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Eduardo Bruera - One of the best experts on this subject based on the ideXlab platform.
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advance directives and do not resuscitate orders in patients with cancer with metastatic spinal cord compression advanced care planning implications
Journal of Palliative Medicine, 2010Co-Authors: Ying Guo, Lynn J Palmer, Josephine Bianty, Benedict Konzen, Ki Y Shin, Eduardo BrueraAbstract:Abstract Objectives: Communication about end-of-life decisions is crucial. Although patients with metastatic spinal cord compression (MSCC) have a median survival time of 3 to 6 months, few data are available concerning the presence of advance directives and do-not-resuscitate (DNR) orders in this population. The objective of this study was to determine presence of advance directives and DNR order among patients with MSCC. Methods: We retrospectively reviewed data concerning advance directives for 88 consecutive patients with cancer who had MSCC and required rehabilitation consultation at The University of Texas M. D. Anderson Cancer Center from September 20, 2005 to August 29, 2008. We characterized the data using univariate descriptive statistics and used the Fisher exact test to find correlations. Results: The mean age of this patient population was 55 years (range, 24–81). Thirty patients (33%) were female. Twenty patients (23%) had a Living Will, 27 patients (31%) had health care proxies, and 10 pati...
Terri R Fried - One of the best experts on this subject based on the ideXlab platform.
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development of personalized health messages to promote engagement in advance care planning
Journal of the American Geriatrics Society, 2016Co-Authors: Terri R Fried, Colleen A Redding, Mark L Robbins, Andrea L Paiva, John R Oleary, Lynne IannoneAbstract:Objectives To develop and test the acceptability of personalized intervention materials to promote advance care planning (ACP) based on the Transtheoretical Model (TTM), in which readiness to change is a critical organizing construct. Design Development study creating an expert system delivering TTM-personalized feedback reports and stage-matched brochures with more-general information on ACP and modifications based on participant reviews. Setting Senior centers. Participants Community-Living persons aged 65 and older (N = 77). Measurements Participant ratings of length, attractiveness, and trustworthiness of and reactions to reports and brochures. Results The expert system assessed participants’ readiness to engage in each of four ACP behaviors: completion of a Living Will, naming a health care proxy, communication with loved ones about quality vs quantity of life, and communication with clinicians about quality vs quantity of life. The system also assessed pros and cons of engagement and values and beliefs that influence engagement. The system provided individualized feedback based on the assessment, with brochures providing additional general information. Initial participant review indicating unacceptable length led to revision of feedback reports from full-sentence paragraph format to bulleted format. After review, the majority of participants rated the materials as easy to read, trustworthy, providing new information, making them more comfortable reading about ACP, and increasing interest in participating in ACP. Conclusion Older adults found an expert system individualized feedback report and accompanying brochure to promote ACP engagement to highly acceptable and engaging. Additional research is necessary to examine the effects of these materials on behavior change.
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association of experience with illness and end of life care with advance care planning in older adults
Journal of the American Geriatrics Society, 2014Co-Authors: Halima Amjad, Virginia Towle, Terri R FriedAbstract:Objectives: To examine whether experiences with illness and end-of-life care are associated with readiness to participate in advance care planning (ACP). Design: Observational cohort study. Setting: Community. Participants: Persons aged 60 and older recruited from physician offices and a senior center. Measurements: Participants were asked about personal experience with major illness or surgery and experience with others' end-of-life care, including whether they had made a medical decision for someone dying, knew someone who had a bad death due to too much or too little medical care, or experienced the death of a loved one who made end-of-life wishes known. Stages of change were assessed for specific ACP behaviors: completion of Living Will and healthcare proxy, communication with loved ones regarding life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same topics. Stages of change included precontemplation, contemplation, preparation, and action or maintenance, corresponding to whether the participant was not ready to complete the behavior, was considering participation in the next 6 months, was planning participation within 30 days, or had already participated. Results: Of 304 participants, 84% had one or more personal experiences or experience with others. Personal experiences were not associated with greater readiness for most ACP behaviors. In contrast, having one or more experiences with others was associated with greater readiness to complete a Living Will and healthcare proxy, discuss life-sustaining treatment with loved ones, and discuss quantity versus quality of life with loved ones and with physicians. Conclusion: Older individuals who have experience with end-of-life care of others demonstrate greater readiness to participate in ACP. Discussions with older adults regarding these experiences may be a useful tool in promoting ACP.
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stages of change for the component behaviors of advance care planning
Journal of the American Geriatrics Society, 2010Co-Authors: Terri R Fried, Colleen A Redding, Mark L Robbins, Andrea L Paiva, John R Oleary, Lynne IannoneAbstract:OBJECTIVES: To develop stages-of-change measures for advance care planning (ACP), conceptualized as a group of interrelated but separate behaviors, and to use these measures to characterize older persons' engagement in and factors associated with readiness to participate in ACP. DESIGN: Observational cohort study. SETTING: Community. PARTICIPANTS: Persons aged 65 and older recruited from physician offices and a senior center. MEASUREMENTS: Stages of change for six ACP behaviors: completion of a Living Will and healthcare proxy, communication with loved ones regarding use of life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same issues. RESULTS: Readiness to participate in ACP varied widely across behaviors. Whereas between approximately 50% and 60% of participants were in the action or maintenance stage for communicating with loved ones about life-sustaining treatment and completing a Living Will, 40% were in the precontemplation stage for communicating with loved ones about quantity versus quality of life, and 70% and 75% were in the precontemplation stage for communicating with physicians. Participants were frequently in different stages for different behaviors. Few sociodemographic, health, or psychosocial factors were associated with stages of change for completing a Living Will, but a broader range of factors was associated with stages of change for communication with loved ones about quantity versus quality of life. CONCLUSION: Older persons show a range of readiness to engage in different aspects of ACP. Individualized assessment and interventions targeted to stage of behavior change for each component of ACP may be an effective strategy to increase participation in ACP.
Deborah Carr - One of the best experts on this subject based on the ideXlab platform.
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advance care planning contemporary issues and future directions
Innovation in Aging, 2017Co-Authors: Deborah Carr, Elizabeth A LuthAbstract:Advance care planning (ACP) is widely considered an essential step toward achieving end-of-life care that is consistent with the preferences of dying patients and their families. ACP comprises a Living Will and a durable power of attorney for health care (DPAHC); these tools enable patients to articulate and convey their treatment preferences when they are still cognitively intact. In this article, we describe the strengths, weaknesses, and correlates of ACP in the United States, with attention to race and socioeconomic disparities therein. We then discuss other public policies and community programs designed to increase both the number of older adults who articulate their preferences for end-of-life care, and efficacy of ACP for ensuring that patients' end-of-life treatment preferences are met. We describe the characteristics, strengths, and limitations of Physician Orders for Life Sustaining Treatment (POLSTs), and describe community programs, educational interventions, and public policies aimed toward increasing the prevalence and efficacy of end-of-life preparations. A key policy advance in the early 2010s has been Medicare coverage of one doctor-patient consultation session regarding end-of-life issues; we highlight the potentials and possible pitfalls of this policy. We conclude by identifying areas for future research, and highlighting practices from other nations that may help improve quality of end-of-life care in the United States.
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end of life planning in a family context does relationship quality affect whether and with whom older adults plan
Journals of Gerontology Series B-psychological Sciences and Social Sciences, 2013Co-Authors: Deborah Carr, Sara M Moorman, Kathrin BoernerAbstract:At the end of life, most older adults suffer from chronic illness, physical discomfort, and compromised cognitive functioning. Under such conditions, they may be incapable of making decisions about their own medical treatments (Silveira, Kim, & Langa, 2010). Decisions about accepting or rejecting treatments often are left to family members who may not know the patient’s preferences or who may disagree about an appropriate course of care. To help ensure that their end-of-life treatment preferences are articulated and heeded by care providers, people can complete advance care planning (ACP) when they are still cognitively intact. ACP comprises formal and informal components: formal ACP includes a Living Will, a legal document specifying the medical treatments one would like to receive, and a durable power of attorney for health care (DPAHC), which designates a person to make decisions on behalf of an incompetent patient. Informal planning refers to discussions about specific treatment preferences and general values. Practitioners concur that planning is most effective when the formal documents are executed following informal discussions with those persons who may represent the patient in the decision-making process (Doukas & Hardwig, 2003). The efficacy of ACP may depend on the cooperation, knowledge, and participation of family members (Kehl, Kirchhoff, Kramer, & Hovland-Scafe, 2009). Family structure, including marital and parental statuses, affects both whether one engages in ACP and whom one names as DPAHC (Carr & Khodyakov, 2007; Kahana, Dan, Kahana, & Kercher, 2004). However, previous studies have not investigated the extent to which the quality of one’s relationships with spouse and children affect whether, how, and with whom older adults prepare for end-of-life care. This partly reflects the fact that studies of ACP historically were based on clinical samples, often of single disease groups, and thus do not obtain rich, comprehensive measures of family relationships. Our study uses data from the Wisconsin Longitudinal Study (WLS), a long-term study of aging that obtains detailed measures on ACP along with general questions assessing family functioning, parent–child relationships, and marital relations; as such, our study represents a first step at exploring the impact of family context on older adults’ end-of-life preparations. Study Aims The WLS obtained reports from relatively healthy older adults (aged 64–65 years) about their ACP, specific DPAHC designations, relationship quality, and potential confounds including socioeconomic status (SES) and health. These data enable us to explore associations between both positive and negative aspects of family relationships and two distinct ACP outcomes: one’s general planning strategy (i.e., discussions only, both formal and informal planning, or neither) and whom one appointed as DPAHC (i.e., spouse, child, other, or none). We expect that persons reporting greater marital satisfaction and more emotional support from children are more likely to engage in either of the two most effective types of ACP: discussions alone or a two-pronged approach comprising both formal and informal preparations. Similarly, we expect that a better quality relationship with a particular family member Will increase the likelihood of that person being appointed DPAHC. These hypotheses are consistent with social support and control theories. The former states that individuals with high-quality relationships may be more highly motivated to engage in protective health behaviors (such as ACP) for the good of their family members. They also may feel encouraged to engage in ACP, a potentially stressful activity, due to the emotional support they receive from family (House, Landis, & Umberson, 1988). Social control perspectives, by contrast, emphasize that significant others may directly regulate, monitor, or urge a loved one’s health behaviors (Lewis & Rook, 1999). The potential impact of strained family relations, operationalized here as criticism from children, is more complex. Criticism from children could increase the likelihood of both ACP and selecting an adult child as DPAHC, if parents interpret such critical interactions as a concerned child’s way of offering assistance. Conversely, if such critical encounters are perceived to be an indicator of discord rather than concern, then frequent criticism may dissuade a parent from naming the child as DPAHC. Unfortunately, our data do not capture a parent’s interpretation of their child’s motivation for being critical; however, we can explore whether such critical exchanges increase or reduce the odds of both ACP and specific DPAHC appointments. All analyses are adjusted for demographic (i.e., sex, number of children), SES (i.e., education, income), and health (i.e., self-rated health, depressive symptoms, hospitalizations) characteristics to account for potentially spurious associations between relationship quality and ACP. Prior studies reveal that these background characteristics are associated with both family relationship quality in later life (Silverstein & Giarrusso, 2010) and ACP (Carr & Khodyakov, 2007). We also adjust for the quality of relationships with friends and more distant family members; these other sources of support may be compensatory and may encourage ACP even if one’s relationships with spouse and children are problematic.
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the social stratification of older adults preparations for end of life health care
Journal of Health and Social Behavior, 2012Co-Authors: Deborah CarrAbstract:I use data from the Wisconsin Longitudinal Study (n = 4,971) to evaluate the extent to which socioeconomic status affects three health-related (Living Will, durable power of attorney for health care, and discussions) and one financial (Will) component of end-of-life planning. Net worth is positively associated with all four types of planning, after demographic, health, and psychological characteristics are controlled. Low rates of health-related planning among persons with low or negative assets are largely accounted for by the fact that they are less likely to execute a Will, an action that triggers health-related preparations. Rates of health-related planning alone are higher among recently hospitalized persons, whereas financial planning only is more commonly done by homeowners and those with richer assets. The results suggest that economically advantaged persons engage in end-of-life planning as a two-pronged strategy entailing financial and health-related preparations. Implications for health policy, practice, and theory are discussed.
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end of life health care planning among young old adults an assessment of psychosocial influences
Journals of Gerontology Series B-psychological Sciences and Social Sciences, 2007Co-Authors: Deborah Carr, Dmitry KhodyakovAbstract:Objectives. End-of-life planning among healthy older adults may protect them from unwanted medical treatments in later life, in the event that they become incapable of making health care decisions for themselves. We explore two formal and one informal components of end-of-life planning (Living Will, durable power of attorney for health care, and discussions) and assess whether one’s health and health care encounters, personal beliefs, and experience with others’ deaths affect these practices. Methods. Using two waves of data (1992‐1993 and 2004) from the Wisconsin Longitudinal Study, we estimated binary and multinomial logistic regression models to predict end-of-life preparations among a sample of communitydwelling persons aged 64‐65 (N ¼ 3,838). Results. Recent hospitalizations, personal beliefs (Death Avoidance and the belief that doctors should control health care decisions), and recent experience with the painful death of a loved one all influence end-of-life preparations. Consistent with past studies, we also found that education, gender, marital status, and religious affiliation affect end-of-life planning. Discussion. Health care providers may encourage end-of-life preparations by assuaging patients’ death anxiety and fostering decision-making autonomy. Initiating discussions about recent deaths of loved ones may be an effective way to trigger patients’ own end-of-life preparations.
Ying Guo - One of the best experts on this subject based on the ideXlab platform.
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advance directives and do not resuscitate orders in patients with cancer with metastatic spinal cord compression advanced care planning implications
Journal of Palliative Medicine, 2010Co-Authors: Ying Guo, Lynn J Palmer, Josephine Bianty, Benedict Konzen, Ki Y Shin, Eduardo BrueraAbstract:Abstract Objectives: Communication about end-of-life decisions is crucial. Although patients with metastatic spinal cord compression (MSCC) have a median survival time of 3 to 6 months, few data are available concerning the presence of advance directives and do-not-resuscitate (DNR) orders in this population. The objective of this study was to determine presence of advance directives and DNR order among patients with MSCC. Methods: We retrospectively reviewed data concerning advance directives for 88 consecutive patients with cancer who had MSCC and required rehabilitation consultation at The University of Texas M. D. Anderson Cancer Center from September 20, 2005 to August 29, 2008. We characterized the data using univariate descriptive statistics and used the Fisher exact test to find correlations. Results: The mean age of this patient population was 55 years (range, 24–81). Thirty patients (33%) were female. Twenty patients (23%) had a Living Will, 27 patients (31%) had health care proxies, and 10 pati...
Josephine Bianty - One of the best experts on this subject based on the ideXlab platform.
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Original Articles Advance Directives and Do-Not-Resuscitate Orders in Patients with Cancer with Metastatic Spinal Cord Compression: Advanced Care Planning Implications
2020Co-Authors: M.d Ying Guo, Josephine Bianty, Ph.d Lynn J Palmer, R N, M.d Benedict Konzen, M.d Ki Shin, M.d. Eduardo BrueraAbstract:Abstract Objectives: Communication about end-of-life decisions is crucial. Although patients with metastatic spinal cord compression (MSCC) have a median survival time of 3 to 6 months, few data are available concerning the presence of advance directives and do-not-resuscitate (DNR) orders in this population. The objective of this study was to determine presence of advance directives and DNR order among patients with MSCC. Methods: We retrospectively reviewed data concerning advance directives for 88 consecutive patients with cancer who had MSCC and required rehabilitation consultation at The University of Texas M. D. Anderson Cancer Center from September 20, 2005 to August 29, 2008. We characterized the data using univariate descriptive statistics and used the Fisher exact test to find correlations. Results: The mean age of this patient population was 55 years (range, 24-81). Thirty patients (33%) were female. Twenty patients (23%) had a Living Will, 27 patients (31%) had health care proxies, and 10 patients (11%) had either out-of-hospital DNR order and=or dictated DNR note. The median survival time for these patients was 4.3 months. Conclusion: Despite strong evidence showing short survival times for MSCC patients, it seems many of these patients are not aware of the urgency to have an advance directive. This may be an indicator of delayed end-oflife palliative care and suboptimal doctor-patient communication. Using the catastrophic event of a diagnosis of MSCC to trigger communication and initiate palliative care may be beneficial to patients and their families
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advance directives and do not resuscitate orders in patients with cancer with metastatic spinal cord compression advanced care planning implications
Journal of Palliative Medicine, 2010Co-Authors: Ying Guo, Lynn J Palmer, Josephine Bianty, Benedict Konzen, Ki Y Shin, Eduardo BrueraAbstract:Abstract Objectives: Communication about end-of-life decisions is crucial. Although patients with metastatic spinal cord compression (MSCC) have a median survival time of 3 to 6 months, few data are available concerning the presence of advance directives and do-not-resuscitate (DNR) orders in this population. The objective of this study was to determine presence of advance directives and DNR order among patients with MSCC. Methods: We retrospectively reviewed data concerning advance directives for 88 consecutive patients with cancer who had MSCC and required rehabilitation consultation at The University of Texas M. D. Anderson Cancer Center from September 20, 2005 to August 29, 2008. We characterized the data using univariate descriptive statistics and used the Fisher exact test to find correlations. Results: The mean age of this patient population was 55 years (range, 24–81). Thirty patients (33%) were female. Twenty patients (23%) had a Living Will, 27 patients (31%) had health care proxies, and 10 pati...