Investigación
Haga clic en los temas abajo para ver la investigación relacionada.
Programa en Linea PREPARE
The patient-facing PREPARE program and an easy-to-read advance directive, without clinician-level or system-level interventions, increased documentation of advance care planning and patient-reported engagement, with statistically higher gains for PREPARE. These tools may mitigate literacy and literacy language barriers to advance care planning, allow patients to begin planning on their own, and could substantially improve the process for diverse English-speaking and Spanish-speaking populations.
Easy-to-use, patient-facing ACP tools, without clinician- and/or system-level interventions, can increase planning documentation 25% to 35%. Combining the PREPARE website with an easy-to-read AD resulted in higher planning documentation than the AD alone, suggesting that PREPARE may increase planning documentation with minimal health care system resources.
The PREPARE program and easy‐to‐read AD empowered patients to actively participate in ACP discussions during clinical visits more than the AD alone. Increased activation was associated with increased ACP documentation. Therefore, PREPARE may mitigate barriers to ACP among English‐ and Spanish‐speaking older adults.
In this pragmatic, real-world study of 315 patients across 17 primary care and cancer clinics, implementation of the online PREPARE program increased advance care planning engagement.
A new, patient-centered ACP website that focuses on preparing patients for communication and decision making significantly improves engagement in the process of ACP and behavior change.
Improving Medical-Legal Advance Care Planning J Pain Symptom Manage, 2020
This article describes the historical disconnects between the medical and legal practice of ACP, recommendations and products of an interprofessional panel of medical and legal experts, and recommendations for future medical-legal collaboration
PREPARE has the potential to engage older adults who are not acutely ill in ACP during their ED visits.
Results indicated that PREPARE is a reflective, capacity-building ACP resource that was acceptable, applicable, and understandable for use in oncology. These findings offer direction for both research and practice.
Instrucciones Anticipadas de Atención de Salud de Fácil Lectura de PREPARE
The redesigned advance directive was rated more acceptable and useful for advance care planning and was preferred over a standard form. It also resulted in higher six-month completion rates.
The patient-facing PREPARE program and an easy-to-read advance directive, without clinician-level or system-level interventions, increased documentation of advance care planning and patient-reported engagement, with statistically higher gains for PREPARE. These tools may mitigate literacy and literacy language barriers to advance care planning, allow patients to begin planning on their own, and could substantially improve the process for diverse English-speaking and Spanish-speaking populations.
Easy-to-use, patient-facing ACP tools, without clinician- and/or system-level interventions, can increase planning documentation 25% to 35%. Combining the PREPARE website with an easy-to-read AD resulted in higher planning documentation than the AD alone, suggesting that PREPARE may increase planning documentation with minimal health care system resources.
Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements.
Improving Medical-Legal Advance Care Planning J Pain Symptom Manage, 2020
This article describes the historical disconnects between the medical and legal practice of ACP, recommendations and products of an interprofessional panel of medical and legal experts, and recommendations for future medical-legal collaboration
Visitas Médicas Grupales de PREPARE
ACP group visits, using PREPARE videos, increased ACP documentation and readiness to engage in ACP.
Using the PREPARE movie to facilitate ACP GVs for diverse adults in safety net, primary care settings is feasible and shows potential for increasing ACP engagement.
This ACP-GV intervention increased ACP documentation among patients with diverse reasons for participating. This is a patient-centered approach to ACP in primary care.
A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system.
Toolkits de Fácil Uso de PREPARE Para Presentar la Planificación Anticipada de la Atención Médica y Cuidados Paliativos
The ACP-Toolkit resulted in higher case manager confidence in facilitating ACP and client readiness to engage in ACP, and usability was high. A brief ACP-Toolkit may be a feasible solution to increase ACP engagement among frail, older adults receiving in-home care.
The PREPARE Symptom Assessment (SA)-Toolkit resulted in decreased symptom burden among diverse older adults and higher caregiver self-efficacy in SA. The SA-Toolkit is acceptable and may help reduce suffering in frail, older patients.
This qualitative study showed that an ACP program is important and feasible for Medicaid-eligible, frail older adults being cared for by in-home supportive services (IHSS). Implementation suggestions by IHSS stakeholders include focusing on case managers rather than in-home caregivers to prevent conflict of interest; tailoring programs to clients' needs; creating educational programs for IHSS staff, clients, and community; and standardizing easy-to-use guides and procedures into IHSS workflows.
A symptom assessment program for Medicaid-funded, in-home support services (IHSS) programs is desired, needed, and feasible and can leverage the established IHSS infrastructure and relationships to assess symptoms in the home. Acknowledging consumer choice, developing appropriate tools and trainings for IHSS staff, and effective messaging of program goals can contribute to success.
Planificación Anticipada de la Atención Médica
The purpose of this paper is to describe the problems with the traditional objective of advance care planning; provide an alternative objective that focuses on preparing patients and surrogates to make the best possible in-the-moment medical decisions; and outline practical steps that clinicians can take to achieve this new objective in the outpatient setting.
Scoping Review of high-quality ACP RCTs from the past decade (January 1, 2010, to March 3, 2020) show predominantly positive primary outcomes for all intervention types. Although some outcomes were mixed, outcomes concerning decreased surrogate distress were consistently positive. Recommendations for further research include tailoring interventions and outcomes for local contexts, to set appropriate expectations of ACP outcomes, and standardize across studies.
A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives.
A large, multidisciplinary Delphi panel developed an Organizing Framework and rated the importance of ACP outcome constructs. Top rated outcomes should be used to evaluate the success of ACP initiatives. More research is needed to create reliable and valid measurement tools for the highest rated outcomes, particularly “care consistent with goals.”
Unintended negative consequences of advance directive legal restrictions may prevent all patients, and particularly vulnerable patients, from making and communicating their end-of-life wishes and having them honored. These restrictions have rendered advance directives less clinically useful. Recommendations include improving readability, allowing oral advance directives, and eliminating witness or notary requirements.
Can we agree to disagree? JAMA, 2009
A narrative essay reflecting on a personal story that changed the way the author, a geriatrician and palliative care physician, talked with patients and families about advance care planning and leeway for decision makers.
Beyond ADs, patients and surrogates recommend several additional steps to prepare for medical decision making including using past experiences to identify values, verifying the surrogate understands their role, deciding whether to grant surrogates leeway, and informing other family and friends of one's wishes. Future ACP interventions should consider incorporating these additional ACP activities.
A commentary discussng why we should view knowledge and documentation of patients' preferences for medical treatment in the medical record through the lens of patient safety.
COVID-19
In this letter to the editor we describe simple steps and simple scripts that all clinicians, regardless of discipline, can use to introduce advance care planning during the COVID-19 pandemic.
Encuesta sobre la Participación en la Planificación Anticipada
Descargue la encuesta de planificación del cuidado anticipado.
Shorter versions of the ACP Engagement Survey were able to detect within-group and between-group changes comparable with the 82-item version and can be useful for efficiently and effectively measuring ACP engagement in research and clinical settings.
Shorter versions of the ACP Engagement Survey are valid, internally consistent, and able to detect change across a broad range of ACP behaviors for English and Spanish speakers. Shorter ACP Surveys can efficiently measure broad ACP behaviors in research and clinical settings.
A new Advance Care Planning Engagement Survey that measures behavior change (knowledge, contemplation, self-efficacy, and readiness) and multiple advance care planning actions demonstrates good reliability and validity. Further research is needed to assess whether survey scores improve in response to advance care planning interventions and whether scores are associated with receipt of care consistent with one's wishes.
Both PREPARE plus an easy-to-read AD and an AD-only markedly increased ACP engagement in a full range of ACP behaviors, including discussions and documentation, and engagement was nearly 100% with PREPARE + AD. Future ACP studies should examine a full range of ACP behaviors beyond ADs and the impact of PREPARE and easy-to-read AD implementation on health care systems.
The ACP Engagement Survey demonstrated feasibility and acceptability in outpatient settings but was less feasible and acceptable among hospitalised patients due to length. A shorter version may improve feasibility. Engagement in ACP was low to moderate.
The Chinese readiness and self-efficacy subscales of the ACP Engagement Survey are valid and reliable tools for assessing the preparedness of the Chinese older adults for ACP.
Descargue la encuesta de planificación del cuidado anticipado.