Survey on advance care planning of Italian outpatients on chronic haemodialysis

Panocchia, Nicola; Tonnara, Giuseppe; Minacori, Roberta; Sacchini, Darío; Bossola, Maurizio; Tazza, Luigi; Gambaro, Giovanni; Spagnolo, Antonio G.

doi:10.1136/bmjspcare-2017-001322

Cited by 6 publications

(31 citation statements)

References 13 publications

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“…Of the 15 observational quantitative studies, five [ 38 , 39 , 40 , 45 , 47 ] were conducted in North America, seven [ 27 , 32 , 33 , 34 , 35 , 36 , 44 ] in Europe and three [ 28 , 31 , 43 ] in Asia. The studies were performed between 1992 and 2020 and mostly in an outpatient setting.…”

Section: Resultsmentioning

confidence: 99%

“…The only quantitative non-randomized study [ 29 ] had low RoB. The quality of the 15 quantitative descriptive studies [ 27 , 28 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 43 , 44 , 45 , 47 ] varied, with eleven studies [ 27 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 44 ] scoring high because of a high participant non-response bias, three studies [ 31 , 40 , 44 ] not providing enough information to assess representativeness, and one study [ 31 ] not providing enough information to assess whether the employed measurements were appropriate. The three mixed methods studies [ 26 , 30 , 42 ] also scored low.…”

Section: Resultsmentioning

confidence: 99%

“…Among the included studies, 19 [ 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 42 , 43 , 44 , 45 , 46 , 47 ] reported data on willingness to receive LSTs; 14 reported data on specific LSTs such as cardiopulmonary resuscitation (CPR) [ 26 , 31 , 32 , 33 , 34 , 36 , 38 , 40 , 42 , 47 ], mechanical ventilation (MV) [ 31 , 32 , 33 , 34 , 36 , 37 , 38 , 42 , 45 ] via endotracheal intubation (ETI) [ 27 ] or non-invasively (NIV) [ 27 ], use of feeding tubes [ 38 , 42 , 43 ], blood transfusion [ 38 ], dialysis [ 42 , 47 ] and implantable cardioverter defibrillator (ICD) withdrawal [ 46 ]. Three studies [ 27 , 30 , 40 ] reported on patients’ willingness to opt for palliation of symptoms, six studies [ 30 , 33 ,…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [ 27 , 30 , 40 ] reported on patients’ willingness to opt for palliation of symptoms, six studies [ 30 , 33 , 35 , 36 , 38 , 45 ] on the patients’ preferred place of care, and eight [ 26 , 28 , 31 , 37 , 41 , 42 , 44 , 46 ] on the wish to be involved in shared decision-making concerning EoL care. Sixteen studies [ 26 , 27 , 28 , 30 , 31 , 33 , 36 , 37 , 38 , 40 , 41 , 42 , 44 , 45 , 46 , 47 ] addressed more than one type of EoL care.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies explored willingness to receive LSTs without specifying the type of intervention [ 28 , 45 ] or by combining two or more LSTs [ 29 , 39 , 44 ] ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

González‐González

Schmucker

Nothacker

et al. 2020

JCM

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Unpredictable disease trajectories make early clarification of end-of-life (EoL) care preferences in older patients with multimorbidity advisable. This mixed methods systematic review synthesizes studies and assesses such preferences. Two independent reviewers screened title/abstracts/full texts in seven databases, extracted data and used the Mixed Methods Appraisal Tool to assess risk of bias (RoB). We synthesized findings from 22 studies (3243 patients) narratively and, where possible, quantitatively. Nineteen studies assessed willingness to receive life-sustaining treatments (LSTs), six, the preferred place of care, and eight, preferences regarding shared decision-making processes. When unspecified, 21% of patients in four studies preferred any LST option. In three studies, fewer patients chose LST when faced with death and deteriorating health, and more when treatment promised life extension. In 13 studies, 67% and 48% of patients respectively were willing to receive cardiopulmonary resuscitation and mechanical ventilation, but willingness decreased with deteriorating health. Further, 52% of patients from three studies wished to die at home. Seven studies showed that unless incapacitated, most patients prefer to decide on their EoL care themselves. High non-response rates meant RoB was high in most studies. Knowledge of EoL care preferences of older patients with multimorbidity increases the chance such care will be provided.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Five studies explored willingness to receive LSTs without specifying the type of intervention [ 28 , 45 ] or by combining two or more LSTs [ 29 , 39 , 44 ] ( Table 3 ).…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

González‐González

Schmucker

Nothacker

et al. 2020

JCM

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Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning

Senteio

Callahan

2020

BMC Nephrol

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Background Advance Care Planning (ACP) is essential for preparation for end-of-life. It is a means through which patients clarify their treatment wishes. ACP is a patient-centered, dynamic process involving patients, their families, and caregivers. It is designed to 1) clarify goals of care, 2) increase patient agency over their care and treatments, and 3) help prepare for death. ACP is an active process; the end-stage renal disease (ESRD) illness trajectory creates health circumstances that necessitate that caregivers assess and nurture patient readiness for ACP discussions. Effective ACP enhances patient engagement and quality of life resulting in better quality of care. Main body Despite these benefits, ACP is not consistently completed. Clinical, technical, and social barriers result in key challenges to quality care. First, ACP requires caregivers to have end-of-life conversations that they lack the training to perform and often find difficult. Second, electronic health record (EHR) tools do not enable the efficient exchange of requisite psychosocial information such as treatment burden, patient preferences, health beliefs, priorities, and understanding of prognosis. This results in a lack of information available to enable patients and their families to understand the impact of illness and treatment options. Third, culture plays a vital role in end-of-life conversations. Social barriers include circumstances when a patient’s cultural beliefs or value system conflicts with the caregiver’s beliefs. Caregivers describe this disconnect as a key barrier to ACP. Consistent ACP is integral to quality patient-centered care and social workers’ training and clinical roles uniquely position them to support ACP. Conclusion In this debate, we detail the known barriers to completing ACP for ESRD patients, and we describe its benefits. We detail how social workers, in particular, can support health outcomes by promoting the health information exchange that occurs during these sensitive conversations with patients, their family, and care team members. We aim to inform clinical social workers of this opportunity to enhance quality care by engaging in ACP. We describe research to help further elucidate barriers, and how researchers and caregivers can design and deliver interventions that support ACP to address this persistent challenge to quality end-of-life care.

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The explorations of the awareness, contemplation, self-Efficacy, and readiness of advance care planning, and its predictors in Taiwanese patients while receiving hemodialysis treatment

Chen

et al. 2022

BMC Palliat Care

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Background End-stage renal disease (ESRD) is a major chronic illness worldwide, and Taiwan reports one of the highest incidence rates of ESRD with 529 cases per million population (pmp). A number of patients with ESRD patients might require lifelong hemodialysis (HD) or peritoneal dialyses (PD). Due to the progression of dialysis, patients are likely to experience other chronic comorbidities, anxiety and depression, frequent hospitalizations, and higher rates of mortality compared to patients with other types of chronic illnesses. As a result, dialysis patients are prone to experience advance care planning (ACP) needs, such as whether they withdraw from receiving dialysis while approaching their end-of-life (EOL). Yet, existing studies have shown that dialysis patients seldom receive timely consultation regarding ACP and there are limited studies examining ACP amongst Taiwan HD patients. Purpose The purpose of this study was to examine ACP awareness, contemplation, self-efficacy and readiness; and factors influencing ACP readiness. Design This cross-sectional descriptive study with convenience sampling was conducted in the out-patient HD unit at a regional teaching hospital in southern Taiwan. A total of 143 ESRD patients undergoing HD treatments were recruited. A 55-item ACP engagement survey containing the subscales of awareness, contemplation, self-efficacy, and readiness was employed. The data were analyzed with t-tests, one-way ANOVAs, Pearson’s correlations and multiple regressions. Results The results of our investigation revealed that approximately half of the participants (n = 67, 46.9%) were not informed of ACP. Although they reported considering their EOL, medical decisions and desired care, they demonstrated significantly low self-efficacy in discussing ACP (t= -5.272, p < 0.001). HD duration influenced all four ACP subscales; religious beliefs significantly influenced ACP-self-efficacy and readiness; and marital status, education, and primary decision-maker status significantly influenced ACP-readiness. The predictors of ACP-readiness were high self-efficacy and being the primary decision-maker (Adjusted R2 61%). Conclusion Most of the HD patients in this study had low ACP-awareness, contemplation, self-efficacy, and readiness, and most had not completed any ACP-related advance directives (AD). Healthcare professionals should proactively provide HD patients with ACP-related information and answer patients’ and medical decision-makers’ questions in a timely manner, thereby improving the quality of EOL care.

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Survey on advance care planning of Italian outpatients on chronic haemodialysis

Cited by 6 publications

References 13 publications

End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review

Supporting quality care for ESRD patients: the social worker can help address barriers to advance care planning

The explorations of the awareness, contemplation, self-Efficacy, and readiness of advance care planning, and its predictors in Taiwanese patients while receiving hemodialysis treatment

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