Abstract

Despite an aging population with increasing proportions of frailty and decline, the rates of documented Advance care plans (ACP), meant to align goals for care with the level of treatment at end-of-life (EOL), are low (~30-40%). Patients expect clinicians to raise the question about serious illness goals for care when the time is right, however, there are a number of barriers to the initiation of these difficult conversations including provider bias and uncertainty. A review of the literature indicates that there are few prognostic indices available for use to identify the right time to initiate EOL conversations based on risk for decline among community-dwelling older adults, and none of them have been developed using information collected during the provision of routine nursing care. Therefore, there is an opportunity to develop and validate a predictive model using a large dataset that is representative of the population that is collected by nurses so that it is possible to identify individuals who are at risk for dying within the year, so that ACP discussions may be seamlessly incorporated into the home health plan of care.

The purpose of this three-manuscript dissertation study was to determine if it is possible to develop and validate a parsimonious 12-month mortality risk prognostication tool for identifying community-dwelling older adults who may benefit from engaging in discussions about EOL goals for care.

Description

This dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 10690258; ProQuest document ID: 2024187287. The author still retains copyright.

Author Details

Suzanne S. Sullivan, PhD, MBA, RN, CHPN

Sigma Membership

Gamma Kappa

Type

Dissertation

Format Type

Text-based Document

Study Design/Type

Other

Research Approach

Pilot/Exploratory Study

Keywords:

End of Life, Advance Care Planning, Clinical Decision Support, Prognostication

Advisor

Sharon Hewner

Second Advisor

Maryann Meeker

Third Advisor

Varun Chandola

Degree

PhD

Degree Grantor

The State University of New York at Buffalo

Degree Year

2018

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2024-08-29

Full Text of Presentation

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