Abstract

Background: Advance care planning (ACP) has been shown to benefit patients and families, yet little is known about how an ACP event impacts communication and conversation about end-of-life treatment wishes and the content of such conversations between patients and family caregivers. Objective: To characterize post-ACP conversations regarding medical wishes between seriously ill patients and their family caregivers. Participants: Patients with advanced illness and family caregivers. Outcome Measured: Post-ACP conversations. Design: As part of a larger randomized controlled trial, dyads consisting of seriously ill patients and their identified family caregiver engaged in ACP and created an advance directive for the patient. Approximately 4 to 6 weeks later, semistructured interviews were conducted with the family caregivers to elucidate the subsequent communications regarding medical wishes. If the dyad did not have any conversations post-ACP, reasons and barriers were explored. Results: The majority of dyads (131/188, 69.7%) had 2 to 3 conversations lasting 3 to 5 minutes each in the weeks immediately following ACP. These conversations most commonly addressed general patient wishes about quality of life and specific medical treatments. The most common reasons for not having conversations were a general discomfort with the topic (13/57, 22.8%) and previously having discussed medical wishes (16/57, 28.1%). Conclusion: The ACP events promote conversation regarding quality of life, general wishes at the end of life, and specific medical wishes. Barriers to conversation following ACP were similar to barriers to ACP in general, suggesting that a more intentional focus on addressing these barriers pre- and post-ACP may be necessary to improve communication.

Original languageEnglish (US)
Pages (from-to)1161-1167
Number of pages7
JournalAmerican Journal of Hospice and Palliative Medicine
Volume35
Issue number9
DOIs
StatePublished - Sep 1 2018

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Advance Care Planning
Caregivers
Communication
Quality of Life
Advance Directives

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Schubart, Jane R. ; Reading, Jean M. ; Penrod, Janice Lee ; Stewart, Renee R. ; Sampath, Ramya ; Lehmann, Lisa S. ; Levi, Benjamin ; Green, Michael. / Family Caregivers’ Characterization of Conversations Following an ACP Event. In: American Journal of Hospice and Palliative Medicine. 2018 ; Vol. 35, No. 9. pp. 1161-1167.
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abstract = "Background: Advance care planning (ACP) has been shown to benefit patients and families, yet little is known about how an ACP event impacts communication and conversation about end-of-life treatment wishes and the content of such conversations between patients and family caregivers. Objective: To characterize post-ACP conversations regarding medical wishes between seriously ill patients and their family caregivers. Participants: Patients with advanced illness and family caregivers. Outcome Measured: Post-ACP conversations. Design: As part of a larger randomized controlled trial, dyads consisting of seriously ill patients and their identified family caregiver engaged in ACP and created an advance directive for the patient. Approximately 4 to 6 weeks later, semistructured interviews were conducted with the family caregivers to elucidate the subsequent communications regarding medical wishes. If the dyad did not have any conversations post-ACP, reasons and barriers were explored. Results: The majority of dyads (131/188, 69.7{\%}) had 2 to 3 conversations lasting 3 to 5 minutes each in the weeks immediately following ACP. These conversations most commonly addressed general patient wishes about quality of life and specific medical treatments. The most common reasons for not having conversations were a general discomfort with the topic (13/57, 22.8{\%}) and previously having discussed medical wishes (16/57, 28.1{\%}). Conclusion: The ACP events promote conversation regarding quality of life, general wishes at the end of life, and specific medical wishes. Barriers to conversation following ACP were similar to barriers to ACP in general, suggesting that a more intentional focus on addressing these barriers pre- and post-ACP may be necessary to improve communication.",
author = "Schubart, {Jane R.} and Reading, {Jean M.} and Penrod, {Janice Lee} and Stewart, {Renee R.} and Ramya Sampath and Lehmann, {Lisa S.} and Benjamin Levi and Michael Green",
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Family Caregivers’ Characterization of Conversations Following an ACP Event. / Schubart, Jane R.; Reading, Jean M.; Penrod, Janice Lee; Stewart, Renee R.; Sampath, Ramya; Lehmann, Lisa S.; Levi, Benjamin; Green, Michael.

In: American Journal of Hospice and Palliative Medicine, Vol. 35, No. 9, 01.09.2018, p. 1161-1167.

Research output: Contribution to journalArticle

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T1 - Family Caregivers’ Characterization of Conversations Following an ACP Event

AU - Schubart, Jane R.

AU - Reading, Jean M.

AU - Penrod, Janice Lee

AU - Stewart, Renee R.

AU - Sampath, Ramya

AU - Lehmann, Lisa S.

AU - Levi, Benjamin

AU - Green, Michael

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Advance care planning (ACP) has been shown to benefit patients and families, yet little is known about how an ACP event impacts communication and conversation about end-of-life treatment wishes and the content of such conversations between patients and family caregivers. Objective: To characterize post-ACP conversations regarding medical wishes between seriously ill patients and their family caregivers. Participants: Patients with advanced illness and family caregivers. Outcome Measured: Post-ACP conversations. Design: As part of a larger randomized controlled trial, dyads consisting of seriously ill patients and their identified family caregiver engaged in ACP and created an advance directive for the patient. Approximately 4 to 6 weeks later, semistructured interviews were conducted with the family caregivers to elucidate the subsequent communications regarding medical wishes. If the dyad did not have any conversations post-ACP, reasons and barriers were explored. Results: The majority of dyads (131/188, 69.7%) had 2 to 3 conversations lasting 3 to 5 minutes each in the weeks immediately following ACP. These conversations most commonly addressed general patient wishes about quality of life and specific medical treatments. The most common reasons for not having conversations were a general discomfort with the topic (13/57, 22.8%) and previously having discussed medical wishes (16/57, 28.1%). Conclusion: The ACP events promote conversation regarding quality of life, general wishes at the end of life, and specific medical wishes. Barriers to conversation following ACP were similar to barriers to ACP in general, suggesting that a more intentional focus on addressing these barriers pre- and post-ACP may be necessary to improve communication.

AB - Background: Advance care planning (ACP) has been shown to benefit patients and families, yet little is known about how an ACP event impacts communication and conversation about end-of-life treatment wishes and the content of such conversations between patients and family caregivers. Objective: To characterize post-ACP conversations regarding medical wishes between seriously ill patients and their family caregivers. Participants: Patients with advanced illness and family caregivers. Outcome Measured: Post-ACP conversations. Design: As part of a larger randomized controlled trial, dyads consisting of seriously ill patients and their identified family caregiver engaged in ACP and created an advance directive for the patient. Approximately 4 to 6 weeks later, semistructured interviews were conducted with the family caregivers to elucidate the subsequent communications regarding medical wishes. If the dyad did not have any conversations post-ACP, reasons and barriers were explored. Results: The majority of dyads (131/188, 69.7%) had 2 to 3 conversations lasting 3 to 5 minutes each in the weeks immediately following ACP. These conversations most commonly addressed general patient wishes about quality of life and specific medical treatments. The most common reasons for not having conversations were a general discomfort with the topic (13/57, 22.8%) and previously having discussed medical wishes (16/57, 28.1%). Conclusion: The ACP events promote conversation regarding quality of life, general wishes at the end of life, and specific medical wishes. Barriers to conversation following ACP were similar to barriers to ACP in general, suggesting that a more intentional focus on addressing these barriers pre- and post-ACP may be necessary to improve communication.

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