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Disease-Specific Advance Care Planning Interventions for Older Adults

  • Palliative Care (D Wu, Section Editor)
  • Published:
Current Geriatrics Reports Aims and scope Submit manuscript

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.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • 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.

    Article  Google Scholar 

  2. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. • 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. • 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.

    Article  Google Scholar 

  6. • 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.

    Article  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  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.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

Dr. Wu is supported through the Hearst American Academy of Hospice and Palliative Medicine Leadership Scholars Fund.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Deborah G. Freeland

  2. Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, 5200 Eastern Ave., Mason F. Lord Building, Suite 2300, Baltimore, MD, 21224, USA

    David Shih Wu

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  1. Deborah G. Freeland
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Correspondence to David Shih Wu.

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Deborah Freeland and David Shih Wu declare no conflict of interest.

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Freeland, D.G., Wu, D.S. Disease-Specific Advance Care Planning Interventions for Older Adults. Curr Geri Rep 8, 12–20 (2019). https://doi.org/10.1007/s13670-019-0272-6

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