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Journal of the American Board of Family Medicine : JABFM
2021 Jan-Feb;34 (1): 171-180.

Feasibility of Group Visits for Advance Care Planning Among Patients with Heart Failure and Their Caregivers.

Julia I Bandini, Alexis Coulourides Kogan, Bonnie Olsen, Jessica Phillips, Rebecca L Sudore, David B Bekelman, Sangeeta C Ahluwalia
Author Information
  1. Julia I Bandini: From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB).
  2. Alexis Coulourides Kogan: From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB).
  3. Bonnie Olsen: From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB).
  4. Jessica Phillips: From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB).
  5. Rebecca L Sudore: From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB).
  6. David B Bekelman: From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB).
  7. Sangeeta C Ahluwalia: From RAND Corporation, Boston, MA (JIB); Department of Family Medicine and Geriatrics, Keck School of Medicine, University of Southern California, Alhambra, CA (ACK, BO); RAND Corporation, Santa Monica, CA (JP, SCA); Department of Medicine, Division of Geriatrics, University of California-San Francisco (RLS); San Francisco VA Medical Center, San Francisco, CA (RLS); Department of Medicine, Eastern Colorado VA Health Care System, Aurora, CO (DBB); Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO (DBB) sahluwal@rand.org.
PMID: 33452095 DOI: 10.3122/jabfm.2021.01.200184

Abstract

BACKGROUND: Group visits have the potential to help patients identify their health care values and engage in the emotionally and cognitively challenging task of advance care planning (ACP) in a resource-efficient manner by providing a forum for social learning and social support.
OBJECTIVE: To evaluate the feasibility and acceptability of disease-specific group visits for patients with heart failure and their caregivers.
DESIGN: Feasibility trial of a 90-minute group visit held for 10 separate groups and led by a trained facilitator using the video-based PREPARE for Your Care ACP tool.
SETTING/SUBJECTS: Older adults with recent hospitalization for heart failure (n = 36; median age, 74 years) and their caregivers (n = 21).
MEASUREMENTS: Pre- and post-visit surveys and a postvisit telephone interview assessing perceived value and acceptability; structured nonparticipant observations to assess process and feasibility.
RESULTS: Mean scores from the postgroup visit evaluation showed that participants reported that they felt comfortable discussing ACP in a group (4.59), understood the information covered (4.70), and were able to identify and clarify their health care values (4.43). Interview and observation data demonstrated that participants were able to identify and clarify their preferences by listening and learning from a diverse range of perspectives in the group and that the disease-focused nature of the group visit created a supportive space for participants to share their experiences.
CONCLUSIONS: Disease-focused ACP group visits were feasible to conduct and acceptable to participants, underscoring their value as an efficient intervention to engage patients and caregivers in the otherwise time- and resource-intensive task of ACP.

Keywords

Advance Care Planning Aging Caregivers Clinical Decision-Making Decision Making Feasibility Studies Geriatrics Heart Failure Qualitative Research Social Learning Social Support Surveys and Questionnaires Terminal Care

References

  1. Patient Educ Couns. 2007 Dec;69(1-3):165-95 [PMID: 17942272]
  2. Ann Behav Med. 2003 Aug;26(1):1-7 [PMID: 12867348]
  3. J Ambul Care Manage. 2014 Jan-Mar;37(1):32-7 [PMID: 24309393]
  4. J Am Board Fam Med. 2017 Jul-Aug;30(4):480-490 [PMID: 28720629]
  5. Heart Lung. 2013 Nov-Dec;42(6):456-61 [PMID: 24075619]
  6. J Am Geriatr Soc. 2010 Dec;58(12):2329-36 [PMID: 21143441]
  7. Am J Hosp Palliat Care. 2009 Dec-2010 Jan;26(6):456-63 [PMID: 19648573]
  8. J Am Board Fam Med. 2006 May-Jun;19(3):276-90 [PMID: 16672681]
  9. J Am Geriatr Soc. 1975 Oct;23(10):433-41 [PMID: 1159263]
  10. J Pain Symptom Manage. 2008 Aug;36(2):149-56 [PMID: 18599259]
  11. Qual Health Res. 2005 Nov;15(9):1277-88 [PMID: 16204405]
  12. Ann Intern Med. 2010 Aug 17;153(4):256-61 [PMID: 20713793]
  13. J Am Geriatr Soc. 2004 Sep;52(9):1463-70 [PMID: 15341547]
  14. Ann Fam Med. 2016 Mar;14(2):125-32 [PMID: 26951587]
  15. Mil Med. 2008 Dec;173(12):1210-3 [PMID: 19149341]
  16. J Am Geriatr Soc. 1997 May;45(5):543-9 [PMID: 9158573]
  17. Health Aff (Millwood). 2017 Jul 1;36(7):1244-1251 [PMID: 28679811]
  18. Ann Intern Med. 2010 Jun 1;152(11):745-6 [PMID: 20513830]
  19. J Pain Symptom Manage. 2018 Feb;55(2):245-255.e8 [PMID: 28865870]
  20. J Palliat Med. 2018 Jun;21(6):853-856 [PMID: 29461918]
  21. Heart Lung. 2009 Jan-Feb;38(1):25-33 [PMID: 19150528]
  22. Heart. 2007 Aug;93(8):963-7 [PMID: 17309905]
  23. J Pain Symptom Manage. 2018 Oct;56(4):575-581.e7 [PMID: 29940209]
  24. J Card Fail. 2008 Mar;14(2):106-13 [PMID: 18325456]
  25. Prim Health Care Res Dev. 2019 Jul 29;20:e79 [PMID: 31868152]
  26. Br J Gen Pract. 2011 Jan;61(582):e49-62 [PMID: 21401993]
  27. J Pain Symptom Manage. 2014 Apr;47(4):674-86 [PMID: 23972574]
  28. JAMA Intern Med. 2017 Aug 1;177(8):1102-1109 [PMID: 28520838]
  29. CMAJ. 2013 Sep 17;185(13):E635-44 [PMID: 23939218]
  30. J Gen Intern Med. 2012 Apr;27(4):445-51 [PMID: 22038469]

Grants

  1. K24 AG054415/NIA NIH HHS
  2. R21 AG053716/NIA NIH HHS

MeSH Term

Advance Care Planning
Aged
Caregivers
Feasibility Studies
Heart Failure
Humans
Surveys and Questionnaires
Journal Article Research Support, N.I.H., Extramural
Article has an altmetric score of 3

Word Cloud

Created with Highcharts 10.0.0groupACPCareparticipantsvisitspatientsidentifycarecaregiversFeasibilityvisit4GrouphealthvaluesengagetasksociallearningfeasibilityacceptabilityheartfailurevalueableclarifyAdvancePlanningHeartFailureCaregiversSocialBACKGROUND:potentialhelpemotionallycognitivelychallengingadvanceplanningresource-efficientmannerprovidingforumsupportOBJECTIVE:evaluatedisease-specificDESIGN:trial90-minuteheld10separategroupsledtrainedfacilitatorusingvideo-basedPREPAREtoolSETTING/SUBJECTS:Olderadultsrecenthospitalizationn = 36medianage74 yearsn = 21MEASUREMENTS:Pre-post-visitsurveyspostvisittelephoneinterviewassessingperceivedstructurednonparticipantobservationsassessprocessRESULTS:Meanscorespostgroupevaluationshowedreportedfeltcomfortablediscussing59understoodinformationcovered7043Interviewobservationdatademonstratedpreferenceslisteningdiverserangeperspectivesdisease-focusednaturecreatedsupportivespaceshareexperiencesCONCLUSIONS:Disease-focusedfeasibleconductacceptableunderscoringefficientinterventionotherwisetime-resource-intensiveVisitsAmongPatientsAgingClinicalDecision-MakingDecisionMakingStudiesGeriatricsQualitativeResearchLearningSupportSurveysQuestionnairesTerminal

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