Kei Ouchi1,2,3, Vinicius Knabben4, Laura Rivera-Reyes4, Niharika Ganta5, Laura P Gelfman6, Rebecca Sudore7, Ula Hwang4,6. 1. 1 Department of Emergency Medicine, Brigham and Women's Hospital , Boston, Massachusetts. 2. 2 Department of Emergency Medicine, Harvard Medical School , Boston, Massachusetts. 3. 3 Serious Illness Care Program , Ariadne Labs, Boston, Massachusetts. 4. 4 Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai , New York, New York. 5. 5 Department of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania. 6. 6 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York. 7. 7 Department of Medicine, University of California , San Francisco, San Francisco, California.
Abstract
BACKGROUND: Emergency department (ED) clinicians often lack training and resources to conduct advance care planning (ACP) conversations. The use of technology for health education is increasing, yet little is known if it can be used to engage older ED patients in ACP. OBJECTIVE: To determine the feasibility of using tablets to provide ACP education ( www.prepareforyourcare.org )(PREPARE) to older ED patients. DESIGN: A feasibility study conducted in late 2014 and early 2015. SETTING/ SUBJECTS: Subjects were recruited from a parent cohort of older adults enrolled in a survey about Geriatric ED care. Inclusion criteria were ≥65 years age and English speaking; exclusions were hearing or vision impairment or if clinically unstable. MEASUREMENTS: Primary outcome was completion of ≥1 of 5 PREPARE modules. Secondary outcomes were ease of use (10-point scale; 1 = very hard, 10 = very easy) and the reasons for refusal to participate. RESULTS: Sixty-one subjects were approached; 24 (39%) were interested in viewing PREPARE after the Geriatric ED survey. Mean age was 75 years (standard deviation [SD] 9); 67% were female and 54% were nonwhite. Seventy-one percent of participants completed ≥1 module. Participants rated the website as easy to use for themselves (mean 8.4, SD 2.39) and for others (mean 7.3, SD 2.31). Of the subjects who declined, top reasons cited were fatigue (26%), already feeling prepared (13%), and technology limitations (11%). CONCLUSION: PREPARE has the potential to engage older adults who are not acutely ill in ACP during their ED visits. Further studies should explore optimal approaches for ED implementation.
BACKGROUND: Emergency department (ED) clinicians often lack training and resources to conduct advance care planning (ACP) conversations. The use of technology for health education is increasing, yet little is known if it can be used to engage older ED patients in ACP. OBJECTIVE: To determine the feasibility of using tablets to provide ACP education ( www.prepareforyourcare.org )(PREPARE) to older ED patients. DESIGN: A feasibility study conducted in late 2014 and early 2015. SETTING/ SUBJECTS: Subjects were recruited from a parent cohort of older adults enrolled in a survey about Geriatric ED care. Inclusion criteria were ≥65 years age and English speaking; exclusions were hearing or vision impairment or if clinically unstable. MEASUREMENTS: Primary outcome was completion of ≥1 of 5 PREPARE modules. Secondary outcomes were ease of use (10-point scale; 1 = very hard, 10 = very easy) and the reasons for refusal to participate. RESULTS: Sixty-one subjects were approached; 24 (39%) were interested in viewing PREPARE after the Geriatric ED survey. Mean age was 75 years (standard deviation [SD] 9); 67% were female and 54% were nonwhite. Seventy-one percent of participants completed ≥1 module. Participants rated the website as easy to use for themselves (mean 8.4, SD 2.39) and for others (mean 7.3, SD 2.31). Of the subjects who declined, top reasons cited were fatigue (26%), already feeling prepared (13%), and technology limitations (11%). CONCLUSION: PREPARE has the potential to engage older adults who are not acutely ill in ACP during their ED visits. Further studies should explore optimal approaches for ED implementation.
Entities:
Keywords:
advance care planning; educational tool; emergency department; geriatrics
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