Honing an advance care planning intervention using qualitative analysis: the Living Well interview

Advance care planning requires an explicit and comprehensive discussion of patient values and conceptualization of quality of life. The Living Well open-ended interview intervention was developed to help patients and their health care agents to engage in a meaningful discussion of values so that decisions made in the last year of life are made with the patients' values in mind. We used qualitative and quantitative analysis to streamline this 10-question interview, and to generate hypotheses for future research. Interviews with 52 terminally ill patients were coded according to methodological weaknesses and content (support, spirit/feelings, palliative care, and quality of life). Node analysis revealed that three primary and three backup/probe questions yielded information that minimized misinformation, sampled from all four content areas, led to discussions of importance for good planning and decision-making, and may have led to earlier hospice admission than the national average. Two emerging themes, Generativity (passing on values or assets to the next generation) and essence (simple pleasures in everyday life), and were then quantitatively analyzed. People who mentioned generativity tended to be older, had a longer length of hospice stay, and a longer time to death after interview, compared to those who did not mention the theme. People who mentioned essence also tended to be older, but tended to have a shorter length of hospice stay and a shorter time to death after the interview. We conclude that this interview may improve access to hospice, and that generativity and essence are worthwhile themes for future research.