CARE MANAGERS’ PERCEPTIONS OF ACP BARRIERS AND BENEFITS: NUANCES FROM A MIXED METHODS ANALYSIS

摘要

Barriers and benefits of advance care planning (ACP) experienced by Area Agency on Aging (AAA) care managers (CMs) were analyzed from a mixed methods approach. This methodology is used to acquire a deeper understanding of perspectives and practices related to ACP, and to identify nuances between quantitative and qualitative data. A two-part study was conducted with CMs; 458 participated in a survey, and 62 also participated in one of 8 focus groups.Results from both surveys and focus groups showed that CMs felt knowledgeable about ACP. CMs were generally comfortable (67%) and confident (67%) when discussing ACP, and qualitative data confirmed that comfort levels tended to rise with experience and personal history with consumers. While ACP was not always easy, and there were some who were uncomfortable due to cultural factors, CMs recognized that consumers were generally comfortable with dying and found value in ACP. While surveys indicated 78% disagreed that ACP takes too much time, qualitative data revealed a more moderate position: some reported time was a “big barrier,” and when others placed ACP as a priority, there was not enough time for other obligations. Finally, CMs recognized their important role in a team-based approach to ACP (64%), despite the fact that they wished physicians would take a more active role.Mixed methods analysis helps unravel complex nuances of CMs perceptions about ACP. In this study, CMs reported their attitudes about ACP, which were confirmed through a rigorous grounded theory qualitative analysis of focus group discussions.