Applying human‐centered design to adapt the Jumpstart Guide for goals‐of‐care discussions in persons living with dementia

Author:

Im Jennifer12ORCID,Kross Erin K.13,Engelberg Ruth A.13,Dotolo Danae G.13,Ungar Anna1,Nielsen Elizabeth1,Torrence Janaki1,Abedini Nauzley C.14

Affiliation:

1. Cambia Palliative Care Center of Excellence at UW Medicine University of Washington Seattle Washington USA

2. Department of Health Systems and Population Health, School of Public Health University of Washington Seattle Washington USA

3. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine University of Washington Seattle Washington USA

4. Division of Gerontology and Geriatric Medicine, Department of Medicine University of Washington Seattle Washington USA

Abstract

AbstractBackgroundGoals‐of‐care discussions (GOCD) are uncommon in persons living with dementia (PLWD) despite the likelihood of eventual loss of decisional capacity in the population. The Jumpstart Guide, an existing serious illness communication priming tool, can improve GOCD in certain populations, but has not previously been adapted for use among PLWD and their caregivers.MethodsUsing human‐centered design (HCD), we adapted the Jumpstart Guide for use with PLWD and their caregivers. We conducted qualitative interviews with clinicians and caregivers of PLWD. Six team members conducted qualitative rapid analysis of interviews leading to the development of summary templates and integrative matrices. Four iterations of the Jumpstart Guide led to the final version.ResultsThirteen clinicians and 11 caregivers were interviewed. Interviews provided key insights into the unique barriers PLWD and their caregivers face during GOCD, including discomfort with accepting a dementia diagnosis and concern with using “serious illness” to describe dementia, as is commonly done in palliative care. Clinicians described differences in GOCD with PLWD compared to other serious illnesses, and the challenge of getting patients and families to think about future health states. Interviews led to Jumpstart Guide adaptations in the following domains: (1) format and structure, (2) content, and (3) specific language. Suggested changes included prioritizing naming a decision‐maker, changing conversation prompts to improve accessibility and understandability, ensuring the Jumpstart Guide could be used with patients as well as their caregivers, and altering language to avoid references to “serious illness” and “abilities.”ConclusionUsing HCD yielded valuable insights from clinicians and caregivers about the unique barriers to conducting GOCD among PLWD and their caregivers. These insights were used to adapt the Jumpstart Guide for use with PLWD and their caregivers, which is currently being tested in a pragmatic randomized controlled trial in outpatient clinics.

Funder

National Institute on Aging

Publisher

Wiley

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