This pilot study explored the feasibility and acceptability of a stage-tailored motivational interviewing intervention with education that focuses on changes in end-of-life (EOL) communication, completion of advance directives (ADs), and readiness for advance care planning (ACP).
Methods:
One group pretest–posttest design was implemented with 30 low-income older adults.
Results:
This pilot study showed its feasibility in enhancing ACP. Action for ACP—that is, identifying a proxy for decision making and documenting EOL treatment preference in an AD—increased significantly by 23.3% (n = 7). The participants’ readiness for ACP, knowledge, self-efficacy, positive attitudes, and perceived importance of ACP increased significantly after the intervention.
Conclusion:
Health care professionals and service providers who interact with older adults should tailor ACP dialogues in accordance with individuals’ motivation.
DesharnaisSCarterREHennessyWKurentJECarterC. Lack of Concordance between physician and patient: Reports on end-of-life care discussions. J Palliat Med. 2007;10(3):728–740.
4.
WhiteDBCurtisJRLoBLuceJM. Decisions to limit life-sustaining treatment for critically ill patients who lack both decision-making capacity and surrogate decision-makers. Crit Care Med. 2006;34(8):2053–2059. 10.1097/01.CCM.0000227654.38708.C1.
5.
SilveiraMJKimSYHLangaKM. Advance directives and outcomes of surrogate decision making before death. N Engl J Med. 2010;362(13):1211–1218.
6.
HeimanHBatesDWFairchildDShaykevichSLehmannLS. Improving completion of advance directives in the primary care setting: a randomized controlled trial. Am J Med. 2004;117(5):318–324.
7.
PearlmanRAStarksHCainKCColeWG. Improvements in advance care planning in the veterans affairs system: Results of a multifaceted intervention. Arch Intern Med. 2005;165(6):667–674.
8.
GoeringPDurbinJFosterRBoylesSHBabiakTLanceeB. Social networks of residents in supportive housing. Commun Ment Health J. 1992;28(3):199–214.
9.
Tamayo-VelázquezMISimón-LordaPVillegas-PorteroR. Interventions to promote the use of advance directives: An overview of systematic reviews. Patient Educ Couns. 2010;80(1):10–20.
10.
JezewskiMAMeekerMASessannaLFinnellDS. The effectiveness of interventions to increase advance directive completion rates. Aging Health. 2007;19(3):519–536.
11.
FinnellDSWuYBJezewskiMAMeekerMASessannaLLeeJ. Applying the transtheoretical model to health care proxy completion. Med Decis Making. 2011;31(2):254–259.
12.
FriedTRReddingCARobbinsMLPaivaAO’LearyJRIannoneL. Stages of change for the component behaviors of advance care planning. J Am Geriatr Soc. 2010;58(12):2329–2336.
13.
WestleyCBriggsLA. Using the stages of change model to improve communication about advance care planning. Nurs Forum. 2004;39(3):5–9.
14.
FriedTRBullockKIannoneLO’LearyJR. Understanding advance care planning as a process of health behavior change. J Am Geriatr Soc. 2009;57(9):1547–1555.
15.
AroraNKAyanianJZGuadagnoliE. Examining the relationship of patients’ attitudes and beliefs with their self-reported level of participation in medical decision-making. Med Care. 2005;43(9):865–872.
16.
MedveneLJBaseMPatrickRWescottJ. Advance directives: assessing stage of change and decisional balance in a community-based educational program. J Appl Soc Psychol. 2007;37(10):2298–2318.
17.
DuckworthKEFortiAMRussellGBNaikSHurdDMcQuellonRP. The process of advance care planning in HCT candidates and proxies: self-efficacy, locus of control, and anxiety levels. Am J Hosp Palliat Med. 2014;31(7):710–716.
18.
EmanuelLLDanisMPearlmanRASingerPA. Advance care planning as a process: structuring the discussions in practice. J Am Geriatr Soc. 1995;43(4):440–446.
19.
NoarSMBenacCNHarrisMS. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. 2007;133(4):673–693.
20.
MillerWRRollnickS. Motivational Interviewing: Helping People Change3rd ed. New York, NY: The Guilford Press; 2013.
21.
DermenKHThomasSN. Randomized controlled trial of brief interventions to reduce college students’ drinking and risky sex. Psychol Addict Behav. 2011;25(4):583–594.
22.
MontiPMBarnettNPColbySM. Motivational interviewing versus feedback only in emergency care for young adult problem drinking. Addiction. 2007;102(8):1234–1243.
23.
ColbySMNargisoJTevyawTO. Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: results from a randomized clinical trial. Addict Behav. 2012;37(7):817–823.
24.
CostanzaMELuckmannRWhiteMJRosalMCLaPelleNCranosC. Moving mammogram-reluctant women to screening: a pilot study. Ann Behav Med. 2009;37(3):343–349.
25.
WahabSPMenonUSzalachaL. Motivational interviewing and colorectal cancer screening: a peek from the inside out. Patient Educ Couns. 2008;72(2):210–217.
26.
PollakKIChildersJWArnoldRM. Applying Motivational interviewing techniques to palliative care communication. J Palliat Med. 2011;14(5):587–592.
27.
SkulasonBHauksdottirAAhcicKHelgasonAR. Death talk: gender differences in talking about one’s own impending death. BMC Palliative Care. 2014;13(1):1–11.
28.
KoELeeJ. Completion of advance directives among low-income older adults: does race/ethnicity matter?Am J Hosp Palliat Med. 2013;31(3):247–253.
29.
ProchaskaJO. Decision making in the transtheoretical model of behavior change. Med Decis Making. 2008;28(6):845–849.
30.
NorcrossJCKrebsPMProchaskaJO. Stages of change. J Clin Psychol. 2011;67(2):143–154.
31.
ProchaskaJOVelicerWF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48.
32.
JezewskiMAFinnellDSWuYBMeekerMASessannaLLeeJ. Psychometric testing of four transtheoretical model questionnaires for the behavior, completing health care proxies. Res Nurs Health. 2009;32(6):606–620.
33.
FriedTRReddingCARobbinsMLPaivaAO'LearyJRIannoneL. Promoting advance care planning as health behavior change: development of scales to assess decisional balance, medical and religious beliefs, and processes of change. Patient Educ Couns. 2012;86(1):25–32.
MurphyCPSweeneyMAChiribogaD. An educational intervention for advance directives. J Prof Nurs. 2000;16(1):21–30.
36.
Institute S. SAS/STAT 9.2 User’s Guide, ed. Cary, NC: SAS Institute Inc; 2002–2008.
37.
SunXYangZ.Generalized McNemar’s Test for Homogeneity of the Marginal Distributions. SAS Global forum. 2008.
38.
BowlingA. Research Methods in Health. Investigating Health and Health Services, 2nd ed. Philadelphia, PA: Open University Press; 2002.
39.
WongYIHadleyTRCulhaneDP. Permanent supportive housing that serves homeless people with serious mental illness, 2006.
40.
BrittEHudsonSMBlampiedNM. Motivational interviewing in health settings: a review. Patient Educ Couns. 2004;53(2):147–155.
41.
BrugJConnerMHarreNKremersSMcKellarSWhitelawS. The Transtheoretical Model and stages of change: a critique: Observations by five Commentators on the paper by Adams, J. and White, M. (2004) Why don’t stage-based activity promotion interventions work?Health Education Research2005;20(2):244–258.
42.
MillerWRRoseGS. Motivational interviewing and decisional balance: contrasting Responses to Client Ambivalence. Behav Cogn Psychother. 2013;43(2)129–141.
43.
SudoreRLFriedTR. Redefining the “planning” in advance care planning: preparing for end-of-life decision making. Ann Intern Med. 2010;153(4):256–261.
44.
DeteringKMHancockADReadeMCSilvesterW. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340:c1345.
