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AIDS Care Jun 2024With advances in medicine, HIV has evolved into a chronic condition for people living with HIV (PLWH). However, many PLWH do not engage in advance care planning (ACP),...
With advances in medicine, HIV has evolved into a chronic condition for people living with HIV (PLWH). However, many PLWH do not engage in advance care planning (ACP), and it occurs primarily in acute situations. ACP may improve preparedness for end-of-life care and increase advance directive (AD) documentation. Searches of PubMed, PsycInfo, and CINHAL were conducted to synthesize current ACP-related randomized controlled trials on two separate populations: (1) PLWH and (2) older adults without HIV. Two articles met inclusion criteria for PLWH, and the intervention had a significant improvement in ACP engagement. For the latter population, thirteen of fourteen articles had interventions that led to statistically significant increases in ACP engagement. This review underscores the need to further investigate the best strategies to improve ACP among PLWH and provides insights from existing ACP interventions for the general population to be adapted to the needs of PLWH.
PubMed: 38838033
DOI: 10.1080/09540121.2024.2361822 -
Medicina (Kaunas, Lithuania) May 2024: Mental capacity is a fundamental aspect that enables patients to fully participate in various healthcare procedures. To assist healthcare professionals (HCPs) in... (Comparative Study)
Comparative Study Meta-Analysis Review
: Mental capacity is a fundamental aspect that enables patients to fully participate in various healthcare procedures. To assist healthcare professionals (HCPs) in assessing patients' capacity, especially in the mental health field, several standardized tools have been developed. These tools include the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), and the Competence Assessment Tool for Psychiatric Advance Directives (CAT-PAD). The core dimensions explored by these tools include Understanding, Appreciation, Reasoning, and Expression of a choice. : This meta-analysis aimed to investigate potential differences in decision-making capacity within the healthcare context among groups of patients with bipolar disorders (BD) and schizophrenia spectrum disorders (SSD). : A systematic search was conducted on Medline/Pubmed, and Scopus. Additionally, Google Scholar was manually inspected, and a manual search of emerging reviews and reference lists of the retrieved papers was performed. Eligible studies were specifically cross-sectional, utilizing standardized assessment tools, and involving patients diagnosed with BD and SSD. Data from the studies were independently extracted and pooled using random-effect models. Hedges' was used as a measure for outcomes. : Six studies were identified, with three studies using the MacCAT-CR, two studies the MacCAT-T, and one the CAT-PAD. The participants included 189 individuals with BD and 324 individuals with SSD. The meta-analysis revealed that patients with BD performed slightly better compared to patients with SSD, with the difference being statistically significant in the domain of Appreciation (ES = 0.23, 95% CI: 0.01 to 0.04, = 0.037). There was no statistically significant difference between the two groups for Understanding (ES = 0.09, 95% CI:-0.10 to 0.27, = 0.352), Reasoning (ES = 0.18, 95% CI: -0.12 to 0.47, = 0.074), and Expression of a choice (ES = 0.23, 95% CI: -0.01 to 0.48, = 0.60). In the sensitivity analysis, furthermore, when considering only studies involving patients in symptomatic remission, the difference for Appreciation also resulted in non-significant (ES = 0.21, 95% CI: -0.04 to 0.46, = 0.102). : These findings indicate that there are no significant differences between patients with BD and SSD during remission phases, while differences are minimal during acute phases. The usefulness of standardized assessment of capacity at any stage of the illness should be considered, both for diagnostic-therapeutic phases and for research and advance directives. Further studies are necessary to understand the reasons for the overlap in capacity between the two diagnostic categories compared in this study.
Topics: Humans; Bipolar Disorder; Decision Making; Informed Consent; Mental Competency; Schizophrenia
PubMed: 38792947
DOI: 10.3390/medicina60050764 -
BMC Health Services Research Apr 2024Providing individualised healthcare in line with patient wishes is a particular challenge for emergency healthcare professionals. Documentation of patient wishes (DPW),...
BACKGROUND
Providing individualised healthcare in line with patient wishes is a particular challenge for emergency healthcare professionals. Documentation of patient wishes (DPW), e.g. as advance directives, can guide clinicians in making end-of-life decisions that respect the patient's wishes and autonomy. However, patient centered decisions are hindered by limited availability of DPWs in emergency settings.
OBJECTIVE
This systematic review aims to congregate present data on recorded rates for DPW existence and availability in the emergency department (ED) as well as contributing factors for these rates.
METHODS
We searched MEDLINE, Google Scholar, Embase and Web of Science databases in September 2023. Publications providing primary quantitative data on DPW in the ED were assessed. Publications referring only to a subset of ED patients (other than geriatric) and investigating DPW issued after admission were excluded.
RESULTS
A total of 22 studies from 1996 to 2021 were included in the analysis. Most were from the US (n = 12), followed by Australia (n = 4), Canada (n = 2), South Korea, Germany, the United Kingdom and Switzerland (n = 1 each). In the general adult population presenting to the ED, 19.9-27.8% of patients reported having some form of DPW, but only in 6.8% or less it was available on presentation. In the geriatric population, DPW rates (2.6-79%) as well as their availability (1.1-48.8%) varied widely. The following variables were identified as positive predictors of having DPW, among others: higher age, poorer overall health, as well as sociodemographic factors, such as female gender, having children, being in a relationship, higher level of education or a recent previous presentation to hospital.
CONCLUSIONS
Existence and availability of a recorded DPW among ED patients was low in general and even in geriatric populations mostly well below 50%. While we were able to gather data on prevalence and predictors, this was limited by heterogeneous data. We believe further research is needed to explore the quality of DPW and measures to increase both rates of existence and availability of DPW in the ED.
Topics: Aged; Adult; Child; Humans; Female; Advance Directives; Emergency Service, Hospital; Hospitalization; Health Personnel; Decision Making
PubMed: 38570808
DOI: 10.1186/s12913-024-10819-1 -
JAMA Mar 2024Child maltreatment is associated with serious negative physical, psychological, and behavioral consequences. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Child maltreatment is associated with serious negative physical, psychological, and behavioral consequences.
OBJECTIVE
To review the evidence on primary care-feasible or referable interventions to prevent child maltreatment to inform the US Preventive Services Task Force.
DATA SOURCES
PubMed, Cochrane Library, and trial registries through February 2, 2023; references, experts, and surveillance through December 6, 2023.
STUDY SELECTION
English-language, randomized clinical trials of youth through age 18 years (or their caregivers) with no known exposure or signs or symptoms of current or past maltreatment.
DATA EXTRACTION AND SYNTHESIS
Two reviewers assessed titles/abstracts, full-text articles, and study quality, and extracted data; when at least 3 similar studies were available, meta-analyses were conducted.
MAIN OUTCOMES AND MEASURES
Directly measured reports of child abuse or neglect (reports to Child Protective Services or removal of the child from the home); proxy measures of abuse or neglect (injury, visits to the emergency department, hospitalization); behavioral, developmental, emotional, mental, or physical health and well-being; mortality; harms.
RESULTS
Twenty-five trials (N = 14 355 participants) were included; 23 included home visits. Evidence from 11 studies (5311 participants) indicated no differences in likelihood of reports to Child Protective Services within 1 year of intervention completion (pooled odds ratio, 1.03 [95% CI, 0.84-1.27]). Five studies (3336 participants) found no differences in removal of the child from the home within 1 to 3 years of follow-up (pooled risk ratio, 1.06 [95% CI, 0.37-2.99]). The evidence suggested no benefit for emergency department visits in the short term (<2 years) and hospitalizations. The evidence was inconclusive for all other outcomes because of the limited number of trials on each outcome and imprecise results. Among 2 trials reporting harms, neither reported statistically significant differences. Contextual evidence indicated (1) widely varying practices when screening, identifying, and reporting child maltreatment to Child Protective Services, including variations by race or ethnicity; (2) widely varying accuracy of screening instruments; and (3) evidence that child maltreatment interventions may be associated with improvements in some social determinants of health.
CONCLUSION AND RELEVANCE
The evidence base on interventions feasible in or referable from primary care settings to prevent child maltreatment suggested no benefit or insufficient evidence for direct or proxy measures of child maltreatment. Little information was available about possible harms. Contextual evidence pointed to the potential for bias or inaccuracy in screening, identification, and reporting of child maltreatment but also highlighted the importance of addressing social determinants when intervening to prevent child maltreatment.
Topics: Adolescent; Child; Humans; Advance Directives; Advisory Committees; Child Abuse; Emergency Service, Hospital; Primary Health Care; United States; Social Determinants of Health; Child Protective Services
PubMed: 38502070
DOI: 10.1001/jama.2024.0276 -
BMC Medical Research Methodology Feb 2024Successfully recruiting male participants to complete a healthcare related study is important for healthcare study completion and to advance our clinical knowledgebase....
BACKGROUND
Successfully recruiting male participants to complete a healthcare related study is important for healthcare study completion and to advance our clinical knowledgebase. To date, most research studies have examined the barriers and facilitators of female participants in longitudinal healthcare-related studies with limited information available about the needs of males in longitudinal research. This systematic review examines the unique barriers and facilitators to male recruitment across longitudinal healthcare-related research studies.
METHODS
Following PRIMSA guidelines, MEDLINE, Embase, CINAHL and Web of Science databases were systematically searched using the terms recruitment and/or retention, facilitators and/or barriers and longitudinal studies from 1900 to 2023 which contained separate data on males aged 17-59 years. Health studies or interventions were defined longitudinal if they were greater than or equal to 12 weeks in duration with 3 separate data collection visits.
RESULTS
Twenty-four articles published from 1976-2023 met the criteria. One-third of the studies had a predominantly male sample and four studies recruited only male participants. Males appear disinterested towards participation in health research, however this lack of enthusiasm can be overcome by clear, non-directive communication, and studies that support the participants interests. Facilitating factors are diverse and may require substantial time from research teams.
CONCLUSIONS
Future research should focus on the specific impact of these factors across the spectrum of longitudinal health-related studies. Based on the findings of this systematic review, researchers from longitudinal health-related clinical trials are encouraged to consider male-specific recruitment strategies to ensure successful recruitment and retention in their studies.
REGISTRATION
This systemic review is registered with the PROSPERO database (CRD42021254696).
Topics: Humans; Male; Female; Health Services Research; Communication; Data Collection; Research Personnel
PubMed: 38389065
DOI: 10.1186/s12874-024-02163-z -
Journal of Pain and Symptom Management Jun 2024Making decisions regarding end-of-life care is particularly challenging for patients and their family caregivers. Studies have advocated that family involvement in... (Meta-Analysis)
Meta-Analysis
CONTEXT
Making decisions regarding end-of-life care is particularly challenging for patients and their family caregivers. Studies have advocated that family involvement in advance care planning is important to provide goal-concordant care and to increase family caregivers' preparation for surrogate decision-making. However, there is a lack of evidence to examine the effectiveness of advance care planning using the patient-caregiver dyadic approach.
OBJECTIVES
To evaluate the effectiveness of dyadic advance care planning.
METHODS
A literature search was systematically carried out in 7 databases from inception to March 2023. All randomized controlled trials with advance care planning interventions for mentally competent adults and their family caregivers were included. Meta-analysis was conducted for available quantitative data related to end-of-life care; Otherwise, narrative syntheses were performed.
RESULTS
In total, 14 randomized controlled trials were included. The main contents of all interventions were summarized into five categories, namely sharing illness experience and perception, introducing knowledge about advance care planning and end-of-life care, discussing individual's/dyads' values, goals, and care preferences, addressing dyads' discordance, and providing supports to complete advance care planning behaviors. The meta-analysis showed that dyadic advance care planning had significant effects on advance directive documentation (OR = 7.58, 95% CI [1.41, 40.63], P = 0.02) and proactive communication with doctors (OR = 2.42, 95% CI [1.42, 4.12], P = 0.001). In addition, interventions may improve dyad's congruence on end-of-life care, family caregivers' confidence in surrogate decision-making, and quality of end-of-life communication.
CONCLUSIONS
This review supports that dyadic advance care planning is a promising approach to preparing patients and their family caregivers for end-of-life communication and decision-making. Given that this multifaceted process is influenced by multiple factors within the socio-cultural context, future studies are warranted to identify the barriers and facilitators to implement dyadic advance care planning in real-world settings.
Topics: Humans; Advance Care Planning; Caregivers; Decision Making; Randomized Controlled Trials as Topic; Terminal Care
PubMed: 38272378
DOI: 10.1016/j.jpainsymman.2024.01.027 -
International Journal of Nursing Studies Mar 2024Advance care planning has been widely recommended to respect the medical care preferences of patients in the final stages of life. However, uptake of advance care... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Advance care planning has been widely recommended to respect the medical care preferences of patients in the final stages of life. However, uptake of advance care planning in healthcare settings remains suboptimal. It may be beneficial to take into account individuals' readiness for advance care planning based on the stages to change identified in the Transtheoretical Model.
OBJECTIVE
To identify the measurements used to assess readiness of advance care planning based on the Transtheoretical Model, to pool the prevalence of readiness stages, and to summarize the factors affecting people's readiness for advance care planning.
DESIGN
Systematic review and meta-analysis.
METHODS
We systematically searched the databases of PubMed, EMBASE, The Cochrane Library, CINAHL, and Web of Science for relevant studies from inception to February 2023. A random effects model was used to estimate the pooled prevalence. And a narrative review on the factors associated with stages of readiness was conducted.
RESULTS
This meta-analysis included 25 studies involving a total of 4237 individuals. The precontemplation stage was the most commonly identified stage of readiness among advance care planning behaviors (26-72 %). The prevalence of readiness stages for advance care planning varied among different types of behavior. The behavior of "talking to health care proxy/family/loved ones about thoughts on quality versus quantity of life" had the highest level of readiness among all listed behaviors, followed by "talking to health care proxy/family/loved ones about living will", "signing a health care proxy form" and "signing a living will", "signing an advance directive", as well as "talking to doctors about living will". Regarding to influencing factors, a majority of sociodemographic and clinical factors did not show consistent associations with readiness, but some studies did suggest potential links with age, health status, countries, type of assessment, core structures of the Transtheoretical Model, and intervention modalities.
CONCLUSIONS
A majority of individuals were unaware of advance care planning. There is an urgent need to promote readiness for such planning. Starting with preliminary activities such as "talking to health care proxy/family/loved ones about thoughts on quality versus quantity of life" can help initiate advance care planning. Better integration of the Transtheoretical Model and interventions into the research of advance care planning readiness are needed.
REGISTRATION
Not registered.
Topics: Humans; Prevalence; Advance Care Planning; Advance Directives; Terminal Care
PubMed: 38262171
DOI: 10.1016/j.ijnurstu.2023.104678 -
BMC Palliative Care Jan 2024Advance directives (ADs) has recently been considered as an important component of palliative care for patients with advanced cancer and is a legally binding directive...
INTRODUCTION
Advance directives (ADs) has recently been considered as an important component of palliative care for patients with advanced cancer and is a legally binding directive regarding a person's future medical care. It is used when a person is unable to participate in the decision-making process about their own care. Therefore, the present systematic review investigated the factors related to ADs from the perspective of cancer patients.
METHODS
A systematic review study was searched in four scientific databases: PubMed, Medline, Scopus, Web of Science, and ProQuest using with related keywords and without date restrictions. The quality of the studies was assessed using the Hawker criterion. The research papers were analyzed as directed content analysis based on the theory of planned behavior.
RESULTS
Out of 5900 research papers found, 22 were included in the study. The perspectives of 9061 cancer patients were investigated, of whom 4347 were men and 4714 were women. The mean ± SD of the patients' age was 62.04 ± 6.44. According to TPB, factors affecting ADs were categorized into four categories, including attitude, subjective norm, perceived behavioral control, and external factors affecting the model. The attitude category includes two subcategories: "Lack of knowledge of the ADs concept" and "Previous experience of the disease", the subjective norm category includes three subcategories: "Social support and interaction with family", "Respecting the patient's wishes" and "EOL care choices". Also, the category of perceived control behavior was categorized into two sub-categories: "Decision-making" and "Access to the healthcare system", as well as external factors affecting the model, including "socio-demographic characteristics".
CONCLUSION
The studies indicate that attention to EOL care and the wishes of patients regarding receiving medical care and preservation of human dignity, the importance of facilitating open communication between patients and their families, and different perspectives on providing information, communicating bad news and making decisions require culturally sensitive approaches. Finally, the training of cancer care professionals in the palliative care practice, promoting the participation of health care professionals in ADs activities and creating an AD-positive attitude should be strongly encouraged.
Topics: Male; Humans; Female; Advance Directives; Palliative Care; Health Personnel; Attitude; Hospice and Palliative Care Nursing; Neoplasms
PubMed: 38166983
DOI: 10.1186/s12904-023-01327-w -
Journal of the American Medical... Dec 2023Discussions between health professionals and nursing home (NH) residents or their families about the current or future goals of health care may be associated with better... (Review)
Review
OBJECTIVES
Discussions between health professionals and nursing home (NH) residents or their families about the current or future goals of health care may be associated with better outcomes at the end of life (EOL), such as avoidance of unwanted interventions or death in hospital. The timing of these discussions varies, and it is possible that their influence on EOL outcomes depends on their timing. This study synthesized current evidence concerning the timing of goals of care (GOC) discussions in NHs and its impact on EOL outcomes.
DESIGN
Systematic review.
SETTING AND PARTICIPANTS
Adult populations in NH settings.
METHODS
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. We searched PubMed, Embase, and Cumulative Index of Nursing and Allied Health from January 2000 to September 2022. We included studies that examined timing of GOC discussions in NHs, were peer-reviewed, and published in English. Quality of the studies was assessed using the Newcastle-Ottawa Scale.
RESULTS
Screening of 1930 abstracts yielded 149 papers that were evaluated for eligibility. Of the 18 articles, representing 16 distinct studies that met review criteria, 12 evaluated the timing of advance directives. There was variation in the timing of GOC discussions and compared with discussions that occurred within a month of death, earlier discussions (eg, at the time of facility admission) were associated with lower rates of hospitalization at the EOL and lower health care costs.
CONCLUSIONS AND IMPLICATIONS
The timing of GOC discussions in NHs varies and evidence suggests that late discussions are associated with poorer EOL outcomes. The benefits of goal-concordant care may be enhanced by earlier and more frequent discussions. Future studies should examine the optimal timing for GOC discussions in the NH population.
Topics: Humans; Nursing Homes; Advance Directives; Hospitalization; Patient Care Planning; Terminal Care
PubMed: 37918815
DOI: 10.1016/j.jamda.2023.09.024 -
Journal of the American Medical... Dec 2023To systematically synthesize the views of community-dwelling Asians on Advance care planning and to summarize the factors and reasons affecting their uptake of ACP. (Review)
Review
OBJECTIVES
To systematically synthesize the views of community-dwelling Asians on Advance care planning and to summarize the factors and reasons affecting their uptake of ACP.
DESIGN
Mixed-methods systematic review (PROSPERO: CRD42018091033).
SETTING AND PARTICIPANTS
Asian adults (≥18 years old) living in the community globally.
METHODS
Medline (Ovid), Web of Science, CINAHL (EBSCO), Open Grey, and Google Scholar were searched from inception to June 30, 2022. Qualitative, quantitative, or mixed-methods studies reporting on the views of non-seriously ill community-dwelling Asian adults on ACP or the factors influencing their ACP uptake were included. Secondary research, studies not published in English, or studies not available as full text were excluded. Two independent teams of researchers extracted data, assessed methodologic quality, and performed the data analysis. Data analysis was conducted using the multistep convergent integrated approach based on Joanna Briggs Institute methodology for mixed-methods systematic review.
RESULTS
Fifty-eight studies were included. Non-seriously ill community-dwelling Asians were willing to engage in ACP (46.5%-84.4%) although their awareness (3.1%-42.9%) and uptake of ACP remained low (14.0%-53.4%). Background factors (sociodemographic factors, and health status, as well as experience and exposure to information) and underlying beliefs (attitude toward ACP, subjective norm, and perceived behavioral control) were found to affect their uptake of ACP. A conceptual framework was developed to facilitate a proper approach to ACP for this population.
CONCLUSIONS AND IMPLICATIONS
A flexible approach toward ACP is needed for non-seriously ill community-dwelling Asians. There is also a need to raise end-of-life and ACP literacy, and to explore ways to narrow the gap in the expectations and implementation of ACP so that trust in its effective execution can be built.
Topics: Adult; Humans; Advance Care Planning; Asian; Attitude; Health Status; Independent Living
PubMed: 37844872
DOI: 10.1016/j.jamda.2023.09.008