Education In Advance Care Planning: A Novel Equity-Based, Interprofessional Service-Learning Approach, Dorothy Yam, Sriya Kudaravalli, Elizabeth A. Mulvaney, Leslie Scheunemann, Grace W. Orsatti

Journal of Innovation in Health Sciences Education

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Introduction: Despite health sciences graduate schools emphasizing service-learning and interprofessionalism, they often struggle to integrate these values into the curricula effectively. Advance care planning is inherently interdisciplinary and presents an opportunity to address equity gaps through service-learning. This report describes a novel interdisciplinary service-learning initiative for graduate student trainees, focused on advance care planning in underserved communities.

Methods: After targeted training, teams of medical, law, and social work students, and professionals from their respective fields, took part in two Life Planning Fairs in historically underserved neighborhoods in Pittsburgh, Pennsylvania. Using a form developed by the Allegheny County Bar Association …

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Advancing Person-Centred Care Through Palliative Care Wa’S Acp Workshops: The Longer-Term Impact, Gertrude G. Phiri, Emma Gunner, Philip Bafile, Davina Porock

Research outputs 2022 to 2026

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Planning for end-of-life and associated decision-making is one of global significance as it impacts the quality of care in palliative care settings, including ensuring that personal preferences are honoured. It is a priority for the Australian health system to use Advance Care Planning (ACP) as it is an effective tool for individuals and their families to make their personal preferences known and implemented. The aim of this project was to evaluate the longer-term impact of the Palliative Care Western Australia (PCWA) ACP workshops. Semi-structured, open-ended questions were used to collect data from 21 participants. Reflexive thematic analysis was used to …

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Conducting Comparative Effectiveness, Multisite Palliative Care And Advance Care Planning Trials: Lessons Learned And Future Directions From Pcori-Funded Studies, Areej El-Jawahri, Brittany Waterman, Susan Enguidanos, Lisa Gibbs, Victor Navarro, Maren Olsen, Jennifer Temel, Annette Totten, Corita R. Grudzen

Department of Medicine Faculty Papers

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The Patient-Centered Outcomes Research Institute (PCORI) funded multiple large-scale comparative effectiveness clinical trials evaluating palliative care (PC) and advance care planning (ACP) healthcare delivery models. This article provides an overview of the most common barriers our investigative teams encountered while implementing these trials and the strategies we utilized to overcome these challenges, with particular attention to identifying research partners for multisite trials; addressing contracting and regulatory issues; creating a team governance structure; training and engaging study staff across sites; recruiting, consenting, and enrolling study participants; collecting PC and ACP data and study outcomes; and managing multisite collaborations. The goal of …

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Honoring Veterans’ Wishes: Efficacy Of An Evidence-Based Shared Decision-Making Tool In Va Icu Goals-Of-Care Discussions, Stephanie Alexander, Anna Astashchanka Md, Venktesh Ramnath Md

Doctor of Nursing Practice Final Manuscripts

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Abstract

Introduction: This Doctor of Nursing Practice project aimed to enhance the knowledge and confidence of the San Diego Veterans Health Administration’s (VASD) Intensive Care Unit (ICU) medical providers in goals-of-care discussions (GOCD). Additionally, this project aimed to improve the documentation of these discussions.

Background: Delays in GOCD can lead to futile medical and surgical interventions, inappropriate antibiotic use, and higher rates of mental health conditions in patients and their loved ones. Earlier GOCD are associated with lower ventilation and resuscitation rates, earlier hospice enrollment, reduced ICU admissions, lower financial costs, and better patient and caregiver quality of life. However, …

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Measuring Decision Aid Effectiveness For End-Of-Life Care: A Systematic Review, M. Courtney Hughes, Erin Vernon, Chinenye Egwuonwu, Oluwatoyosi Afolabi

Faculty Articles, Papers, and Other Scholarship

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Objective

To systematically review research analyzing the effectiveness of decision aids for end-of-life care, including how researchers specifically measure decision aid success.

Methods

We conducted a systematic review synthesizing quantitative, qualitative, and mixed-methods study results using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched through February 18, 2023. Inclusion criteria required articles to evaluate end-of-life care decision aids. The review is registered under PROSPERO (#CRD42023408449).

Results

A total of 715 articles were initially identified, with 43 meeting the inclusion criteria. Outcome measures identified included decisional conflict, less aggressive care desired, knowledge improvements, communication improvements, tool …

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Education For Primary Care Providers On Advance Care Planning: A Systematic Literature Review, Lindsey Ward

DNP Qualifying Manuscripts

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Background: Healthcare providers in primary care treat patients at various stages of life. As patients age, it becomes necessary for providers to support their older patients throughout the aging process and address patient care even into life’s end stages. Primary care providers (PCPs) are well-positioned to provide this support and can do so through incorporating end-of-life (EOL) conversations in practice. Such discussions are called advance care planning (ACP). Though PCPs can play a crucial role in their patients’ EOL care decisions, providers report their limited knowledge of ACP as a barrier to its application.Consequently, further education for providers on utilizing …

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Meaningful Engagement Of Patients And Families In A Complex Trial Of Advance Care Planning In Primary Care, Angela K. Combe, Deborah L. Dokken, Mary M. Minniti, Annette M. Totten

Patient Experience Journal

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Engagement of Patient and Family Advisors (PFAs) is increasingly recommended as best practice in research. During the design and conduct of a large trial of advance care planning (ACP) in primary care, we expanded on the funder’s (Patient-Centered Outcomes Research Institute®) requirement for an engagement plan and sought to develop an innovative approach to fostering and sustaining meaningful engagement of PFAs throughout all phases of the trial. Structures were developed that integrated PFAs into planning and provided the foundation for their ongoing participation. A continuous quality improvement approach became the framework for ongoing engagement. This involved setting goals; collecting data …

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Just-In-Time Decision Making: Preliminary Findings Of A Goals Of Care Rapid Response Team, Donna S Zhukovsky, Yvonne Heung, Parema Enriquez, Nelda Itzep, Zhanni Lu, Nico Nortje, Penny Stanton, Angelique Wong, Eduardo Bruera

Faculty, Staff and Student Publications

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CONTEXT: The COVID-19 pandemic placed the issue of resource utilization front and center. Our comprehensive cancer center developed a Goals of Care Rapid Response Team (GOC RRT) to optimize resource utilization balanced with goal-concordant patient care.

OBJECTIVES: Primary study objective was to evaluate feasibility of the GOC RRT by describing the frequency of consultations that occurred from those requested. Secondary objectives included adherence to consultation processes in terms of core team member participation and preliminary efficacy in limiting care escalation.

METHODS: We conducted a retrospective chart review of patients referred to GOC RRT (3/23/2020-9/30/2020). Analysis was descriptive. Categorical variables were …

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Palliative And End-Of-Life Care Access For Immigrants Living In High-Income Countries: A Scoping Review, Gertrude G. Phiri, Joyce Muge-Sugutt, Davina Porock

Research outputs 2022 to 2026

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This scoping review aimed to explore what is known about palliative and End-of-Life (EOL) care access by immigrants with culturally and linguistically diverse (CALD) background living in high-income Organization for Economic Co-operation and Development (OECD) countries. CaLD immigrants have low utilization of palliative care services with patients’ family members taking up the role of caring, leading to immigrants not fully benefiting from the specialized services that are offered to alleviate suffering and promote quality of life. While there is some research in this area mainly in Europe, it cannot be said about all high-income OECD countries. Achieving person-centered care in …

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Low Rates Of Structured Advance Care Planning Documentation In Electronic Health Records: Results Of A Single-Center Observational Study, Adela Wu, Robert J Huang, Gabriela Ruiz Colón, Chris Zembrzuski, Chirag B Patel

Faculty, Staff and Student Publications

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BACKGROUND: Proper advance care planning (ACP) documentation both improves patient care and is increasingly seen as a marker of high quality by governmental payers. The transition of most medical documentation to electronic health records (EHR) allows for ACP documents to be rapidly disseminated across diverse ambulatory practice settings. At the same time, the complexity and heterogeneity of the EHR, as well as the multiple potential storage locations for documentation, may lead to confusion and inaccessibility. There has been movement to promote structured ACP (S-ACP) documentation within the EHR.

METHODS: We performed a retrospective cohort study at a single, large university …

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Hospice Response To Covid-19: Promoting Sustainable Inclusion Strategies For Racial And Ethnic Minorities, M. Courtney Hughes, Erin Vernon

Faculty Articles, Papers, and Other Scholarship

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There is a disproportionate burden of illness and death among racial/ethnic minorities related to COVID-19. The importance of reaching groups suffering the most with resources such as advance directive guidance, telehealth, and culturally sensitive education materials is vital to providing quality, inclusive care. A crisis presents an opportunity to unite and problem-solve to help avoid the dire consequences facing inaction. In this way, inclusive responses by hospices, social workers, other community partners during the COVID-19 pandemic can help reach and alleviate the pain of those groups most afflicted. We offer hospice inclusion strategies that align with general pandemic response trends …

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Perinatal Palliative Care Birth Planning As Advance Care Planning., Donnamaria E. Cortezzo, Kelstan Ellis, Amy Schlegel

Manuscripts, Articles, Book Chapters and Other Papers

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Purpose of Review: A significant number of pregnancies are complicated by a fetus with a life-limiting diagnosis. As diagnoses are made earlier in the pregnancy, families experience anticipatory grief and are faced with navigating goals of care for a baby that has yet to be born. With the support of the care team, families can begin to grieve, plan, and make meaningful memories during the duration of the pregnancy, the birth of their baby, and life of the child. Creating a palliative care birth plan, which expands beyond the traditional concept for delivery planning to include prenatal, perinatal, and neonatal …

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Goals Of Care 101, Alexandra Evans, Do, Adam Pennarola, Md, Elham Siddiqui, Md

Department of Family & Community Medicine Presentations and Grand Rounds

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Hospice and Palliative Medicine - Alexandra Evans, DO

Approaching Goals of Care in the Outpatient World - Elham Siddiqui, MD

Inpatient Goals of Care Discussion - Adam Pennarola, MD

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Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

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Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

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Communication About End Of Life For Patients Living With Amyotrophic Lateral Sclerosis: A Scoping Review Of The Empirical Evidence, Shelagh K. Genuis, Westerly Luth, Sandra Campbell, Tania M. Bubela, Wendy S. Johnston

Office of the Provost

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Background: Communication about end of life, including advance care planning, life-sustaining therapies, palliative care, and end-of-life options, is critical for the clinical management of amyotrophic lateral sclerosis patients. The empirical evidence base for this communication has not been systematically examined.
Objective: To support evidence-based communication guidance by (1) analyzing the scope and nature of research on health communication about end of life for amyotrophic lateral sclerosis; and (2) summarizing resultant recommendations.
Methods: A scoping review of empirical literature was conducted following recommended practices. Fifteen health-related and three legal databases were searched; 296 articles were screened for inclusion/exclusion criteria; and quantitative …

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