approach end-of-life communication, variation in attitudes about the right time to start, time constraints, and worries about patient reluctance. 13,[15][16][17][18][19] While multiple communication training programs have improved clinicians' skills, [20][21][22][23] several important challenges remain. First, some courses require two to four days of clinicians' time in workshops outside of their clinical setting.…”

mentioning

confidence: 99%

Training Clinicians in Serious Illness Communication Using a Structured Guide: Evaluation of a Training Program in Three Health Systems

Paladino

Kilpatrick

O’Connor

et al. 2020

Journal of Palliative Medicine

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Background: Failure to initiate discussions about patients' values and goals in serious illness remains a common problem. Many clinicians are inadequately trained for these discussions. Objective: Evaluate whether a novel train-the-trainer model results in high-quality training that improves clinicians' self-reported competencies in serious illness communication. Design: Multimethod evaluation of an educational program. Setting/Context: In 2016, three faculty at Ariadne Labs (AL) conducted three train-the-trainer courses to equip faculty trainers at each of the three institutions to teach serious illness communication to clinicians. Measures: As collected by a post-training questionnaire, primary evaluation measure is clinicians' self-reported change in skills after the training compared with before. Secondary measures include a course evaluation and qualitative learnings. Results: From 2016 to 2018, AL trained 22 trainers (19/22 were palliative care specialists) in three systems, who trained 297 clinicians (49% physicians; 35% advanced practice clinicians; 12% registered nurses, social workers, or chaplain; 4.0% Other) spanning subspecialties (48%); primary care (28%); palliative care (17%); and other (7.1%). Clinicians reported statistically significant improvement in all skills for two of the systems, with a third system demonstrating improvement in all skills with two reaching statistical significance (p < 0.0001). Participants rated the quality of the training highly (95% mostly/extremely effective) and shared a diverse array of takeaways that reflect positive shifts in knowledge, attitudes, and skills. Conclusion: Serious illness communication training, delivered through a train-the-trainer model, was highly acceptable and resulted in significant self-reported improvements in competencies of clinicians. This may be a viable method for health systems seeking to train their clinical workforce.

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“…Further, because of inadequate time to discuss ACP in community settings, physicians and nurses may not be able to fully understand the wishes of older adults. It is for this reason that other healthcare workers are expected to discuss ACP more actively 25 , 26 ) .…”

Section: Discussionmentioning

confidence: 99%

Interprofessional case conferences to bridge perception gaps regarding ethical dilemmas in home-based end-of-life care: a qualitative study

et al. 2020

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Objective: The aim of this study was to examine the effectiveness and efficiency of interprofessional case conferences on home-based end-of-life care to bridge perceptions gaps regarding ethical dilemmas among different healthcare professionals and analyze essential issues extracted the interprofessional discussions. Patients and Methods: The participants could spend only a limited amount of time after their working hours. Therefore, we shortened and simplified each of three case scenarios so that the discussions do not last longer than 90 minutes. For the case conferences, we selected 3 cases, which entailed the following ethical dilemmas pertaining to home-based end-of-life care: refusal of hospital admission, passive euthanasia, and emergency transport. Participant responses were audio-recorded, transcribed, and analyzed using qualitative content analysis and Jonsen’s four topics approach. Results: A total of 136 healthcare professionals (11 physicians, 35 nurses, and 90 care workers) participated in the case conferences. The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts. Despite the short duration of each case conference (90 minutes), the participants were able to discuss a wide range of medical ethical issues that were related to the provision of appropriate home-based end-of-life care to older adults. These issues included discrimination against older adults (ageism), self-determination, an unmet desire for caregiver-patient communication, insufficient end-of-life care skills and education, healthcare costs, and legal issues. Conclusion: The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts.

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Perspectives of Health-Care Providers Toward Advance Care Planning in Patients With Advanced Cancer and Congestive Heart Failure

Cited by 57 publications

References 12 publications

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care

Training Clinicians in Serious Illness Communication Using a Structured Guide: Evaluation of a Training Program in Three Health Systems

Interprofessional case conferences to bridge perception gaps regarding ethical dilemmas in home-based end-of-life care: a qualitative study

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