Alexis Coulourides Kogan, PhD; Kya Kraus, MS; Bonnie Olsen, PhD; Julia I. Bandini, PhD; Sangeeta C. Ahluwalia, PhD
Corresponding Author: Alexis Coulourides Kogan, PhD; University of Southern California. Email: acoulour@usc.edu
Section: Original Research
Publication: 3/26/2021
Background: Advance care planning (ACP) is critical for older adults with heart failure, however, patient- and clinician-level barriers exist. Using a group visit (GV) approach to engage patients in ACP has proven effective among a general geriatric population, yet little is known about clinician perceptions/likelihood of referral. Methods: Qualitative study to understand clinician perspectives on GVs for ACP among older adult patients with heart failure and their caregiver. Twenty physicians and advance practice providers in family, internal, cardiology, and palliative medicine at an academic health center in Los Angeles County participated in telephone-based interviews guided by a semi-structured research protocol. Transcripts were analyzed used a grounded theory approach. Results: Results highlight variability in clinician engagement in ACP but greater agreement around the factors that prompt discussions. Qualitative themes included: 1) Inherent properties of GVs (characteristics that make a GV an ideal format for most are also what makes them less ideal for some, and risk-to-benefit ratio for GVs); 2) Purpose of GVs (general education, “priming the pump” for subsequent discussions, providing the tools for action); and 3) Format and procedures for GVs (participant inclusion/exclusion considerations, organizing groups by a unifying characteristic, and the link back to clinicians). Conclusions: This is the first study to gain clinician insights into ACP GVs specific to patients and caregivers affected by heart failure. Results shed light on an important topic and, corroborated by prior research, suggest key considerations for conducting GVs for ACP among older adult patients with heart failure and their caregivers.