RAND Corporation, Santa Monica, California, USA.
UCLA Fielding School of Public Health, Los Angeles, California, USA.
J Am Geriatr Soc. 2021 Oct;69(10):2908-2915. doi: 10.1111/jgs.17283. Epub 2021 Jun 2.
Advance care planning (ACP) is critically important for heart failure patients, yet important challenges exist. Group visits can be a helpful way to engage patients and caregivers in identifying values and preferences for future care in a resource-efficient way. We sought to evaluate the impact of group visits for ACP among older adults with heart failure and their caregivers on ACP-related outcomes.
We conducted a mixed-methods pilot study evaluating the impact of an ACP group visit for older adults with heart failure and their caregivers on ACP-related outcomes including readiness and self-efficacy. The evidence-based PREPARE for Your Care video-based intervention was used to guide the group visits. Twenty patients and 10 caregivers attended one of the five 90-min group visits led by a trained facilitator. Group visit participants completed pre-, post-, and 1-month follow-up surveys using validated 5-point ACP readiness and self-efficacy scales. Qualitative feedback obtained within 3 days of a group visit was analyzed using a directed content analysis.
Patient participants had a median age of 78 years. Approximately half were female while caregiver participants were mostly female. Participants were predominantly white. Patient readiness scores improved significantly pre-to-post (+0.53; p = 0.002) but was not sustained at 1-month follow-up. Patient and caregiver self-efficacy showed some improvement pre-to-post but was also not sustained at follow-up. Interviews revealed positive impacts of group visits across the three themes: encouraging reviewing or revisiting prior ACP activities, motivating patients to take direct steps towards ACP, and serving as a "wake-up" call to action.
Disease-focused group visits may have a short-term effect on ACP outcomes but ongoing touchpoints are likely necessary to sustain ACP over time. The results highlight a need for follow-up ACP conversations after a single group visit. Timing for follow-ups and the ideal person to follow-up ACP conversations needs to be explored.
预先医疗照护计划（ACP）对心力衰竭患者至关重要，但仍存在重要挑战。小组访问可以帮助以资源高效的方式让患者及其照护者参与确定未来护理的价值观和偏好。我们旨在评估针对心力衰竭老年患者及其照护者的 ACP 小组访问对 ACP 相关结果的影响。
我们进行了一项混合方法试点研究，评估了针对心力衰竭老年患者及其照护者的 ACP 小组访问对 ACP 相关结果（包括准备度和自我效能感）的影响。使用基于证据的 PREPARE for Your Care 视频干预来指导小组访问。由经过培训的主持人领导的五场 90 分钟小组访问共吸引了 20 名患者和 10 名照护者参加。小组访问参与者使用经过验证的 5 分制 ACP 准备度和自我效能感量表完成了预访、随访和 1 个月随访调查。在小组访问后 3 天内收集的定性反馈使用定向内容分析进行分析。
患者参与者的中位年龄为 78 岁。大约一半是女性，而照护者参与者主要是女性。参与者主要是白人。患者准备度评分在预访和随访之间显著提高（+0.53；p=0.002），但在 1 个月随访时未维持。患者和照护者自我效能感在预访和随访之间有所提高，但也未维持。访谈揭示了小组访问在三个主题方面的积极影响：鼓励回顾或重新审视先前的 ACP 活动、激励患者直接采取 ACP 措施，以及作为采取行动的“警钟”。
以疾病为重点的小组访问可能对 ACP 结果产生短期影响，但随着时间的推移，可能需要持续的 ACP 接触点来维持 ACP。结果强调了在单次小组访问后需要进行后续 ACP 对话。需要探索后续 ACP 对话的时间安排和理想的跟进人员。
