PROMOTING AWARENESS AND IMPLEMENTATION OF ADVANCE CARE PLANNING: A CONTENT ANALYSIS OF DECISION AIDS

Sunday, October 19, 2014
Poster Board # PS1-46

Vinay Patel, MD1, Thomas Lynch, PhD2, Rebecca Aslakson, MD, PhD3, Anne Schuster, MHS1, Katherine Smith, PhD4 and John F.P. Bridges, PhD5, (1)Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (2)Department of Anesthesiology and Critical Care & Palliative Care Program, Kimmel Cancer Center at Johns Hopkins, Johns Hopkins School of Medicine, Baltimore, MD, (3)Department of Anesthesiology and Critical Care, Johns Hopkins Hospital, Baltimore, MD, USA, Baltimore, MD, (4)Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (5)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Purpose: To engage stakeholders in the identification of advance care planning (ACP) decision aid features meaningful to perioperative settings and to categorize these features in existing decision aids.

Method: Stakeholder engagement and qualitative content-analysis methods were used to characterize ACP decision aids. A multi-stakeholder (n=14) workshop was convened and included patient family members, surgeons, health services researchers, palliative care clinicians, and patient safety and quality researchers. Using design-thinking techniques, stakeholders reviewed and discussed seven ACP paper-based decision aids. Informed by this engagement, two reviewers independently and qualitatively abstracted ACP decision aid characteristics for 15 decision aids. Discordance was resolved by consensus, and by engaging a third reviewer. Finally, all ACP decision aids were categorized using a deliberative pile-sort process involving multiple investigators.

Result: Stakeholders disliked content and images that framed ACP from an end-of-life perspective. They identified support for choosing a surrogate, opportunities to identify personal priorities, and assistance in imagining states worse than death, as potentially beneficial to a surgical population. In general, the paper-based decision aids were primarily produced by organizations in the United States (93%), ranged in length from 6 to 78 pages with a mean of 25 pages, and ranged in grade reading levels from the fifth-to-twelfth grade with nearly half (40%) written at or above a ninth-grade reading level. The content analysis revealed that a majority of decision aids contained content about choosing a surrogate decision maker (66%) and offered information pertaining to legal and non-legal medical documents (93%). A minority of decision aids (13%) addressed states worse than death. Three categories of decision aids were also identified which were termed informative (33%), semi-action oriented (33%), and action-oriented (33%).

Conclusion: Stakeholders advocated for a decision aid that accounts for the needs of surgical patients’ and reflects their readiness to engage with ACP. Action-oriented decision aids demonstrated approaches to enable patients to deliberate about their personal medical choices, however a significant number of decision aids may discourage active participation in decision-making, as they were long, written at advanced reading levels, and tended towards educating rather than activating. To implement the findings of this study, further research is needed to identify patient preferences and acceptance of ACP decision-aid characteristics in the surgical setting.

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