What Can a Primary Care Physician Discuss With Older Patients to Improve Advance Directive Completion Rates? A Clin-IQ

Myers, Judith M.; Duthie, Edmund H.; Denson, Kathryn; Denson, Steven; Simpson, Deborah

doi:10.17294/2330-0698.1412

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…9 Features and processes common to primary care practices that have also been shown to be important to expanding ACP conversations with patients include the following: transferable electronic health records, 10,12,13 enhancing capacity of clinicians, 10 integrating ACP conversations into practice workflow, 10 potential for team-based care, and continuity of conversations across visits. 14,15 These are features of practices that may be found in Advanced Primary Care Practice transformation models such as the Patient Centered Medical Home (hereafter designated APCP/PCMH), a major innovation in primary care over the last 2 decades. 16 Advanced primary care models focus on the provision of comprehensive, accessible, patient-centered care that is coordinated across care settings and that improve the patient experience and quality of care provided.…”

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confidence: 99%

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Nowels

Sheffler

et al. 2019

J Am Board Fam Med

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Introduction: Primary care practices are essential settings for Advance Care Planning (ACP) conversations with patients. We hypothesized that such conversations occur more routinely in Advanced Primary Care/Patient Centered Medical Home (APCP/PCMH) Practices using practice transformation strategies. Methods: We analyzed characteristics of physician respondents and their practices associated with ACP discussions in older and sicker patients using US data from the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We developed an index of APCP/PCMH features as a practice covariable. Results: Respondents (N ‫؍‬ 1001) were predominantly male (60%) and >45 years old (74%). Multivariable analyses showed that suburban practice location was associated with fewer ACP conversations; working in a practice commonly seeing patients with multiple chronic conditions or who have palliative care needs, and working in a practice from which home visits are made, were associated with more ACP conversations. Physicians compensated in part by capitation were more likely to report ACP conversations. No association was found between a single item asking if the practice was an APCP/PCMH and having ACP conversations. However, higher scores on an index of APCP/PCMH features were associated with more ACP conversations. Conclusions: In this sample of US primary care physicians, the types of patients seen, practice location, and physician compensation influenced whether physicians routinely discuss ACP with patients who are older and sicker. Practices demonstrating more features of APCP/PCMH models of primary care are also associated with ACP discussions.

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confidence: 99%

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Nowels

Sheffler

et al. 2019

J Am Board Fam Med

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“…By offering group visits for ACP and focusing on these topics, it may convey an importance for ACP and normalize these conversations, which has been found to be associated with greater rates of advance directive completion. 19 In addition, group visits for ACP among patients with heart failure may be key to bringing up a vital conversation that might otherwise not be taking place, especially due to the widespread phenomenon of patients with heart failure not viewing their condition as terminal. 20,21 For example, a recent study on the attitudes of oncologists, cardiologists, and primary care physicians toward ACP found that only 15% of cardiologists felt it was their responsibility to engage patients in ACP, compared with 68% of primary care physicians.…”

Section: Discussionmentioning

confidence: 99%

“…23 Therefore, a summary notice entered in the EHR, as suggested by the clinicians in our study, may be a way to not only inform clinicians about their patient's participation in an ACP group visit but may also serve as a point of discussion and action during subsequent medical visits. Additional research on ACP in general, and on group visits specifically, points to the importance of more than 1 meeting/conversation 10,11,17,19,23,24 revisited over an extended period of time. 19 This also suggests the need to standardize clinical workflows around ACP 25 and incorporate information technology 26 (ie, EHR triggers, reminders, summary notes, single location to upload completed ACP forms), a sentiment reported by our participants.…”

Section: Discussionmentioning

confidence: 99%

Clinician Perspectives on Group Visits for Advance Care Planning Among Caregivers and Older Adult Patients With Heart Failure

et al. 2021

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Background: Advance care planning (ACP) is critical for older adults with heart failure; however, patient-level and clinician-level barriers exist. Although a group visit (GV) approach to engage patients in ACP has proven effective among general geriatric populations, little is known about clinician perceptions/likelihood of referral.Methods: Qualitative study to understand clinician perspectives on GVs for ACP among older adult patients with heart failure and caregivers. Twenty physicians and advance practice providers participated in telephone-based interviews guided by a semistructured research protocol. Transcripts were analyzed using a grounded theory approach.Results: Results highlight variability in clinician engagement in ACP but greater agreement around the factors that prompt discussions. Qualitative themes included (1) inherent properties of GVs (characteristics that make GVs ideal for most but less ideal for some, risk-to-benefit ratio); (2) purpose of GVs (general education, "priming the pump" for subsequent discussions, providing tools for action); and (3) format and procedures for GVs (inclusion/exclusion considerations, organizing by unifying characteristic, link back to clinicians).Conclusions: This is the first study to gain clinician insights into ACP GVs specific to patients and caregivers affected by heart failure. Results shed light on an important topic and suggest key considerations for conducting GVs for ACP. (

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“…It can be interpreted that there is a perception among the healthcare providers who use electronic ADs have higher PEOU, which in turn, results in higher SU. the primary care clinic may be because providers in the primary care centers have the opportunity to engage patients in discussions about ADs during their routine medical visits (Myers, Duthie, Denson, Denson, & Simpson, 2017).…”

Section: The Relationships Between the Peou And Su Of Electronic Adsmentioning

confidence: 99%

Exploring Perceptions of Health Care Providers' Use of Electronic Advance Directive Forms in Electronic Health Records

Folarinde¹,

Alexander²,

Galambos³

et al. 2019

J Gerontol Nurs

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iii appreciated more than you know. I cannot forget to mention the school's wonderful resources, expert faculty, and generous staff that have made the online program less stressful for the distance students. I would like to thank Ms. Sherry Cass, executive assistant, Sinclair School of Nursing for her assistance in obtaining the affiliation agreement from Grady Health System for my project. Thank you for an outstanding job; it was not an easy task at all getting documents signed in a very big organization like Grady. I would also like to thank Ms. Shirley Marshall, research administration, Grady Research Oversight Committee and Dr. Terri Summer, Director, Grady Nursing Research and Education. Thank you for your support and assistance in getting approvals for my research. My sincere appreciation also goes to Ms. Esele Carswell, Director of 10A Oncology Department and Ms. Pooja Mishra, Director of Grady Georgia Cancer Center for Excellence for approving your departments to be used for the study and encouraging your staffs to participate in the study. My profound appreciation also goes to the entire staff of Grady, who participated in my study and most especially, Dr. Claudia Fotzeu, Dr. Sanjay Jain, and Dr. Olatunji Alese of Grady Georgia Cancer Canter for Excellence for your immense contributions towards my data collection. Your time, support, and contributions are highly acknowledged and appreciated. Finally, I would like to express incredible gratitude to my parents, family and friends, especially my husband, Michael, who has been a pillar of support and my children, Blessing and Busayo. Thank you to for your amazing support and prayers, without which I would not have been able to realize my dreams and goals.

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What Can a Primary Care Physician Discuss With Older Patients to Improve Advance Directive Completion Rates? A Clin-IQ

Cited by 5 publications

References 7 publications

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations

Clinician Perspectives on Group Visits for Advance Care Planning Among Caregivers and Older Adult Patients With Heart Failure

Exploring Perceptions of Health Care Providers' Use of Electronic Advance Directive Forms in Electronic Health Records

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