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Development of a cognitive model for advance care planning discussions : results from a quality improvement initiative

Jacobsen, Juliet LU ; Robinson, Ellen ; Jackson, Vicki A ; Meigs, James B and Billings, J Andrew (2011) In Journal of Palliative Medicine 14(3). p.6-331
Abstract

BACKGROUND: Residents struggle with advance care planning (ACP) discussions in the inpatient setting, and may not be aware of newer models for ACP that stress the importance of giving prognostic information and making a recommendation about cardiopulmonary resuscitation to patients and families.

METHODS: A controlled study of a cognitive model for ACP embedded in a quality improvement (QI) project.

RESULTS: In the setting of a QI project for medical residents and interdisciplinary staff, we developed and implemented a cognitive model of ACP discussions that involved two types of meetings for patients: (1) information-sharing meetings for seriously ill but clinically stable patients and (2) decision-making meetings for... (More)

BACKGROUND: Residents struggle with advance care planning (ACP) discussions in the inpatient setting, and may not be aware of newer models for ACP that stress the importance of giving prognostic information and making a recommendation about cardiopulmonary resuscitation to patients and families.

METHODS: A controlled study of a cognitive model for ACP embedded in a quality improvement (QI) project.

RESULTS: In the setting of a QI project for medical residents and interdisciplinary staff, we developed and implemented a cognitive model of ACP discussions that involved two types of meetings for patients: (1) information-sharing meetings for seriously ill but clinically stable patients and (2) decision-making meetings for clinically unstable patients. Patients on the intervention floor were significantly more likely to have a discussion about goals of care (33.8%) than patients on the control floor (21.2%, p = < 0.001) and significantly more likely to have a limitation of life-sustaining treatment upon discharge (19.1% vs. 13.9%, p = 0.04).

CONCLUSIONS: For both residents and interdisciplinary staff, application of a cognitive model that clearly defines goals and expectations for ACP discussions prior to meeting with patients and families improves rates of ACP discussions.

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author
; ; ; and
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Advance Care Planning, Cognition, Communication, Female, Humans, Male, Middle Aged, Models, Psychological, Physician-Patient Relations, Quality Assurance, Health Care/organization & administration
in
Journal of Palliative Medicine
volume
14
issue
3
pages
6 pages
publisher
Mary Ann Liebert, Inc.
external identifiers
  • pmid:21247300
  • scopus:79952288864
ISSN
1096-6218
DOI
10.1089/jpm.2010.0383
language
English
LU publication?
no
id
8bd9b4f3-13ce-4b16-907c-e14b1fd9aafe
date added to LUP
2024-11-13 14:19:19
date last changed
2025-04-04 14:17:30
@article{8bd9b4f3-13ce-4b16-907c-e14b1fd9aafe,
  abstract     = {{<p>BACKGROUND: Residents struggle with advance care planning (ACP) discussions in the inpatient setting, and may not be aware of newer models for ACP that stress the importance of giving prognostic information and making a recommendation about cardiopulmonary resuscitation to patients and families.</p><p>METHODS: A controlled study of a cognitive model for ACP embedded in a quality improvement (QI) project.</p><p>RESULTS: In the setting of a QI project for medical residents and interdisciplinary staff, we developed and implemented a cognitive model of ACP discussions that involved two types of meetings for patients: (1) information-sharing meetings for seriously ill but clinically stable patients and (2) decision-making meetings for clinically unstable patients. Patients on the intervention floor were significantly more likely to have a discussion about goals of care (33.8%) than patients on the control floor (21.2%, p = &lt; 0.001) and significantly more likely to have a limitation of life-sustaining treatment upon discharge (19.1% vs. 13.9%, p = 0.04).</p><p>CONCLUSIONS: For both residents and interdisciplinary staff, application of a cognitive model that clearly defines goals and expectations for ACP discussions prior to meeting with patients and families improves rates of ACP discussions.</p>}},
  author       = {{Jacobsen, Juliet and Robinson, Ellen and Jackson, Vicki A and Meigs, James B and Billings, J Andrew}},
  issn         = {{1096-6218}},
  keywords     = {{Advance Care Planning; Cognition; Communication; Female; Humans; Male; Middle Aged; Models, Psychological; Physician-Patient Relations; Quality Assurance, Health Care/organization & administration}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{6--331}},
  publisher    = {{Mary Ann Liebert, Inc.}},
  series       = {{Journal of Palliative Medicine}},
  title        = {{Development of a cognitive model for advance care planning discussions : results from a quality improvement initiative}},
  url          = {{http://dx.doi.org/10.1089/jpm.2010.0383}},
  doi          = {{10.1089/jpm.2010.0383}},
  volume       = {{14}},
  year         = {{2011}},
}