Browsing by Author "Shaw, Marta"

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    Behaviors in Advance Care Planning and ACtions Survey (BACPACS): development and validation part 1
    (2017-11-22) Kassam, Aliya; Douglas, Maureen L; Simon, Jessica; Cunningham, Shannon; Fassbender, Konrad; Shaw, Marta; Davison, Sara N
    Abstract Background Although advance care planning (ACP) is fairly well understood, significant barriers to patient participation remain. As a result, tools to assess patient behaviour are required. The objective of this study was to improve the measurement of patient engagement in ACP by detecting existing survey design issues and establishing content and response process validity for a new survey entitled Behaviours in Advance Care Planning and ACtions Survey (BACPACS). Methods We based our new tool on that of an existing ACP engagement survey. Initial item reduction was carried out using behavior change theories by content and design experts to help reduce response burden and clarify questions. Thirty-two patients with chronic diseases (cancer, heart failure or renal failure) were recruited for the think aloud cognitive interviewing with the new, shortened survey evaluating patient engagement with ACP. Of these, n = 27 had data eligible for analysis (n = 8 in round 1 and n = 19 in rounds 2 and 3). Interviews were audio-recorded and analyzed using the constant comparison method. Three reviewers independently listened to the interviews, summarized findings and discussed discrepancies until consensus was achieved. Results Item reduction from key content expert review and conversation analysis helped decrease number of items from 116 in the original ACP Engagement Survey to 24–38 in the new BACPACS depending on branching of responses. For the think aloud study, three rounds of interviews were needed until saturation for patient clarity was achieved. The understanding of ACP as a construct, survey response options, instructions and terminology pertaining to patient engagement in ACP warranted further clarification. Conclusions Conversation analysis, content expert review and think aloud cognitive interviewing were useful in refining the new survey instrument entitled BACPACS. We found evidence for both content and response process validity for this new tool.
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    Characterizing Readiness for Advance Care Planning: An Interpretive Descriptive Study in Supportive Living
    (2015-04-30) Shaw, Marta; Hewson, Jennifer; Hogan, David
    Currently, patient wishes for healthcare at EOL are not readily followed due to a lack of effective communication as well as discordance between patients’ preferences and medical orders. Advance Care Planning involves reflection on and communication of a person’s future healthcare preferences. In Supportive Living, residents are at risk of cognitive decline and frailty, requiring healthcare decisions. ACP is recommended but readiness to engage is not known. The purpose of this study was to explore perceptions of readiness, factors influencing readiness and strategies to improve ACP interventions of SL residents, their families/decision-makers and clinicians. This qualitative study utilized an Interpretive Descriptive approach. For SL residents, ACP is related to making the transition to SL. Families of SL residents draw on experience as a prior decision-maker. Clinicians vary in their comfort with ACP engagement. Themes across the groups include: variable definition of ACP, roles in ACP, readiness for engagement and barriers/facilitators. These findings can be used to contribute to the understanding of ACP engagement, inform the clinical approach and provide future direction for ACP research.
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    Optimizing Advance Care Planning in the Acute Cardiac Care Setting: A combined quality improvement and knowledge translation approach.
    (2019-03-17) Shaw, Marta; Holroyd-Leduc, Jayna M.; Simon, Jessica E.; White, Deborah Elizabeth; Flemons, William Ward; Grant, Jeff Andrew
    Advance care planning (ACP) is a process by which patients are able to prepare for future in-the-moment medical decision-making and share their values, wishes and preferences. ACP is important as patients are often not well informed about life-sustaining treatments, they can endure more invasive care at end of life than they would want, and they spend more time in hospital than they prefer. Despite known benefits of ACP and recognition of its importance, its integration into regular clinical workflow remains limited. We conducted three studies to examine and address the problem of integrating ACP process into clinical workflow. The first study utilized qualitative methods to characterize ACP process across clinical contexts. In the second study, we utilized an integrated knowledge translation approach to design and implement a multifaceted intervention to routinize ACP process in one hospital unit. We assessed outcomes using an interrupted time series design, and collected data for thirty-two weeks; before, during and after the intervention period. In our third study, we utilized multiple methods to conduct a process evaluation to better understand the effectiveness of our ACP intervention implementation procedure. From our first study, we found that there was significant variability of ACP process both across and within clinical contexts. Segmented regression analysis from our ACP intervention, showed an increase in the proportion of patients to be discharged with a prepared green sleeve, containing their ACP documentation. No significant change was measured for the remaining process and outcome measures. The process evaluation indicated that limitations in the engagement of physicians may have constrained the impact of the intervention. Future opportunities have already begun to address implementation challenges of this work and are using tailored and targeted approaches to improve the reach of intervention components. This program of study comprised of an effort to improve the integration of ACP process into clinical workflow using an iKT approach. Process evaluation helped to provide a deeper understanding of the implementation process. Future research can help to address implementation challenges of this study by focusing on tailored engagement of knowledge users and a strengthening of skill and team building.