Increasing Advance Care Planning Using a Surgical Optimization Program for Older Adults

Anna Kata, Rebecca Sudore, Emily Finlayson, Jeanette M Broering, Sarah Ngo, Victoria L Tang, Anna Kata, Rebecca Sudore, Emily Finlayson, Jeanette M Broering, Sarah Ngo, Victoria L Tang

Abstract

Objectives: To describe an innovative model of care, the Surgery Wellness Program (SWP), that uses a multidisciplinary team to develop and implement preoperative care plans for older adults, and its effect on engagement in advance care planning (ACP).

Design: Retrospective analysis of clinical demonstration project.

Setting: Preoperative optimization program for older adults undergoing surgery at a 796-bed academic tertiary hospital.

Participants: Older adults (N=131) who participated in the SWP from February 2015 to August 2017.

Intervention: All SWP participants met with a geriatrician who engaged them in a semistructured ACP discussion. Trained medical and nurse practitioner students were used as health coaches who contacted participants regularly to address and document ACP.

Measurements: Self-report of ACP engagement before and after participation in the SWP was determined using SWP geriatrician and health coach progress notes. Medical records were examined for scanned documentation. Feasibility data on number of health coach calls were collected.

Results: After completion of the program, the proportion of participants with a designated surrogate increased from 67% to 78% (p<.001), completed advance directive (AD) from 51% to 72% (p<.001), and an AD scanned into the medical record from 14% to 60% (p<.001). Participants who underwent surgery received a median of 4 health coaching calls over a median of 27 days between their clinic visit and surgery. Case examples are presented to highlight how the SWP attends to the many components of the ACP process.

Conclusion: Preoperative optimization programs provide a unique opportunity to engage older adults in ACP.

Keywords: advance care planning; advance directive; geriatric surgery; older adult; preoperative period.

Conflict of interest statement

Conflict of Interest: PREPARE for Your Care™ is a product trademarked by the University of California Board of Regents. Dr. Finlayson reports being founding shareholder of Ooney Inc. Remaining authors have no conflicts to report.

© 2018, Copyright the Author Journal compilation © 2018, The American Geriatrics Society.

Figures

Figure 1.
Figure 1.
Percent of patients engaging in different ACP behaviors before and after participation in the SWP (N=131). SWP = Surgery Wellness Program. ACP = Advance Care Planning. AD = Advance directive. McNemar’s test p

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Source: PubMed

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