Human-Centered Design of an Advance Care Planning Group Visit for Mild Cognitive Impairment

• Published in: The Gerontologist Vol. 62; no. 8; pp. 1226 - 1237
• Main Authors: Daddato, Andrea E, Staton, Elizabeth W, Bettcher, Brianne M, Shanbhag, Prajakta, Lum, Hillary D
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 07-09-2022
• Subjects: Advance Care Planning; Advance directives; Cognition; Cognitive ability; Cognitive Dysfunction - therapy; Dementia; Dyads; Humans; Intervention; Intervention Research; Older people; Planning; Recruitment; Research design; Surveys and Questionnaires; End-of-life care planning; Dementia; Stakeholder engagement
• ISSN: 0016-9013; 1758-5341
• DOI: 10.1093/geront/gnab181

Abstract
Background and Objectives
While advance care planning (ACP) is critical for ensuring optimal end-of-life outcomes among individuals with mild cognitive impairment (MCI), many individuals who may benefit from ACP have not initiated this process. This article aims to describe the iterative design of an MCI group visit-based intervention and evaluate the feasibility and acceptability of the intervention.
Research Design and Methods
We used human-centered design, rapid-cycle prototyping, and multiple methods to adapt an ENgaging in Advance Care planning Talks (ENACT) Group Visits intervention. We convened an advisory panel of persons with MCI and care partners (n = 6 dyads) to refine the intervention and conducted a single-arm pilot of 4 MCI ENACT intervention prototypes (n = 13 dyads). We used surveys and interviews to assess outcomes from multiple perspectives.
Results
The advisory panel affirmed that ACP is a priority for individuals with MCI, described the need for ACP in a group setting, and suggested refinements to ACP resources for the MCI ENACT intervention. Feasibility of recruitment was limited. MCI ENACT intervention participants strongly agreed that group discussions provided useful information and recommended the intervention. Themes supporting acceptability included (a) feedback on acceptability of the intervention, (b) previous experiences with ACP, and (c) reasons for participation, including desire for discussions about MCI and how it relates to ACP.
Discussion and Implications
Despite stakeholders’ positive ratings of acceptability of the MCI ENACT intervention, future work is needed to enhance the feasibility of recruitment to support implementation into clinical settings.