Action research study on advance care planning for residents and their families in the long-term care facility

Abstract

BackgroundResearch in Taiwan has indicated that advance care planning is rarely undertaken in long-term care facilities. The purpose of this study was to develop an advance care planning interview guideline and care model to facilitate the process of advance care planning for residents and their families in long-term care facilities.MethodsThis study follows an action research design. Cycles of planning, action, observation, and reflection were planned and modified based on the results of interviews with residents and their families as well as meetings with staff. To establish the interview guideline and care model through this action research study, residents and their families were interviewed separately. The researcher subsequently held meetings with staff members to evaluate the results and identify problems during each advance care planning process. This information was synthesised and used to modify the care model for implementation with the next resident–family pair. This process was performed a total of ten times.ResultsThis study included residents (N = 10), their families (N = 20), and medical staff (N = 4) at a long-term care facility. The interviews and meetings were audio recorded, transcribed, and subjected to a simple thematic analysis together with the field notes and reflection logs. Four themes emerged from the data related to: opening the conversation with the interview guidelines about the life story of residents; continuing life stories to the quality of remaining years of the residents; gradually changing the topic to the end-of-life care issues; and concluding the conversation by explaining the content of advance directives and hospice care.ConclusionsThe advance care planning care model was implemented following logical thinking from a Chinese perspective. This consisted of opening, developing, changing, and concluding through the views of Confucianism, Buddhism, and Taoism. The research findings indicate that the model successfully facilitated the process of advance care planning for residents and their families.

Family‐oriented interventions in long‐term care residential facilities for older people: A scoping review of the characteristics and outcomes

“…For instance, Hanson et al 40 used an 18‐min decision aid video for family members followed by a staff‐family discussion; a 1‐h preparatory session was provided to the staff, but the duration of the staff‐family discussion was not reported. Another example is Lee et al 43 who conducted 72 30–40‐min interviews with residents and families to assist them in the advanced care planning process. This duration included also the duration needed to develop an advanced care planning model; the exact duration needed to implement the model was not reported.…”

“…This scoping review included 15 articles 21,[34][35][36][37][38][39][40][41][42][43][44][45][46][47] representing 13 distinct studies: one article for each study, with two studies that were represented by two articles for each. Extracted information from these articles are summarized in Table 1.…”

“…Interventions were typically multifaceted and included education and training (n = 10), [36][37][38][39][40][41][42][43]46,47 conversation and psychological support (n = 6), 36,[40][41][42][43]47 development and implementation of care plans and care models (n = 2), 37,38 introducing new elements (e.g., iPads, 39 assessment tools 45 ) into the care process (n = 2), and psychotherapy (e.g., dignity therapy, 34,35 life review, 44 and creating music and other memory cues database 21 ) (n = 4). Education to residents and families included providing information about the resident's condition, goal of care, and treatment options, with a focus on providing psychological support and eliciting residents' and families' treatment preferences and wishes.…”

“…Education to residents and families included providing information about the resident's condition, goal of care, and treatment options, with a focus on providing psychological support and eliciting residents' and families' treatment preferences and wishes. [36][37][38][40][41][42][43]47 This was achieved through face-to-face or telephone conversations and case conferences. For staff education, three studies provided palliative care education as the core component of the intervention, 37,38,46,47 and six studies provided staff education as a preparatory phase.…”

Asian patients’ perspectives on advance care planning: A mixed-method systematic review and conceptual framework

“…Patients' belief that talking about ACP would make their relatives sad 55 Patients' concern that ACP would cause distress or burden for family members 41,42,48,50,58 Patients' concern of implications of ACP Patients' concern that ACP would cause conflict within their family members 44,50,58 Patients' concern of the psychological discomfort produced when thinking about a terminal illness 33 Patients' wish to entrust decision-making to family members 25,36,[41][42][43][44]50,57,58 Patients' preference for passive involvement in decision-making…”