Study: Advance Care Planning Training Leads to Better Conversations for People with Dementia
Training practitioners about advance care planning (ACP) for patients with dementia significantly increased the incidence of ACP conversations and the number of medical and non-medical preferences discussed, according to a study in the June issue of JAMDA.
In Educating Dutch General Practitioners in Dementia Advance Care Planning: A Cluster Randomised Controlled Trial, general practitioners (GPs) who received ACP training, including information about shared decision-making and participation in role-playing, were better equipped to have care planning conversations with patients who have dementia. As a result, more patients with dementia had ACP conversations documented in their medical files. Additionally, the GPs held more discussions with these patients about both medical preferences (e.g., resuscitation and hospitalization) and non-medical preferences (e.g., activities and social contacts).
The conversations were meaningful to patients with dementia, the authors said. They observed that non-medical preferences were discussed more often, supporting findings from other studies that people with dementia “consider discussions of these non-medical care goals important for their current and remaining phase of life.” This suggests, they indicated, that starting ACP by discussing non-medical issues may be a successful strategy for involving people with dementia in conversations on future medical and end-of-life preferences.
With 50 million people currently diagnosed with dementia, the authors noted that care for these patients “should be proactive, focus on living and dying well, and include advance planning.” They observed that ACP was recently redefined as “a process that enables individuals to define [and discuss] goals and preferences for future medical treatment and care… to discuss these goals and preferences with family and health care providers, and to record and review these preferences if appropriate.” This means, the authors stressed, that “ACP includes the physical, the social, spiritual, and psychological domains.”
This study was conducted by researchers at the Department of IQ Healthcare, Radbound University Medical Centre, Nijmegen, The Nethrlands; Department of Primary and Community Care, Radbound University Medical Centre, Nijmegen, The Netherlands; Radboundumic Alzheimer Center, Nijmegen, The Netherlands; Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands; Department for Health Evidence, Radbound University Medical Centre, Nijmegen, The Netherlands; Research Group Innovating with Older Adults, Windesheim University, Zwolle, The Netherlands; Department of Anaesthesiology, Pain, and Palliative Medicine, Radbound University Medical Centre, Nijmegen, The Netherlands; and Department of Geriatric Medicine, Radbound University Medical Center, Nijmegen, The Netherlands.
JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit www.jamda.com for more information.
About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit www.paltc.org for more information.