Academic journal article Care Management Journals

Measuring Case Managers' Advance Care Planning Practice: Translating Focus Group Findings to Survey Development

Academic journal article Care Management Journals

Measuring Case Managers' Advance Care Planning Practice: Translating Focus Group Findings to Survey Development

Article excerpt

Sequential mixed methods is a useful research design to inform second-stage methodology when investigating an area of practice in which relatively little is known. This article describes how focus group findings were used to measure advance care planning practice among community-based case managers. The initial qualitative study utilized focus groups to explore aspects of practice in this area. Data revealed themes that embodied ambiguous views of advance care planning, divergent roles in practice, a continuum of practice activities, and multiple facilitators and barriers to practice. In order to further examine case managers' advance care planning practices, qualitative findings were used to develop the Case Managers Advance Care Planning Practices Instrument. Implications for qualitative to quantitative measurement are discussed.

Keywords: qualitative research; translational research; survey development

Exploratory research is useful to better understand a range of phenomenon, including perceptions of views and experiences in growing areas of professional practice. Qualitative methods such as focus group interviews are particularly valuable to uncover idiographic aspects that underlie practice, and quantitative methods such as surveys are practical approaches to empirically describe and analyze factors associated with practice. Mixedmethods research done well can strengthen the study by exploring research questions from different perspectives and through differing data sources and analyses (Yin, 2006). Mixed-methods studies can be emergent, with one method preceding the other sequentially, or integrated (Creswell, Shope, Plano Clark, & Green, 2006). Qualitative to quantitative approaches tend to be most relevant for studies in which, initially, little is known regarding a phenomenon of interest. This article describes how the findings from focus groups with community-based case managers in the southeastern United States were used to inform the development of a survey to measure advance care planning practices (ACPPs).


Although advance care planning (ACP) is an increasingly important aspect of professional practice with older adults, it is poorly understood. There is mounting interest to better understand professional communication in this area. The need to study providers' ACPPs has been recommended by the Agency for Healthcare Research Quality (Lorenz et al., 2004), medicine (Lynn, 1997), nursing (Ferrell, 2005), social work (Kramer, Christ, Bern-Klug, & Francoeur, 2005), and gerontology (George, 2002).

As core providers of care to older adults, case managers represent a growing profession designed to assist elders with multiple and advanced chronic diseases to maintain autonomy in the community (Stone, Reinhard, Machemer, & Rudin, 2002). However, elders' complex health needs impact their ability to remain at home (Lawler, 2001). Furthermore, the unpredictable nature of the chronic diseases and complications of elders served by case managers place the elders at risk of "relapse" (Dyeson, Murphy, & Stryker, 1999), and fluctuations in health deterioration and mental incapacitation underscore the critical need to plan in advance for future care needs (Kass-Bartelmes & Hughes, 2004). Therefore, exploratory research was needed to better understand the role that case managers perform in facilitating future care plans.

As part of a sequential mixed-methods study intended to better understand ACPPs, qualitative inquiry was first used to explore case managers' perceptions of ACP, including practices performed, perceived roles, and factors influencing practice in this area. On the basis of the findings from the qualitative study, a survey was developed for the second phase of the mixed-methods design that attempted to validate and broaden the scope of these findings by determining the following: (a) the frequency with which the community-based case managers engage in ACPP as defined in the first phase of the study and (b) the prevalence and, ultimately, the generalizability of these descriptive patterns and associated factors across a larger sample population. …

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