Upstreaming and Normalizing Advance Care Planning Conversations—A Public Health Approach

Prince-Paul, Maryjo; DiFranco, Evelina

doi:10.3390/bs7020018

Cited by 49 publications

(41 citation statements)

References 16 publications

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“…To facilitate these changes, we need to enhance education and awareness of palliative care amongst healthcare professionals and the community [ 13 ]. By increasing the presence of palliative care in the community and normalising conversations, the stigma of talking about death can be slowly but surely chipped away, not just our patients but also among our healthcare colleagues [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

Chen

et al. 2020

BMC Geriatr

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Background With increasing cost of healthcare in our aging society, a consistent pain point is that of end-of-life care. It is particularly difficult to prognosticate in non-cancer patients, leading to more healthcare utilisation without improving quality of life. Additionally, older adults do not age homogenously. Hence, we seek to characterise healthcare utilisation in young-old and old-old at the end-of-life. Methods We conducted a single-site retrospective review of decedents under department of Advanced Internal Medicine (AIM) over a year. Young-old is defined as 65–79 years; old-old as 80 years and above. Data collected was demographic characteristics; clinical data including Charlson Comorbidity Index (CCI), FRAIL-NH and advance care planning (ACP); healthcare utilisation including days spent in hospital, hospital admissions, length of stay of terminal admission and clinic visits; and quality of end-of-life care including investigations and symptomatic control. Documentation was individually reviewed for quality of communication. Results One hundred eighty-nine older adult decedents. Old-old decedents were mostly females (63% vs. 42%, p = 0.004), higher CCI scores (7.7 vs 6.6, p = 0.007), similarly frail with lower polypharmacy (62.9% vs 71.9%, p = 0.01). ACP uptake was low in both, old-old 15.9% vs. young-old 17.5%. Poor prognosis was conveyed to family, though conversation did not result in moderating extent of care. Old-old had less healthcare utilisation. Adjusting for sex, multimorbidity and frailty, old-old decedents had 7.3 ± 3.5 less hospital days in their final year. Further adjusting for cognition and residence, old-old had 0.5 ± 0.3 less hospital admissions. When accounted for home care services, old-old spent 2.7 ± 0.8 less hospital days in their last admission. Conclusion There was high healthcare utilisation in older adults, but especially young-old. Enhanced education and goal-setting are needed in the acute care setting. ACP needs to be reinforced in acute care with further research to evaluate if it reduces unnecessary utilisation at end-of-life.

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Section: Discussionmentioning

confidence: 99%

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

Chen

et al. 2020

BMC Geriatr

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“…Increasing death literacy among patients and family members is deemed to facilitate ACP discussion. 57 In this review, an increase in patient’s understanding of life-sustaining treatment, and willingness of participating in end-of-life care discussion were found by providing informative materials such as video decision aids and information sheets. However, there was scant evidence reporting the subsequent increase of ACP documentation to guide clinical practice in accordance with patient’s wishes, leading to better healthcare outcomes.…”

Section: Discussionmentioning

confidence: 99%

The conceptual models and mechanisms of action that underpin advance care planning for cancer patients: A systematic review of randomised controlled trials

et al. 2018

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Background:No systematic review has focused on conceptual models underpinning advance care planning for patients with advanced cancer, and the mechanisms of action in relation to the intended outcomes.Aim:To appraise conceptual models and develop a logic model of advance care planning for advanced cancer patients, examining the components, processes, theoretical underpinning, mechanisms of action and linkage with intended outcomes.Design:A systematic review of randomised controlled trials was conducted, and was prospectively registered on PROSPERO. Narrative synthesis was used for data analysis.Data sources:The data sources were MEDLINE, CINAHL, PsycINFO, EMBASE, CENTRAL, PROSPERO, CareSearch, and OpenGrey with reference chaining and hand-searching from inception to 31 March 2017, including all randomised controlled trials with advance care planning for cancer patients in the last 12 months of life. Cochrane quality assessment tool was used for quality appraisal.Results:Nine randomised controlled trials were included, with only four articulated conceptual models. Mechanisms through which advance care planning improved outcomes comprised (1) increasing patients’ knowledge of end-of-life care, (2) strengthening patients’ autonomous motivation, (3) building patients’ competence to undertake end-of-life discussions and (4) enhancing shared decision-making in a trustful relationship. Samples were largely highly educated Caucasian.Conclusion:The use of conceptual models underpinning the development of advance care planning is uncommon. When used, they identify the individual behavioural change. Strengthening patients’ motivation and competence in participating advance care planning discussions are key mechanisms of change. Understanding cultural feasibility of the logic model for different educational levels and ethnicities in non-Western countries should be a research priority.

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“…Specifically, the authors examine the importance of and the approaches for beginning the conversation about death and dying earlier rather than later. Amongst the three articles, one creates the argument that the communication about end of life should begin far earlier than is the current norm in their article “Upstreaming and Normalizing Advance Care Planning Conversations—A Public Health Approach” [ 18 ]. The second and third articles discuss unique situations to begin the conversations of death and dying.…”

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confidence: 99%

Family Communication at the End of Life

Keeley

2017

Behavioral Sciences

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People often feel awkward and ill at ease when faced with the opportunity for communication at the end of life, thus the overall theme for the articles in this special issue is the creation of more awareness and knowledge regarding the depth, breadth, and importance of current research exploring family communication at the end of life. This introductory essay attempts to accomplish the following: (1) discuss the importance of talk regarding death; (2) highlight the formative role of family interactions on the death and dying process; and (3) outline the articles in this special issue. Scholars contributing to this special issue on “Family Communication at the End of Life” have provided evidence that communication is important between and for terminally ill individuals, family members, and healthcare/palliative care specialists. Overall, research exploring communication at the end of life is especially relevant because every person experiences the death and loss of loved ones, and ultimately faces the reality of their own death.

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Upstreaming and Normalizing Advance Care Planning Conversations—A Public Health Approach

Cited by 49 publications

References 16 publications

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old

The conceptual models and mechanisms of action that underpin advance care planning for cancer patients: A systematic review of randomised controlled trials

Family Communication at the End of Life

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