Match!

Using Implementation Science to Further the Adoption and Implementation of Advance Care Planning in Rural Primary Care.

Published on Jan 1, 2020in Journal of Nursing Scholarship2.54
· DOI :10.1111/JNU.12513
Heather V. Nelson-Brantley2
Estimated H-index: 2
(KU: University of Kansas),
Carol Buller1
Estimated H-index: 1
(KU: University of Kansas)
+ 3 AuthorsShellie D. Ellis12
Estimated H-index: 12
(KU: University of Kansas)
Abstract
PURPOSE: To analyze the literature on advance care planning (ACP) in primary care through the lens of implementation science, with a focus on implications for rural settings. DESIGN: Scoping review of the literature. METHODS: The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PsycINFO, and the Psychology and Behavioral Sciences Collection databases were searched for studies related to ACP adoption and implementation in primary care. The Theoretical Domains Framework was used to map the literature to 14 determinants that serve as barriers or facilitators to ACP. The Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors was used to analyze the stage of implementation for each of the included studies. FINDINGS: Four steps to ACP were specified: identification, conversation, documentation, and follow-up. Determinants were identified for each step, but studies largely focused on the conversation step. Professional role and identity, environmental context and resources, and emotion were the most frequently cited determinants in initiating conversations. The identification step was largely determined by behavioral regulation. For documenting ACP, environmental context and resource determinants were most prevalent. In the few studies that addressed follow-up, providers expressed a desire for electronic reminders as a behavioral regulator to follow-up. CONCLUSIONS: While ACP has been shown to have patient, family, and societal benefits, its uptake in primary care has been minimal. Because ACP is a complex process that is highly context dependent, implementation science is critical to inform its successful adoption and implementation. Smaller healthcare networks, adaptable professional roles, trusted relationships, and tight-knit community might be important facilitators of ACP in rural primary care. CLINICAL RELEVANCE: Findings from this study can be used to accelerate ACP implementation in rural primary care.
  • References (48)
  • Citations (1)
📖 Papers frequently viewed together
2017
1 Author (Naomi Olson)
2016
4 Authors (Sheldon Steiner, ..., Anne Cioletti)
78% of Scinapse members use related papers. After signing in, all features are FREE.
References48
Newest
#1Linda Lee (McMaster University)H-Index: 36
#2Loretta M. Hillier (HHS: Hamilton Health Sciences)H-Index: 14
Last. Karen SlonimH-Index: 4
view all 5 authors...
Background:Advance care planning (ACP) provides clarity on goals and preferences for future health-care decisions, the timeliness of which is critical for persons with dementia.Aim:This study asses...
Source
#1R LakinJoshua (Harvard University)
#2BenottiEmily (Brigham and Women's Hospital)
Last. SandersJustin (Harvard University)
view all 5 authors...
Abstract Background: Evidence demonstrates that discussion between clinicians and seriously ill patients about their goals and preferences, or serious illness communication, is a high-value interve...
Source
#1L RoseBarbaraH-Index: 1
#2LeungStephanieH-Index: 1
Last. ChildersJulie (University of Pittsburgh)H-Index: 1
view all 4 authors...
Abstract Background: Primary care physicians recognize the importance of advance care planning (ACP) conversations and report lack of training and time in the office to start them. Previous efforts...
2 CitationsSource
#1Jolien J Glaudemans (UvA: University of Amsterdam)H-Index: 2
#2Anja E de Jong (UvA: University of Amsterdam)H-Index: 1
Last. D. Ick L. Willems (UvA: University of Amsterdam)H-Index: 1
view all 5 authors...
Background Few older people benefit from advance care planning (ACP), due to several barriers related to primary care professionals, such as insufficient knowledge, negative beliefs and a lack of time. Information on overcoming these barriers is limited. We assumed primary care professionals experienced in ACP with older patients are likely to have learned how to overcome these barriers. Objective To investigate how Dutch primary care professionals experienced in ACP with older patients overcome...
3 CitationsSource
OBJECTIVES: Advance care planning (ACP) involvement could be substantially different by physician specialty or sex group, with implications for training and methods to increase ACP activities. The objective of this article is to compare primary care physicians (PCPs) and other specialty physicians and female compared with male physicians' views and interactions surrounding ACP. METHODS: This was a secondary analysis of an online anonymous survey distributed through a survey link to healthcare pr...
1 CitationsSource
#1Bram TilburgsH-Index: 3
Last. Yvonne EngelsH-Index: 21
view all 6 authors...
Background ACP enables individuals to define and discuss goals and preferences for future medical treatment and care with family and healthcare providers, and to record these goals and preferences if appropriate. Because general practitioners (GPs) often have long-lasting relationships with people with dementia, GPs seem most suited to initiate ACP. However, ACP with people with dementia in primary care is uncommon. Although several barriers and facilitators to ACP with people with dementia have...
4 CitationsSource
#1Sumytra Menon (NUS: National University of Singapore)H-Index: 4
#2Marijke C. Kars (UU: Utrecht University)H-Index: 12
Last. Johannes J. M. van Delden (UU: Utrecht University)H-Index: 34
view all 5 authors...
Abstract Context Advance care planning (ACP) has been shown to improve end-of-life care, but it was developed in the U.S., and most research has been conducted in western communities. Objectives We aimed to study the attitudes and perceptions of patients with life-limiting illnesses, informal caregivers, doctors, nurses, and medical social workers regarding ACP in a multicultural family centric community. Methods We conducted an explorative qualitative study, using focus groups and individual in...
8 CitationsSource
#1Terry Fulmer (John A. Hartford Foundation)H-Index: 32
#2Marcus Escobedo (John A. Hartford Foundation)H-Index: 4
Last. Angela HultH-Index: 1
view all 6 authors...
OBJECTIVES To evaluate physicians' views on advance care planning, goals of care, and end‐of‐life conversations. DESIGN Random sample telephone survey. SETTING United States. PARTICIPANTS Physicians (primary care specialists; pulmonology, cardiology, oncology subspecialists) actively practicing medicine and regularly seeing patients aged 65 and older (N=736; 81% male, 75% white, 66% aged ≥50. MEASUREMENTS A 37‐item telephone survey constructed by a professional polling group with national expert...
9 CitationsSource
BACKGROUND: Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit pla...
3 CitationsSource
#1Zachary Munn (The Joanna Briggs Institute)H-Index: 20
#2Cindy Stern (The Joanna Briggs Institute)H-Index: 10
Last. Zoe Jordan (The Joanna Briggs Institute)H-Index: 15
view all 5 authors...
Systematic reviews have been considered as the pillar on which evidence-based healthcare rests. Systematic review methodology has evolved and been modified over the years to accommodate the range of questions that may arise in the health and medical sciences. This paper explores a concept still rarely considered by novice authors and in the literature: determining the type of systematic review to undertake based on a research question or priority. Within the framework of the evidence-based healt...
27 CitationsSource
Cited By1
Newest