Research Library

Our research library is a great place to learn more about advance care planning.  Not only can you find information about the projects Respecting Choices has been working on, but you can also see what other people have said about the Respecting Choices approach.  Please click one of the above links and spend some time learning with us.

NOTICE
Abstracts and links are presented to assist in education and research. All copyrights are the properties of their respective owners, and copying and dissemination of articles may be a violation of copyright or other laws.

J Palliat Med. 2012 Jan; 15(1): 77-85. Epub 2012 Jan 10
The POLST Program: A Retrospective Review of the Demographics of Use and Outcomes in One Community Where Advance Directives Are Prevalent
Hammes BJ, Rooney BL, Gundrum JD, Hickman SE, Hager N

J Palliat Med. Nov 2011, 14(11): 1224-1230
Disease Specific Advance Care Planning for Heart Failure Patients: Implementation in a Large Health System
Schellinger, S, Sidebottom, A, Briggs, L
http://www.liebertonline.com/doi/abs/10.1089/jpm.2011.0105
abbey.sidebottom@allina.com

J Adolesc Health. 2011 Jun;48(6):633-6. Epub 2010 Dec 30  
Spirituality in HIV-infected Adolescents and Their Families: FAmily CEntered (FACE) Advance Care Planning and Medication Adherence
Lyon ME, Garvie PA, Kao E, Briggs L, He J, Malow R, D'Angelo LJ, McCarter R.
http://www.sciencedirect.com/science/article/pii/S1054139X10004349

Oncology Nurse Advisor 2010 Oct
Disease-specific advance care planning: Conversations emphasize patient preferences and provide clarity
Sandra Schellinger, MSN, RN, ANP; Abbey Sidebottom, MPH; Linda Briggs, MS, MA, RN
www.oncologynurseadvisor.com/disease.../178063/

J Palliat Med. 2010 Apr
Ask a Different Question, Get a Different Answer: Why Living Wills are Poor Guides to Care Preferences at the End of Life
Winter L, Parks SM, Diamond JJ
1 Center for Applied Research on Aging and Health, Thomas Jefferson University, Philadelphia, Pennsylvania
Abstract
Abstract Context: Living wills have a poor record of directing care at the end of life, as a copious literature attests. Some speculation centers on the questionable correspondence between the scenario described in living wills versus the real-life circumstances that typically arise at the end of life. Objective: To assess the strength of association between responses to a standard living will question and preferences for treatments in six end-of-life scenarios. Design: Cross-sectional. Setting: Telephone interviews. Participants: Two hundred two community-dwelling men and women 70 years of age or older in the greater Philadelphia area. Main outcome measures: Strength of preferences for four life-sustaining treatments in each of six poor-health scenarios. Results: Associations between responses to the standard living will question and preferences for treatment (means across the four) in six specific scenarios were statistically significant but modest in size, accounting for 23% of variance at most. The association for the worse-case scenario (severe stroke with coma) was significantly stronger than for any other association. Conclusions: The modest correspondence between living will responses and wishes for life-sustaining treatment in specific scenarios helps to elucidate the living will's poor performance. Presentation of more realistic end-of-life scenarios should improve the living will's ability to guide care, as well as preparing patients and families better for the end of life.

BMJ 2010 March;340:c1345
The impact of advance care planning on end of life care in elderly patients: randomised controlled trial
Karen M Detering, Andrew D Hancock, Michael C Reade, William Silvester
Respecting Patient Choices Program, Austin Health, PO Box 555, Heidelberg, Victoria, Australia 3084, Intensive Care Unit, Austin Health
Abstract
Objective To investigate the impact of advance care planning on end of life care in elderly patients. Design Prospective randomised controlled trial. Setting Single centre study in a university hospital in Melbourne, Australia. Participants 309 legally competent medical inpatients aged 80 or more and followed for six months or until death. Interventions Participants were randomised to receive usual care or usual care plus facilitated advance care planning. Advance care planning aimed to assist patients to reflect on their goals, values, and beliefs; to consider future medical treatment preferences; to appoint a surrogate; and to document their wishes. Main outcome measures The primary outcome was whether a patient’s end of life wishes were known and respected. Other outcomes included patient and family satisfaction with hospital stay and levels of stress, anxiety, and depression in relatives of patients who died. Results 154 of the 309 patients were randomised to advance care planning, 125 (81%) received advance care planning, and 108 (84%) expressed wishes or appointed a surrogate, or both. Of the 56 patients who died by six months, end of life wishes were much more likely to be known and followed in the intervention group (25/29, 86%) compared with the control group (8/27, 30%; P<0.001). In the intervention group, family members of patients who died had significantly less stress (intervention 5, control 15; P<0.001), anxiety (intervention 0, control 3; P=0.02), and depression (intervention 0, control 5; P=0.002) than those of the control patients. Patient and family satisfaction was higher in the intervention group. Conclusions Advance care planning improves end of life care and patient and family satisfaction and reduces stress, anxiety, and depression in surviving relatives.
http://www.bmj.com/cgi/content/full/340/mar23_1/c1345
Karen.detering@austin.org.au

Arch Intern Med. 2009 Mar 9;169(5):480-8
Health care costs in the last week of life: associations with end-of-life conversations
Zhang B, Wright AA, Huskamp HA, Nilsson ME, Maciejewski ML, Earle CC, Block SD, Maciejewski PK, Prigerson HG
Abstract
Background  Life-sustaining medical care of patients with advanced cancer at the end of life (EOL) is costly. Patient-physician discussions about EOL wishes are associated with lower rates of intensive interventions.  Methods  Funded by the National Institute of Mental Health and the National Cancer Institute, Coping With Cancer is a longitudinal multi-institutional study of 627 patients with advanced cancer. Patients were interviewed at baseline and were followed up through death. Costs for intensive care unit and hospital stays, hospice care, and life-sustaining procedures (eg, mechanical ventilator use and resuscitation) received in the last week of life were aggregated. Generalized linear models were applied to test for cost differences in EOL care. Propensity score matching was used to reduce selection biases. Results  Of 603 participants, 188 (31.2%) reported EOL discussions at baseline. After propensity score matching, the remaining 415 patients did not differ in sociodemographic characteristics, recruitment sites, illness acknowledgment, or treatment preferences. Further analyses, adjusted by quintiles of propensity scores and significant confounders, revealed that the mean (SE) aggregate costs of care (in 2008 US dollars) were $1876 ($177) for patients who reported EOL discussions compared with $2917 ($285) for patients who did not, a cost difference of $1041 (35.7% lower among patients who reported EOL discussions) (P =.002). Patients with higher costs had worse quality of death in their final week (Pearson production moment correlation partial r = –0.17, P =.006).  Conclusions  Patients with advanced cancer who reported having EOL conversations with physicians had significantly lower health care costs in their final week of life. Higher costs were associated with worse quality of death.
http://www.ncbi.nlm.nih.gov/pubmed/19752418

J Palliat Med. 2009 Feb;12(2):133-41
Use of the Physician Orders for Life-Sustaining Treatment (POLST) paradigm program in the hospice setting
Hickman SE, Nelson CA,Moss AH, Hammes BJ, Terwilliger A, Jackson A, Tolle SW
School of Nursing, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
Abstract
Background: The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm Program was designed to ensure the full range of patient treatment preferences are honored throughout the health care system. Data are lacking about the use of POLST in the hospice setting. Objective: To assess use of the POLST by hospice programs, attitudes of hospice personnel toward POLST, the effect of POLST on the use of life-sustaining treatments, and the types of treatments options selected by hospice patients. Design: A telephone survey was conducted of all hospice programs in three states (Oregon, Wisconsin, and West Virginia) to assess POLST use. Staff at hospices reporting POLST use (n = 71) were asked additional questions about their attitudes toward the POLST. Chart reviews were conducted at a subsample of POLST-using programs in Oregon (n = 8), West Virginia (n = 5), and Wisconsin (n = 2). Results: The POLST is used widely in hospices in Oregon (100%) and West Virginia (85%) but only regionally in Wisconsin (6%). A majority of hospice staff interviewed believe the POLST is useful at preventing unwanted resuscitation (97%) and at initiating conversations about treatment preferences (96%). Preferences for treatment limitations were respected in 98% of cases and no one received unwanted cardiopulmonary resuscitation (CPR), intubation, intensive care, or feeding tubes. A majority of hospiceorders wanted more than the lowest level of treatment in at least one other category such as antibiotics or hospitalization. patients (78%) with do-not-resuscitate (DNR)Conclusions: The POLST is viewed by hospice personnel as useful, helpful, and reliable. It is effective at ensuring preferences for limitations are honored. When given a choice, most hospice patients want the option for more aggressive treatments in selected situations.
hickmans@ohsu.edu 
http://www.ncbi.nlm.nih.gov/pubmed/19207056

Ann Intern Med. 2008 Mar 4;148(5):405-6; author reply 406
Can't we improve on advance directives?
Brasic GM, Hammes BJ
http://www.ncbi.nlm.nih.gov/pubmed/18316762
Comment on: Ann Intern Med. 2007 Jul 3;147(1):51-7

AJAN 2007; 24(4): 29-36
Patient advocacy and advance care planning in the acute hospital setting
Marion Seal, RN, BN, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
camseal@chariot.net.au

Hastings Cent Rep. 2005 Nov-Dec;Spec No:S26-30
Hope for the future: achieving the original intent of advance directives
Hickman SE, Hammes BJ, Moss AH, Tolle SW
http://www.ncbi.nlm.nih.gov/pubmed/16468252

J Palliat Med. 2005 Aug;8(4):766-73
Pediatric advance care planning
Hammes BJ, Klevan J, Kempf M, Williams MS
Department of Medical Humanities, Gundersen Lutheran Medical Foundation, La Crosse, WI, USA
Abstract
Objective: This study describes the process and population involved in pediatric advance care planning at one Midwest medical center. The outcomes and the parents' perceptions of this planning are also discussed. Methods: Pediatric patients with advance directives were identified from ethics consultations records. Information about the type of advance directive, the patient's medical condition and care received was obtained from the medical records. Parents of the children were then contacted and interviewed in regard to the advance care planning process done for their child. The interviews were audiotaped and transcribed. Transcribed interviews were reviewed and themes were identified. Results: Seventeen children from 16 families were included in the study. Almost all of the patients had progressive disorders other than cancer. Of the 17 children, 9 are deceased, 7 died at home and 2 died at a hospital. Eight of the children's advance directives were followed during the dying process, while 1 was not. Thirteen parents were interviewed. Twelve stated that the process of advance care planning benefited their children and their family. Rarely, individuals in the community raised concerns about the child's advance directive. Conclusions: Even though the topic of their child's death is difficult, the majority of the interviewed parents found the advance care planning process for the child helpful because it assured the best care for the child, including preserving their child's quality of life and avoiding unnecessary suffering.
http://www.ncbi.nlm.nih.gov/pubmed/16128650

Hastings Cent Rep. 2004 Sep-Oct;34(5):4-5; author reply 5-6
A viable alternative to traditional living wills
Hickman SE, Hammes BJ, Tolle SW, Moss AH
http://www.ncbi.nlm.nih.gov/pubmed/16128650

J Palliat Med. 2004 Apr;7(2):335-40
Communication, trust,and making choices:advance care planning four years on
Romer AL, Hammes BJ
http://www.ncbi.nlm.nih.gov/pubmed/15130214

J Palliat Med. 2004 Apr;7(2):233-45
Measuring patient treatment preferences in end-of-life care research: applications for advance care planning interventions and response shift research
Schwartz CE, Merriman MP, Reed GW, Hammes BJ
Quality Metric Incorporated, Lincoln, Rhode Island, USA
Abstract
Understanding the dynamics of patient treatment preferences can be important for end-oflife are research, and has particular salience not only to guide a process of advance care planning (ACP) but also as an outcome measure. Ascertaining the reliability and responsiveness of preferences for life-sustaining treatments within and between patients is a necessary foundation for utilizing patient-agent congruence as an outcome for ACP interventions. This study validated a modified version of the Emanuel and Emanuel Medical Directive for use in both research and clinical applications. Seriously ill patients (n = 168) were asked at baseline and 21 days to consider four common end-of-life health state scenarios, to indicate their goals for treatment, and to state their preferences for six specific treatments. We investigated the reliability and validity of this tool. We found that preferences for life-sustaining treatments were highly intercorrelated, and internally consistent across treatments by scenario and across scenarios by treatment. Preferences for pain medications were, however, distinct from preferences for other treatments. Preference scores exhibited stability over follow-up, and demonstrated both concurrent and discriminant validity. We detected a small effect size for change in preferences as a function of health state change, suggesting that reprioritization response shifts do occur but are small in magnitude in these patient samples over this time frame. We conclude that this measure is reliable and valid for use in clinical settings and for evaluating interventions designed to improve patient-agent congruence about patient preferences for life-sustaining treatments. Clinical applications of the tool are discussed.
carolyn.schwartz@deltaquest.org
http://www.ncbi.nlm.nih.gov/pubmed/15130201

J Prof Nurs. 2004 Jan-Feb;20(1):47-58
Patient-centered advance care planning in special patient populations: a pilot study
Briggs LA, Kirchhoff KT, Hammes BJ, Song MK, Colvin ER
Gundersen Lutheran Medical Foundation, La Crosse, WI 54601, USA
labriggs@gundluth.org
http://www.ncbi.nlm.nih.gov/pubmed/15011193

J Palliat Med. 2001 Winter;4(4):453-6
What does it take to help adults successfully plan for future medical decisions?
Hammes BJ
http://www.ncbi.nlm.nih.gov/pubmed/11798476
Comment on: J Palliat Med. 2001 Winter;4(4):481-9

HEC Forum. 1999 Sep;11(3):256-7
Should HECs conduct retrospective review of cases from their institution for educational purposes? Yes.
Hammes BJ
Gunderson Lutheran Medical Foundation, La Crosse, WI 54601, USA
http://www.ncbi.nlm.nih.gov/pubmed/11556377

Arch Intern Med. 1998 Feb 23;158(4):383-90
Death and end-of-life planning in one midwestern community
Hammes BJ, Rooney BL
Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, USA
bhammes@gc.gundluth.org
http://www.ncbi.nlm.nih.gov/pubmed/9487236

WMJ. 1998 Jan;97(1):55-7
CPR practices in Wisconsin long-term care facilities
Hammes BJ, Kane RS
Gundersen Lutheran Medical Foundation, La Crosse, WI, USA
http://www.ncbi.nlm.nih.gov/pubmed/9448509

Arch Dermatol. 1996 Sep;132(9):1070-3
Professional ethics and managed care in dermatology
Hammes BJ, Webster S
Department of Medical Humanities, Gundersen Lutheran Medical Center, La Crosse, WI, USA
The way health care is financed in the United States is changing quickly. Fee-for-service arrangements in which health care providers exercised great autonomy over health care services financed by third-party payers is quickly giving way to a variety of managed care approaches. The driving force behind this change is the desire to control the growth of health care cost. In the simplest term, costs are controlled in a managed care system by controlling the provision of services. Broadly speaking, 1 of 2 methods is used to control costs. Either physician behavior or subscriber behavior is modified or limited.
http://www.ncbi.nlm.nih.gov/pubmed/8795548

J Pain Symptom Manage. 1994 Apr;9(3):166-70
The ethics of pain management for cancer patients: case studies and analysis
Hammes BJ, Cain JM
Gundersen Lutheran Medical Foundation, La Crosse, WI, USA
Numerous national guidelines have addressed the ethical issues of pain management. Despite these efforts, many cancer patients get inadequate pain control. While there are many reasons for this situation, part of the problem is the complexity of applying these ethical standards to particular cases. In an effort to strengthen such clinical judgment, this essay analyzes two cases of pain management for cancer patients.
http://www.ncbi.nlm.nih.gov/pubmed/7516957

J Pain Symptom Manage. 1994 Apr;9(3):160-5
Ethics and pain management: respecting patient wishes
Cain JM, Hammes BJ
University of Washington Medical Center, Department of Obstetrics and Gynecology, Seattle, WA, USA
The fear of pain is common among cancer patients. The management of cancer pain can raise troubling ethical issues for medicine and society. Medical caregivers have an ethical duty to provide therapy that benefits patients by achieving one or more goals of medicine at all points. Pain and symptom relief may be the only achievable goal when curative therapy has failed. Relief of pain can restore decision-making capacity and enhance the patient's right to self-determination. The underpinning ethical principles and extensions of these principles in the medical context of pain control with varying medical goals in cancer care,including dying patients, is explored.
http://www.ncbi.nlm.nih.gov/pubmed/7516956

ANNA J. 1993 Oct;20(5):564-8
Moving beyond the Patient Self-Determination Act: educating patients to be autonomous
Colvin ER, Myhre MJ, Welch J, Hammes BJ
This article explores the limitations of the Patient Self-Determination Act. We need to think of advance directives as a process of understanding, reflecting, and discussing, not just a written document. Further, health care professionals must initiate the process of advance directive education in the outpatient setting. Our dialysis unit has successfully integrated this view into daily care of patients and families.
http://www.ncbi.nlm.nih.gov/pubmed/8285797

Nephrol News Issues. 1992 Feb;6(2):34, 42
What is appropriate care? We need to take a stand.
Hammes BJ, Dahlberg P, Colvin E
http://www.ncbi.nlm.nih.gov/pubmed/1557151

ANNA J. 1991 Dec;18(6):557-60
"If I only knew:" a patient education program on advance directives
Colvin ER, Hammes BJ
This article describes a unique renal patient education program on advance directives. It explains why the program was developed, the components of the program and their use, and the effects of the program. It is argued that programs like this one are needed to provide patients with reliable information aboutadvance directives in a sensitive, time efficient manner.
http://www.ncbi.nlm.nih.gov/pubmed/1750787

Nephrol News Issues. 1991 Jun;5(6):18-22
Advance directives by dialysis patients: a practical approach to tough ethical decisions
Hammes BJ, Dahlberg P, Colvin E
Http://www.ncbi.nlm.nih.gov/pubmed/1961295