The Experts below are selected from a list of 4248 Experts worldwide ranked by ideXlab platform
Rebecca L Sudore - One of the best experts on this subject based on the ideXlab platform.
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engaging diverse english and spanish speaking older adults in Advance care planning the prepare randomized clinical trial
JAMA Internal Medicine, 2018Co-Authors: Rebecca L Sudore, John Boscardin, Mary T Katen, Dean Schillinger, Stacy Osua, Deborah E BarnesAbstract:Importance Advance care planning improves the receipt of medical care aligned with patients’ values; however, it remains suboptimal among diverse patient populations. To mitigate literacy, cultural, and language barriers to Advance care planning, easy-to-read Advance Directives and a patient-directed, online Advance care planning program called PREPARE For Your Care (PREPARE) were created in English and Spanish. Objective To compare the efficacy of PREPARE plus an easy-to-read Advance Directive with an Advance Directive alone to increase Advance care planning documentation and patient-reported engagement. Design, Setting, and Participants A comparative efficacy randomized clinical trial was conducted from February 1, 2014, to November 30, 2017, at 4 safety-net, primary-care clinics in San Francisco among 986 English-speaking or Spanish-speaking primary care patients 55 years or older with 2 or more chronic or serious illnesses. Interventions Participants were randomized to PREPARE plus an easy-to-read Advance Directive (PREPARE arm) or the Advance Directive alone. There were no clinician-level or system-level interventions. Staff were blinded for all follow-up measurements. Main Outcomes and Measures The primary outcome was documentation of new Advance care planning (ie, legal forms and/or documented discussions) at 15 months. Patient-reported outcomes included Advance care planning engagement at baseline, 1 week, 3 months, 6 months, and 12 months using validated surveys. Intention-to-treat analyses were performed using mixed-effects logistic and linear regression, controlling for time, health literacy, and baseline Advance care planning, clustering by physician, and stratifying by language. Results Among the 986 participants (603 women and 383 men), the mean (SD) age was 63.3 (6.4) years, 387 of 975 (39.7%) had limited health literacy, and 445 (45.1%) were Spanish speaking. No participant characteristic differed between the 2 groups, and retention was 85.9% (832 of 969) among survivors. Compared with the Advance Directive alone, PREPARE resulted in a higher rate of Advance care planning documentation (unadjusted, 43.0% [207 of 481] vs 33.1% [167 of 505];P Conclusions and Relevance 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 vs Advance Directive alone. These tools may mitigate literacy and 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. Trial Registration ClinicalTrials.gov identifiers:NCT01990235andNCT02072941
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effect of the prepare website vs an easy to read Advance Directive on Advance care planning documentation and engagement among veterans a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D Mcmahan, Mary T Katen, Deborah E BarnesAbstract:Importance:Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing Advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective:To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read Advance Directive (AD) to increase planning documentation. Design, Setting, and Participants:This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Interventions:Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. Main Outcomes and Measures:The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. Results:The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P <.001 at each follow-up). Conclusions and Relevance: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. Trial Registration:clinicaltrials.gov Identifier: NCT01550731.
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effect of the prepare website vs an easy to read Advance Directive on Advance care planning documentation and engagement among veterans a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D Mcmahan, Mary T Katen, Deborah E BarnesAbstract:Importance Documentation rates of patients’ medical wishes are often low. It is unknown whether easy-to-use, patient-facing Advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read Advance Directive (AD) to increase planning documentation. Design, Setting, and Participants This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Interventions Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. Main Outcomes and Measures The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. Results The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P Conclusions and Relevance 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. Trial Registration clinicaltrials.gov Identifier:NCT01550731
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engagement in multiple steps of the Advance care planning process a descriptive study of diverse older adults
Journal of the American Geriatrics Society, 2008Co-Authors: Rebecca L Sudore, Brie A Williams, Seth C Landefeld, Adam D Schickedanz, Karla Lindquist, Steven Z Pantilat, Dean SchillingerAbstract:OBJECTIVES: To assess engagement in multiple steps of the Advance care planning (ACP) process 6 months after exposure to an Advance Directive. In this study, ACP is conceptualized similarly to the behavior change model. DESIGN: Descriptive study. SETTINGS: County general medicine clinic in San Francisco. PARTICIPANTS: One hundred seventy-three English or Spanish speakers, aged 50 and older (mean 61) given a standard (12th-grade reading level) and an easy-to-read (5th-grade reading level) Advance Directive. MEASUREMENTS: Six months after exposure to two Advance Directives, self-reported ACP contemplation; discussions with family, friends discussions with clinicians; and documentation were measured. Associations were examined between ACP steps and between subject characteristics ACP engagement. RESULTS: Most participants (73%) were nonwhite and 31% had less than a high school education. Sixty-one percent contemplated ACP, 56% discussed ACP with family or friends, 22% discussed ACP with clinicians, and 13% documented ACP wishes. Subjects who had discussed ACP with their family or friends were more likely to discuss ACP with their clinicians (36% vs 2%, P<.001) and document ACP wishes (18% vs 4%, P=.009) than those who had not. Latinos and subjects with less than a high school education discussed ACP more often with family or friends (P<.06) and clinicians (P<.03) than other ethnic groups and subjects with more education. CONCLUSIONS: ACP involves distinct steps including contemplation, discussions, and documentation. The ACP paradigm should be broadened to include contemplation and discussions. Promoting discussions with family and friends may be one of the most important targets for ACP interventions, and literacy- and language-appropriate Advance Directives may help reverse patterns of sociodemographic disparities in ACP.
Deborah E Barnes - One of the best experts on this subject based on the ideXlab platform.
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engaging diverse english and spanish speaking older adults in Advance care planning the prepare randomized clinical trial
JAMA Internal Medicine, 2018Co-Authors: Rebecca L Sudore, John Boscardin, Mary T Katen, Dean Schillinger, Stacy Osua, Deborah E BarnesAbstract:Importance Advance care planning improves the receipt of medical care aligned with patients’ values; however, it remains suboptimal among diverse patient populations. To mitigate literacy, cultural, and language barriers to Advance care planning, easy-to-read Advance Directives and a patient-directed, online Advance care planning program called PREPARE For Your Care (PREPARE) were created in English and Spanish. Objective To compare the efficacy of PREPARE plus an easy-to-read Advance Directive with an Advance Directive alone to increase Advance care planning documentation and patient-reported engagement. Design, Setting, and Participants A comparative efficacy randomized clinical trial was conducted from February 1, 2014, to November 30, 2017, at 4 safety-net, primary-care clinics in San Francisco among 986 English-speaking or Spanish-speaking primary care patients 55 years or older with 2 or more chronic or serious illnesses. Interventions Participants were randomized to PREPARE plus an easy-to-read Advance Directive (PREPARE arm) or the Advance Directive alone. There were no clinician-level or system-level interventions. Staff were blinded for all follow-up measurements. Main Outcomes and Measures The primary outcome was documentation of new Advance care planning (ie, legal forms and/or documented discussions) at 15 months. Patient-reported outcomes included Advance care planning engagement at baseline, 1 week, 3 months, 6 months, and 12 months using validated surveys. Intention-to-treat analyses were performed using mixed-effects logistic and linear regression, controlling for time, health literacy, and baseline Advance care planning, clustering by physician, and stratifying by language. Results Among the 986 participants (603 women and 383 men), the mean (SD) age was 63.3 (6.4) years, 387 of 975 (39.7%) had limited health literacy, and 445 (45.1%) were Spanish speaking. No participant characteristic differed between the 2 groups, and retention was 85.9% (832 of 969) among survivors. Compared with the Advance Directive alone, PREPARE resulted in a higher rate of Advance care planning documentation (unadjusted, 43.0% [207 of 481] vs 33.1% [167 of 505];P Conclusions and Relevance 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 vs Advance Directive alone. These tools may mitigate literacy and 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. Trial Registration ClinicalTrials.gov identifiers:NCT01990235andNCT02072941
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effect of the prepare website vs an easy to read Advance Directive on Advance care planning documentation and engagement among veterans a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D Mcmahan, Mary T Katen, Deborah E BarnesAbstract:Importance:Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing Advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective:To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read Advance Directive (AD) to increase planning documentation. Design, Setting, and Participants:This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Interventions:Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. Main Outcomes and Measures:The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. Results:The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P <.001 at each follow-up). Conclusions and Relevance: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. Trial Registration:clinicaltrials.gov Identifier: NCT01550731.
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effect of the prepare website vs an easy to read Advance Directive on Advance care planning documentation and engagement among veterans a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D Mcmahan, Mary T Katen, Deborah E BarnesAbstract:Importance Documentation rates of patients’ medical wishes are often low. It is unknown whether easy-to-use, patient-facing Advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read Advance Directive (AD) to increase planning documentation. Design, Setting, and Participants This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Interventions Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. Main Outcomes and Measures The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. Results The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P Conclusions and Relevance 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. Trial Registration clinicaltrials.gov Identifier:NCT01550731
Mary T Katen - One of the best experts on this subject based on the ideXlab platform.
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engaging diverse english and spanish speaking older adults in Advance care planning the prepare randomized clinical trial
JAMA Internal Medicine, 2018Co-Authors: Rebecca L Sudore, John Boscardin, Mary T Katen, Dean Schillinger, Stacy Osua, Deborah E BarnesAbstract:Importance Advance care planning improves the receipt of medical care aligned with patients’ values; however, it remains suboptimal among diverse patient populations. To mitigate literacy, cultural, and language barriers to Advance care planning, easy-to-read Advance Directives and a patient-directed, online Advance care planning program called PREPARE For Your Care (PREPARE) were created in English and Spanish. Objective To compare the efficacy of PREPARE plus an easy-to-read Advance Directive with an Advance Directive alone to increase Advance care planning documentation and patient-reported engagement. Design, Setting, and Participants A comparative efficacy randomized clinical trial was conducted from February 1, 2014, to November 30, 2017, at 4 safety-net, primary-care clinics in San Francisco among 986 English-speaking or Spanish-speaking primary care patients 55 years or older with 2 or more chronic or serious illnesses. Interventions Participants were randomized to PREPARE plus an easy-to-read Advance Directive (PREPARE arm) or the Advance Directive alone. There were no clinician-level or system-level interventions. Staff were blinded for all follow-up measurements. Main Outcomes and Measures The primary outcome was documentation of new Advance care planning (ie, legal forms and/or documented discussions) at 15 months. Patient-reported outcomes included Advance care planning engagement at baseline, 1 week, 3 months, 6 months, and 12 months using validated surveys. Intention-to-treat analyses were performed using mixed-effects logistic and linear regression, controlling for time, health literacy, and baseline Advance care planning, clustering by physician, and stratifying by language. Results Among the 986 participants (603 women and 383 men), the mean (SD) age was 63.3 (6.4) years, 387 of 975 (39.7%) had limited health literacy, and 445 (45.1%) were Spanish speaking. No participant characteristic differed between the 2 groups, and retention was 85.9% (832 of 969) among survivors. Compared with the Advance Directive alone, PREPARE resulted in a higher rate of Advance care planning documentation (unadjusted, 43.0% [207 of 481] vs 33.1% [167 of 505];P Conclusions and Relevance 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 vs Advance Directive alone. These tools may mitigate literacy and 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. Trial Registration ClinicalTrials.gov identifiers:NCT01990235andNCT02072941
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effect of the prepare website vs an easy to read Advance Directive on Advance care planning documentation and engagement among veterans a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D Mcmahan, Mary T Katen, Deborah E BarnesAbstract:Importance:Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing Advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective:To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read Advance Directive (AD) to increase planning documentation. Design, Setting, and Participants:This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Interventions:Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. Main Outcomes and Measures:The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. Results:The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P <.001 at each follow-up). Conclusions and Relevance: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. Trial Registration:clinicaltrials.gov Identifier: NCT01550731.
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effect of the prepare website vs an easy to read Advance Directive on Advance care planning documentation and engagement among veterans a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D Mcmahan, Mary T Katen, Deborah E BarnesAbstract:Importance Documentation rates of patients’ medical wishes are often low. It is unknown whether easy-to-use, patient-facing Advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read Advance Directive (AD) to increase planning documentation. Design, Setting, and Participants This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Interventions Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. Main Outcomes and Measures The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. Results The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P Conclusions and Relevance 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. Trial Registration clinicaltrials.gov Identifier:NCT01550731
Marvin S Swartz - One of the best experts on this subject based on the ideXlab platform.
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facilitation of psychiatric Advance Directives by peers and clinicians on assertive community treatment teams
Psychiatric Services, 2017Co-Authors: Michele M Easter, Lorna L Moser, Jeffrey W Swanson, Allison G Robertson, Marvin S SwartzAbstract:Objective:Psychiatric Advance Directives (PADs) provide a legal mechanism for competent adults to document care preferences and authorize a surrogate to make treatment decisions. In a controlled research setting, an evidence-based intervention, the facilitated psychiatric Advance Directive (FPAD), was previously shown to overcome most barriers to PAD completion. This study examined implementation of the FPAD intervention in usual care settings as delivered by peer support specialists and nonpeer clinicians on assertive community treatment (ACT) teams.Methods:A total of 145 ACT consumers were randomly assigned, within teams, to FPAD with facilitation by either a peer (N=71) or a clinician (N=74). Completion rates and PAD quality were compared with the previous study’s standard and across facilitator type. Logistic regression was used to estimate effects on the likelihood of PAD completion.Results:The completion rate of 50% in the intent-to-treat sample (N=145) was somewhat inferior to the prior standard (6...
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medication preferences and adherence among individuals with severe mental illness and psychiatric Advance Directives
Psychiatric Services, 2010Co-Authors: Christine M Wilder, Lorna L Moser, Jeffrey W Swanson, Eric B Elbogen, Marvin S SwartzAbstract:Objective: Psychiatric Advance Directives allow patients with severe mental illness to document their preferences for particular medications. This study investigated the role of psychiatric Advance Directives in treatment choice and medication adherence. Methods: A total of 123 persons with severe mental illness recorded medication preferences in psychiatric Advance Directives. The authors compared medication preferences to prescribed medications over 12 months, determined concordance between preferred and prescribed medications, and examined the effect of concordance on medication adherence at 12 months. Results: Participants requested a median of two medications in their psychiatric Advance Directives (range from zero to six) and refused a median of one medication (range from zero to ten). Between baseline and follow-up there was a 27% increase in the number of medications prescribed that had been requested on the psychiatric Advance Directive (Wilcoxon matched pairs, p<.001). After correction for the number of medications listed in the psychiatric Advance Directive, a 10% increase in concordance remained significant (p<.001). Being prescribed at least one medication requested in the psychiatric Advance Directive predicted higher medication adherence at 12 months, after the analysis controlled for relevant covariates (odds ratio=7.8, 95% confidence interval=1.8–34.0). Conclusions: Providing information about medication preferences in psychiatric Advance Directives may increase prescribing of patient-preferred medications even in noncrisis settings. Patients who were prescribed medications that they requested in Advance were significantly more likely to adhere to medications, supporting the benefit of patient participation in medication choice. Psychiatric Advance Directives appear to be a clinically useful conduit for communicating patient medication preferences. (Psychiatric Services 61:380–385, 2010)
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autonomy and the use of Directive intervention in the treatment of individuals with serious mental illnesses a survey of social work practitioners
Social Work in Mental Health, 2009Co-Authors: Anna Scheyett, Jeffrey W Swanson, Marvin S Swartz, Eric B Elbogen, Richard A Van Dorn, Mimi Kim, Joelle FerronAbstract:Social workers in mental health settings struggle to support the principle of autonomy while weighing the need to Directively intervene when there is a risk of harm or when clients are nonadherent to treatment. However, our understanding of this tension is incomplete. We therefore engaged in a survey of 193 social workers in North Carolina regarding attitudes toward autonomy and Directive interventions, and examined correlates of these attitudes. Findings revealed that respondents having a client with a psychiatric Advance Directive were significantly more supportive of client autonomy. Respondents who were licensed, working in an inpatient setting, or had briefer client contacts were more likely to endorse the need for Directive interventions, and those working in the public sector reported more use of warnings to improve adherence. Implications for practice, training, and research are discussed.
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facilitated psychiatric Advance Directives a randomized trial of an intervention to foster Advance treatment planning among persons with severe mental illness
American Journal of Psychiatry, 2006Co-Authors: Jeffrey W Swanson, Marvin S Swartz, Eric B Elbogen, Richard A Van Dorn, M Joelle S W Ferron, Ryan H Wagner, Barbara J Mccauley, Mimi KimAbstract:Objective: Studies show a high potential demand for psychiatric Advance Directives but low completion rates. The authors conducted a randomized study of a structured, manualized intervention to facilitate completion of psychiatric Advance Directives. Method: A total of 469 patients with severe mental illness were randomly assigned to a facilitated psychiatric Advance Directive session or a control group that received written information about psychiatric Advance Directives and referral to resources in the public mental health system. Completion of an Advance Directive, its structure and content, and its short-term effects on working alliance and treatment satisfaction were recorded. Results: Sixty-one percent of participants in the facilitated session completed an Advance Directive or authorized a proxy decision maker, compared with only 3% of control group participants. Psychiatrists rated the Advance Directives as highly consistent with standards of community practice. Most participants used the Advance...
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mandated community treatment beyond outpatient commitment
Psychiatric Services, 2001Co-Authors: John Monahan, Richard J Bonnie, Paul S Appelbaum, Pamela S Hyde, Henry J Steadman, Marvin S SwartzAbstract:Outpatient commitment, although often viewed as merely an extension of inpatient commitment, is only one of a growing array of legal tools used to mandate treatment adherence. The authors describe various forms of mandated community treatment. People with severe and chronic mental disorders often depend on goods and services provided by the social welfare system. Benefits disbursed by representative payees and the provision of subsidized housing have both been used as leverage to ensure treatment adherence. Many discharged patients are arrested for criminal offenses. Favorable disposition of their cases by a mental health court may be tied to participation in treatment. Under outpatient commitment statutes, judges can order committed patients to comply with prescribed treatment. Patients may attempt to maximize their control over treatment in the event of later deterioration by executing an Advance Directive. The ideological posturing that currently characterizes the field must be replaced by an evidence-based approach.
Mariko A Feuz - One of the best experts on this subject based on the ideXlab platform.
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effect of the prepare website vs an easy to read Advance Directive on Advance care planning documentation and engagement among veterans a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D Mcmahan, Mary T Katen, Deborah E BarnesAbstract:Importance:Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing Advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective:To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read Advance Directive (AD) to increase planning documentation. Design, Setting, and Participants:This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Interventions:Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. Main Outcomes and Measures:The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. Results:The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P <.001 at each follow-up). Conclusions and Relevance: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. Trial Registration:clinicaltrials.gov Identifier: NCT01550731.
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effect of the prepare website vs an easy to read Advance Directive on Advance care planning documentation and engagement among veterans a randomized clinical trial
JAMA Internal Medicine, 2017Co-Authors: Rebecca L Sudore, John Boscardin, Mariko A Feuz, Ryan D Mcmahan, Mary T Katen, Deborah E BarnesAbstract:Importance Documentation rates of patients’ medical wishes are often low. It is unknown whether easy-to-use, patient-facing Advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. Objective To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read Advance Directive (AD) to increase planning documentation. Design, Setting, and Participants This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Interventions Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. Main Outcomes and Measures The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. Results The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P Conclusions and Relevance 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. Trial Registration clinicaltrials.gov Identifier:NCT01550731