Using a Values Discussion Guide to facilitate communication in advance care planning.
The utility of values clarification tools for advance care planning needs further study. This descriptive, qualitative study aimed to describe patients' and surrogates' experiences using a Values Discussion Guide (VDG), both with and without a professional facilitator. Ten male Veterans Health Administration outpatients over age 50 and their health care agents completed audio-taped discussions, both without and with a facilitator, and responded to structured feedback interviews. Most participants found a discussion using the VDG to be helpful and reassuring. Discussions varied in quantity and quality, and participants varied in preferring self-guided versus professionally facilitated discussions. The best interchanges were elicited by questions about prior experience with medical decisions, for oneself or others, and trusted versus non-trusted others to help with decision-making. A VDG appears a useful tool in a repertoire of advance care planning tools, which need to be geared towards the needs and abilities of particular patients and families.
VA Boston Healthcare System and Department of Psychiatry, Harvard Medical School, VA Medical Center 3-5-C, 940 Belmont Street, Brockton, MA 02301, USA. michele.karel@med.va.gov
Michele J
MJ
Karel
Jean
J
Powell
Michael D
MD
Cantor
D032722:Advance Care Planning / Q000592:standards*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001293:Attitude to Death; D001294:Attitude to Health; D001900:Boston; D002755:Choice Behavior; D003142:Communication; D003657:Decision Making; D004522:Educational Status; D005246:Feedback; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic / Q000592:standards*; D036301:Qualitative Research; D014728:Veterans / Q000523:psychology