Background
Methods
The intervention
Barriers and facilitators to implementation
Observations
Surveys
Survey | Key Content | Timing of Survey |
---|---|---|
Social worker monthly assessment | Satisfaction with the intervention Recommendations for future efforts to implement | Monthly following social worker first SDM-RSC intervention session |
Nephrologist post-study assessment | Satisfaction with the intervention Recommendations for future efforts to implement | End of the intervention phase of the study |
Participant-Patient post-intervention assessment | Satisfaction with the intervention | 1 to 3 days following intervention session |
Participant-Family post-intervention assessment | Satisfaction with the intervention | 1 to 3 days following intervention session |
Fidelity assessment
Analyses
Observations and open-ended survey questions
Surveys
Fidelity assessment
Results
Characteristic | % (n) |
---|---|
Gender | |
Female | 49% (61) |
Male | 51% (64) |
Age (years) | |
18–64 | 31% (39) |
65+ | 69% (86) |
Race, Ethnicity | |
American Indian | 12% (15) |
Asian | 1% (1) |
Native Hawaiian | 0% (0) |
Black or African American | 14% (18) |
White | 46% (57) |
More than 1 race | 4% (5) |
Unknown or Other | 23% (21) |
Ethnicity | |
Hispanic or Latino | 37% (46) |
Not Hispanic or Latino | 62% (78) |
Unknown or not reported | 1% (1) |
Education (N = 124) | |
<High school education | 22% (22) |
Graduated | 32% (40) |
Some college | 28% (35) |
College graduate | 18% (23) |
Medical History (N = 120) | |
History of myocardial infarction | 23% (24) |
History of diabetes | 73% (87) |
Sample Quotes from Surveys | |
---|---|
What Worked Well | |
Intervention Characteristics | Put[s] the patient in control [of the discussion], not like rounds (SW) [Provided] an opportunity to talk with family and patient together (SW) Fostered trust between the patient and the team (SW) |
Process | Having patient’s pre-survey ahead of time Intervention guideline (SW) E-mail reminders about what to cover (SW) Having privacy of an isolation room if ACP discussion took place while patient on dialysis (SW) |
What Did Not Work Well | |
Intervention Characteristics | SW must be [physically] present at ACP discussion [not on phone] (SW) |
Process | Families and patients needed more preparation for ACP discussion (SW) Doctor and social worker need to meet before ACP discussion to coordinate roles (SW) Too much time between recruitment and intervention (SW) Not good to have ACP discussion while patient on dialysis (SW) |
Inner Setting | Hard to schedule time when all can be there (SW) Recording intervention session felt awkward (SW) |
Outer Setting | Some patients not ready to discuss ACP (SW) Difficulty conducting discussion with patients with limited English proficiency (SW) |
Personal Characteristics | None – the intervention is not necessary |
Recommendations for Changes | |
Process | Start ACP either as soon as a patient begins or just prior to beginning hemodialysis Have more frequent follow-up discussions after initial discussion (SW) Meet patients at their homes for ACP discussions (MD) Conduct ACP discussions during rounds (MD) Have hospice worker or hospice handout at ACP discussion (SW) Train all dialysis staff to talk about ACP (MD) Make training inter-professional (SW) |
Inner Setting | Make it a policy to hold ACP discussions annually (SW) |
Outer Setting | Pay SW more for the additional work (MD) |
Personal Characteristics | None – the intervention is not necessary (SW) |