IU Indianapolis ScholarWorks :: Browsing by Author "Torke, Alexia"

Browsing by Author "Torke, Alexia"

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Advance Care Planning in A Preoperative Clinic: A Retrospective Chart Review
(Springer, 2019-01-02) Sinha, Shilpee; Gruber, Rachel N.; Cottingham, Ann H.; Nation, Barb; Lane, Kathleen A.; Bo, Na; Torke, Alexia; Medicine, School of Medicine
Patients seen in preoperative testing clinics are at an increased risk of surgical complications and most are incapacitated for during anesthesia. Advance directives (ADs) are important to guide care in the event of emergencies when patients are unable to speak for themselves. The goal of this study was to determine the frequency with which ADs are completed for patients seen in preoperative clinics prior to elective surgery and identify demographic and clinical characteristics associated with having ADs available in the electronic medical record (EMR).
Comparing Engagement in Advance Care Planning Between Stages of Heart Failure
(2019-08) Catalano, Lori A.; Hickman, Susan; Von Ah, Diane; Torke, Alexia; Weaver, Michael
Heart failure is a terminal disease with an unpredictable trajectory. Family members of patients with heart failure are often called upon to make decisions about treatment and end of life care, sometimes with little guidance as to the patients’ wishes. Advance care planning (ACP) is an ongoing process by which patients make decisions about their future healthcare. Only about one-third of patients with heart failure have participated in ACP, which is a similar percentage to the overall population. Despite increased focus on ACP and interventions to improve it, the rates of ACP in the population remain relatively unchanged. There is a need to develop interventions that are targeted based on patient engagement in the process rather than the existing broad-based interventions. The purpose of this dissertation study is to examine the relationship between the American Heart Association stage of heart failure and readiness to engage in advance care planning. The study consisted of mailed surveys that consisted of demographic questionnaires and the Advance Care Planning Engagement Survey. Engagement was analyzed in relation to heart failure stage, heart failure class, comorbidities, perception of health status, recent hospitalizations, making healthcare decisions for others, and demographic variables. The results demonstrated that although there was no significant association between heart failure stage or class and engagement in advance care planning, there were significant associations between medical comorbidities and advance care planning engagement. Other significantly associated participant characteristics included age, gender, education, ethnicity, and income. Findings suggest that people with multiple comorbid conditions will be more likely to be ready to engage in ACP than those with fewer health conditions. The results from this study will contribute to the development of strategies to improve advance care planning that are targeted based on engagement level.
Crucial Conversations for High-Risk Populations before Surgery: Advance Care Planning in a Preoperative Setting
(Mary Ann Liebert, Inc., 2021-10-06) Patel, Roma; Torke, Alexia; Nation, Barb; Cottingham, Ann; Hur, Jennifer; Gruber, Rachel; Sinha, Shilpee; Medicine, School of Medicine
Background: High-risk patients undergoing elective surgery are at risk for perioperative complications, including readmissions and death. Advance care planning (ACP) may allow for preparation for such events. Objectives: (1) To assess the completion rate of advance directives (ADs) and their association with one year readmissions and mortality (2) to examine clinical events for decedents. Design: This is an observational cohort study conducted through chart review. Setting/Subjects: Subjects were 400 patients undergoing preoperative evaluation for elective surgery at two hospitals in the United States. Measurements: The prevalence of ADs at the time of surgery and at one year, readmissions, and mortality at one year were determined. Results: Three-hundred ninety patients were included. In total, 102 (26.4%) patients were readmitted, yet did not complete an AD. Seventeen (4.4%) patients filed an AD during follow-up. Nineteen patients died and mortality rate was 4.9%. There was a significant association between completing an AD before death. Of the decedents, seven (37%) underwent resuscitation, but only four had ADs. Conclusions: Many high-risk surgical patients would benefit from ADs before clinical decline. Preoperative clinics present a missed opportunity to ensure ACP occurs before complications arise.
Development of a Protocol for Successful Palliative Care Consultation in Population of Patients Receiving Mechanical Circulatory Support
(Elsevier, 2017) Sinha, Shilpee; Belcher, Carey; Torke, Alexia; Howard, Joycelyn; Caccamo, Marco; Slaven, James A.; Gradus-Pizlo, Irmina; Department of Medicine, School of Medicine
Background In 2014, Joint Commission recommended palliative care (PC) engagement in ventricular assist device (VAD) implantation as destination therapy. Limited information is available on established PC protocols in the mechanical circulatory support (MCS) population. Measures The goals of our PC consultation were to document advance care planning (ACP) discussions and designate a surrogate decision maker (SDM) prior to MCS implantation. A retrospective analysis compared the frequency of PC consults, ACP discussion, and SDM before and after protocol implementation. Intervention A protocol was developed to conduct interdisciplinary PC consultations for the MCS population. Outcomes The percentage of PC consults placed prior to MCS implantation increased from 11 (17.2%) pre-protocol to 56 (96.6%) post-protocol (p<0.0001), and documented SDM increased from 26 (40.6%) pre-protocol to 57 (98.3%) post protocol (p<0.0001). Conclusion Close PC/cardiology collaboration can substantially improve ACP discussions and SDM documentation in the MCS population. This multidisciplinary protocol facilitates successful PC consultations.
An educational video improves physician knowledge of a public health care law that affects patient care during hospital clinical practice
(Sage, 2021-05-31) Comer, Amber R.; Salven, James; Torke, Alexia; Medicine, School of Medicine
When public health laws are passed that affect clinical practice within hospitals, it is important to educate physicians about best practices in implementing these laws into routine patient care in hospitals. An educational video was developed to inform physicians about a new state public health care law. This study sought to determine whether an educational video about a new state public health care law improves physicians' knowledge of the law and how to implement the law during clinical practice. A total of n=33 internal medicine physicians participated in this study. This study found that an educational video was successful in increasing physician knowledge about a new public health care law that affects clinical practice. The utilization of validated educational videos may provide a useful resource when attempting to provide education about new public health laws that effect the provision of medical care.
The effect of a state health care consent law on patient care in hospitals: A survey of physicians
(Sciedu Press, 2018-03-05) Comer, Amber R.; Gaffney, Margaret; Stone, Cynthia; Torke, Alexia; Physical Therapy, School of Health and Human Sciences
Objective: When a patient cannot make medical decisions for him or herself, and has not appointed a healthcare representative, default state healthcare consent laws determine who is able to make healthcare decisions for the patient. The narrow construction of some state laws leaves many patients in situations where the closest person to the patient does not qualify as a representative under the law, or where the patient has too many representatives and a consensus cannot be reached on the patient’s medical care. Methods: In order to determine how state healthcare consent laws affect patient care in hospitals, a survey of 412 Indiana physicians was conducted. Results: The data shows 53.8% of physicians experienced a delay in patient care because they were unable to identify a legally appropriate health care representative. Almost half (46.01%) of physicians experienced delay of patient care due to the inability to identify a ﬁnal decision maker when disputes arose between multiple legal representatives. Conclusions: The results of this study have important implications for hospital administrators as a delay in patient care can be costly and unnecessarily utilizes hospital resources. Additionally, the results of this study have important implications for the status of state surrogate decision making laws. Amending state laws to include more potential surrogates, has the potential to minimize delays in patient care and ensure that appropriate surrogates are making medical care decisions for patients without the undue burden of court intervention.
Feasibility Of Ecological Momentary Assessment Of Surrogates For Cognitively Impaired Icu Patients: A Pilot Study
(Oxford University Press, 2022) Taylor, Tracy; Burke, Emily; Slaven, James; Pfeffer, Bruce; Varner Perez, Shelley; Banks, Sarah; Torke, Alexia; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health
We explore the feasibility of ecological momentary assessment (EMA) with surrogate decision makers (SDMs) of critically ill hospitalized adults, to obtain in-the-moment participant-reported data. In this small pilot, 23 SDMs were approached. 82.6% were white, 53.9% were female, and 53.9% were 55 years and older. 25% were spouse or partner, 25% were adult children, 30% were parents, and 20% were other relations. Average ICU length of stay was 13.46 days (range 1.73-77.79). 13 SDMs enrolled (56.52%). Using Twilio, an automated text was sent to SDMs containing a secure link to the surveys. Up to five questions about anxiety, depression, distress, communication, and spiritual well-being were sent up to twice per day. Most participants (84.62%) completed EMA surveys for 5 or more days. Most SDMs stated that the surveys were not burdensome. Of those who declined participation (n= 10), accessibility to a smartphone, stress, and availability to complete texted surveys were noted as barriers to participation. The data suggest that EMA is a valuable tool to inform clinical interventionists and care providers interacting with SDMs. Future research will assess EMA with a larger group of SDMs, utilizing questions that help identify gaps in communication and opportunities to provide support to SDMs. Although surrogates are often under high stress in the ICU setting, they are willing to provide real-time EMA feedback on their experiences. EMA can provide a “just in time” option for research and clinical intervention that focuses on bridging gaps that may contribute to better outcomes for SDMs.
Glucose level decline precedes dementia in elderly African Americans with diabetes
(Elsevier, 2017-02) Hendrie, Hugh C.; Zheng, Mengjie; Li, Wei; Lane, Kathleen; Ambuehl, Roberta; Purnell, Christianna; Unverzagt, Frederick W.; Torke, Alexia; Balasubramanyam, Ashok; Callahan, Chris M.; Gao, Sujuan; Psychiatry, School of Medicine
INTRODUCTION: High blood glucose levels may be responsible for the increased risk for dementia in diabetic patients. METHODS: A secondary data analysis merging electronic medical records (EMRs) with data collected from the Indianapolis-Ibadan Dementia project (IIDP). Of the enrolled 4105 African Americans, 3778 were identified in the EMR. Study endpoints were dementia, mild cognitive impairment (MCI), or normal cognition. Repeated serum glucose measurements were used as the outcome variables. RESULTS: Diabetic participants who developed incident dementia had a significant decrease in serum glucose levels in the years preceding the diagnosis compared to the participants with normal cognition (P = .0002). They also had significantly higher glucose levels up to 9 years before the dementia diagnosis (P = .0367). DISCUSSION: High glucose levels followed by a decline occurring years before diagnosis in African American participants with diabetes may represent a powerful presymptomatic metabolic indicator of dementia.
Non-Traditional Surrogate Decision Makers for Hospitalized Older Adults
(Lippincott, Williams & Wilkins, 2018-04) Comer, Amber R.; Slaven, James E.; Montz, Annie; Burke, Emily; Inger, Lev; Torke, Alexia; Robert H. Mckinney School of Law
Background Without advanced preparation of legal documents, state law determines who may serve as a surrogate decision maker for patients in hospitals. Objectives To examine the relationship characteristics associated with traditional versus non-traditional healthcare surrogates who are making medical decisions for patients in hospitals. Research Design Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study. Subjects 364 patient/ surrogate dyads consisting of patients age 65 years and older admitted to the medical or medical ICU services who lacked decision making capacity based on a physician assessment and also had a surrogate available. Results This study of surrogate decision makers for hospitalized older adults found that the relationships of non-traditional surrogates such as, nieces, nephews, and friends serving in the surrogate role is nearly identical to those of traditional, first degree relatives serving as a surrogate. Over two-thirds (71.2%) of non-traditional surrogates saw the patient in person at least weekly compared to 80.8% of legal surrogates (p-value .9023). Almost all traditional and non-traditional surrogates discussed the patient’s medical preferences with the patient (96.9% of legal surrogates and 89.2% of non-traditional surrogates; p=0.0510). Conclusion This study shows that both traditional and non-traditional surrogates, who are a patient’s primary care giver have similar relationships with patients. The findings of this study suggest that requiring family members such as grandchildren to take the extra step of formal appointment through a legal channel may not be necessary to protect patients. Therefore, broader state laws expanding the list of surrogates authorized by state statute to include more non-traditional surrogates may be necessary.
Physician understanding and application of surrogate decision-making laws in clinical practice
(Taylor & Francis, 2016) Comer, Amber Rose; Gaffney, Margaret; Stone, Cynthia L.; Torke, Alexia; Department of Health Sciences, School of Health and Rehabilitation Sciences
Background: Although state surrogate laws are the most common way surrogate decision makers are identified, no studies have been conducted to determine physician understanding of these laws or how these laws are utilized during clinical practice. The purpose of this study is to better understand how surrogate decision-making laws function in practice. Methods: A cross-sectional survey of 412 physicians working in Indiana hospitals was conducted between November 2014 and January 2015 to determine physicians' knowledge of Indiana's surrogate decision-making law and physicians' approaches to hypothetical cases using the law in clinical practice. Results: Fewer than half of physicians (48%) were able to correctly identify all legally allowable surrogate decision makers. Of those physicians who knew the law, nearly all of them (98%) indicated that they would violate the law during clinical practice by allowing nonlegal surrogates such as grandchildren to make medical decisions. Conclusions: A majority of physicians endorse relying on surrogates who have strong ties to the patient but are not legally allowable in Indiana. It is possible that these decisions reflect sound ethical reasoning even though they are illegal. Due to the narrow construction of some state surrogate decision laws, physicians may be placed in the position where they must either choose to follow medical ethical principles or the law. To alleviate these issues, state surrogate decision laws need to be amended to include a broader list of surrogates, such as extended family and close friends.

Browsing by Author "Torke, Alexia"

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