4 research outputs found

    Advance care planning after hospital discharge: qualitative analysis of facilitators and barriers from patient interviews

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    Abstract Background Patients who engage in Advance Care Planning (ACP) are more likely to get care consistent with their values. We sought to determine the barriers and facilitators to ACP engagement after discharge from hospital. Methods Prior to discharge from hospital eligible patients received a standardized conversation about prognosis and ACP. Each patient was given an ACP workbook and asked to complete it over the following four weeks. We included frail elderly patients with a high risk of death admitted to general internal medicine wards at a tertiary care academic teaching hospital. Four weeks after discharge we conducted semi-structured interviews with patients. Interviews were transcribed, coded and analysed with thematic analysis. Themes were categorized according to the theoretical domains framework. Results We performed 17 interviews. All Theoretical Domain Framework components except for Social/Professional Identity and Behavioral Regulation were identified in our data. Poor knowledge about ACP and physician communication skills were barriers partially addressed by our intervention. Some patients found it difficult to discuss ACP during an acute illness. For others acute illness made ACP discussions more relevant. Uncertainty about future health motivated some participants to engage in ACP while others found that ACP discussions prevented them from living in the moment and stripped them of hope that better days were ahead. Conclusions For some patients acute illness resulting in admission to hospital can be an opportunity to engage in ACP conversations but for others ACP discussions are antithetical to the goals of hospital care

    Performance of a Scoping Review to Inform Development of an ICU Bereavement Program

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    Currently, there are no cohesive, dedicated bereavement support programs offered to family members who lose a loved one in the Intensive Care Unit (ICU) in Saskatchewan. This bereaved population has a high incidence of complicated grief and PTSD symptoms (19% and up to 50%, respectively). Post-ICU bereavement has been recognized as a significant gap in clinical care, and the need for more research in this field has been recognized. The goal of this study is to determine what interventions for supporting ICU bereaved families have been reported in the literature, survey the practices of ICUs across Canada to identify what, if any, programs have been implemented, and utilize these findings to inform the development and implementation of an ICU Bereavement Program in Saskatoon
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