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Advance Care Planning

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Rebecca L Sudore – 1st expert on this subject based on the ideXlab platform

  • provider perspectives on Advance Care Planning for patients with kidney disease whose job is it anyway
    Clinical Journal of The American Society of Nephrology, 2016
    Co-Authors: Ann M Ohare, Rebecca L Sudore, Jackie Szarka, Lynne V Mcfarland, Janelle S Taylor, Ranak B Trivedi, Lynn F Reinke

    Abstract:

    BACKGROUND AND OBJECTIVES:There is growing interest in efforts to enhance Advance Care Planning for patients with kidney disease. Our goal was to elicit the perspectives on Advance Care Planning of multidisciplinary providers who Care for patients with Advanced kidney disease. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who Care for patients with Advanced kidney disease. Participants were asked about their perspectives and experiences related to Advance Care Planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory. RESULTS:The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of Advance Care Planning for patients with Advanced kidney disease. We identified four overlapping themes: (1) medical Care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of Advance Care Planning and its relationship with other aspects of Care, such as dialysis decision making; (3) unclear locus of responsibility and authority for Advance Care Planning; and (4) lack of active collaboration and communication around Advance Care Planning among different providers caring for the same patients. CONCLUSIONS:The comments of providers who Care for patients with Advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around Advance Care Planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around Advance Care Planning among the different providers who Care for patients with Advanced kidney disease.

  • Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?
    Clinical Journal of The American Society of Nephrology, 2016
    Co-Authors: Ann M. O’hare, Rebecca L Sudore, Jackie Szarka, Lynne V Mcfarland, Janelle S Taylor, Ranak B Trivedi, Lynn F Reinke

    Abstract:

    Background and objectives There is growing interest in efforts to enhance Advance Care Planning for patients with kidney disease. Our goal was to elicit the perspectives on Advance Care Planning of multidisciplinary providers who Care for patients with Advanced kidney disease. Design, setting, participants, & measurements Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who Care for patients with Advanced kidney disease. Participants were asked about their perspectives and experiences related to Advance Care Planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory. Results The comments of providers interviewed for this study spoke to significant system–level barriers to supporting the process of Advance Care Planning for patients with Advanced kidney disease. We identified four overlapping themes: (1) medical Care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of Advance Care Planning and its relationship with other aspects of Care, such as dialysis decision making; (3) unclear locus of responsibility and authority for Advance Care Planning; and (4) lack of active collaboration and communication around Advance Care Planning among different providers caring for the same patients. Conclusions The comments of providers who Care for patients with Advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around Advance Care Planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around Advance Care Planning among the different providers who Care for patients with Advanced kidney disease.

  • Advance Care Planning meets group medical visits the feasibility of promoting conversations
    Annals of Family Medicine, 2016
    Co-Authors: Jacqueline Jones, Daniel D Matlock, Russell E Glasgow, Ingrid Lobo, Cari Levy, Robert S Schwartz, Rebecca L Sudore, Jean S Kutner

    Abstract:

    Author(s): Lum, Hillary D; Jones, Jacqueline; Matlock, Daniel D; Glasgow, Russell E; Lobo, Ingrid; Levy, Cari R; Schwartz, Robert S; Sudore, Rebecca L; Kutner, Jean S | Abstract: Primary Care needs new models to facilitate Advance Care Planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health Care providers. We describe the feasibility of the first primary Care-based group visit model focused on Advance Care Planning.We conducted a pilot demonstration of an Advance Care Planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing Advance Care Planning, choosing surrogate decision-makers, and completing Advance directives. We used the RE-AIM framework to evaluate the project.Ten of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing Advance Care Planning. Patients reported increases in detailed Advance Care Planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to Advance Care Planning and that they initiated discussions about a broad range of relevant topics.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.

Jean Lake Holley – 2nd expert on this subject based on the ideXlab platform

  • Advance Care Planning for Patients with Advanced CKD: A Need to Move Forward
    Clinical Journal of The American Society of Nephrology, 2015
    Co-Authors: Jean Lake Holley, Sara N. Davison

    Abstract:

    For well over a decade, we have known that dialysis patients and their families and friends desire opportunities to engage in Advance Care Planning with their nephrologist and dialysis teams ([1][1]–[3][2]). Clinical practice guidelines have recommended Advance Care Planning as central tenets of

  • Advance Care Planning in ckd esrd an evolving process
    Clinical Journal of The American Society of Nephrology, 2012
    Co-Authors: Jean Lake Holley

    Abstract:

    Summary Advance Care Planning was historically considered to be simply the completion of a proxy (health Care surrogate designation) or instruction (living will) directive that resulted from a conversation between a patient and his or her physician. We now know that Advance Care Planning is a much more comprehensive and dynamic patient-centered process used by patients and families to strengthen relationships, achieve control over medical Care, prepare for death, and clarify goals of Care. Some Advance directives, notably designated health Care proxy documents, remain appropriate expressions of Advance Care Planning. Moreover, although physician orders, such as do-not-resuscitate orders and Physician Orders for Life-Sustaining Treatment, may not be strictly defined as Advance directives, their completion, when appropriate, is an integral component of Advance Care Planning. The changing health circumstances and illness trajectory characteristic of ESRD mandate that Advance Care Planning discussions adapt to a patient’s situation and therefore must be readdressed at appropriate times and intervals. The options of withholding and withdrawing dialysis add ESRD-specific issues to Advance Care Planning in this population and are events each nephrologist will at some time confront. Advance Care Planning is important throughout the spectrum of ESRD and is a part of nephrology practice that can be rewarding to nephrologists and beneficial to patients and their families.

  • Advance Care Planning in CKD/ESRD: An Evolving Process
    Clinical Journal of The American Society of Nephrology, 2012
    Co-Authors: Jean Lake Holley

    Abstract:

    Summary Advance Care Planning was historically considered to be simply the completion of a proxy (health Care surrogate designation) or instruction (living will) directive that resulted from a conversation between a patient and his or her physician. We now know that Advance Care Planning is a much more comprehensive and dynamic patient-centered process used by patients and families to strengthen relationships, achieve control over medical Care, prepare for death, and clarify goals of Care. Some Advance directives, notably designated health Care proxy documents, remain appropriate expressions of Advance Care Planning. Moreover, although physician orders, such as do-not-resuscitate orders and Physician Orders for Life-Sustaining Treatment, may not be strictly defined as Advance directives, their completion, when appropriate, is an integral component of Advance Care Planning. The changing health circumstances and illness trajectory characteristic of ESRD mandate that Advance Care Planning discussions adapt to a patient’s situation and therefore must be readdressed at appropriate times and intervals. The options of withholding and withdrawing dialysis add ESRD-specific issues to Advance Care Planning in this population and are events each nephrologist will at some time confront. Advance Care Planning is important throughout the spectrum of ESRD and is a part of nephrology practice that can be rewarding to nephrologists and beneficial to patients and their families.

Catherine Exley – 3rd expert on this subject based on the ideXlab platform

  • A qualitative study: Professionals’ experiences of Advance Care Planning in dementia and palliative Care, ‘a good idea in theory but⋯’
    Palliative Medicine, 2013
    Co-Authors: Louise Robinson, Claire Dickinson, Claire Bamford, Alexa Clark, Julian Hughes, Catherine Exley

    Abstract:

    BACKGROUND: Advance Care Planning comprises discussions about an individual’s wishes for future Care while they have capacity. AIM: To explore professionals’ experiences on the implementation of Advance Care Planning in two areas of clinical Care, dementia and palliative Care. DESIGN: Qualitative study, focus groups and individual interviews. Setting: North East of England. Sample: Ninety-five participants from one Primary Care Trust, two acute National Health Service Hospital Trusts, one Ambulance Trust, one Local Authority and voluntary organisations and the legal sector. RESULTS: Fourteen focus groups and 18 interviews were held with 95 participants. While professionals agreed that Advance Care Planning was a good idea in theory, implementation in practice presented them with significant challenges. The majority expressed uncertainty over the general value of Advance Care Planning, whether current service provision could meet patient wishes, their individual roles and responsibilities and which aspects of Advance Care Planning were legally binding; the array of different Advance Care Planning forms and documentation available added to the confusion. In dementia Care, the timing of when to initiate Advance Care Planning discussions was an added challenge. CONCLUSIONS: This study has identified the professional, organisational and legal factors that influence Advance Care Planning implementation; professional training should target these specific areas. There is an urgent need for standardisation of Advance Care Planning documentation. Greater clarity is also required on the roles and responsibilities of different professional groups. More complex aspects of Advance Care Planning may be better carried out by those with specialist skills and experience than by generalists caring for a wide range of patient groups with different disease trajectories.