Bacewicz, Aleksandra

Defenbaugh, Nicole, PhD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksUSF-LVHN SELECTA Multi-Methodological Examination ofPerceptions Surrounding Advance Care Planning(ACP)Aleksandra BacewiczUSF MCOM-LVHN Campus, Aleksandra.Bacewicz@lvhn.orgNicole Defenbaugh PhDLehigh Valley Health Network, nicole.defenbaugh@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/select-programPart of the Medical Education CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtBacewicz, A. Defenbaugh, N. (2018, March). A Multi-Methodological Examination of Perceptions Surrounding Advance Care Planning(ACP). Poster Presented at: 2018 SELECT Capstone Posters and Presentations Day. Kasych Family Pavilon, Lehigh Valley HealthNetwork, Allentown, PA.© 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaAccording to the National Institute on Aging (NIA),advance care planning (ACP) involves learning aboutthe decisions that might need to be made regardingmedical treatment near the end of life and consideringthese ahead of time.1 ACP “informs and empowerspatients to have a say about their current and futuretreatment”, enabling patients to receive care in linewith their goals of care and values.2 ACP allows forimprovement in patient and family experience at theend of life, as well as provision of patient choice.3According to national data, approximately 56% ofindividuals surveyed have not communicated theirend-of-life wishes with anyone else.4 A paltry 23% ofpeople have actually put their wishes into writing; only7% are estimated to have had end-of-life discussionswith their doctor.4 Despite these statistics, over 80%of individuals surveyed felt it was important to havethese discussions with their physicians.  This data ismirrored locally; the LVHN DCH found that themajority of people surveyed understand or have heardabout an AD, but only 47% of these individuals havecompleted one.5These findings indicate that there are communicationgaps and strong emotional responses to ACP and End ofLife issues in general, which should be more thoroughlystudied to elucidate how progress can be made to moveACP discussions forward.Suggestions for future research:• Use Grounded Theory to develop theoreticalexplanations to:– Understand reasons underlying misconceptionsabout ACP in our community and medicalsystem– Make improvements on the reasons elucidated• Assess and address gaps in medical education inrelation to ACP understanding and discussionA Multi-Methodological Examination of Perceptions Surrounding AdvanceCare Planning (ACP)This multi-methodological analysis points to potentialdifficulties and misconceptions around discussion ofACP. The quantitative data also echo prior findings thatthere is a gap between knowledge of ACP andcompletion of an AD.Two primary categories that recurred within each layerof qualitative data analysis are 1. emotional response toACP, and 2. communication.  All encompassed by theanalysis—patients, families, clinicians, and theresearcher– experienced strong and wide-rangingemotions when engaging with ACP-related topics.Secondly, each participant group was found to haveexperiences surrounding the communication of ACP-related issues, including barriers to communication andmiscommunication.  Sub-themes reveal issues including:seeing ACP as inapplicable to own life, reluctance todiscuss EoL issues and ACP, as well as family as essentialto provide support and assist with decision-making.This QI project entailed leadership and all componentsof emotional intelligence throughout the process.  Bothresearchers had to engage those around them inemotionally fraught topics, and have strong leadershipfor the organization of various events.• QI project through the LVHN Department ofCommunity Health• 3-PRONGED APPROACH1. Community ACP– pre and post quantitative surveys2. LVHN Staff ACP– one-time quantitative surveys3. Multi-site experiences in 3 contexts:• Professional: medical student/clinician (InternalMedicine, Palliative Medicine, C/L Psychiatry)• Community: researcher, facilitator• Personal: patient, family member• Qualitative data analysis– Initial coding– Thematic analysisAleksandra Bacewicz, MPH1,2 and Nicole Defenbaugh, PhD1,21,2 USF Morsani College of Medicine SELECT Program/Lehigh Valley Health Network Department of Community HealthBackground Results DiscussionConclusions &ImplicationsACKNOWLEDGEMENTS:Robert Motley, MD; LVHN Department of CommunityHealth Data Team and ACP Group, respectivelyREFERENCES1National Institute on Aging. Advance care planning: Tips from the National Institute onAging, https://www.nia.nih.gov/health/publication/advance-care-planning#what (Accessed10 July 2017). 2Dtering KM, Hancock AD, Reade MC, et al. The impact of advance careplanning on end of life care in elderly patients: randomized controlled trial. BMJ2010;340c1345. 3Steinberg KE. Advance care planning: Just do it! JAMA 15(2014);454-456.4Defenbaugh N and Grube. The Department of Community Health Executive Summary.Report, LVHN Department of Community Health, US June 2016. 5Defenbaugh NL. TheDepartment of Community Health Executive Summary. Report, LVHN Department ofCommunity Health, US July 2017. 6Defenbaugh, N. The Dept of Community Health FY16-17ACP Summary. November 2017. 7Defenbaugh, N. Flu Clinic Results, 2017. November 2017.Problem Statement &GoalsThere is a discrepancy between knowledge of ACP and theactual completion and discussion of ACP between patientsand clinicians.GOALS:• Assess the perceptions surrounding ACP and relatedtopics (e.g., advance directives, end of life care) amongparticipants: patients, families, clinicians, and theresearcher• Elucidate challenges to having conservations around ACPin the healthcare systemCOMMUNITY ACPLVHN STAFF ACPMethodsAdvance Directive KnowledgeHave heard of AD Don't understandUnderstand orheard of87%Completed an Advance DirectiveHave completed Have not completedCompleted48%Have heard of AD Don't understandUnderstand orheard of82.5%Have completed Have not completedCompleted26.2%Table 1. Community ACP Events FY16-176# People Reached 370# of Events 8Types of Events Hello Conversation Game, Info Table,Video/DiscussionGender 72%  female28% maleEducation 79%  finished more education after high school21%  high school or lessAge 43% under 6557%  65+Understand/heard of AD 87%Completed AD 48%Table 2. LVHN Staff ACP Events7# People Reached 343Gender (n=343) 67.1%  female26.2%  male0.3%  otherEducation (n=343) 34.4%  some college21.3%  Bachelor’s degree14.9%  HS diploma10.5%  graduate degree5.0%  some HSAge (n=312) 66.6%  under 6533.4% 65+Understand/heard of AD (n=331) 82.5%I am comfortable talking with my familyabout EoL wishes (n=309)93.9%  yes6.1%  noI am comfortable talking with my physicianabout EoL wishes (n=309)90.9%  yes9.1%  noCompleted AD (n=332) 26.2% yes73.8% noIf yes: have you shared your AD with yourfamily (n=30)96.7%  yes3.3%  noIf yes: have you shared your AD with yourphysician? (n=30)50%  yes50%  noMULTI-SITE EXPERIENCESCOMMUNITY ACPLVHN Staff ACPTable 3. Multi-site experiencesMajor categories by participant groupAll Emotional response to ACPCommunicationPatients Emotional response to clinical carePatient choice/autonomyPatient experienceComfort/familiarityIdentityFamily Members Emotional response to patient careFamily relationships/caregiver supportFamily decision-makingComfort/familiarityClinicians Clinical behaviorClinical decision-makingClinician emotion

A Multi-Methodological Examination of Perceptions Surrounding Advance Care Planning (ACP)

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A Multi-Methodological Examination of Perceptions Surrounding Advance Care Planning (ACP)

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