A study of current status of acceptance and influencing factors of advance care planning for patients with malignant tumors

Objective:To assess the ACP acceptance among patients with malignant tumor in China and factors affecting adoption and timing.Methods:Quantitative study:The convenience sampling method was adopted from October 2020 to October 2021 to investigate 200 oncology patients by a general information questionnaire,patient's advance care planning acceptance questionnaire(ACPQ).Multiple linear stepwise regression was used to analyze the influencing factors of ACP acceptance.Qualitative study:A purposive sampling method was used to select 31 oncology patients and 13 clinical nurses for semi-structured interviews.The data were analyzed using Colaizzi's seven steps.Results:The quantitative study revealed that patients with malignancy had an upper-middle acceptance score of(66.15±7.684)for ACP,with attitude(11.26±2.064),feelings(36.64±4.208),and intention(18.25±3.275)scores.Multiple linear regression analysis showed that religious beliefs,education,monthly income,bereavement experience and notification of condition were independent risk factors for acceptance of ACP(P<0.05).The qualitative study showed that(1)oncology patients have low awareness,high demand,and low acceptability of ACP intervention;(2)they preferred to discuss ACP when medical condition or treatment plan changes;(3)family members were usually involved in ACP discussions,followed by medical personnel;(4)economy,environment,companion,and doctor-patient relationship will all influence ACP implementation.As for nurses,they(1)were unsure about the dynamic changes of ACP content and its optimal timing;(2)had limited ACP knowledge;(3)were affected by environmental factors and nurse-patient relationships;(4)were prone to have disagreements due to inadequate organization department assistance.Conclusions:clinical practitioners should discuss ACP with patients in specific conditions to increase patient acceptance.ACP development requires updated legislation,professional training,and a standardized ACP system.

Advance care planning readiness for Chinese older people:An integrative review and conceptual framework

Advance care planning is a process of discussion in which patients can communicate their end-of-life care preferences to family members and health care providers for consideration.Readiness for advance care planning is a patient's preparedness to engage in advance care planning.This review aims to develop the conceptual framework for advance care planning readiness for Chinese older people.The current knowledge from the published studies was identified and synthesized by an integrative review.The conceptual framework was developed based on the social-ecological model and the theory of planned behavior.The factors from the social environment/community,health care professionals,and individual/family layers were defined.These factors may influence an individual's medical decision-making,which in turn triggers individual behavioral mechanisms that arise from interactions between motivations,attitudes,and beliefs.Relevant factors should be considered when assessing the behavior of personnel engaged in advance care planning or formulating appropriate intervention measures to improve advance care planning par ticipation in China.This framework can be used to guide studies that explore how the social/familial/individual factors predict the readiness for advance care planning among Chinese older people,and to design intervention studies to test the effect of family function on the readiness for advance care planning.

Visual analysis of advance care planning related studies

Backgroud:To provide a reference for the further development of the field of the advance care planning(ACP),through the visual analysis of the related literature on the ACP.Methods:Taking the core collection database of Web of ScienceTM as data sources,the method of subject word retrieval is adopted.Literature metrology and CiteSpaceⅤinformation visualization software were used to analyze the literature on ACP published from inception to September 2019.Results:A total of 1,981 literature were included.The number of ACP studies increased,USA published the most literature in the world,followed by Australia,Britain,Canada and the Netherlands and so on.The most leading published journal was the Journal of Palliative Medicine,and the highest impact factor was Palliative Medicine(4.956).Sudore,Rebecca L and Hillary D Lum are the key researcher networks with the largest amount of articles published in ACP field.The research content mainly included the definition,implementation process and implementation effect of ACP.Research focused on palliative care,hospice care,decision-making,communication,patient preference and so on.Conclusion:The studies on ACP is on the rise,the research content is deepening,which suggests that we can learn from the research results of foreign countries in this field and continue to deepen the research in the field of ACP in China.

The effect of advance care planning in patients with dementia: a protocol of systematic review and meta-analysis

Aim:To comprehensively synthesize and compare the effect of advance care planning for dementia patients.Design:Systematic review and meta-analysis.Methods:Ten electronic databases will be searched:the Cochrane Library,PubMed,Medline,Embase,PsycINFO,CINAHL PLUS,Scopus,Web of Science,British Nursing Index,clinical Trials,and grey literature sources.Individually or cluster randomized controlled trials that evaluated advance care planning in people with dementia will be incorporated.The research screening flow diagrams will be detailed in the PRISMA flow chart.Data extraction will be carried out in Microsoft Excel 2019 independently by two researchers,any disagreements will be discussed with the third researcher and resolved.We will use the Cochrane Risk of Bias tool to assess the methodological quality.Review Manager 5.3 Software will be used for data synthesis.If sufficient data from studies are available,we will conduct a subgroup analysis of the main outcomes.Conclusion:The systematic review will combine existing trials which may contribute to more convincing conclusions,providing new ideas for medical workers to implement palliative therapy in dementia patients,and further promoting the application of advance care planning for dementia patients.

The perceptions and experiences of advanced cancer patients and their families in advance care planning:a systematic review and synthesis of qualitative studies

Background:The goal of this study was to conduct a meta-synthesis of advanced cancer patients’and their relatives’experiences with advanced care planning(ACP)and to provide evidence-based guidance for the development and implementation of ACP in advanced cancer patients.Methods:We searched databases including China Knowledge Network,Wanfang database,VIP database,China Biomedical Literature Database,PubMed,Web of Science,Embase,Cochrane Library,and Cinahl from inception to April 2022 to collect qualitative studies on advanced cancer patients and families'experience about ACP.We use Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research to evaluate the quality of literature.After quality assessment,meta-synthesis was used to summarize and explain the results.Results:Eleven qualitative studies were included involving 29 results and ten categories.Three integrated themes were extracted:facilitators and barriers to the implementation of advanced medical care programs as perceived by patients and families with advanced cancer;attitudes of patients with advanced cancer and their families towards pre-existing medical care programs;suggestions from patients with advanced cancer and their families on the implementation elements of the pre-existing medical care program.Conclusion:ACP is a complex social process and influenced by many factors.It requires joint efforts of different stakeholders to achieve high-quality and successful ACP.

Medical decision making for older adults： an international perspective comparing the United States and India

There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutane- ous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advan- tages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac dis- ease with comparisons of West to East, focusing particularly on the United States versus India.

Co-Occurrence of COVID-19 Infection and Intracerebral Hemorrhage in an Older Adult: A Case Report

Coronavirus disease 2019 (COVID-19) often has multifaceted presentations, even in young adults, which poses a significant challenge to clinicians who are caring for older adults. Older patients often present with subtle atypical manifestations, and failure to recognize these may lead to a cascade of negative events. Age-related immune system changes, comorbidities, and atypical presentations often make early diagnosis of COVID-19 difficult. Here, we report a case of an 82-year-old moderately frail male patient who presented with generalized body weakness and tested positive for COVID-19. On the second day of admission, he developed unilateral body weakness and aphasia, and computed tomography of the brain revealed acute right frontal spontaneous intracerebral hemorrhage with no vascular anomaly. He did not have any traditional risk factors for intracerebral hemorrhage and was not on any anticoagulants. The course of this case illustrates the delicate balance between the atypical presentations of COVID-19, the importance of a comprehensive geriatric assessment, and the management of older adults during the COVID-19 pandemic.

Strategies and challenges in the treatment of chronic venous leg ulcers

Evaluating patients with chronic venous leg ulcers(CVLUs)is essential to find the underlying etiology.The basic tenets in managing CVLUs are to remove the etiological causes,to address systemic and metabolic conditions,to examine the ulcers and artery pulses,and to control wound infection with debridement and eliminating excessive pressure on the wound.The first-line treatments of CVLUs remain wound care,debridement,bed rest with leg elevation,and compression.Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable.Hydrogen peroxide is harmful to the growth of granulation tissue in the wound.Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency.Yet,not all CVLUs are candidates for surgical treatment because of comorbidities.When standard care of wound for 4 wk failed to heal CVLUs effectively,use of advanced wound care should be considered based on the available evidence.Negative pressure wound therapy facilitates granulation tissue development,thereby helping closure of CVLUs.Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs.Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs.Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing.Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer.The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.

Wound dressing products:A translational investigation from the bench to the market

Chronic skin wounds affect more than 40 million patients globally and represent a severe growing burden for the healthcare systems,with annual costs expected to exceed$15 billions by 2022.To satisfy the huge demand for effective wound care products,different types of wound dressings have been introduced on the market dur-ing the last decades.Based on“the moist wound healing theory”postulated by Prof Winter in 1962,bandages were initially designed to recreate the optimal wound environment to favor the healing process.Then,thanks to the advancements achieved in biomaterial design and processing,biotechnology,imaging and electronic fields,great effort has been devoted to the development of formulations able to actively participate to tissue healing.Indeed,both the literature and the market report the design of medicated wound dressings,i.e.,wound care products releasing anti-microbial agents,anti-inflammatory drugs,or bioactive molecules.In this scenario,this review aims at critically describing the currently available wound care products,highlighting their proved effec-tiveness in wound management.Moreover,an overview of the main strategies exploited to design personalized wound dressings has been reported.Lastly,concerns on regulatory affairs and practical issues limiting the clinical translation of advanced research platforms have also been discussed.