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

Nelson-Brantley, Heather V; Buller, Carol; Befort, Christie A.; Ellerbeck, Edward F.; Shifter, Ariel; Ellis, Shellie

doi:10.1111/jnu.12513

Cited by 18 publications

(26 citation statements)

References 50 publications

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“…To our knowledge this is the first study to explore ACP in Australian general practice using the TDF, and our use of an implementation sciences framework may assist in developing interventions to increase the uptake of ACP in dementia in primary care. Of the 14 TDF domains, the ones we found to be most relevant to the practice of ACP correlated with those of a scoping review by a research group in the US (Nelson-Brantley et al 2020), which also found social/professional role and identity, as well as environmental context and resources, to be important determinants in initiating ACP.…”

Section: Discussionmentioning

confidence: 61%

Advance care planning in dementia: a qualitative study of Australian general practitioners

Alam

Barton

Prathivadi

et al. 2021

Aust. J. Primary Health

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As the population ages, so does the prevalence of dementia, a condition in which timely advance care planning (ACP) is recommended. This study explored the barriers and enablers of ACP for Australian GPs caring for people with dementia. Semi-structured qualitative telephone interviews informed by the theoretical domains framework (TDF) were conducted with 16 GPs from the south-east region of metropolitan Melbourne. The most prevalent domains of the TDF were: (1) environmental context and resources; (2) beliefs about consequences; and (3) social/professional role and identity. Further thematic analysis found that: (1) ACP was felt to be within the scope of general practice, but more so before the onset of dementia because lack of confidence in capacity assessment acted as a barrier once a diagnosis was made; (2) beliefs about the perceived benefits of ACP motivated GPs to engage patients in ACP; and (3) doctors felt that patients were often reluctant to discuss ACP, especially in the time-pressured context of the standard consultation. This study's use of the TDF provides direction for potential interventions to alleviate challenges faced by Australian GPs with ACP in dementia. Improving ACP in general practice may require a focus on public health campaigns to educate patients about the benefits of ACP before the onset of dementia. GPs' difficulty assessing a patient's decisional capacity may be addressed through skills development workshops.

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Section: Discussionmentioning

confidence: 61%

Advance care planning in dementia: a qualitative study of Australian general practitioners

Alam

Barton

Prathivadi

et al. 2021

Aust. J. Primary Health

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“…Our system serves a mixed-rurality population, and rurality constraints (e.g., gaps in palliative care availability and longer travel distances for care) may further reduce ACP feasibility. [7] Predicting mortality using clinician gestalt alone may have limited accuracy, but combining gestalt with a predictive model may be synergistic. [14] Therefore, to help prioritize ACPs when resources are limited, and to encourage clinicians to have ACPs in those more likely to bene t, we developed a model to predict mortality occurring 5-to-90 days after the start of an inpatient admission.…”

Section: Background and Signi Cancementioning

confidence: 99%

Can a “goldilocks” Mortality Predictor Perform Consistently Across Time and Equitably Across Populations?

Handler

Lee

Iyer

et al. 2022

Preprint

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Objective: Advance care planning (ACP) facilitates end-of-life care, yet many die without one. Timely and accurate mortality prediction may encourage ACP. Therefore, we assessed performance equity and consistency for a novel 5-to-90-day mortality predictor. Methods: Predictions were made for the first day of included adult inpatient admissions on a retrospective dataset. Performance was assessed across various demographies, geographies, and timeframes. Results: AUC-PR remained at 29% both pre- and during COVID. Pre-COVID-19 recall and precision were 58% and 25% respectively at the 12.5% cutoff, and 12% and 44% at the 37.5% cutoff. During COVID-19, recall and precision were 59% and 26% at the 12.5% cutoff, and 11% and 43% at the 37.5% cutoff. Pre-COVID, recall dropped at both cutoffs if recent data was not made available to the model; and compared to the overall population, recall was lower at the 12.5% cutoff in the White, non-Hispanic subgroup and at both cutoffs in the rural subgroup. During COVID-19, precision at the 12.5% cutoff was lower than that of the overall population for the non-White and non-White female subgroups. No other statistically significant differences were seen between subgroups and the corresponding overall population. Conclusions: Overall predictive performance during the pandemic was unchanged from pre-pandemic performance. Although some comparisons (especially precision at the 37.5% cutoff) were underpowered, precision at the 12.5% cutoff was equitable across most demographies, regardless of the pandemic. Mortality prediction to prioritize ACP conversations can be provided consistently and equitably across many studied timeframes, geographies, and demographies.

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“…A multidisciplinary approach seems to be the most appropriate to ensure a broad, multidimensional and individualised ACP process [12]. Specifically, primary care (PC) professionals have been recognized as the most suited to promote ACP processes, since the long-term nature of the relationships between PC professionals and patients is unique compared to other fields within the public health system [13][14][15]. This characteristic might help PC professionals build trust with patients, and it could explain the positive attitudes expressed to ACP process and its value on the improvement of the end-of life process [16].…”

Section: Introductionmentioning

confidence: 99%

Primary Care Professionals’ Self-Efficacy Surrounding Advance Care Planning and Its Link to Sociodemographics, Background and Perceptions: A Cross-Sectional Study

Lasmarías

Aradilla-Herrero

Esquinas

et al. 2021

IJERPH

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Primary care (PC) professionals have been considered the most appropriate practitioners for leading Advance care planning (ACP) processes with advanced chronic patients. Aim: To explore how PC doctors’ and nurses’ self-efficacy surrounding ACP is linked to their sociodemographic characteristics, background and perceptions of ACP practices. Methods: A cross-sectional study was performed. Sociodemographics, background and perceptions about ACP in practice were collected using an online survey. The Advance Care Planning Self-Efficacy Spanish (ACP-SEs) scale was used for the self-efficacy measurement. Statistical analysis: Bivariate, multivariate and backward stepwise logistic regression analyses were performed to identify variables independently related to a higher score on the ACP-SEs. Results: N = 465 participants, 70.04% doctors, 81.47% female. The participants had a mean age of 46.45 years and 66.16% had spent >15 years in their current practice. The logistic regression model showed that scoring ≤ 75 on the ACP-SEs was related to a higher score on feeling sufficiently trained, having participated in ACP processes, perceiving that ACP facilitates knowledge of preferences and values, and perceiving that ACP improves patients’ quality of life. Conclusion: Professionals with previous background and those who have a positive perception of ACP are more likely to feel able to carry out ACP processes with patients.

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

Cited by 18 publications

References 50 publications

Advance care planning in dementia: a qualitative study of Australian general practitioners

Advance care planning in dementia: a qualitative study of Australian general practitioners

Can a “goldilocks” Mortality Predictor Perform Consistently Across Time and Equitably Across Populations?

Primary Care Professionals’ Self-Efficacy Surrounding Advance Care Planning and Its Link to Sociodemographics, Background and Perceptions: A Cross-Sectional Study

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