Sangeeta C Ahluwalia1, David B Bekelman2, Alexis K Huynh3, Thomas J Prendergast4, Scott Shreve5, Karl A Lorenz6. 1. Oregon State University, Corvallis, OR, USA VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA sangeeta.c.ahluwalia@oregonstate.edu. 2. Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. 3. VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 4. Portland VA Medical Center, Portland, OR, USA Oregon Health and Science University, Portland, OR, USA. 5. Lebanon VA Medical Center, Lebanon, PA, USA. 6. VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Abstract
BACKGROUND: Early and repeated patient-provider conversations about advance care planning (ACP) are now widely recommended. We sought to characterize barriers and strategies for realizing an iterative model of ACP patient-provider communication. METHODS: A total of 2 multidisciplinary focus groups and 3 semistructured interviews with 20 providers at a large Veterans Affairs medical center. Thematic analysis was employed to identify salient themes. RESULTS: Barriers included variation among providers in approaches to ACP, lack of useful information about patient values to guide decision making, and ineffective communication between providers across settings. Strategies included eliciting patient values rather than specific treatment choices and an increased role for primary care in the ACP process. CONCLUSIONS: Greater attention to connecting providers across the continuum, maximizing the potential of the electronic health record, and linking patient experiences to their values may help to connect ACP communication across the continuum.
BACKGROUND: Early and repeated patient-provider conversations about advance care planning (ACP) are now widely recommended. We sought to characterize barriers and strategies for realizing an iterative model of ACP patient-provider communication. METHODS: A total of 2 multidisciplinary focus groups and 3 semistructured interviews with 20 providers at a large Veterans Affairs medical center. Thematic analysis was employed to identify salient themes. RESULTS: Barriers included variation among providers in approaches to ACP, lack of useful information about patient values to guide decision making, and ineffective communication between providers across settings. Strategies included eliciting patient values rather than specific treatment choices and an increased role for primary care in the ACP process. CONCLUSIONS: Greater attention to connecting providers across the continuum, maximizing the potential of the electronic health record, and linking patient experiences to their values may help to connect ACP communication across the continuum.
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