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Attitudes and completion of advance care planning: Assessing the contribution of health beliefs about Alzheimer's disease among Israeli laypersons

Published online by Cambridge University Press:  27 May 2019

Perla Werner Open the ORCID record for Perla Werner [Opens in a new window]  and
Ile Kermel Schiffman
Perla Werner*
Affiliation:
Department of Community Mental Health, University of Haifa, Israel
Ile Kermel Schiffman
Affiliation:
Department of Community Mental Health, University of Haifa, Israel
*
Author for correspondence: Perla Werner, Ph.D. Department of Community Mental Health, University of Haifa, Mt. Carmel, Haifa, Israel. E-mail: werner@research.haifa.ac.il Phone: 972-54-3933066
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Abstract

Objectives

The purpose of this study was to assess laypersons’ attitudes and completion of advance care planning (ACP) and to examine associations with sociodemographic characteristics and health beliefs on Alzheimer's disease.

Methods

A cross-sectional telephone survey was conducted during April and May 2017, with a sample of 514 Israeli adults, aged 18 years and above. A structured, pretested questionnaire assessing participants’ awareness, attitudes, and completion of ACP, as well as health beliefs on Alzheimer's disease (subjective knowledge, susceptibility, and worry), and sociodemographic factors, was used.

Results

Two-fifths of the participants had heard of at least one of the terms: advance directives or durable power of attorney. Overall, participants expressed positive attitudes toward ACP. Results of regression models showed that gender, religiosity, and subjective knowledge of Alzheimer's disease were statistically significant correlates of attitudes toward ACP. Adding health beliefs on Alzheimer's disease doubled the amount of the variance explained, from 3% to 6%.

Significance of results

Our results support the use of cognitive models of health behavior by assessing intra-personal beliefs and knowledge to understand ACP attitudes and completion. Specifically, we demonstrated the importance of knowledge of Alzheimer's disease for ACP attitudes, suggesting the importance of including a module on the topic to ACP interventions.

Keywords

Advance care planningAlzheimer's diseaseattitudessurvey

Information

Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 6 , December 2019 , pp. 655 - 661
Copyright
Copyright © Cambridge University Press 2019 

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References

Alzheimer's Disease International, ADI (2018) Available at https://www.alz.co.uk/sites/default/files/pdfs/national-plans-examples-2017.pdf (accessed 5 May 2018).Google Scholar
Bar-Sela, G, Mitnik, I, Zalman, D, et al. (2017) Medical students’ attitudes towards participating in a palliative medicine course: A new specialty in Israel. Palliative & Supportive Care 16, 528–533.Google Scholar
Beit-Hallahmi, B (2015) Psychological perspectives on religion and religiosity. London, Routledge.Google Scholar
Bentur, N and Sternberg, S (2017) Implementation of advance care planning in Israel: A convergence of top-down and bottom-up processes. The Gerontologist, doi.org/10.1093/geront/gnx157.Google Scholar
Black, K, Reynolds, SL, and Osman, H (2008) Factors associated with advance care planning among older adults in southwest Florida. Journal of Applied Gerontology 27, 93–109.Google Scholar
Braun, UK, Ford, ME, Beyth, RJ, et al. (2010) The physician's professional role in end-of-life decision-making: voices of racially and ethnically diverse physicians. Patient Education and Counseling 80, 3–9.Google Scholar
Brinkman-Stoppelenburg, A, Rietjens, JA, and van der Heide, A (2014) The effects of advance care planning on end-of-life care: A systematic review. Palliative Medicine 28, 1000–1025.Google Scholar
Brodsky, J, Bentur, N, Laron, M, et al. (2013) Addressing Alzheimer's and other types of dementia: Israeli national strategy. Jerusalem: Myers-JDC-Brookdale Institute and Ministry of Health.Google Scholar
Carr, D and Khodyakov, D (2007) End-of-life health care planning among young-old adults: An assessment of psychosocial influences. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62, S135–S141.Google Scholar
Clark, MA, Person, SD, Gosline, A, et al. (2018) Racial and Ethnic Differences in Advance Care Planning: Results of a Statewide Population-Based Survey. Journal of Palliative Medicine 21, 1078–1085.Google Scholar
Conner, M and Norman, P (2005) Predicting health behaviour. McGraw-Hill Education (UK).Google Scholar
Conroy, S, Fade, P, Fraser, A, et al. (2009) Advance care planning: concise evidence-based guidelines. Clinical Medicine 9, 76–79.Google Scholar
Cotter, VT, Spriggs, M, and Razzak, R (2018) Advance Care Planning in Early Stage Dementia. The Journal for Nurse Practitioners 14, 142–147.Google Scholar
De Vleminck, A, Pardon, K, Beernaert, K, et al. (2014) Barriers to advance care planning in cancer, heart failure and dementia patients: A focus group study on general practitioners’ views and experiences. PloS One 9, e84905, doi:10.1371/journal.pone.0084905.Google Scholar
Dixon, J, Karagiannidou, M, and Knapp, M (2018) The effectiveness of advance care planning in improving end-of-life outcomes for people with dementia and their carers: A systematic review and critical discussion. Journal of Pain and Symptom Management 55, 132–150.Google Scholar
Dobbs, D, Park, NS, Jang, Y, et al. (2015) Awareness and completion of advance directives in older Korean-American adults. Journal of the American Geriatrics Society 63, 565–570.Google Scholar
Douglas, R and Brown, HN (2002) Patients’ attitudes toward advance directives. Journal of Nursing Scholarship 34, 61–65.Google Scholar
Ernecoff, NC, Keane, CR, and Albert, SM (2016) Health behavior change in advance care planning: an agent-based model. BMC Public Health 16, 193.Google Scholar
Feder, SL, Collett, D, Conley, S, et al. (2018) How skilled do Israeli nurses perceive themselves to be in providing palliative care? Results of a national survey. International Journal of Palliative Nursing 24, 56–63.Google Scholar
Ferrer, RA and Klein, WM (2015) Risk perceptions and health behavior. Current Opinion in Psychology 5, 85–89.Google Scholar
Fischer, SM, Sauaia, A, Min, SJ, et al. (2012) Advance directive discussions: lost in translation or lost opportunities? Journal of Palliative Medicine 15, 86–92.Google Scholar
Fortinsky, RH and Downs, M (2014) Optimizing person-centered transitions in the dementia journey: A comparison of national dementia strategies. Health Affairs 33, 566–573.Google Scholar
Fried, TR, Bullock, K, Iannone, L, et al. (2009) Understanding advance care planning as a process of health behavior change. Journal of the American Geriatrics Society 57, 1547–1555.Google Scholar
Galloway, RD (2003) Health promotion: Causes, beliefs and measurements. Clinical Medicine & Research 1, 249–258.Google Scholar
Garrido, MM, Idler, EL, Leventhal, H, et al. (2012) Pathways from religion to advance care planning: Beliefs about control over length of life and end-of-life values. The Gerontologist 53, 801–816.Google Scholar
Hong, M, Yi, E, Johnson, KJ, et al. (2018) Facilitators and barriers for advance care planning among ethnic and racial minorities in the US: A systematic review of the current literature. Journal of Immigrant and Minority Health 20, 1277–1287.Google Scholar
Howard, M, Day, AG, Bernard, C, et al. (2018) Development and psychometric properties of a survey to assess barriers to implementing advance care planning in primary care. Journal of Pain and Symptom Management 55, 12–21.Google Scholar
Huang, IA, Neuhaus, JM, and Chiong, W (2016) Racial and ethnic differences in advance directive possession: Role of demographic factors, religious affiliation, and personal health values in a national survey of older adults. Journal of Palliative Medicine 19, 149–156.Google Scholar
Institute of Medicine (2014) Dying in America: Improving quality and honoring individual preferences near the end of life. Available at https://iom.nationalacademies.org/~/media/Files/Report%20Files/2014/EOL/Report%20Brief.pdf.(accessed 22 April 2018).Google Scholar
Jimenez, G, Tan, WS, Virk, AK, et al. (2018) Overview of systematic reviews of advance care planning: Summary of evidence and global lessons. Journal of Pain and Symptom Management 56, 436–459.Google Scholar
Katz, R, Lowenstein, A, Halperin, D, et al. (2015) Generational solidarity in Europe and Israel. Canadian Journal on Aging 34, 342–355.Google Scholar
Ke, L, Huang, X, O'Connor, M, et al. (2015) Nurses’ views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies. Journal of Clinical Nursing 24, 2057–2073.Google Scholar
Khosla, N, Curl, AL, and Washington, KT (2016) Trends in engagement in advance care planning behaviors and the role of socioeconomic status. American Journal of Hospice and Palliative Medicine 33, 651–657.Google Scholar
Lee, H and Park, Y (2014) Attitudes toward advance directives of older adults using senior centers. Journal of Korean Gerontological Nursing 16, 160–169.Google Scholar
Lovell, A and Yates, P (2014) Advance care planning in palliative care: A systematic literature review of the contextual factors influencing its uptake 2008–2012. Palliative Medicine 28, 1026–1035.Google Scholar
Lund, S, Richardson, A, and May, C (2015) Barriers to advance care planning at the end of life: An explanatory systematic review of implementation studies. Plos One 10, e0116629.Google Scholar
Lum, HD, Barnes, DE, Katen, MT, et al. (2018) Improving a full range of advance care planning behavior change and action domains: the PREPARE randomized trial. Journal of Pain and Symptom Management 56, 575–582.Google Scholar
Marshall, P, Avery, G, and Weed, LD (2017) Increasing African American advance directives: Implementing the five wishes education protocol. Journal of Nursing and Health Care 1, 144–147.Google Scholar
Mousing, CA, Timm, H, Lomborg, K, et al. (2018) Barriers to palliative care in people with chronic obstructive pulmonary disease in home care: A qualitative study of the perspective of professional caregivers. Journal of Clinical Nursing 27, 650–660.Google Scholar
Nakanishi, M, Nakashima, T, Shindo, Y, et al. (2015) An evaluation of palliative care contents in national dementia strategies in reference to the European association for palliative care white paper. International Psychogeriatrics 27, 1551–1561.Google Scholar
Ng, AMF, Leung, DYP, and Chan, HYL (2015) Effect of advance care planning on knowledge, behavior, and well-being of older adults: a systematic. Asian Journal of Gerontology & Geriatrics 10, 10.Google Scholar
Ng, QX, Kuah, TZ, Loo, GJ, et al. (2017) Awareness and attitudes of community-dwelling individuals in Singapore towards participating in advance care planning. Annals of the Academy of Medicine Singapore, 46, 84–90.Google Scholar
Nolan, MT and Bruder, M (1997) Patients’ attitudes toward advance directives and end-of-life treatment decisions. Nursing Outlook 45, 204–208.Google Scholar
Pereira-Salgado, A, Mader, P, O'Callaghan, C, et al. (2018) A website supporting sensitive religious and cultural advance care planning (ACPTalk): Formative and summative evaluation. JMIR Research Protocols 7.Google Scholar
Puchalski, CM and O'Donnell, E (2005) Religious and spiritual beliefs in end of life care: how major religions view death and dying. Techniques in Regional Anesthesia and Pain Management 9, 114–121.Google Scholar
Raijmakers, NJ, Rietjens, JA, Kouwenhoven, PS, et al. (2013) Involvement of the Dutch general population in advance care planning: A cross-sectional survey. Journal of Palliative Medicine 16, 1055–1061.Google Scholar
Rao, JK, Anderson, LA, Lin, F, et al. (2014) Completion of advance directives among US consumers. American Journal of Preventive Medicine 46, 65–70.Google Scholar
Rao, JK, Anderson, LA, and Smith, SM (2002) End of life is a public health issue. American Journal of Preventive Medicine 23, 215–220.Google Scholar
Rizzi, L, Rosset, I, and Roriz-Cruz, M (2014) Global epidemiology of dementia: Alzheimer's and vascular types. BioMed Research International, http://dx.doi.org/10.1155/2014/908915Google Scholar
Ryan, T, M-Amen, K, and McKeown, J (2017) The advance care planning experiences of people with dementia, family caregivers and professionals: A synthesis of the qualitative literature. Annals of Palliative Medicine 6, 380–389.Google Scholar
Sable-Smith, A, Arnett, KR, Nowels, MA, et al. (2017) Interactions with the healthcare system influence advance care planning activities: results from a representative survey in 11 developed countries. Family Practice 35, 307–311.Google Scholar
Seymour, J (2018) The impact of public health awareness campaigns on the awareness and quality of palliative care. Journal of Palliative Medicine 21, S30–S36.Google Scholar
Shvartzman, P, Reuven, Y, Halperin, M, et al. (2015) Advance directives - the Israeli experience. Journal of Pain and Symptom Management 49, 1097–1101.Google Scholar
Silverstein, M, Gans, D, and Yang, FM (2006) Intergenerational support to aging parents: The role of norms and needs. Journal of Family Issues 27, 1068–1084.Google Scholar
Sudore, RL, Schillinger, D, Knight, SJ, et al. (2010) Uncertainty about advance care planning treatment preferences among diverse older adults. Journal of Health Communication 15, 159–171.Google Scholar
Sudore, RL, Barnes, DE, Le, GM, et al. (2016) Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial. BMJ Open 6, e011705.Google Scholar
Sudore, RL, Lum, HD, You, JJ, et al. (2017a) Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. Journal of Pain and Symptom Management 53, 821–832.Google Scholar
Sudore, RL, Boscardin, J, Feuz, MA, et al. (2017b) Effect of the prepare website vs an easy-to-read advance directive on advance care planning documentation and engagement among veterans: a randomized clinical trial. JAMA Internal Medicine 177, 1102–1109.Google Scholar
Teixeira, A, Hanvey, L, Tayler, C, et al. (2015) What do Canadians think of advanced care planning? Findings from an online opinion poll. BMJ Supportive & Palliative Care 5, 40–47, doi:10.1136/bmjspcare-2013-000473.Google Scholar
Van der Steen, JT, Radbruch, L, Hertogh, CM, et al. (2014) White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European association for palliative care. Palliative Medicine 28, 197–209.Google Scholar
Werner, P, Goldberg, S, Mandel, S, et al. (2013) Gender differences in lay persons’ beliefs and knowledge about Alzheimer's disease (AD): A national representative study of Israeli adults. Archives of Gerontology and Geriatrics 56, 400–404.Google Scholar
Zhang, N, Ning, X, Zhu, M, et al. (2015) Attitudes towards advance care planning and healthcare autonomy among community-dwelling older adults in Beijing, China. BioMed Research International, 2015, http://dx.doi.org/10.1155/2015/453932.Google Scholar