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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Health behavior change in advance care planning: an agent-based model

Authors: Natalie C. Ernecoff, Christopher R. Keane, Steven M. Albert

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

A practical and ethical challenge in advance care planning research is controlling and intervening on human behavior. Additionally, observing dynamic changes in advance care planning (ACP) behavior proves difficult, though tracking changes over time is important for intervention development. Agent-based modeling (ABM) allows researchers to integrate complex behavioral data about advance care planning behaviors and thought processes into a controlled environment that is more easily alterable and observable. Literature to date has not addressed how best to motivate individuals, increase facilitators and reduce barriers associated with ACP. We aimed to build an ABM that applies the Transtheoretical Model of behavior change to ACP as a health behavior and accurately reflects: 1) the rates at which individuals complete the process, 2) how individuals respond to barriers, facilitators, and behavioral variables, and 3) the interactions between these variables.

Methods

We developed a dynamic ABM of the ACP decision making process based on the stages of change posited by the Transtheoretical Model. We integrated barriers, facilitators, and other behavioral variables that agents encounter as they move through the process.

Results

We successfully incorporated ACP barriers, facilitators, and other behavioral variables into our ABM, forming a plausible representation of ACP behavior and decision-making. The resulting distributions across the stages of change replicated those found in the literature, with approximately half of participants in the action-maintenance stage in both the model and the literature.

Conclusions

Our ABM is a useful method for representing dynamic social and experiential influences on the ACP decision making process. This model suggests structural interventions, e.g. increasing access to ACP materials in primary care clinics, in addition to improved methods of data collection for behavioral studies, e.g. incorporating longitudinal data to capture behavioral dynamics.
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Literature
1.
2.
Sudore RL, Schickedanz AD, Landefeld CS, Williams BA, Lindquist K, Pantilat SZ, et al. Engagement in multiple steps of the advance care planning process: a descriptive study of diverse older adults. J Am Geriatr Soc. 2008;56(6):1006–13.CrossRefPubMed
3.
Emanuel LL, Danis M, Pearlman RA, Singer PA. Advance care planning as a process: structuring the discussions in practice. J Am Geriatr Soc. 1995;43(4):440–6.CrossRefPubMed
4.
Sudore RL, Fried TR. Redefining the “planning” in advance care planning: preparing for end-of-life decision making. Ann Intern Med. 2010;153(4):256–61.PubMedCentralCrossRefPubMed
5.
6.
Singer PA, Martin DK, Lavery JV, Thiel EC, Kelner M, Mendelssohn DC. Reconceptualizing advance care planning from the patient’s perspective. Arch Intern Med. 1998;158(8):879–84.CrossRefPubMed
7.
Moorman SM, Inoue M. Persistent problems in end-of-life planning among young-and middle-aged American couples. J Gerontol Ser B Psychol Sci Soc Sci. 2013;68(1):97–106.CrossRef
8.
Schickedanz AD, Schillinger D, Landefeld CS, Knight SJ, Williams BA, Sudore RL. A Clinical Framework for Improving the Advance Care Planning Process: Start with Patients’ Self‐Identified Barriers. J Am Geriatr Soc. 2009;57(1):31–9.PubMedCentralCrossRefPubMed
9.
Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, et al. Use of intensive care at the end of life in the United States: An epidemiologic study*. Crit Care Med. 2004;32(3):638–43.CrossRefPubMed
10.
Teno JM, Gruneir A, Schwartz Z, Nanda A, Wetle T. Association Between Advance Directives and Quality of End‐of‐Life Care: A National Study. J Am Geriatr Soc. 2007;55(2):189–94.CrossRefPubMed
11.
Kirchhoff KT, Hammes BJ, Kehl KA, Briggs LA, Brown RL. Effect of a Disease‐Specific Planning Intervention on Surrogate Understanding of Patient Goals for Future Medical Treatment. J Am Geriatr Soc. 2010;58(7):1233–40.PubMedCentralCrossRefPubMed
12.
Houben CH, Spruit MA, Groenen MT, Wouters EF, Janssen DJ. Efficacy of Advance Care Planning: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2014;15(7):477-489.
13.
Pollack KM, Morhaim D, Williams MA. The public’s perspectives on advance directives: Implications for state legislative and regulatory policy. Health Policy. 2010;96(1):57–63.CrossRefPubMed
14.
Keane C. Modeling Behavior in Complex Public Health Systems: Simulation and Games for Action and Evaluation: Springer Publishing Company, New York; 2013
15.
Grefenstette JJ, Brown ST, Rosenfeld R, DePasse J, Stone NT, Cooley PC, et al. FRED (A Framework for Reconstructing Epidemic Dynamics): an open-source software system for modeling infectious diseases and control strategies using census-based populations. BMC Public Health. 2013;13(1):940.PubMedCentralCrossRefPubMed
16.
17.
Gorman DM, Mezic J, Mezic I, Gruenewald PJ. Agent-based modeling of drinking behavior: a preliminary model and potential applications to theory and practice. Am J Public Health. 2006;96(11):2055.PubMedCentralCrossRefPubMed
18.
Hu X, Puddy RW. An agent-based model for studying child maltreatment and child maltreatment prevention. In: Advances in Social Computing: Springer-Verlag Berlin Heidelberg; 2010. p. 189–98.
19.
Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48.CrossRefPubMed
20.
Fried TR, Redding CA, Robbins ML, Paiva A, O’Leary JR, Iannone L. Promoting advance care planning as health behavior change: development of scales to assess Decisional Balance, Medical and Religious Beliefs, and Processes of Change. Patient Educ Couns. 2012;86(1):25–32.PubMedCentralCrossRefPubMed
21.
Fried TR, Redding CA, Robbins ML, Paiva A, O’Leary JR, Iannone L. Stages of change for the component behaviors of advance care planning. J Am Geriatr Soc. 2010;58(12):2329–36.PubMedCentralCrossRefPubMed
22.
Pearlman RA, Cole WG, Patrick DL, Starks HE, Cain KC. Advance care planning: eliciting patient preferences for life-sustaining treatment. Patient Educ Couns. 1995;26(1):353–61.CrossRefPubMed
23.
Westley C, Briggs LA. Using the stages of change model to improve communication about advance care planning. In: Nursing forum; 2004: Wiley Online Library; Hoboken, NJ. 2004. p. 5–12.
24.
Wilensky, U. NetLogo v.5.0.4. http://​ccl.​northwestern.​edu/​netlogo/​.​ Center for Connected Learning and Computer-Based Modeling, Northwestern University, Evanston, IL. 1999
25.
Metadata
Title
Health behavior change in advance care planning: an agent-based model
Authors
Natalie C. Ernecoff
Christopher R. Keane
Steven M. Albert
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-2872-9

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