People take time to plan how they wish to spend their time and resources. It is also advisable for one to show interest in planning how to be taken care of towards the end of life. It is difficult to make informed decisions about the kind of medical and emotional support to be accorded to one in the most vulnerable moments. The situation is worsened by a failure by patients to disclose to those whom they love how they wish to be taken care of in their most vulnerable moments. A lot has been written on viable initiatives that can be taken to make people have a dignified end of life and to maintain their reputation until death. This study is based on a critical critique of an article by Mi-Kyung Song and Ward; “Making Visible a Theory-Guided Advance Care Planning Intervention” to answer the question, “Does educating our patients about end of life decisions early on benefit patients?”
Key words: end-of-life, patients, decisions, emotional support, patients’ education
The Benefits of Educating Patients about End of Life
It is important to plan all aspects of our lives. We need to plan our careers, schedules, vacations and projects. Despite the clear understanding about the essence of planning, people have not fully recognized the importance of planning the end of life. Failure to plan our end of life means that we hardly think about it as a reality and that we do not take time to share our ideas about the end of our lives with those whom we love. It means that we give room for others to take over the decision making process at a time when we become vulnerable and when we highly need to be comforted and understood besides having a desire to be dignified. We are always confronted by the reality whenever we think about the death of our loved ones or our own death. It is at such points that our belief and attitudes about pain and suffering, religion and parting ways with those whom we love start tormenting us. Although some people believe that it is good to let things unfold as they may, there is a lot of advocacy for planning. Planning can involve provision of early education to patients about end of life decisions. This study is based on a critical assimilation, analysis and critique research article “Making Visible a Theory-Guided Advance Care Planning Intervention” by Mi-Kyung Song and Ward. The critique is intended to help in answering the question “Does educating our patients about end of life decisions early on benefit patients?”
To answer the research, Songs’ article is identified as a reliable source from which vital information is obtained. The purpose of the study under analysis was to give details concerning a theory-guided advance care planning intervention that calls for sharing the illness representations of the patient to boost trust. It is abbreviated as “SPIRIT”. The article was based on an examination of the level of effectiveness of SPIRIT as an intervention that can help patients and their surrogates prepare for end-of-life decision making.
This article utilizes a case study design alongside an extensive literature review. The findings that are presented in the article are based on extensive theoretical underpinnings. Song also used the case study design in that he used a population of the sample target patients and racial or ethnic groups. Song’s a article provides critical description of the proposed intervention’s theoretical basis and uses a requisite intervener training to create awareness about the intervention and to advocate for the implementation of the intervention component and fidelity monitoring. As mentioned earlier, Song’s study used a sample that was constituted by patients, racial and ethnic groups. The choice of the study population was done in such a way that it could be possible to understand the perception of patients who are directly targeted by the study. In this case, the selected patients and members of different racial groups are considered key informants who are capable of providing first hand information based on their personal experiences with the subject under study. The decision to use patients in this study and to incorporate members of different racial groups increased credibility of the study. It is because patients provide primary information as the subject under investigation is directly focused on them.
The intervention was first tested and realized to be efficacious among non-Hispanic Caucasians who were suffering from serious heart disease. Two pilot studies followed that were aimed at evaluating the extent to which the intervention would be applicable to other ethnic populations who suffered from kidney diseases. It was vital to include members of different racial backgrounds to understand the impacts of culture in determining the way end-of-life decisions are made.
The researcher collected data from the selected population in a form of an interview that involved the use of two main tools of data collection. The tools that were used were intended at assisting patients fill questionnaires that would later be analyzed to assess the efficiency of ‘SPIRIT’. The two tools that were used are The Goals of Care document and the Values About Life-Sustaining Treatment Outcomes. Data was collected from the sample population with the help of surrogates who were advised to ask patients to seek clarification in case some aspects were unclear to them. Such an initiative made it possible to ensure that the information that was collected from the participants was reliable and that it reflected the patient’s perception on the subject under investigation. The sessions were done face-to-face hence they allowed for clarification to be given to make the study more effective.
The main limitation that is observable in the study is the fact that little was one to safeguard patient’s rights. It is important for every study to be conducted with close ethical consideration to ensure that participants are well protected. The patients were not well educated on the goals of the study before their inclusion as participants. It would be important for future studies on a subject of this nature; that calls for patient’s direct participation to be preceded by extensive education so that participants give an informed consent to take part in the study. A lot should also be done to ensure that patient participants are not exposed to any sort of danger as they are engaged in interviews. The sessions should also be kept short so as to safeguard against fatigue as patients should not take part in long interviews.
From the study, a number of findings were made. The findings supported the effectiveness of initiatives that are aimed at sharing patients’ illness representations to increase trust (SPIRIT). The study justified that SPIRIT is effective in helping patients prepare to make the end-of-life decisions. When early education is provide to patients, they are assisted in surrogate determination. Patients are informed of what to expect and they are given an opportunity to share their interests with those whom they love. Such opportunities make it possible for healthcare providers to understand how patients would like to be handled during their most vulnerable times. It means that the kind of care that is given to them as they approach their death is based on their own interest as opposed to a situation when others are left to decide for them.
The study is based on two main theories; namely, Leventhal’s theory and Hewson theory. The former is focused on content of patients’ beliefs as the later is focused on ways of changing beliefs. Using the two theories, it is possible to create psycho-educational interventions. The interventions are effective as they facilitate understanding of patient’s symptoms and their perceptions about their illness then helping them to change negative perceptions in a manner that enables them to effectively manage their illness.
To conclude, this study has justified the fact that provision of early education to patients helps in establishing an understanding of patients’ emotional, cognitive, religious and spiritual perception regarding their illness. The initiatives can serve as a pointer to measures that can be taken to offer individualized healthcare information. It also facilitates effective provision of mechanical support at end-of-life for patients who suffer from end-organ failure. It is because the education helps to empower patients to evaluate their values and make informed choices regarding various mechanical supports that they would want to be given towards the end of their life. The article by Song justifies the fact that provision of early education to patients about end of life decisions is beneficial in helping patients make informed end of life plans.