Episode 43: Advance Care Planning and Patient Safety
October 9, 2015
Why Advance Care Planning is a Major Safety Issue – Understanding Barriers to a Novel Social Process from Multiple Perspectives
In this episode Dr. Jessica Simon describes Advance Care Planning as a novel social process with 5 elements:
1. Think
2. Learn
3. Choose
4. Communicate
5. Document
It’s an iterative process that should be revised when patients’ wishes, values and circumstances change. Unfortunately patient’s wishes and values are not always heard and followed by the healthcare team. This miss match between the patients’ preferences and the received care generates a major safety issue with several costs for patients and family members, healthcare providers, and the healthcare system. On the positive side Jessica outlines several benefits for participating in Advance Care Planning, in particular for the patients and their families, but also for the healthcare system and the healthcare providers.
Jessica talks about the ACCEPT study and how critical it is to ask the patients what is important to them to understand their wishes and values and have shared decision-making. Moreover, she describes the Alberta context and its unique province – wide Advance Care Planning Goals of Care Designation Policy.
Jessica describes the ACP CRIO Program and her interest in understanding the barriers and facilitators to engaging in Advance Care Planning. Within this program Jessica and her team use the Knowledge to Action Cycle and the Theoretical Domain as frameworks for their research. She explains how useful these frameworks are in guiding them to the use of a new healthcare policy. Jessica concludes with a detailed description of the interventions she has designed and how she has been testing these tools with patients and healthcare providers.
After listening to this podcast the listeners will be able to:
Understand the term “Advance Care Planning” and its 5 elements
Recognize the harms and benefits in Advance Care Planning
Learn about national and local findings in Advance Care Planning
Understand the Knowledge to Action Cycle and The Theoretical Domains Frameworks
Dr. Jessica Simon, MD, Division Head Department of Pallitive Medicine
Dr. Jessica Simon is a co-lead on ACP CRIO “Advance Care Planning and Goals of Care Alberta: a population based knowledge translation intervention study.” This is a program of research about advance care planning in Alberta funded by Alberta Innovates Health Solutions. She is also the Physician Consultant, Advance Care Planning and Goals of Care for Calgary Zone of Alberta Health Services as well as Associate Professor and Division Head for Palliative Medicine in the Department of Oncology at the University of Calgary.
References:
Heyland DK1, Barwich D, Pichora D, Dodek P, Lamontagne F, You JJ, Tayler C, Porterfield P, Sinuff T, Simon J; ACCEPT (Advance Care Planning Evaluation in Elderly Patients) Study Team; Canadian Researchers at the End of Life Network (CARENET). Failure to engage hospitalized elderly patients and their families in advance care planning. – PubMed – NCBI
JAMA Intern Med. 2013 May 13;173(9):778-87. doi: 10.1001/jamainternmed.2013.180.
You JJ1, Dodek P2, Lamontagne F2, Downar J2, Sinuff T2, Jiang X2, Day AG2, Heyland DK2; ACCEPT Study Team and the Canadian Researchers at the End of Life Network (CARENET). What really matters in end-of-life discussions? Perspectives of patients in hospital with serious illness and their families. – PubMed – NCBICMAJ. 2014 Dec 9;186(18):E679-87. doi: 10.1503/cmaj.140673. Epub 2014 Nov 3.
Read More:
www.acpcrio.org
www.conversationsmatter.ca
Theoretical Domain Framework
Click on the image to learn more about the Knowledge -To- Action Cycle
