Dool, B.J. van den (2021) Hospital initiated Advance Care Planning for patients with COPD and CHF: Room for improvement of quality in the psychological and spiritual palliative domains: A retrospective quantitative and qualitative cohort study of hospital initiated advance care plan documentation for patients with COPD or CHF. thesis, Medicine.
Full text available on request.Abstract
Background: Palliative care is difficult to implement in standard care for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), even though high symptom burden and diminished quality of life are described. Starting advance care planning (ACP) during a hospital admission might improve the organization of palliative care, thereby improving the quality of life. Aim: To assess the quality of hospital initiated ACP-documents for patients with COPD or CHF and explore how these are experienced by their general practitioners (GP). Methods: Quantitative analysis was performed on 111 prospectively gathered, hospital initiated ACP- documents (COPD n=42, CHF n=69). Quality was assessed as low, medium, good or high by mean scores of a six-point Likert-scale on whether a domain or symptom was discussed and whether it was documented with a possible intervention. Additionally, documents drafted by regular and palliative care teams (RCT, PCT) were compared. Qualitative research on GPs experiences with newly drafted ACP-documents consisted of semi-structured interviews. Results: Overall, the current somatic and care domain were of good and high quality for patients with COPD (mean scores: 3.98 and 4.09) and CHF (mean scores: 3.55 and 3.90). The psychological domains scored medium as more symptoms were documented without treatment (COPD: 14.3%, CHF: 20.3%) and the spiritual domains were of low quality due to lack of actual documentation (COPD: 28.5%, CHF: 39.2%). The reported expected domains were predominantly focussed on somatic symptoms. Documents drafted by RCTs were equal to those drafted by PCTs in terms of overall quality. Unfortunately, interviews with GPs could not be performed. Conclusions: In general the documents were assessed as of good quality, however there is room for improvement in the psychological and spiritual domain. As the documentation drafted by PCTs and RCTs were of equal quality, this method can be widely implemented in the care given at hospital wards. Key words: Palliative Care, Advance Care Planning, proactive care planning, Chronic Obstructive Pulmonary Disease, chronic heart failure
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Graeff, P. de and Reyners, A.K.L. |
| Faculty: | Medical Sciences |
| Date Deposited: | 06 Jan 2022 11:12 |
| Last Modified: | 06 Jan 2022 11:12 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2969 |
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