Browsing by Subject "Advance care planning"

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    Evaluation of the acceptability and validity of the Serious Illness Conversation Guide in oncology patients in South Africa
    (2025) Burger, Henriette; Krause, Stephanie
    Background: Advance care planning (ACP) is the process through which a health care professional (HCP) guides a patient with a life-threatening illness to better understand their disease and to make value-concordant decisions for their future medical care including their end-of-life (EOL) care. The Serious Illness Conversation Guide (SICG, Ariadne Labs 2017) was developed and validated as a structured guide for HCPs when having ACP conversations with patients. Decision-making near the end of life is influenced by many factors including health status, socio-economic status, culture, ethnicity, and decisional control preferences. To our knowledge no study has explored the acceptability and validity of the SICG (Ariadne Labs) in cancer patients in South Africa (SA). Objectives: The aims of this study are to explore the local acceptability and validity of an internationally validated serious illness conversation guide for use in advance care planning conversations in South African patients with advanced cancer. Methods: A mixed-methods study design was used to explore the local acceptability and validity of the SICG using a survey and focus-group discussions (FGD) with healthcare professionals. In the quantitative survey each participant was asked to classify the local acceptability of each SICG prompt according to a 3-tiered system. Further survey questions assessed their practice settings, patterns of ACP, perceptions of cross-cultural acceptability of prompts, and the need for additional questions in the SICG. The FGD transcripts were qualitatively analysed using both inductive and deductive thematic analysis to reflect the research question as well as emerging themes. Results: Focus group discussions (FGD) were conducted with 17 healthcare workers during 2021. Analysis of the survey and FGD data suggests that several SICG prompt are not cross- culturally acceptable in their current state in the South African setting. Emerging factors influencing acceptability in the SA oncology context included poor illness understanding, the use of complex and incongruent language, health system limitations, the role of the family, and the role of belief systems and culture. Conclusion: The findings of this study can be used to adapt the Serious Illness Conversation Guide for the South African population to increase uptake of ACP and improve understanding of EOL care preferences for South Africans.
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    Open Access
    How to achieve the desired outcomes of advance care planning in nursing homes: a theory of change
    (BioMed Central, 2018-02-14) Gilissen, J; Pivodic, L; Gastmans, C; Vander Stichele, R; Deliens, L; Breuer, E; Van den Block, L
    Background: Advance care planning (ACP) has been identified as particularly relevant for nursing home residents, but it remains unclear how or under what circumstances ACP works and can best be implemented in such settings. We aimed to develop a theory that outlines the hypothetical causal pathway of ACP in nursing homes, i.e. what changes are expected, by means of which processes and under what circumstances. Methods: The Theory of Change approach is a participatory method of programme design and evaluation whose underlying intention is to improve understanding of how and why a programme works. It results in a Theory of Change map that visually represents how, why and under what circumstances ACP is expected to work in nursing home settings in Belgium. Using this approach, we integrated the results of two workshops with stakeholders (n = 27) with the results of a contextual analysis and a systematic literature review. Results: We identified two long-term outcomes that ACP can achieve: to improve the correspondence between residents’ wishes and the care/treatment they receive and to make sure residents and their family feel involved in planning their future care and are confident their care will be according to their wishes. Besides willingness on the part of nursing home management to implement ACP and act accordingly, other necessary preconditions are identified and put in chronological order. These preconditions serve as precursors to, or requirements for, accomplishing successful ACP. Nine original key intervention components with specific rationales are identified at several levels (resident/family, staff or nursing home) to target the preconditions: selection of a trainer, ensuring engagement by management, training ACP reference persons, in-service education for healthcare staff, information for staff, general practitioners, residents and their family, ACP conversations and documentation, regular reflection sessions, multidisciplinary meetings, and formal monitoring. Conclusions: The Theory of Change map presented here illustrates a theory of how ACP is expected to work in order to achieve its desired long-term outcomes while highlighting organisational factors that potentially facilitate the implementation and sustainability of ACP. We provide the first comprehensive rationale of how ACP is expected to work in nursing homes, something that has been called for repeatedly.