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Feasibility of a Brief Intervention to Facilitate Advance Care Planning Conversations for Patients with Life-Limiting Illness in the Emergency Department.
Pajka, Sarah E; Hasdianda, Mohammad Adrian; George, Naomi; Sudore, Rebecca; Schonberg, Mara A; Bernstein, Edward; Tulsky, James A; Block, Susan D; Ouchi, Kei.
Afiliación
  • Pajka SE; Department of Emergency Medicine and Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Hasdianda MA; Department of Emergency Medicine and Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • George N; Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA.
  • Sudore R; Department of Emergency Medicine, Center for Adult Critical Care, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA.
  • Schonberg MA; Department of Medicine, University of California, San Francisco, California, USA.
  • Bernstein E; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
  • Tulsky JA; The Brief Negotiated Interview Active Referral to Treatment Institute, Boston University School of Public Health, Boston, Massachusetts, USA.
  • Block SD; Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
  • Ouchi K; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
J Palliat Med ; 24(1): 31-39, 2021 01.
Article en En | MEDLINE | ID: mdl-32471321
Background: Advance care planning (ACP) conversations are an important intervention to provide care consistent with patient goals near the end of life. The emergency department (ED) could serve as an important time and location for these conversations. Objectives: To determine the feasibility of an ED-based, brief negotiated interview (BNI) to stimulate ACP conversations among seriously ill older adults. Methods: We conducted a pre/postintervention study in the ED of an urban, tertiary care, academic medical center. From November 2017 to May 2019, we prospectively enrolled adults ≥65 years of age with serious illness. Trained clinicians conducted the intervention. We measured patients' ACP engagement at baseline and follow-up (3 ± 1 weeks) and reviewed electronic medical record documentation of ACP (e.g., medical order for life-sustaining treatment [MOLST]). Results: We enrolled 51 patients (mean age = 71; SD 12), 41% were female, and 51% of patients had metastatic cancer. Median duration of the intervention was 11.8 minutes; few (6%) of the interventions were interrupted. We completed follow-up for 61% of participants. Patients' self-reported ACP engagement increased from 3.0 to 3.7 out of 5 after the intervention (p < 0.01). Electronic documentation of health care proxy forms increased (75%-94%, n = 48) as did MOLST (0%-19%, n = 48) during the six months after the ED visit. Conclusion: A novel, ED-based, BNI intervention to stimulate ACP conversations for seriously ill older adults is feasible and may improve ACP engagement and documentation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Intervención en la Crisis (Psiquiatría) / Planificación Anticipada de Atención Límite: Aged / Female / Humans / Male Idioma: En Revista: J Palliat Med Asunto de la revista: SERVICOS DE SAUDE Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Intervención en la Crisis (Psiquiatría) / Planificación Anticipada de Atención Límite: Aged / Female / Humans / Male Idioma: En Revista: J Palliat Med Asunto de la revista: SERVICOS DE SAUDE Año: 2021 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos