A Context-oriented Communication Algorithm for Advance Care Planning A Model to Assist Palliative Care in Heart Failure
- Authors
- Kim, JinShil; Kim, Shinmi; Shin, Mi-Seung; Jin, Jae Ok; Kim, Yunmi; Lee, Mee-Ok
- Issue Date
- Sep-2018
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- advance care planning; communication; Delphi technique; heart failure; palliative care
- Citation
- JOURNAL OF CARDIOVASCULAR NURSING, v.33, no.5, pp.446 - 452
- Journal Title
- JOURNAL OF CARDIOVASCULAR NURSING
- Volume
- 33
- Number
- 5
- Start Page
- 446
- End Page
- 452
- URI
- https://scholarworks.bwise.kr/gachon/handle/2020.sw.gachon/3457
- DOI
- 10.1097/JCN.0000000000000396
- ISSN
- 0889-4655
- Abstract
- Background: 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). Objectives: The aim of this study was to solicit professional opinions about the feasibility of using an exemplary context-oriented communication algorithm for ACP discussions. Methods: Using a panel of expert physicians and nurses in cardiovascular care, a 3-round Delphi study was conducted to evaluate the proposed model. Results: 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 chi(2) > 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). Conclusions: A context-oriented communication model could be used to facilitate the decision-making process for palliative care and continuity of care in HF.
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Collections - 의과대학 > 의학과 > 1. Journal Articles
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