This article is more than 5 years old. Information may no longer be current.
Advance care planning with nurses increases patient use of health care proxies
FORT WORTH, Texas — Discussions about advanced care planning between nurses and patients in non-oncology outpatient infusion centers were effective in increasing the number of health care proxy forms completed by patients, according to Mary Kiely, DNP, ANP-BC, of the New York University Langone Health Orthopedic Center.
Kiely, presenting a poster at the Rheumatology Nurses Society Annual Conference, said she and her colleagues also concluded that educational initiatives for patients and advanced practice nurses in outpatient facilities can increase the likelihood of implementing shared decision-making and advance care planning.
“We started this quality improvement project because we noticed that the rheumatologists who were treating our patients were not addressing any advance care planning with the patients,” Kiely told Healio Rheumatology. “We also recognize that autoimmune disease has not only significant risk for morbidity, but also for premature mortality, so we felt it was important for patients to start thinking about advance care planning. We wanted to introduce it in a way that was nonthreatening, in a non-crisis situation, so we thought the infusion center was the perfect setting for that, as we already had a relationship with the patients, and had time to speak with them.”
To increase engagement in advance care planning discussions among patients with chronic immune-mediated inflammatory diseases at their infusion center, Kiely and colleagues approached 320 patients, asking if they understood the role of a health care proxy. If they did not, the nurses would explain their role to the patient, as well as encourage and offer support in completion of a proxy form.
According to Kiely, the nurses used a three-step methodology for shared decision-making in discussing health care proxies and other needs with their patients:
- Team talk, in which nurses made their patients aware of health care proxies and the required form;
- Option talk, in which the nurses give patients the option to choose a proxy now or in the future; and
- Decision talk, where nurses help the patient complete the form designating a proxy, with the option to review that decision at any time.
According to the researchers, engaging in a conversation about choosing a health care proxy increased the proportion of patients with proxies from 12.9% to 26% during a period of 8 months. Kiely added that nurses at the infusion center have now approached more than 500 patients regarding proxies, and that, “most surprisingly,” those in the 18- to 25-year age group have been the most open to the practice.
“You don’t really think about that patient population considering this, but it makes sense because when they turn 18 their parents no longer are making decisions for them,” Kiely said. “So, for them, it can be reassuring to know that they can identify a person who would do that.”
According to Kiely, the study demonstrates the need to open a dialogue with patients about advance care planning.
“The first step for that is identifying a health care proxy,” she said. “We used the three-step approach — methodology that is based on shared decision making, so that patients felt supported and not intimidated. However, I think that dialogue has to start early, before there is a crisis.” – by Jason Laday
Reference:
Kiely M. Shared decision-making in a non-oncology outpatient infusion center. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 8-11, 2018; Fort Worth, Texas.
Disclosure: Kiely reports no relevant financial disclosures.