Professional judgments about advance care planning with community-dwelling consumers.
*Attitude of Health Personnel; *Decision Making; *Health Care Surveys; Advance Care Planning; Advance Care Planning/organization & administration/*statistics & numerical data; Attitude of Health Personnel; Consumer Behavior/*statistics & numerical data; Consumer Satisfaction – Statistics and Numerical Data; Decision Making; Human; Humans; Management; Midwestern United States; Models; Organizational; Patient Satisfaction – Statistics and Numerical Data; Patient Satisfaction/*statistics & numerical data; Population Surveillance; Questionnaires; Randomized Controlled Trials; Surveys; Surveys and Questionnaires
CONTEXT: There is limited research on how community-based long-term care (CBLTC) providers' personal characteristics and attitudes affect their decisions to initiate advance care planning (ACP) conversations with consumers. OBJECTIVES: To examine judgments by CBLTC providers as to whether a consumer was in need of ACP and to compare the relative influence of situational features of the consumer with the influence of personal characteristics of the CBLTC provider. METHODS: Factorial surveys with vignettes with randomly assigned situational features of a hypothetical consumer were obtained from 182 CBLTC providers at three Area Agencies on Aging located in the Midwestern U.S. Measures included the consumer's situational features, such as demographics, diagnosis, pain level, level of functioning, and caregiver involvement. Personal characteristics of the CBLTC provider included demographics, discipline, past experience with ACP, and attitudes toward ACP. RESULTS: Hierarchical linear models indicated that most variability in ACP decisions was the result of differences among CBLTC providers (64%) rather than consumers' situational features. Positive decisions to discuss ACP were associated with consumers who needed assistance with legal issues and had a cancer diagnosis; these variables explained 8% of the vignette level variance. Significant personal characteristics of the CBLTC provider included a nursing background, less direct contact with consumers, past experience with ACP, and positive attitudes toward ACP; these variables explained 41% of the person-level variance. CONCLUSION: This study shows the lack of normative consensus about ACP and highlights the need for consistent educational programs regarding the role of the CBLTC provider in the ACP process.
Baughman Kristin R; Ludwick Ruth E; Merolla David M; Palmisano Barbara; Hazelett Susan; Winchell Janice; Hewit Michael
Journal of pain and symptom management
2012
2012-01
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/10.1016/j.jpainsymman.2011.03.023" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2011.03.023</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>
Disentangling consumer and provider predictors of advance care planning.
*Advance Care Planning; *Long-Term Care; Adult; advance care planning; Advance Care Planning; Age Factors; area agencies on aging; Attitude of Health Personnel; care management; Caregivers; community-based care; Conceptual Framework; Consumers; Data Analysis Software; Discussion; Factorial Design; factorial surveys; Female; Human; Humans; Judgment; Long Term Care; long-term care; Middle Age; Multivariate Analysis; Quasi-Experimental Studies; Questionnaires; Random Sample; Registered Nurses; Social Workers; Surveys; Surveys and Questionnaires; Vignettes
Factorial surveys were used to examine community-based long-term care providers' judgments about consumers' need for advance care planning (ACP) and comfort levels in discussing ACP. Providers (448 registered nurses and social workers) judged vignettes based on hypothetical consumers. Hierarchical linear models indicated providers judged consumers who were older, had end-stage diagnoses, multiple emergency department visits, and uninvolved caregivers as most in need of ACP. These variables explained 10% of the variance in judgments. Providers' beliefs about ACP predicted judgments of need for ACP and comfort level in discussing ACP. Provider characteristics explained more variance in comfort levels (44%) than in judgments of need (20%). This study demonstrates the need for tailored educational programs to increase comfort levels and address ACP misconceptions.
Baughman Kristin R; Ludwick Ruth; Merolla David; Palmisano Barbara; Hazelett Susan; Allen Kyle R; Sanders Margaret
The American journal of hospice & palliative care
2013
2013-11
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/10.1177/1049909112464692" target="_blank" rel="noreferrer noopener">10.1177/1049909112464692</a>
The Relationship Between Organizational Characteristics and Advance Care Planning Practices.
Administrative Personnel; Adult; advance care planning; Advance Care Planning; Advance Care Planning/*organization & administration/standards; area agency on aging; Attitude of Health Personnel; care management; Case Management; Case Managers; Chi Square Test; Clinical Protocols/standards; community-based long-term care; Confidence Intervals; Cross Sectional Studies; Cross-Sectional Studies; Data Analysis Software; Descriptive Research; Descriptive Statistics; Female; Funding Source; Government Agencies; Human; Humans; Inservice Training/organization & administration; Interviews; Logistic Regression; Long Term Care; Male; Medicaid; Medicaid/statistics & numerical data; Middle Age; Middle Aged; Midwestern United States; Multivariate Analysis; nurses; Odds Ratio; Ohio; organizational characteristics; Organizational Culture; Practice Guidelines as Topic; Questionnaires; Registered Nurses; Rural Areas; social workers; Social Workers; Surveys; T-Tests; Telephone; United States; Urban Areas
Organizational characteristics may impede the uniform adoption of advance care planning (ACP) best practices. We conducted telephone interviews with site directors of a Midwestern state's Medicaid waiver program administered by the Area Agencies on Aging and surveyed the 433 care managers (registered nurses and social workers) employed within these 9 agencies. Care managers at 2 agencies reported more frequent ACP discussions and higher levels of confidence. Both sites had ACP training programs, follow-up protocols, and informational packets available for consumers that were not consistently available at the other agencies. The findings point to the need for consistent educational programs and policies on ACP and more in depth examination of the values, beliefs, and resources that account for organizational differences in ACP.
Baughman Kristin R; Ludwick Ruth; Palmisano Barbara; Hazelett Susan; Sanders Margaret
The American journal of hospice & palliative care
2015
2015-08
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/10.1177/1049909114530039" target="_blank" rel="noreferrer noopener">10.1177/1049909114530039</a>
Factors Associated With Advance Care Planning Discussions by Area Agency on Aging Care Managers.
Female; Male; Ohio; Aged; Advance Directives; Human; Chi Square Test; Cross Sectional Studies; Surveys; Middle Age; Correlation Coefficient; T-Tests; Case Managers; Secondary Analysis; Advance Care Planning – In Old Age
Hazelett Susan; Baughman Kristin R; Palmisano Barbara; Sanders Margaret; Ludwick Ruth E
American Journal of Hospice & Palliative Medicine
2013
2013-12
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/10.1177/1049909112475153" target="_blank" rel="noreferrer noopener">10.1177/1049909112475153</a>
A 4-Year Integrated Curriculum in Palliative Care for Medical Undergraduates.
Ohio; Students; Education; Human; Descriptive Statistics; Funding Source; Curriculum Development; Medical; Hospice Care – Education; Palliative Care – Education
Radwany Steven M; Stovsky Erica J; Frate Dean M; Dieter Kevin; Friebert Sarah; Palmisano Barbara; Sanders Margaret
American Journal of Hospice & Palliative Medicine
2011
2011-12
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/10.1177/1049909111406526" target="_blank" rel="noreferrer noopener">10.1177/1049909111406526</a>
Building Provider-Caregiver Partnerships: Curricula for Medical Students and Residents
PROBLEM: A disconnect exists between caregivers and health care providers, resulting in fragmented communication, which increases caregiver stress and compromises patient care. Although providers have a responsibility to recognize caregiver burden, they receive scant training on issues important to caregivers. APPROACH: From 2014-2017, as part of the Building Caregiver Partnerships Through Interprofessional Education project-a collaborative effort between Northeast Ohio Medical University and Summa Health-the authors developed curricula to foster effective partnerships between health care providers and caregivers by exposing medical students and residents to highly personal caregiving narratives. The curricula center on a short film featuring four families representing diverse caregiving experiences. The authors crafted several discussion guides, case-based learning exercises, structured clinical encounters, team-based simulations, and clinical cases as companion educational tools for the film. OUTCOMES: Medical students reported the educational tools piloted to be valuable in broadening their understanding of caregivers' needs, while residents reported the educational tools piloted to also be valuable in improving their communication and building partnerships with caregivers. Undergraduate and graduate faculty reported finding the pilots valuable. NEXT STEPS: Future goals include conducting an outcome evaluation, based on ACGME milestones, to identify and examine the clinical outcomes to determine if communication increases and quality of care improves as a result of the project. The authors we would also like to include caregivers in the evaluation. Finally, because caregiving is best addressed from a team approach, the authors would like to pilot the project at other health professions programs.
Blackie Michael; Baughman Kristin R; Palmisano Barbara; Sanders Margaret; Sperling David; Scott Erin; Radwany Steven; Drost Jennifer; Thomas Jon
Academic Medicine: Journal of the Association of American Medical Colleges
2019
2019-05
<a href="http://doi.org/10.1097/ACM.0000000000002806" target="_blank" rel="noreferrer noopener">10.1097/ACM.0000000000002806</a>