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Description
Advance care planning is a process that allows for patient autonomy at the end of life. Yet, less than 30% of Americans over the age of 65 have an advance care plan. Advance care planning has positive effects on patients, families and healthcare systems. However, both patients and healthcare providers

Advance care planning is a process that allows for patient autonomy at the end of life. Yet, less than 30% of Americans over the age of 65 have an advance care plan. Advance care planning has positive effects on patients, families and healthcare systems. However, both patients and healthcare providers report barriers to completing and discussing advance care planning. Many different interventions have been studied to increase advance care planning rates. Engaging patients and providers electronically before or during appointments in outpatient clinics and community settings has shown marked improvement in advance care plan discussions and documentation rates. To address this complex issue, two community-based seminars with electronic pre-engagement for adults has been proposed to improve advance care planning completion rates.
ContributorsCole, Alison (Author) / Nunez, Diane (Thesis advisor)
Created2020-04-24
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Description

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care

Disease burden is higher in the United States than in comparable countries. The Patient Self Determination Act of 1990 requires healthcare facilities to provide Advance Care Planning (ACP) information to all Medicare patients. The healthcare staffs’ (n=7) commitment to 3-days of ACP training increase ACP rates in the primary care setting. The Medicare Incentive Program is the platform for this initiative. This quantitative project used a valid and reliable pre and posttest design that consisted of 27 items on a Likert-scale. A 3.5-month chart audit (n=91) was conducted to assess the completion rate. Descriptive statistics was used to describe the demographic data.

The results of the two-tailed Wilcoxon signed rank test were significant based on an alpha value of 0.05, V = 0.00, z = -2.37, p = .018. There was a significant increase in the post-readiness to change average scores. A Mann Whitney test was used to analyze the statistically significant difference between the averages in two ACP types and electronic health record documentation (EHR). Staff did not always code (Mdn = 0.00) but they documented in the EHR (Mdn =1.00; 512.00, p = 0.003). ACP discussion was performed 63% of the time during Annual Wellness Visits (AWV), and there was a 49% increase in the EHR documentation. Trained staff are key stakeholders in guiding ACP conversations. They understand the barriers, impact, and consequences related to the lack of advance directives.

ContributorsBautista, Hija Mae (Author) / Johannah, Uriri-Glover (Thesis advisor)
Created2020-04-30
Description

Maria is a United States citizen whose parents just recently obtained legal status in the US due to Maria having turned 21. Maria has been around the undocumented population her entire life due to a large part of her family being undocumented. She became very involved with the undocumented movement

Maria is a United States citizen whose parents just recently obtained legal status in the US due to Maria having turned 21. Maria has been around the undocumented population her entire life due to a large part of her family being undocumented. She became very involved with the undocumented movement back in 2010 with the passing of SB1070 in Arizona. She states that the reason she became so involved at this time was because she realized how these anti-immigrant laws were affecting her family and her community. She has worked on many campaigns at the local level such as the recall of Russell Pierce, the Adios Arpaio Campaign among other things. She is set to graduate from ASU this May 2015 with a degree in Political Science and Transborder Studies, and hopes to study law one day. She currently works with Unite Here a labor union and continues to be involved with varies campaigns some being DACA/DAPA information sessions among other things

ContributorsGil, Junive (Interviewer)
Created2015-04-30
Description

In her interview, Monica discusses her association with the Grassroots Leadership Organization and her involvement with DreamZone. She talks about why DreamZone is important and why she is politically inclined. She talks about DreamZone’s Clinton Global Initiative campaign and her involvement at the White House breakout sessions after DACA was

In her interview, Monica discusses her association with the Grassroots Leadership Organization and her involvement with DreamZone. She talks about why DreamZone is important and why she is politically inclined. She talks about DreamZone’s Clinton Global Initiative campaign and her involvement at the White House breakout sessions after DACA was signed. She has been involved in sit-ins and letter writing campaigns

ContributorsSolis, Holly (Interviewer)
Created2015-04-28
Description

Jonathan was born in a small farming town in Maryland. He talks about racism, segregation and the homophobic climate that prevailed in his hometown, and how that informed his activism and that of his parents. During middle school, he got involved in activism around queer youth of color. In the

Jonathan was born in a small farming town in Maryland. He talks about racism, segregation and the homophobic climate that prevailed in his hometown, and how that informed his activism and that of his parents. During middle school, he got involved in activism around queer youth of color. In the beginning, he was mostly involved in LGBT issues. Later, he also organized around economic injustice in peasant and working class communities.

ContributorsVan Der Heyden, Cynthia (Interviewer)
Created2015-04-03
Description

Dulce attended school in Mexico up until junior high before coming to the United States on a visa. While in high school she became involved with the robotics team at Carl Hayden and thanks to the encouragement by her two teacher she decided to pursue a STEM education at ASU.

Dulce attended school in Mexico up until junior high before coming to the United States on a visa. While in high school she became involved with the robotics team at Carl Hayden and thanks to the encouragement by her two teacher she decided to pursue a STEM education at ASU. She was enrolled at ASU already when the law passed and was unaware of any other undocumented student at the ASU campus at the time. It was through the scholarship(s) that were made available to these undocumented student who were already enrolled at ASU that these undocumented students connected. What originally started off as students discussing various topics through blackboard, then google drive, led to the founding of the Arizona Dream Act Coalition (ADAC). She is co-founder for the ADAC and was the acting president for 2 years, now she just volunteers whenever she can, currently running for a position in the upcoming Executive board. She graduated from ASU with a degree in mechanical engineering, but is currently has her own business as a real estate agent for the past 10 years. She is in the process of applying for citizenship.

ContributorsGil, Junive (Interviewer)
Created2015-05-15
Description

In his interview, Seth discusses his hometown as well as his study abroad experiences. He describes how he has come to learn about the undocumented youth movement and his role in the DreamZone workshop. He talks about current political reform and his involvement in political discussion in person and on

In his interview, Seth discusses his hometown as well as his study abroad experiences. He describes how he has come to learn about the undocumented youth movement and his role in the DreamZone workshop. He talks about current political reform and his involvement in political discussion in person and on social media. He describes his experience with AZ Quip and how he feels it is included.

ContributorsSolis, Holly (Interviewer)
Created2015-04-07
Description

Jesus went to Gadsden High School in Anthony, New Mexico. He studied engineering at Texas A&M University, but ended up changing his major to journalism and mass communication with an emphasis in pubic relations. He worked in housing residential education for about a year in Florida, but later moved to

Jesus went to Gadsden High School in Anthony, New Mexico. He studied engineering at Texas A&M University, but ended up changing his major to journalism and mass communication with an emphasis in pubic relations. He worked in housing residential education for about a year in Florida, but later moved to Arizona State University to pursue a PHD in education policy and evaluation. Through his work with students and the community, he became aware of the political and social issues in Arizona. This awareness eventually led him and a friend to create DREAMzone.

Jesus is involved with DREAMzone, the Queer Undocumented Immigrant Project (Q.U.I.P.), Arcoíris Liberation Team, and Familia: Trans Queer Liberation Movement (California). He was president of the Latino Graduate Student Alliance and is currently the vice-president of the Graduate & Professional Student Association.

ContributorsVan Der Heyden, Cynthia (Interviewer)
Created2015-04-23
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Description
Purpose: Advance care planning (ACP) allows an individual to discuss and document their personal preferences at end-of-life. ACP has been shown to improve communication and reduce discomfort for patients and their families. The literature supports utilizing formalized, multimodality training programs for healthcare providers in order to increase their confidence in

Purpose: Advance care planning (ACP) allows an individual to discuss and document their personal preferences at end-of-life. ACP has been shown to improve communication and reduce discomfort for patients and their families. The literature supports utilizing formalized, multimodality training programs for healthcare providers in order to increase their confidence in initiating ACP discussions. These findings led to the initiation of an evidence-based practice project in a primary care setting with the purpose of increasing advance care planning discussions between providers and patients with the use of a standardized education tool.

Background and Significance: National regulations mandate that patients are provided information about advance directives in the healthcare setting, but completion rates are not monitored and continue to be low. ACP is now a billable service for healthcare providers, but it has not provided enough incentive to increase completion rates. Barriers for healthcare providers in the outpatient setting include lack of time, protocols, and lack of education on how to initiate and foster advance care planning discussions.

Methods: Healthcare providers in a primary care office attended a 15-minute structured educational session with and a toolkit was provided on the importance of ACP, how to initiate conversations with patients, and bill for the service. Participants completed a portion of the Knowledge, Attitudinal, and Experiential Survey on Advance Directives (KAESAD) survey assessing their confidence in ACP before and three months post intervention. Participant confidence (N = 6) in ACP was analyzed using the Wilcoxin test and descriptive statistics. The number of billed ACP services for the office was collected for four months post intervention and compared to the previous four months. Outcomes: A significant increase in provider confidence after participating in a multimodality education program was found in the results (Z = -2.21, p = .03). There was a 42.1% increase in the number of billed ACP discussions for the office in the four months post intervention.

Conclusion: The future desired state is that ACP discussions become standard practice in primary care leading to the completion of advance directives. This can be accomplished through formalized education sessions and resources for providers in order to increase their confidence in initiating ACP discussions with patients. The ultimate goal is to decrease unnecessary spending at end-of-life while improving patient and family satisfaction with the quality of care received at end-of-life.
ContributorsSmith, Arsena (Author) / Nunez, Diane (Thesis advisor)
Created2018-04-30
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Description
Many older Americans don’t have an advance directive (AD). ADs are legal documents that allow a person to express what types of medical treatment or cares that they want at the end of their life if they were unable to speak for themselves. Patients without an AD could

Many older Americans don’t have an advance directive (AD). ADs are legal documents that allow a person to express what types of medical treatment or cares that they want at the end of their life if they were unable to speak for themselves. Patients without an AD could receive unwanted treatment. Providers can utilize advance care planning (ACP) to educate patients and support them in forming a medical power of attorney (MPOA) and AD. Evidence suggests that having ACP conversations can engage a patient to form an AD. The purpose of this project was to see if ACP discussions with older patients encouraged them to complete an AD and MPOA.

The project used a mixed method design. Participants were recruited from a primary care practice. Descriptive statistics described the sample and outcome variable. An independent t- test measured if there were significant changes in the participant responses for the ACP survey.

The average age (standard deviation) of the chart review sample was 72.22 (SD=9.47). The ages ranged from 60 to 100 years of age. Most of the sample in the chart audit were female with 105 (53%) participants and 95 (48%) were male. Most of the sample, 183 (92.5%) reported having a chronic health condition and 17 (7.5%) of the sample reported having no chronic condition. Overall, the results were inclined towards a significant difference in participants who did the ACP discussions and those who did not when comparing completed AD forms.
ContributorsKrasowski, Maria (Author) / Rauton, Monica (Thesis advisor)
Created2018-05-01