Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado
College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Ann Fam Med. 2016 Mar;14(2):125-32. doi: 10.1370/afm.1906.
Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care-based group visit model focused on advance care planning.
We conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project.
Ten of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics.
A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system.
初级保健需要新的模式来促进预先护理计划的对话。这些对话侧重于严重疾病的偏好，可能涉及患者、决策者和医疗保健提供者。我们描述了第一个以初级保健为基础的专注于预先护理计划的小组访问模型的可行性。
我们在老年病诊所进行了一项预先护理计划小组访问的试点示范。患者年龄至少为 65 岁。由老年病医生和社会工作者共同主持的 2 次 2 小时小组会议，患者分组参加。活动包括考虑个人价值观、讨论预先护理计划、选择替代决策人以及完成预先指示。我们使用 RE-AIM 框架来评估该项目。
11 名临床医生中有 10 名推荐患者参与。在 80 名受邀患者中，有 32 名参加了 5 个小组访问组（参与率为 40%），有 27 名参加了两次会议（保留率为 84%）。平均年龄为 79 岁；59%的参与者为女性，72%为白人。大多数人认为小组访问比通常的诊所访问更有利于讨论预先护理计划。患者报告在参与后详细的预先护理计划对话有所增加（从 19%到 41%，P =.02）。定性分析发现，老年人愿意分享个人价值观和与预先护理计划相关的挑战，并且他们主动讨论了广泛的相关主题。
促进预先护理计划讨论和增加患者参与的小组访问是可行的。该模型值得进一步评估，以提高患者、临床医生和系统的预先护理计划结果的有效性。
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