title: High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study.
abstract: Many patients with chronic illnesses report a desire for increased involvement in medical decision-making. This pilot study aimed to explore how patients with exacerbation-prone disease trajectories such as advanced heart failure or chronic obstructive pulmonary disease experience advance care planning using an online decision aid and to compare whether patients with different types of exacerbation-prone illnesses had varied experiences using the tool.
  
  
  
  Pre-intervention questionnaires measured advance care planning knowledge. Post-intervention questionnaires measured: (1) advance care planning knowledge; (2) satisfaction with tool; (3) decisional conflict; and (4) accuracy of the resultant advance directive. Comparisons were made between patients with heart failure and chronic obstructive pulmonary disease.
  
  
  
  Over 90% of the patients with heart failure (n = 24) or chronic obstructive pulmonary disease (n = 25) reported being "satisfied" or "highly satisfied" with the tool across all satisfaction domains; over 90% of participants rated the resultant advance directive as "very accurate." Participants reported low decisional conflict. Advance care planning knowledge scores rose by 18% (p < 0.001) post-intervention. There were no significant differences between participants with heart failure and chronic obstructive pulmonary disease.
  
  
  
  Patients with advanced heart failure and chronic obstructive pulmonary disease were highly satisfied after using an online advance care planning decision aid and had increased knowledge of advance care planning. This tool can be a useful resource for time-constrained clinicians whose patients wish to engage in advance care planning.
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA lvanscoy@hmc.psu.edu.
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Van Scoy
authors.affiliation: Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Green
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Anne Ef
authors.initials: AE
authors.lastname: Dimmock
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bascom
authors.affiliation: Division of Cardiology, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Boehmer
authors.affiliation: Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Hensel
authors.affiliation: Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Hozella
authors.affiliation: Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Lehman
authors.affiliation: Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Jane R
authors.initials: JR
authors.lastname: Schubart
authors.affiliation: Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Elana
authors.initials: E
authors.lastname: Farace
authors.affiliation: Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Renee R
authors.initials: RR
authors.lastname: Stewart
authors.affiliation: Department of Humanities, Penn State College of Medicine, Hershey, Pennsylvania, USA Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Levi
mesh_terms: D032722:Advance Care Planning; D000368:Aged; D002908:Chronic Disease; D003220:Conflict, Psychological; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000523:psychology*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: End-of-life care; chronic illness; decision-making; palliative care; patient-centered care