Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults.
Objectives: To describe an innovative model of care, the Surgery Wellness Program (SWP), that uses a multidisciplinary team to develop and implement preoperative care plans for older adults, and its effect on engagement in advance care planning (ACP). Design: Retrospective analysis of clinical demon...
| Published in: | Journal of the American Geriatrics Society Vol. 66; no. 10; pp. 2017 - 2022 |
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| Main Authors: | , , , , , |
| Format: | Article |
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Wiley-Blackwell
Oct2018
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=132307353&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 132307353 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00028614 20Q jtl: Journal of the American Geriatrics Society issn: 00028614 maglogo: Y pubinfo: dt: Oct2018 vid: 66 iid: 10 pid: 480 pub: Wiley-Blackwell artinfo: ui: 132307353 10.1111/jgs.15554 ppf: 2017 ppct: 5 formats: tig: atl: Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults. aug: au: Kata, Anna Sudore, Rebecca Finlayson, Emily Broering, Jeanette M. Ngo, Sarah Tang, Victoria L. affil: Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco California Division of Geriatrics, Veterans Affairs Medical Center, San Francisco California Department of Surgery, University of California, San Francisco California Department of Urology, University of California, San Francisco California Division of Hospital Medicine, Department of Medicine, Veterans Affairs Medical Center, San Francisco California su: Elder care Health planning Self-evaluation Advance directives (Medical care) Evaluation of human services programs Academic medical centers Geriatricians Health care teams Mathematical models Nurse practitioners Preoperative care Theory Tertiary care sug: subj: Elder care Health planning Self-evaluation Advance directives (Medical care) Evaluation of human services programs Continuing Care Retirement Communities Specialty (except Psychiatric and Substance Abuse) Hospitals Academic medical centers Geriatricians Health care teams Mathematical models Nurse practitioners Preoperative care Theory Tertiary care keyword: advance care planning advance directive geriatric surgery older adult preoperative period advance care planning advance directive geriatric surgery older adult preoperative period ab: Objectives: To describe an innovative model of care, the Surgery Wellness Program (SWP), that uses a multidisciplinary team to develop and implement preoperative care plans for older adults, and its effect on engagement in advance care planning (ACP). Design: Retrospective analysis of clinical demonstration project. Setting: Preoperative optimization program for older adults undergoing surgery at a 796‐bed academic tertiary hospital. Participants: Older adults (N=131) who participated in the SWP from February 2015 to August 2017. Intervention: All SWP participants met with a geriatrician who engaged them in a semistructured ACP discussion. Trained medical and nurse practitioner students were used as health coaches who contacted participants regularly to address and document ACP. Measurements: Self‐report of ACP engagement before and after participation in the SWP was determined using SWP geriatrician and health coach progress notes. Medical records were examined for scanned documentation. Feasibility data on number of health coach calls were collected. Results: After completion of the program, the proportion of participants with a designated surrogate increased from 67% to 78% (p<.001), completed advance directive (AD) from 51% to 72% (p<.001), and an AD scanned into the medical record from 14% to 60% (p<.001). Participants who underwent surgery received a median of 4 health coaching calls over a median of 27 days between their clinic visit and surgery. Case examples are presented to highlight how the SWP attends to the many components of the ACP process. Conclusion: Preoperative optimization programs provide a unique opportunity to engage older adults in ACP. See related editorial by Jason Johanning pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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