Advance Care Planning and Analysis Paper.
Read the section titled “Reflective Practice: Pants on Fire” from the chapter “Health Policy, Politics, and Professional Ethics” and address the questions below.
How do you judge Palin’s quote below, as an effective strategy to oppose Democrats’ plans for health care reform or unethical scaremongering?
“And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s death panel so his bureaucrats can decide, based on a subjective judgment of their level of productivity in society, whether they are worthy of health care. Such a system is downright evil.”
Reflect on what informs your judgment: commitment to advance care planning, analysis of facts, and/or political party loyalties?
Is it right for nurses to endorse health reform legislation even if the legislation is not perfect?
Does this apply to the recently failed American Health Care Act?
To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations. Design Systematic review and meta-analyses. Data Sources Medline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists. Study Selection Randomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English. Data Extraction and Synthesis Fifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: ‘advance directives’ and ‘communication.’ Main Outcomes and Measures Primary outcome measures were completion of advance directives and occurrence of end-of-life discussions.
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Secondary outcomes were concordance between preferences for care and delivered care, knowledge of ACP, end-of-life care preferences, quality of communication, satisfaction with healthcare, decision-al conflict, use of healthcare services, and symptoms. Advance Care Planning and Analysis Paper.Results Interventions focusing on advance directives as well as interventions that also included communication about end-of-life care increased the completion of advance directives and the occurrence of end-of-life care discussions between patients and healthcare professionals. In addition, interventions that also included communication about ACP, improved concordance between preferences for care and delivered care and may improve other outcomes, such as quality of communication. Conclusions ACP interventions increase the completion of advance directives, occurrence of discussions about ACP, concordance between preferences for care and delivered care, and are likely to improve other outcomes for patients and their loved ones in different adult populations. Future studies are necessary to reveal the effective elements of ACP and should focus on the best way to implement structured ACP in standard care.Advance Care Planning and Analysis Paper.
