Evaluation of a Collaborative Advance Care Planning Intervention among Older Adult Home Health Patients and Their Caregivers

• Published in: Journal of palliative medicine Vol. 23; no. 9; p. 1214
• Main Authors: Tay, Djin L, Ellington, Lee, Towsley, Gail L, Supiano, Katherine, Berg, Cynthia A
• Format: Journal Article
• Language: English
• Published: United States 01.09.2020
• Subjects: caregivers; shared decision making; communication; home care services; advance care planning
• ISSN: 1557-7740
• DOI: 10.1089/jpm.2019.0521

Caregivers are decision stakeholders; yet, few interventions have been developed to help patients and caregivers collaborate on advance care planning (ACP). To evaluate a theory-based ACP pilot intervention, , to improve decisional quality, readiness, collaboration, and concordance in ACP decisions for older adult home health (HH) patients and caregivers. A one-group, pre- and posttest study using matched questionnaires was conducted. The intervention consisted of a clinical vignette, theoretically guided conversation prompts, and a shared decision-making activity.  = 36 participants (  = 18 HH patients;  = 18 family and nonfamily caregivers) were purposively recruited from a HH agency to participate in the intervention at patients' homes. Demographic and baseline measures were collected for relationship quality, health status, and previous ACP engagement. Outcome measures included perceptions of collaboration, readiness for ACP, concordance in life-sustaining treatment preferences (cardiopulmonary resuscitation, antibiotics, artificial nutrition and hydration, and mechanical ventilation), and decisional conflict. Descriptive statistics, Cohen's κ coefficients, paired tests, McNemar's tests, and Wilcoxon signed-rank tests (and effect size estimates,  =  /√ ) were calculated using R-3.5.1 (  < 0.05). Single value imputation was used for missing values. While no significant differences were found for perceptions of collaboration, and readiness for ACP, patients (  = 0.38,  = 0.02) and caregivers (  = 0.38,  = 0.02) had reduced decisional conflict at posttest. Patients' and caregivers' agreement increased by 27.7% for an item assessing patients' preference for artificial nutrition and hydration (  = 0.03). This study suggests that collaborative ACP decision making may improve decisional conflict for older adult HH patients and their caregivers.