A Context-oriented Communication Algorithm for Advance Care Planning
| Autor: | Shinmi Kim, Jae Ok Jin, Yunmi Kim, Mee-Ok Lee, Mi-Seung Shin, JinShil Kim |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Advance care planning Palliative care Delphi Technique Referral Clinical Decision-Making Delphi method Context (language use) 030204 cardiovascular system & hematology Likert scale Advance Care Planning 03 medical and health sciences 0302 clinical medicine Nursing Content validity Humans Medicine Mental Competency 030212 general & internal medicine Patient participation Heart Failure Advanced and Specialized Nursing business.industry Communication Palliative Care Female Family Relations Patient Participation Cardiology and Cardiovascular Medicine business Algorithm Algorithms |
| Zdroj: | Journal of Cardiovascular Nursing. 33:446-452 |
| ISSN: | 1550-5049 0889-4655 |
| DOI: | 10.1097/jcn.0000000000000396 |
| Popis: | Access to consultation or referral for decisions about advance care planning (ACP) is limited, particularly for nonmalignant models pertinent to palliative care in heart failure (HF). The aim of this study was to solicit professional opinions about the feasibility of using an exemplary context-oriented communication algorithm for ACP discussions. Using a panel of expert physicians and nurses in cardiovascular care, a 3-round Delphi study was conducted to evaluate the proposed model. A consensus was determined based on a content validity ratio (CVR) of 0.318 or greater, a critical value for selection of an item scored as important (≥4 on a 5-point Likert scale). A total of 50, 44, and 38 experts in Korea completed each round, respectively. Item evaluation did not differ across rounds (Friedman χ2 > P = .05), except for timing of the ACP discussion. A lack of consensus was observed on the issue of after HF diagnosis for right timing of the ACP discussion across rounds (CVRs from −0.80 to −0.83); consensus was reached on the expectation of a terminal state (CVRs from 0.60 to 0.78). Content validity ratios were moderately high for Korean advance directive, ranging from 0.59 to 0.91. Experts also reached consensus about each of 5 steps of a communication model—patients’ determination of decisional capacity (CVR, 0.72–1.0), awareness (CVR, 0.95–1.0), willingness for advance care planning (CVR, 0.76–0.84), family dynamics (CVR, 0.92–1.0) and patient readiness for advance care planning (CVR, 0.76–0.95). A context-oriented communication model could be used to facilitate the decision-making process for palliative care and continuity of care in HF. |
| Databáze: | OpenAIRE |
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