Top

Current Geriatrics Reports

Published in:

01-03-2019 | Care | Palliative Care (D Wu, Section Editor)

Disease-Specific Advance Care Planning Interventions for Older Adults

Authors: Deborah G. Freeland, David Shih Wu

Published in: Current Geriatrics Reports | Issue 1/2019

Abstract

Purpose of Review

Advance care planning is beneficial but underutilized for older patients with dementia, cancer, end-stage renal disease, lung disease, or heart failure. The purpose of this paper is to highlight recent disease-specific innovations aimed at improving the delivery of advance care planning for older adults.

Recent Findings

We highlight 13 studies within the last 5 years focusing on advance care planning models in older adults with the above diseases.

Summary

Useful interventions include incorporation of non-physician facilitators, varying platforms of ACP delivery, surrogate participation, and written communication of patient preferences to other providers. Several existing models were applicable across disease types. Further research comparing advance care planning models in older adults is warranted.

• Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary delphi panel. J Pain Symptom Manag. 2017;53(5):821–32. https://doi.org/10.1016/j.jpainsymman.2016.12.331. A Delphi panel defines ACP and highlights strategies for implementation. CrossRef

De Vleminck A, Pardon K, Beernaert K, Deschepper R, Houttekier D, Van Audenhove C, et al. Barriers to advance care planning in cancer, heart failure and dementia patients: a focus group study on general practitioners’ views and experiences. PLoS One. 2014;9(1):e84905. https://doi.org/10.1371/journal.pone.0084905.CrossRefPubMedPubMedCentral

• Chandar M, Bockstein B, Zunamon A, Silverman I, Dlouhy S, Ashlevitz K, et al. Perspectives of health-care providers toward advance care planning in patients with advanced cancer and congestive heart failure. Am J Hosp Palliat Care. 2017;34(5):423–9. https://doi.org/10.1177/1049909116636614. Study reveals low sense of responsibility amongst physicians regarding whose role it is to initiate ACP. CrossRefPubMed

Murray SA, Kendall M, Boyd K, Sheikh A. Illness trajectories and palliative care. BMJ. 2005;30:1007–11. https://doi.org/10.1136/bmj.330.7498.1007.CrossRef

• DeLima TJ, Sanchez-Reilly S, Bernacki R, O’Neill L, Morrison LJ, Kapo J, et al. Advance care planning in cognitively impaired older adults. J Am Geriatr Soc. 2018;66(8):1469–74. https://doi.org/10.1111/jgs.15471. Review article highlights barriers to ACP in patients with dementia and recommends best practices for overcoming challenges. CrossRef

• Bonner GJ, Wang E, Wilkie DJ, Ferrans CE, Dancy B, Watkins YJ. Advance care treatment plan (ACT-Plan) for African American family caregivers. Dementia (London). 2014;13(1):79–95. https://doi.org/10.1177/1471301212449408. Pilot study with intervention applied to caregivers of patients with dementia delivered in large groups with culturally-sensitive methodology; shows trends towards positive patient-centered outcomes. CrossRef

Hilgeman MM, Allen RS, Snow AL, Durkin DW, DeCoster J, Burgio LD. Preserving identity and planning for advance care (PIPAC): preliminary outcomes from a patient-centered intervention for individuals with mild dementia. Aging Ment Health. 2014;18(4):411–24. https://doi.org/10.1080/13607863.2013.868403.CrossRefPubMed

Reinhardt JP, Chichin E, Posner L, Kassabian S. Vital conversations with family in the nursing home: preparation for end-end-stage dementia care. J Soc Work End Life Palliat Care. 2014;10:112–26. https://doi.org/10.1080/15524256.2014.906371.CrossRefPubMed

Brazil K, Gillian C, Cardwell C, Clarke M, Hudson P, Froggatt K, et al. Effectiveness of advance care planning with family carers in dementia nursing homes: a paired cluster randomized controlled trial. Palliat Med. 2018;32(3):603–12. https://doi.org/10.1177/0269216317722413.CrossRefPubMed

10.

Arcand M, Caron C. Comfort care at the end of life for persons with Alzheimer’s disease or other degenerative diseases of the brain--a guide for caregivers. Sherbrooke: Centre de sante et de services sociaux--institut universitaire de geriatrie de Sherbrooke; 2005.

11.

Oosterink JJ, Oosterveld-Vlug MG, Glaudemans JJ, Pasman HR, Willems DL, Onwuteaka-Philipsen BD. Interprofessional communication between oncologic specialists and general practitioners on end-of-life issues needs improvement. Fam Pract. 2016;33(6):727–32. https://doi.org/10.1093/fampra/cmw064.CrossRefPubMed

12.

Michael N, O’Callaghan C, Baird A, Gough K, Krishnasamy M, Hiscock N, et al. A mixed method feasibility study of a patient- and family-centred advance care planning intervention for cancer patients. BMC Palliat Care. 2015;14:27. https://doi.org/10.1186/s12904-015-0023-1.

13.

Green MJ, Schubert JR, Whitehead MM, Farce E, Lehman E, Levi BH. Advance care planning does not adversely affect home or anxiety among patients with advanced cancer. J Pain Symptom Manag. 2015;49(6):1088–96. https://doi.org/10.1016/j.jpainsymman.2014.11.293.CrossRef

14.

• Rocque GB, Dionne-Odom JN, Huang CS, Niranjan SJ, Williams CP, Jackson BE, et al. Implementation and impact of patient lay navigator led advance care planning conversations. J Pain Symptom Manag. 2017;53:682–92. https://doi.org/10.1016/j.jpainsymman.2016.11.012. Mixed methods study with lay-navigator led ACP discussions for patients with cancer, highlighting feasibility of non-physician led ACP. CrossRef

15.

Schenker Y, White D, Rosenzweig M, Chu E, Moore C, Ellis P, et al. Care management by oncology nurses to address palliative care needs: a pilot trial to assess feasibility, acceptability, and perceived effectiveness of the CONNECT intervention. J Palliat Med. 2015;18(3):232–40. https://doi.org/10.1089/jpm.2014.0325.

16.

Reinke LF, Vig EK, Tartaglione EV, Backhus LM, Gunnink E, Au DH. Protocol and pilot testing: the feasibility and acceptability of a nurse-led telephone-based palliative care intervention for patients newly diagnosed with lung cancer. Contemp Clin Trials. 2018;64:30–4. https://doi.org/10.1016/j.cct.2017.11.013.CrossRefPubMed

17.

Saran R, Robinson B, Abbott KC, Agodoa LYC, Bhave N, Bragg-Gresham J, et al. US Renal Data System 2017 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2018;71(3S1). https://doi.org/10.1053/j.ajkd.2018.01.002.

18.

Da Silva-Gane M, Farrington K. Supportive care in advanced kidney disease: patient attitudes and expectations. J Ren Care. 2014;40:30–5. https://doi.org/10.1111/jorc.12093.CrossRefPubMed

19.

Amro OW, Ramasamy M, Strom JA, Weiner DE, Jaber BL. Nephrologist-facilitated advance care planning for hemodialysis patients: a quality improvement project. Am J Kidney Dis. 2016;68(1):103–9. https://doi.org/10.1053/j.ajkd.2015.11.024.CrossRefPubMedPubMedCentral

20.

• Song M, Ward SE, Fine JP, Hanson LC, Lin F, Hladik GA, et al. Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates. Am J Kidney Dis. 2015;66(5):813–22. https://doi.org/10.1053/j.ajkd.2015.05.018. Randomized controlled trial with ESRD patients using an innovative ACP model: patient-caregiver dyads, a nurse facilitator, and dissemination of documentation; showing positive patient-centered outcomes. CrossRefPubMedPubMedCentral

21.

Pinnock H, Kendall M, Murray SA, Worth A, Levack P, Porter M, et al. Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study. BMJ Support Palliat Care. 2011;1(2):174–83. https://doi.org/10.1136/bmjspcare.d142rep.

22.

Lanken PN, Terry PB, Delisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med. 2008;177(8):912–27. https://doi.org/10.1164/rccm.200605-587ST.

23.

Leung JM, Udris EM, Uman J, Au DH. The effect of end-of-life discussions on perceived quality of care and health status among patients with COPD. Chest. 2012;142(1):128–33. https://doi.org/10.1378/chest.11-2222.

24.

Harrington SE, Rogers E, Davis M. Palliative care and chronic obstructive pulmonary disease: where the lines meet. Curr Opin Pulm Med. 2017;23(2):154–60. https://doi.org/10.1097/MCP.0000000000000358.CrossRefPubMed

25.

• Sinclair C, Auret AK, Evans SF, Williamson F, Dormer S, Wilkinson A, et al. Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advice care planning intervention. BMJ Open. 2017;7:e013415. https://doi.org/10.1136/bmjopen-2016-013415. Randomized controlled trial of a nurse-led intervention for patients with lung disease revealing increased ACP uptake. CrossRefPubMedPubMedCentral

26.

Prognostic Indicator Guidance (6th edition) [Internet]. The Gold Standards Framework. 2011 [cited 16 December 2018]. Available from: http://www.goldstandardsframework.org.uk/PIG.

27.

Sobanski P, Jaarsma T, Krajnik M. End of life matters in chronic heart failure patients. Curr Opin Support Palliat Care. 2014;8(4):364–70. https://doi.org/10.1097/SPC.0000000000000094.CrossRefPubMed

28.

Matlock DD, Stevenson LW. Life-saving devices reach the end of life with heart failure. Prog Cardiovasc Dis. 2012;55(3):274–81. https://doi.org/10.1016/j.pcad.2012.10.007.CrossRefPubMedPubMedCentral

29.

Kelley AS, Reid MC, Miller DH, Fins JJ, Lach MS. Implantable cardioverter-defibrillator deactivation at the end of life: a physician survey. Am Heart J. 2009;157(4):702–8. https://doi.org/10.1016/j.ahj.2008.12.011.CrossRefPubMed

30.

Hauptman PJ, Swindle J, Hussain Z, Biener L, Burroughs TE. Physician attitudes toward end-stage heart failure: a national survey. Am J Med. 2008;121(2):127–35. https://doi.org/10.1016/j.amjmed.2007.08.035.CrossRefPubMed

31.

• Metzger M, Song MK, Ward S, Chang PP, Hanson LC, Lin FC. A randomized controlled pilot trial to improve advance care planning for LVAD patients and their surrogates. Heart Lung. 2016;45(3):186–92. https://doi.org/10.1016/j.hrtlng.2016.01.005. Randomized controlled trial applying an innovative ACP intervention called SPIRIT to improve end-of-life decision congruence between LVAD patients and their surrogates. CrossRefPubMedPubMedCentral

Title: Disease-Specific Advance Care Planning Interventions for Older Adults
Authors: Deborah G. Freeland
David Shih Wu
Publication date: 01-03-2019
Publisher: Springer US
Keywords: Care
Dementia
Living Will
Dementia
Published in: Current Geriatrics Reports / Issue 1/2019
Electronic ISSN: 2196-7865
DOI: https://doi.org/10.1007/s13670-019-0272-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Disease-Specific Advance Care Planning Interventions for Older Adults

Abstract

Purpose of Review

Recent Findings

Summary

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 1/2019

Deprescribing: Right-Sizing Medication Regimens to Optimize Outcomes in Palliative Care

Mobile Health Technologies for Older Adults with Cardiovascular Disease: Current Evidence and Future Directions

Reduced Dose Direct Oral Anticoagulants in Older Adults with Atrial Fibrillation

Pharmacologic Management of Agitation in Patients with Dementia

Wearable Sensor Technology to Measure Physical Activity (PA) in the Elderly

Workforce Issues in Geriatrics in Rural America

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page