Differing needs for Advance Care Planning in the Veterans Health Administration: use of latent class analysis to identify subgroups to enhance Advance Care Planning via Group Visits for veterans.

IF 3 1区 哲学 Q1 ETHICS BMC Medical Ethics Pub Date : 2024-10-28 DOI:10.1186/s12910-024-01117-w
Monica M Matthieu, Songthip T Ounpraseuth, J Silas Williams, Bo Hu, David A Adkins, Ciara M Oliver, Laura D Taylor, Jane Ann McCullough, Mary J Mallory, Ian D Smith, Jack H Suarez, Kimberly K Garner
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Abstract

Background: Advance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a "Next Step" to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings.

Methods: We conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018-2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group.

Results: Analysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans.

Conclusion: Greater attention must be paid to ACP and veterans' prior knowledge of ACP to consistently encourage annual review and status updates.

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退伍军人健康管理局中对预先护理规划的不同需求:使用潜类分析法确定子群体,通过集体探访加强退伍军人的预先护理规划。
背景:通过小组探访进行预先护理规划(ACP-GV)是一种以患者为中心的干预措施,由临床医生通过小组方式促进退伍军人做出医疗决策。小组参与者记录 "下一步",用于规划未来的护理需求。下一步 "可能包括在预先指示中记录偏好、与家人讨论计划或满足其 ACP 需求的任何其他事项。本评估旨在确定在实施 ACP-GV 计划之前,是否存在可识别的具有不同需求的小组参与者亚群,如果存在,则利用有关亚群的信息来改进在美国退伍军人事务部 (VA) 医疗机构中为退伍军人提供的计划:我们对一项质量改进评估的全国数据进行了二次分析。来自所有 50 个州、地区和哥伦比亚特区退伍军人事务部用户的行政医疗保健记录的患者和提供者级别数据提供了 2018-2022 联邦财政年度期间参加 ACP-GV 的退伍军人的数据(N = 26857)。潜类分析旨在根据退伍军人在参加 ACP-GV 前的 ACP 自我效能水平,以及由此产生的参加 ACP-GV 的退伍军人亚群之间的任何人口统计学差异,确定各种退伍军人亚群。ACP 自我效能感来自小组活动期间使用的参与者工作表中的七个项目:分析结果显示,退伍军人分为两个不同的群体,他们在参加 ACP-GV 前的 ACP 自我效能水平有一个方面的差异:对 ACP 的先前了解。对 ACP 预先了解较多的退伍军人会确定下一步行动,重点是检查他们目前的 AD 状态并进行更新,而对 ACP 预先了解较少的退伍军人会确定下一步行动,与家人更充分地讨论 ACP。不同亚群的退伍军人在年龄、性别、种族、民族和婚姻状况方面存在差异:结论:必须更加关注 ACP 和退伍军人对 ACP 的预先了解,以持续鼓励进行年度审查和状态更新。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMC Medical Ethics
BMC Medical Ethics MEDICAL ETHICS-
CiteScore
5.20
自引率
7.40%
发文量
108
审稿时长
>12 weeks
期刊介绍: BMC Medical Ethics is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies.
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