Optimizing Advance Care Planning in the Acute Cardiac Care Setting: A combined quality improvement and knowledge translation approach.

Shaw, Marta

Optimizing Advance Care Planning in the Acute Cardiac Care Setting: A combined quality improvement and knowledge translation approach.

dc.contributor.advisor	Holroyd-Leduc, Jayna M.
dc.contributor.advisor	Simon, Jessica E.
dc.contributor.author	Shaw, Marta
dc.contributor.committeemember	White, Deborah Elizabeth
dc.contributor.committeemember	Flemons, William Ward
dc.contributor.committeemember	Grant, Jeff Andrew
dc.date	2019-06
dc.date.accessioned	2019-03-21T18:46:37Z
dc.date.available	2019-03-21T18:46:37Z
dc.date.issued	2019-03-17
dc.description.abstract	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.	en_US
dc.identifier.citation	Shaw, M. (2019). Optimizing Advance Care Planning in the Acute Cardiac Care Setting: A combined quality improvement and knowledge translation approach (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.	en_US
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/36309
dc.identifier.uri	http://hdl.handle.net/1880/110092
dc.language.iso	en	en_US
dc.publisher.faculty	Cumming School of Medicine	en_US
dc.publisher.institution	University of Calgary	en
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.	en_US
dc.subject.classification	Education--Health	en_US
dc.subject.classification	Health Care Management	en_US
dc.subject.classification	Medicine and Surgery	en_US
dc.title	Optimizing Advance Care Planning in the Acute Cardiac Care Setting: A combined quality improvement and knowledge translation approach.	en_US
dc.type	doctoral thesis	en_US
thesis.degree.discipline	Medicine – Community Health Sciences	en_US
thesis.degree.grantor	University of Calgary	en_US
thesis.degree.name	Doctor of Philosophy (PhD)	en_US
ucalgary.item.requestcopy	true