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Use of a values inventory as a discussion aid about end-of-life care: A pilot randomized controlled trial

Published online by Cambridge University Press:  13 October 2015

Shailaja Menon ,
Laurence B. McCullough ,
Rebecca J. Beyth ,
Marvella E. Ford ,
Donna Espadas  and
Ursula K. Braun
Shailaja Menon*
Affiliation:
VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Laurence B. McCullough
Affiliation:
Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
Rebecca J. Beyth
Affiliation:
Geriatric Research Education Clinical Center, North Florida/South Georgia Veterans Health System, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
Marvella E. Ford
Affiliation:
Department of Public Health Sciences and Cancer Disparities, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina
Donna Espadas
Affiliation:
VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
Ursula K. Braun
Affiliation:
VA Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Section of Geriatrics, Department of Medicine, Baylor College of Medicine, Houston, Texas
*
Address correspondence and reprint request to Shailaja Menon, VA Medical Center (152), 2002 Holcombe Boulevard, Houston, Texas 77030. E-mail: smenon@bcm.edu.
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Abstract

Objective:

We examined the utility of a brief values inventory as a discussion aid to elicit patients' values and goals for end-of-life (EoL) care during audiotaped outpatient physician–patient encounters.

Method:

Participants were seriously ill male outpatients (n = 120) at a large urban Veterans Affairs medical center. We conducted a pilot randomized controlled trial, randomizing 60 patients to either the intervention (with the values inventory) or usual care. We used descriptive statistics and qualitative methods to analyze the data. We coded any EoL discussions and recorded the length of such discussions.

Results:

A total of 8 patients (13%) in the control group and 13 (23%) in the intervention group had EoL discussions with a physician (p = 0.77). All EoL discussions in the control group were initiated by the physician, compared with only five (38%) in the intervention group. Because most EoL discussions took place toward the end of the encounter, discussions were usually brief.

Significance of results:

The outpatient setting has been promoted as a better place for discussing EoL care than a hospital during an acute hospitalization for a chronic serious illness. However, the low effectiveness of our intervention calls into question the feasibility of discussing EoL care during a single outpatient visit. Allowing extra time or an extra visit for EoL discussions might increase the efficacy of advance care planning.

Keywords

Advance care planningTerminal careRandomized controlled trialVeteransOutpatientsAmbulatory care

Information

Type
Original Articles
Information
Palliative & Supportive Care , Volume 14 , Issue 4 , August 2016 , pp. 330 - 340
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

Auer, P. (2008). Primary care end-of-life planning for older adults with chronic illness. The Journal for Nurse Practitioners, 4, 185–191.CrossRefGoogle Scholar
Back, A.L., Arnold, R.M. & Baile, W.F. (2007). Efficacy of communication skills training for giving bad news and discussing transitions to palliative care. Archives of Internal Medicine, 167, 453–460.CrossRefGoogle ScholarPubMed
Barakat, A., Barnes, S.A. & Casanova, M.A. (2013). Advance care planning knowledge and documentation in a hospitalized cancer population. Proceedings (Baylor University, Medical Center), 26(4), 368–372.CrossRefGoogle Scholar
Braun, U.K. & McCullough, L.B. (2011). Preventing life-sustaining treatment by default. Annals of Family Medicine, 9, 250–256.CrossRefGoogle ScholarPubMed
Braun, U.K., Beyth, R.J. & Ford, M.E. (2014). Decision-making styles of seriously ill male Veterans for end-of-life care: Autonomists, altruists, authorizers, absolute trusters, and avoiders. Patient Education and Counseling, 94, 334–341.CrossRefGoogle ScholarPubMed
Brown, R., Butow, P. & Wilson-Genderson, M. (2012). Meeting the decision-making preferences of patients with breast cancer in oncology consultations: Impact on decision-related outcomes. Journal of Clinical Oncology, 30, 857–862.CrossRefGoogle ScholarPubMed
Carr, D. (2012). “I don't want to die like that …”: The impact of significant others' death on quality on advance care planning. The Gerontologist, 52, 770–781.CrossRefGoogle ScholarPubMed
Chan, H.Y. & Pang, S.M. (2010). Let me talk: An advance care planning programme for frail nursing home residents. Journal of Clinical Nursing, 19, 3073–3084.CrossRefGoogle ScholarPubMed
Cherlin, E., Fried, T. & Prigerson, HG. (2005). Communication between physicians and family caregivers about care at the end of life: When do discussions occur and what is said? Journal of Palliative Medicine, 8, 1176–1185.CrossRefGoogle ScholarPubMed
Clayton, J.M., Butow, P.N. & Tattersall, M.H. (2007). Randomized controlled trial of a prompt list to help advanced cancer patients and their caregivers to ask questions about prognosis and end-of-life care. Journal of Clinical Oncology, 25, 715–723.CrossRefGoogle ScholarPubMed
Curtis, J.R. & Patrick, D.L. (1997). Barriers to communication about end-of-life care in AIDS patients. Journal of General Internal Medicine, 12, 736–741.CrossRefGoogle ScholarPubMed
Curtis, J.R., Engelberg, R.A. & Wenrich, M.D. (2005). Missed opportunities during family conferences about end-of-life care in the intensive care unit. American Journal of Respiratory and Critical Care Medicine, 171, 844–849.CrossRefGoogle ScholarPubMed
Detering, K.M., Hancock, A.D. & Reade, M.C. (2010). The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. BMJ, 340, c1345.CrossRefGoogle ScholarPubMed
Doukas, D.J. & McCullough, L.B. (1991). The values history: The evaluation of the patient's values and advance directives. The Journal of Family Practice, 32, 145–153.Google ScholarPubMed
Elo, S. & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62, 107–115.CrossRefGoogle ScholarPubMed
Emanuel, L.L., von Gunten, C.F. & Ferris, F.D. (2000). Advance care planning. Archives of Family Medicine, 9, 111.CrossRefGoogle ScholarPubMed
Fried, T.R., Bullock, K. & Iannone, L. (2009). Understanding advance care planning as a process of health behavior change. Journal of the American Geriatrics Society, 57(9), 1547–1555.CrossRefGoogle ScholarPubMed
Fryer-Edwards, K., Arnold, R.M. & Baile, W. (2006). Reflective teaching practices: An approach to teaching communication skills in a small-group setting. Academic Medicine, 81, 638–644.CrossRefGoogle Scholar
Glass, A.P. & Nahapetyan, L. (2008). Discussions by elders and adult children about end-of-life preparation and preferences. Preventing Chronic Disease, 5, A08.Google ScholarPubMed
Harrington, S.E. & Smith, T.J. (2008). The role of chemotherapy at the end of life: “When is enough, enough?” The Journal of the American Medical Association, 299, 2667–2678.CrossRefGoogle Scholar
Huskamp, H.A., Keating, N.L. & Malin, J.L. (2009). Discussions with physicians about hospice among patients with metastatic lung cancer. Archives of Internal Medicine, 169, 954–962.CrossRefGoogle ScholarPubMed
Knauft, E., Nielsen, E.L. & Engelberg, R.A. (2005). Barriers and facilitators to end-of-life care communication for patients with COPD. Chest, 127, 2188–2196.CrossRefGoogle ScholarPubMed
Mack, J.W., Weeks, J.C. & Wright, A.A. (2010). End-of-life discussions, goal attainment, and distress at the end of life: Predictors and outcomes of receipt of care consistent with preferences. Journal of Clinical Oncology, 28, 1203–1208.CrossRefGoogle ScholarPubMed
McJannett, M., Butow, P. & Tattersall, M.H. (2003). Asking questions can help: Development of a question prompt list for cancer patients seeing a surgeon. European Journal of Cancer Prevention, 12, 397–405.CrossRefGoogle ScholarPubMed
Murphy, D.J., Knaus, W.A. & Lynn, J. (1990). Study population in SUPPORT: Patients (as defined by disease categories and mortality projections), surrogates, and physicians. Journal of Clinical Epidemiology, 43, 11S–28S.CrossRefGoogle ScholarPubMed
Newton, J., Clark, R. & Ahlquist, P. (2009). Evaluation of the introduction of an advanced care plan into multiple palliative care settings. International Journal of Palliative Nursing, 15, 554–561.CrossRefGoogle ScholarPubMed
Obler, D., Greutmann, M. & Colman, J.M. (2012). Knowledge of and preference for advance care planning by adults with congenital heart disease. The American Journal of Cardiology, 109, 1797–1800.CrossRefGoogle Scholar
Pearlman, R.A., Starks, H. & Cain, K.C. (2005). Improvements in advance care planning in the Veterans Affairs system: Results of a multifaceted intervention. Archives of Internal Medicine, 165, 667–674.CrossRefGoogle ScholarPubMed
Rennie, D. (2001). CONSORT revised: Improving the reporting of randomized trials. The Journal of the American Medical Association, 285, 2006–2007.CrossRefGoogle ScholarPubMed
Ruddick, W. (1999). Hope and deception. Bioethics, 13, 343–357.CrossRefGoogle ScholarPubMed
Selman, L., Harding, R. & Beynon, T. (2007). Improving end-of-life care for patients with chronic heart failure: “Let's hope it'll get better, when I know in my heart of hearts it won't.” Heart, 93, 963–967.CrossRefGoogle Scholar
Smucker, W.D., Ditto, P.H. & Moore, K.A. (1993). Elderly outpatients respond favorably to a physician-initiated advance directive discussion. The Journal of the American Board of Family Practitioners, 6, 473–482.Google ScholarPubMed
Street, R.L. Jr. & Voigt, B. (1997). Patient participation in deciding breast cancer treatment and subsequent quality of life. Medical Decision Making, 17, 298–306.CrossRefGoogle ScholarPubMed
The, A.M., Hak, T., Koeter, G., et al. (2000). Collusion in doctor–patient communication about imminent death: An ethnographic study. BMJ, 321, 1376–1381.CrossRefGoogle ScholarPubMed
Tierney, W.M., Dexter, P.R. & Gramelspacher, G.P. (2001). The effect of discussions about advance directives on patients' satisfaction with primary care. Journal of General Internal Medicine, 16, 32–40.Google ScholarPubMed
Volandes, A.E., Paasche-Orlow, M.K. & Mitchell, S.L. (2013). Randomized controlled trial of a video decision support tool for cardiopulmonary resuscitation decision making in advanced cancer. Journal of Clinical Oncology, 31, 380–386.CrossRefGoogle ScholarPubMed
Walczak, A., Mazer, B. & Butow, P.N. (2013). A question prompt list for patients with advanced cancer in the final year of life: Development and cross-cultural evaluation. Palliative Medicine, 27, 779–788.CrossRefGoogle ScholarPubMed
Yuen, J.K., Reid, M.C. & Fetters, M.D. (2011). Hospital do-not-resuscitate orders: Why they have failed and how to fix them. Journal of General Internal Medicine, 26, 791–797.CrossRefGoogle Scholar
Zhang, B., Wright, A.A. & Huskamp, H.A. (2009). Health care costs in the last week of life: Associations with end-of-life conversations. Archives of Internal Medicine, 9(169), 480–488CrossRefGoogle Scholar