Although meeting patients' preferences is a central component of quality chronic and end-of-life care, patients' preferences are frequently not met. A necessary first step to meeting preferences is to improve advance care planning, the process by which patients express their preferences for future care in the case that they can no longer participate in decision-making. The results of study on which this competitive renewal is based suggest that the traditional conceptualization of advance care planning (ACP) as the completion of documents is inadequate. Rather, ACP is better conceptualized as a process of communication between patient and both caregiver and physician about patients' treatment goals. Further, ACP may be best conceptualized as a health behavior.
The aim of this project is to apply models of health behavior change to advance care planning in order to determine the components, dimension, and scope of potential interventions to improve ACP. The project proposes the use of mixed qualitative and quantitative methods. In the qualitative portion, focus groups and individual interviews will be utilized to elicit the perceptions of older community-dwelling persons with advanced cancer, congestive heart failure, and chronic obstructive pulmonary disease and their caregivers regarding the constructs of the Health Beliefs and Transtheoretical Models as they relate to ACP. Standard qualitative analytical techniques will be used to ground an understanding of the concepts of susceptibility, barriers, benefits, self-efficacy, stages of change, and processes of change as they relate to ACP in the experiences of patients and caregivers of diverse ethnic and racial backgrounds. In the quantative portion of the study, scales will be developed to facilitate the measurement of these concepts. The development of quantitative measures is a necessary prerequisite for future work to examine relationships among the constructs and between the constructs and ACP, which will provide further insights into the design of effective interventions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
3R01AG019769-06S1
Application #
7672627
Study Section
Special Emphasis Panel (ZRG1-HOP-B (02))
Program Officer
Nielsen, Lisbeth
Project Start
2001-10-01
Project End
2011-03-31
Budget Start
2008-08-15
Budget End
2011-03-31
Support Year
6
Fiscal Year
2008
Total Cost
$151,065
Indirect Cost
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
043207562
City
New Haven
State
CT
Country
United States
Zip Code
06520
Amjad, Halima; Towle, Virginia; Fried, Terri (2014) Association of experience with illness and end-of-life care with advance care planning in older adults. J Am Geriatr Soc 62:1304-9
Fried, Terri R; Redding, Colleen A; Robbins, Mark L et al. (2012) Promoting advance care planning as health behavior change: development of scales to assess Decisional Balance, Medical and Religious Beliefs, and Processes of Change. Patient Educ Couns 86:25-32
Fried, Terri R; Redding, Colleen A; Robbins, Mark L et al. (2011) Agreement between older persons and their surrogate decision-makers regarding participation in advance care planning. J Am Geriatr Soc 59:1105-9
Garlo, Katherine; O'Leary, John R; Van Ness, Peter H et al. (2010) Burden in caregivers of older adults with advanced illness. J Am Geriatr Soc 58:2315-22
Fried, Terri R; Redding, Colleen A; Robbins, Mark L et al. (2010) Stages of change for the component behaviors of advance care planning. J Am Geriatr Soc 58:2329-36
Solomon, Rachel; Kirwin, Paul; Van Ness, Peter H et al. (2010) Trajectories of quality of life in older persons with advanced illness. J Am Geriatr Soc 58:837-43
Thomas, John M; O'Leary, John R; Fried, Terri R (2009) Understanding their options: determinants of hospice discussion for older persons with advanced illness. J Gen Intern Med 24:923-8
Fried, Terri R; Bullock, Karen; Iannone, Lynne et al. (2009) Understanding advance care planning as a process of health behavior change. J Am Geriatr Soc 57:1547-55
Fried, Terri R; O'Leary, John R (2008) Using the experiences of bereaved caregivers to inform patient- and caregiver-centered advance care planning. J Gen Intern Med 23:1602-7
Van Ness, Peter H; Towle, Virginia R; O'Leary, John R et al. (2008) Religion, risk, and medical decision making at the end of life. J Aging Health 20:545-59

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