Amanda J Reich1, Stephen Perez2, Priscilla Gazarian2, Noah D'Arcangelo3,4, Kristina Gonzales3,4, Phillip Rodgers5, Deepshikha C Ashana6, Joel S Weissman2, Keren Ladin3,4. 1. Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, Suite 2-016, Boston, MA, 02120, USA. ajreich@bwh.harvard.edu. 2. Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, Suite 2-016, Boston, MA, 02120, USA. 3. Department of Occupational and Community Health, Tufts University, Medford, USA. 4. Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA, 02155, USA. 5. Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, USA. 6. Dept. of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, USA.
Abstract
BACKGROUND: To date, most research on patients' experiences with advance care planning (ACP) focuses on motivations to engage in discussions and how patients prepare. Gaps remain in understanding how non-critically ill Medicare patients perceive ACP encounters, including how they characterize positive and negative experiences with ACP. OBJECTIVES: Understanding these patients' perceptions is imperative as Medicare has sought to incentivize provision of ACP services via two billing codes in 2016. DESIGN: Qualitative focus group study. Thematic analysis was performed to assess participants ACP experience. PARTICIPANTS: Medicare beneficiaries who had engaged in or were billed for ACP. KEY RESULTS: Seven focus groups were conducted with 34 Medicare beneficiaries who had engaged in ACP across 5 US health systems. Participants described a spectrum of perceptions regarding ACP, and a range of delivery approaches, including group ACP, discussions with specialists during serious illness, and ACP in primary care settings during wellness visits. Despite being billed for ACP or having ACP services noted in their medical record, many did not recognize that they had engaged in ACP, expressed lack of clarity over the term "ACP," and were unaware of the Medicare billing codes. Among participants who described quality patient-centered ACP experiences, three additional themes were identified: trusted and established patient/clinician relationships, transparent communication and documentation, and an understanding that ACP is revisable. Participants offered recommendations for clinicians and health systems to improve the patient ACP experience. CONCLUSIONS: Findings include actionable steps to promote patient-centered ACP experiences, including clinician training to support improved communication and facilitating shared decision-making, allocating sufficient clinical time for discussions, and ensuring that documentation of preferences is clear and accessible. Other approaches such as group ACP and ACP navigators may help to support patient interests within clinical constraints and need to be further explored.
BACKGROUND: To date, most research on patients' experiences with advance care planning (ACP) focuses on motivations to engage in discussions and how patients prepare. Gaps remain in understanding how non-critically ill Medicare patients perceive ACP encounters, including how they characterize positive and negative experiences with ACP. OBJECTIVES: Understanding these patients' perceptions is imperative as Medicare has sought to incentivize provision of ACP services via two billing codes in 2016. DESIGN: Qualitative focus group study. Thematic analysis was performed to assess participants ACP experience. PARTICIPANTS: Medicare beneficiaries who had engaged in or were billed for ACP. KEY RESULTS: Seven focus groups were conducted with 34 Medicare beneficiaries who had engaged in ACP across 5 US health systems. Participants described a spectrum of perceptions regarding ACP, and a range of delivery approaches, including group ACP, discussions with specialists during serious illness, and ACP in primary care settings during wellness visits. Despite being billed for ACP or having ACP services noted in their medical record, many did not recognize that they had engaged in ACP, expressed lack of clarity over the term "ACP," and were unaware of the Medicare billing codes. Among participants who described quality patient-centered ACP experiences, three additional themes were identified: trusted and established patient/clinician relationships, transparent communication and documentation, and an understanding that ACP is revisable. Participants offered recommendations for clinicians and health systems to improve the patient ACP experience. CONCLUSIONS: Findings include actionable steps to promote patient-centered ACP experiences, including clinician training to support improved communication and facilitating shared decision-making, allocating sufficient clinical time for discussions, and ensuring that documentation of preferences is clear and accessible. Other approaches such as group ACP and ACP navigators may help to support patient interests within clinical constraints and need to be further explored.
Authors: Gabrielle B Rocque; J Nicholas Dionne-Odom; Chao-Hui Sylvia Huang; Soumya J Niranjan; Courtney P Williams; Bradford E Jackson; Karina I Halilova; Kelly M Kenzik; Kerri S Bevis; Audrey S Wallace; Nedra Lisovicz; Richard A Taylor; Maria Pisu; Edward E Partridge; Thomas W Butler; Linda A Briggs; Elizabeth A Kvale Journal: J Pain Symptom Manage Date: 2017-01-03 Impact factor: 3.612
Authors: C Adrian Austin; Dinushika Mohottige; Rebecca L Sudore; Alexander K Smith; Laura C Hanson Journal: JAMA Intern Med Date: 2015-07 Impact factor: 21.873