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Readiness of Advance Care Planning Among Patients With Cardiovascular Disease
BACKGROUND: Advance care planning (ACP) is a widely advocated strategy to improve outcomes at end-of-life care for patients suffering from heart failure (HF). However, finding the right time to start ACP is challenging for healthcare providers because it is often a sensitive issue for patients with...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205245/ https://www.ncbi.nlm.nih.gov/pubmed/35722131 http://dx.doi.org/10.3389/fcvm.2022.838240 |
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author | Fukue, Noriko Naito, Emiko Kimura, Masayasu Ono, Kaoru Sato, Shinichi Takaki, Akira Ikeda, Yasuhiro |
author_facet | Fukue, Noriko Naito, Emiko Kimura, Masayasu Ono, Kaoru Sato, Shinichi Takaki, Akira Ikeda, Yasuhiro |
author_sort | Fukue, Noriko |
collection | PubMed |
description | BACKGROUND: Advance care planning (ACP) is a widely advocated strategy to improve outcomes at end-of-life care for patients suffering from heart failure (HF). However, finding the right time to start ACP is challenging for healthcare providers because it is often a sensitive issue for patients with HF and their families. We interviewed patients with cardiovascular diseases regarding ACP readiness and investigated the relationship between the ACP desire and multiple clinical prognostic parameters. METHOD: Eighty-one patients (average age 81.8 ± 10.3 years old, 42 men, 62 cases of HF) who introduced cardiac rehabilitation were inquired about previous ACP experience, a desire for ACP, understanding of their cardiovascular diseases, and lifestyle-associated questionnaires. Multiple logistic regression analyses were employed to identify the clinical parameters associated with ACP desire. Patients who desired ACP were also asked about their preferences for medical care at the end-of-life. RESULTS: Nine patients (11.1%) had previous experience with ACP, and 28 (34.6%) preferred to implement ACP. Patients who did not want to implement ACP were 54.3%. Patients with HF showed a higher acceptance rate of ACP (odds ratio [OR] 5.56, p = 0.015). Interestingly, patients harboring skeletal muscle frailty showed lower ACP acceptance, while patients with non-frailty rather positively wanted to implement ACP. Two types of prognosis evaluation scales, such as the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) risk score and the Japanese Version of Supportive and Palliative Care Indicators Tool (SPICT-JP), identified 31 patients (38.3%) needing ACP; however, 19 (61.3%) did not want ACP. The wish not to attempt resuscitation and life-prolonging treatment at the end-of-life reached approximately 70% among patients who requested ACP. CONCLUSIONS: Although patients with HF tended to be ready for implementing ACP, the presence of skeletal muscle frailty was negatively associated with ACP preference. Indeed, patients who should be considered ACP were not carried out and did not desire it. Earlier introduction of ACP into patients before having skeletal muscle frailty may be considered. |
format | Online Article Text |
id | pubmed-9205245 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-92052452022-06-18 Readiness of Advance Care Planning Among Patients With Cardiovascular Disease Fukue, Noriko Naito, Emiko Kimura, Masayasu Ono, Kaoru Sato, Shinichi Takaki, Akira Ikeda, Yasuhiro Front Cardiovasc Med Cardiovascular Medicine BACKGROUND: Advance care planning (ACP) is a widely advocated strategy to improve outcomes at end-of-life care for patients suffering from heart failure (HF). However, finding the right time to start ACP is challenging for healthcare providers because it is often a sensitive issue for patients with HF and their families. We interviewed patients with cardiovascular diseases regarding ACP readiness and investigated the relationship between the ACP desire and multiple clinical prognostic parameters. METHOD: Eighty-one patients (average age 81.8 ± 10.3 years old, 42 men, 62 cases of HF) who introduced cardiac rehabilitation were inquired about previous ACP experience, a desire for ACP, understanding of their cardiovascular diseases, and lifestyle-associated questionnaires. Multiple logistic regression analyses were employed to identify the clinical parameters associated with ACP desire. Patients who desired ACP were also asked about their preferences for medical care at the end-of-life. RESULTS: Nine patients (11.1%) had previous experience with ACP, and 28 (34.6%) preferred to implement ACP. Patients who did not want to implement ACP were 54.3%. Patients with HF showed a higher acceptance rate of ACP (odds ratio [OR] 5.56, p = 0.015). Interestingly, patients harboring skeletal muscle frailty showed lower ACP acceptance, while patients with non-frailty rather positively wanted to implement ACP. Two types of prognosis evaluation scales, such as the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) risk score and the Japanese Version of Supportive and Palliative Care Indicators Tool (SPICT-JP), identified 31 patients (38.3%) needing ACP; however, 19 (61.3%) did not want ACP. The wish not to attempt resuscitation and life-prolonging treatment at the end-of-life reached approximately 70% among patients who requested ACP. CONCLUSIONS: Although patients with HF tended to be ready for implementing ACP, the presence of skeletal muscle frailty was negatively associated with ACP preference. Indeed, patients who should be considered ACP were not carried out and did not desire it. Earlier introduction of ACP into patients before having skeletal muscle frailty may be considered. Frontiers Media S.A. 2022-06-02 /pmc/articles/PMC9205245/ /pubmed/35722131 http://dx.doi.org/10.3389/fcvm.2022.838240 Text en Copyright © 2022 Fukue, Naito, Kimura, Ono, Sato, Takaki and Ikeda. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Cardiovascular Medicine Fukue, Noriko Naito, Emiko Kimura, Masayasu Ono, Kaoru Sato, Shinichi Takaki, Akira Ikeda, Yasuhiro Readiness of Advance Care Planning Among Patients With Cardiovascular Disease |
title | Readiness of Advance Care Planning Among Patients With Cardiovascular Disease |
title_full | Readiness of Advance Care Planning Among Patients With Cardiovascular Disease |
title_fullStr | Readiness of Advance Care Planning Among Patients With Cardiovascular Disease |
title_full_unstemmed | Readiness of Advance Care Planning Among Patients With Cardiovascular Disease |
title_short | Readiness of Advance Care Planning Among Patients With Cardiovascular Disease |
title_sort | readiness of advance care planning among patients with cardiovascular disease |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9205245/ https://www.ncbi.nlm.nih.gov/pubmed/35722131 http://dx.doi.org/10.3389/fcvm.2022.838240 |
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