Patient-centered advance care planning in special patient populations: a pilot study
Section snippets
Theoretical framework
The PC-ACP interview was constructed by integrating the familiar and effective advance care planning facilitation skills embedded in the nationally recognized program Respecting Choices (Hammes & Briggs, 2000) with two social science theories: the interactive decision-making model (Pierce & Hicks, 2001) and the representational approach to patient education (Donovan & Ward, 2001).
The interactive decision-making model, which originates from several economic principles and decision theories, has
Design
An experimental design was used in this study. Patients were paired with their surrogates and assigned to one of three disease conditions to receive either the intervention or the usual care (Fig 1).
Sample and setting
Participants were recruited from the heart failure clinic, renal dialysis unit, and cardiovascular surgery clinic at Gundersen Lutheran Medical Foundation in La Crosse, Wisconsin, a 325-bed clinically affiliated organization that has participated in the development of the community-based Respecting
Sample characteristics
Most patients were 61 to 70 years old (M = 68.7, SD = 9.2). All patients and their surrogates were white. Approximately 62 percent of the patients in the experimental group were women. About 80 percent of patients in the control group were men (Table 2). Most surrogates were women in both groups (≥ 71 percent). Surrogates had a mean age of 50 ± 14.8 years. Children accounted for 76.9 percent of surrogates in the experimental group; spouses accounted for 50 percent of surrogates in the control
Discussion
The approach tested in this pilot study, the PC-ACP interview, shows that this unique intervention to promote shared decision-making might contribute to improvement in care at the end of life. The PC-ACP interview appeared to be acceptable to most participating patients and their surrogates. The most important finding was that the interview could result in higher congruence between the patient and surrogate and at the same time decrease the patient’s decisional conflict. This result contradicts
Conclusions
Findings of this study suggest that the PC-ACP interview can enhance surrogates’ understanding of patients’ preferences for future medical treatment and surrogates’ roles in decision-making for the patient. It is expected that increasing the surrogate’s understanding of the patient’s wishes improves the congruence between the patient and surrogate in medical decision-making; this understanding can empower the surrogate to speak for the patient when the patient becomes incapacitated. To create
∗Assistant Director for Advance Care Planning, Gundersen Lutheran Medical Foundation, La Crosse, WI.
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2022, Journal of Pain and Symptom ManagementUnderstanding the Role of Knowledge in Advance Care Planning Engagement
2021, Journal of Pain and Symptom ManagementCitation Excerpt :This investigation expands on the results of prior studies demonstrating knowledge gaps regarding the purpose of living wills and the role of healthcare agents. Our true or false questionnaire incorporated items addressing the role of ACP instruments, comparable to the stated aims of questionnaires utilized in prior randomized controlled trials.15-19 While these studies did not publish their knowledge scales nor the proportions of respondents who answered individual items correctly, they give examples of questions, including whether ADs allow the patient to make different choices in the future15 and in what circumstances the surrogate may be asked to become involved in decision-making.15,18
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2021, ResuscitationCitation Excerpt :Advance care planning discussions led by trained nurse facilitators or social workers are associated with an increase in patient knowledge about advance care planning, significantly more advance care planning discussions with physicians and a higher likelihood to agree to a DNACPR decision.10,265–268 A patient-centred advance care planning approach increases the congruence in decision-making for future medical treatment between patients and their surrogate, improves satisfaction with the decision-making process and decreases the decisional conflict.269 A pilot RCT addressing specific cultural factors by a tailored intervention using a bilingual, bicultural patient navigator suggests improved palliative care outcomes for minority groups facing advanced medical illness.270
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∗Assistant Director for Advance Care Planning, Gundersen Lutheran Medical Foundation, La Crosse, WI.
†Rodefer Chair and Professor, University of Wisconsin-Madison School of Nursing, Madison, WI.
‡Director of Medical Humanities, Gundersen Lutheran Medical Foundation, La Crosse, WI.
§Doctoral candidate, University of Wisconsin-Madison School of Nursing, Madison, WI.
¶IRB and Ethics Committee Coordinator, Gundersen Lutheran Medical Foundation, La Crosse, WI.