Development of a Scale to Assess Physician Advance Care Planning Self-Efficacy.
*Self Efficacy; Adult; advance care planning; Advance Care Planning; Advance Care Planning/*organization & administration; Attitude of Health Personnel; Attitudes; Chronic Disease; Communication; Cross Sectional Studies; Cross-Sectional Studies; end-of-life care; Exploratory Research; family medicine; Family/*psychology; Female; Health Knowledge; Human; Humans; Instrument Construction; Instrument Validation; Male; Middle Aged; Physician-Patient Relations; Physicians; Physicians – Psychosocial Factors; Practice; Reliability and Validity; scale development; Scales; self-efficacy; Self-Efficacy – Evaluation; Surveys and Questionnaires/*standards; Terminal Care/psychology; Validation Studies
BACKGROUND: Although patients prefer that physicians initiate advance care planning (ACP) conversations, few physicians regularly do so. Physicians may be reluctant to initiate ACP conversations because they lack self-efficacy in their skills. Yet, no validated scale on self-efficacy for ACP exists. Our objective was to develop a scale that measures physicians' ACP self-efficacy (ACP-SE) and to investigate the validity of the tool. METHODS: Electronic questionnaires were administered to a random sample of family medicine physicians (n = 188). Exploratory factor analysis was performed to determine whether the scale was multidimensional. An initial assessment of the scale's validity was also conducted. RESULTS: The exploratory factor analysis indicated that a single factor was appropriate using all 17 items. A single, unidimensional scale was created by averaging the 17 items, yielding good internal consistency (Cronbach alpha = 0.95). The average scale score was 3.94 (standard deviation = 0.71) on a scale from 1 to 5. The scale was moderately correlated with a global single-item measure of self-efficacy for ACP ( r = .79, P \textless .001), and the scale differentiated between physician groups based on how much ACP they were doing, how recently they had an ACP conversation, formal training on ACP, and knowledge of ACP. In a multivariate analysis, the ACP-SE scale was a strong predictor of the percentage of patients with chronic life-limiting diseases with whom the physician discussed ACP. CONCLUSION: The final ACP-SE scale included 17 items and demonstrated high internal consistency.
Baughman Kristin R; Ludwick Ruth; Fischbein Rebecca; McCormick Kenelm; Meeker James; Hewit Mike; Drost Jennifer; Kropp Denise
The American journal of hospice & palliative care
2017
2017-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1049909115625612" target="_blank" rel="noreferrer noopener">10.1177/1049909115625612</a>
Results of the promoting effective advance care planning for elders (PEACE) randomized pilot study.
*Quality of Life; 80 and over; Activities of Daily Living; Advance Care Planning; Advance Care Planning/*organization & administration; Aged; Case Management – Methods; Chi Square Test; Community-Institutional Relations; Comparative Studies; Decision Making; Descriptive Statistics; Disease Management; Family; Female; Frail Elderly; Geriatric Assessment/methods; Health Promotion; Health Resource Utilization; Health Services for the Aged/organization & administration; Home Care Services/*organization & administration; Human; Humans; Interdisciplinary Communication; Long Term Care; Long-Term Care/*organization & administration; Male; Medicaid – Ohio; Multidisciplinary Care Team; Ohio; Outcomes (Health Care); Palliative Care; Palliative Care/organization & administration; Patient; Physicians; Pilot Projects; Pilot Studies – Ohio; Program Evaluation; Psychological Tests; Quality of Life; Random Assignment; Reference Values; Repeated Measures; Scales; Spiritual Care; T-Tests; Treatment Outcome
The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were \textgreater60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician. This pilot was not powered to test hypotheses; instead, it was hypothesis generating. Primary outcomes measured symptom control, mood, decision making, spirituality, and quality of life. Little difference was seen in primary outcomes; however, utilization favored the IG. At 12 months, the IG had fewer hospital visits (50% vs. 55%, P=0.65) and fewer nursing facility admissions (22.5% vs. 32.5%, P=0.32). Using hospital-based specialists interfacing with a community agency to provide a team-based approach to care of consumers with chronic illnesses was found to be feasible. Lack of change in symptom control or quality of life outcome measures may be related to the tools used, as these were validated in populations closer to the end of life. Data from this pilot study will be used to calculate the sample size needed for a fully powered trial.
Radwany Steven M; Hazelett Susan E; Allen Kyle R; Kropp Denise J; Ertle Denise; Albanese Teresa H; Fosnight Susan M; Moore Pamela S
Population Health Management
2014
2014-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1089/pop.2013.0017" target="_blank" rel="noreferrer noopener">10.1089/pop.2013.0017</a>
Managing in the trenches of consumer care: the challenges of understanding and initiating the advance care planning process.
*Health Personnel/psychology/standards; *Health Services for the Aged; *Long-Term Care/methods/organization & administration/psychology; *Patient Care Management/methods/organization & administration; Advance Care Planning; Advance Care Planning/*organization & administration; Attitude of Health Personnel; Case Management; Convenience Sample; Decision Making; Family Relations; Focus Groups; Funding Source; Human; Humans; Interpersonal Relations; Long Term Care; Needs Assessment; Nurse Attitudes; Ohio; Patient Education as Topic; Professional Role; Professional-Patient Relations; Qualitative Research; Qualitative Studies; Social Work/*standards; Social Worker Attitudes; Terminal Care/organization & administration/psychology; Thematic Analysis
To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.
Baughman Kristin R; Aultman Julie; Hazelett Susan; Palmisano Barbara; O'Neill Anne; Ludwick Ruth; Sanders Margaret
Journal of gerontological social work
2012
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1080/01634372.2012.708389" target="_blank" rel="noreferrer noopener">10.1080/01634372.2012.708389</a>