Feasibility of Group Visits for Advance Care Planning Among Patients with Heart Failure and Their Caregivers

	Patients(n = 36)	Caregivers(n = 21)	Total(n = 57)
Age, median*	74	N/A	N/A
Female, n (%)	18 (50)	17 (81)	35 (61)
Race/ethnicity, n (%)
White	26 (72)	12 (57)	38 (67)
Black	4 (11)	0 (0)	4 (7)
Latino/Hispanic	4 (11)	5 (24)	9 (16)
Asian Pacific Islander	0 (0)	1 (5)	1 (2)
Other/multiethnic	2 (6)	3 (14)	5 (9)
Married	16 (44)	14 (67)	30 (53)

↵* Median based off of 31 patients (patient age missing for 5 patients).

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Table 3.

Group Visit Evaluation

Participant Response	Patients (n = 36)		Caregivers (n = 21)
Participant Response	Mean	SD	Mean	SD
I felt comfortable discussing the topics covered in today’s group visit.	4.59	0.76	4.7	0.47
I understood what was discussed today.	4.7	0.74	4.74	0.45
The group visit provided the right amount of information.	4.57	0.80	4.5	0.61
The group visit helped me to identify and clarify my healthcare values.	4.43	0.83	4.44	0.70
The group visit helped me learn more about advance care planning.	4.43	0.89	4.5	0.76
The time allotted for the group visit was adequate.	4.24	0.86	4.5	0.51

SD, standard deviation.

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Table 4.

Group Dynamics Themes from Follow-Up Interviews

Group Dynamics Theme	Quote
1. Participants leveraged others’ experiences to identify and clarify their own preferences.	“I think being in a group was helpful because you can get ideas from others about tricks or ways to talk about this and how others do it—getting information from other people was helpful. Piece together others’ strategies for talking about these things and take what is helpful for me.” (Patient)“It was interesting and you learn from what other people have done and gone through. I find that more interesting and more valuable to learn more about other people’s experiences.” (Patient)“I was able to hear other people’s stories and that was a value to me. I was not intimidated in the group visit at all. I find it better to be in a group visit like that than to do it on your own.” (Patient)
2. There was value in mixed compositions of the groups to understand alternative perspectives (i.e. patients and caregivers together; a mix of genders).	“I thought about what my family is going through with me with the heart condition, my family and my friends. You see the other side of the coin!” (Patient)“And hearing others’ experiences put a face to it. It was good to hear people speak because I haven’t had that experience in my life.” (Caregiver)“I think it actually helped [to be with others] because without having your spouse there who feels totally different than I do, it helps to hear other people who think that. I think it’s very helpful.” (Patient)“They were all women, except mostly me, it would have been nice if I could relate to other men.” (Patient)
3. Disease-focused nature and support group aspect provided participants with a safe space to share difficult experiences as well as their preferences and values.	“I just think being around other people who have had similar experiences is always helpful even if it might be an uncomfortable topic.” (Patient)“Well being one of the heart failure people, it was good. (laughs) [What made it good?] It was kind of close to a support group knowing other people there have the same issues.” (Patient)“I do think it was helpful for a group setting. It’s not an easy thing to talk about in our culture. It’s not something you talk about during a meal. It’s kind of hard for the kids. You don’t want to talk about it. It’s never really a good time to bring it up even though it’s always in the back of people’s minds. It’s educational, kind of thing—you go there and learn about it. It would be easier for people to swallow that in a group setting. Yeah I think it’s a good way of doing it.” (Caregiver)“[What was most helpful?] Actually it was the input from the other people there—we kept thinking we’re on our own problems—but I think other people have the same problems.” (Caregiver)
4. Group visit facilitated camaraderie among participants	“She [facilitator] was really good. She was very helpful. She made us feel very friendly with each other. And in one hour or a couple of others, we felt like we were actually friends. And we started talking and feeling good about each other. So she made it happen.” (Patient)“It stimulated a lot of conversation. When I was leaving people were talking at the elevators. But I liked what I saw when it was over.” (Patient)“[What did you like best?] Probably the interaction among all the people. We actually got some side benefits from it from contacts to be made from people who are having the same problems as my husband.” (Caregiver)