End-of-Life Conversations and Hospice Placement: Association With Less Aggressive Care Desired in the Nursing Home

Reinhardt, Joann P.; Downes, Deirdre; Cimarolli,; Bomba, Patricia A.

doi:10.1093/geroni/igy023.1369

Cited by 3 publications

(3 citation statements)

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“…Despite the known benefits, ACP is rarely a component of usual practice in LTC [13,14]. Key barriers to ACP engagement include lack of resident and family preparedness [15,16], limited staff time, and discomfort and uncertainties from all parties regarding what to discuss beyond single medical decisions and funeral planning [17][18][19][20]. ACP programs that include multiple steps have shown some successful outcomes in increasing ACP engagement in LTC [13].…”

Section: Introductionmentioning

confidence: 99%

Exploration of the acceptability and usability of advance care planning tools in long term care homes

et al. 2020

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Objectives Despite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake amongst the generable population. Yet, their potential for improving ACP uptake in LTC has yet to be examined. This study explored if available ACP tools are acceptable for use in LTC by (a) eliciting staff views on the content and format that would support ACP tool usability in LTC (b) examining if publicly available ACP tools include content identified as relevant by LTC home staff. Ultimately this study aimed to identify the potential for existing ACP tools to improve ACP engagement in LTC. Methods A combination of focus group deliberations with LTC home staff (N = 32) and content analysis of publicly available ACP tools (N = 32) were used to meet the study aims. Results Focus group deliberations suggested that publicly available ACP tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist. Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%). Conclusions ACP tools that include psychosocial content may improve ACP uptake in LTC because they elicit future care issues considered pertinent and can be supported by a range of clinical and non-clinical staff. To increase usability and engagement ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.

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Section: Introductionmentioning

confidence: 99%

Exploration of the acceptability and usability of advance care planning tools in long term care homes

et al. 2020

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“…Missed conversations tend to occur when neither NH staff nor FCs recognize that a resident's clinical condition is changing, or when either party assumes to know the resident's end‐of‐life care preferences (Auriemma et al, 2022; Towsley et al, 2015). Studies have shown missed opportunities for end‐of‐life communication with physicians, who are often viewed by FCs as “missing in action” (Shield et al, 2005,), and little inclusion of FCs in care plan meetings (Reinhardt et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Lived experiences of end‐of‐life communication among nursing home staff: An interpretive phenomenological study

Gonella

Conti²,

Albanesi³

et al. 2022

Journal of Advanced Nursing

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Aims:To explore and understand lived experiences of end-of-life communication among nursing home staff.Design: Interpretive phenomenological study. Methods:In-person, semi-structured, in-depth interviews were conducted from May to August 2021 with 21 nursing home staff members involved in end-of-life communication (four managers, four chief nurses, three chief medical officers, three nurses, three psychologists, two occupational therapists, one chief nurse aide and one nurse aide). Data were analysed by van Manen's hermeneutic approach, which uses the lifeworld existentials of spatiality, corporeality, temporality and relationality to guide reflection on the human experience. Data were reported according to the Consolidated Criteria for Reporting Qualitative Research.Results: Thirteen categories were identified and framed within the four existentials.Regarding spatiality, end-of-life communication took place in a physical, mental, socio-cultural and professional competence space. With regard to corporeality, interviewees reported difficulties in managing their own feelings and those of family caregivers. For temporality, interviewees reported delays in end-of-life communication due to staffing issues and an increase in urgent and temporary relief admissions to nursing homes. To compensate, they tried to assure that all interactions that did take place were of high quality. Finally, with regard to relationality, interviewees lived end-of-life communication through their relationships with family caregivers and colleagues. The supportive role of colleagues was expressed as teamwork, which helped promote reflexivity about how to tailor communication, manage challenging emotions and situations, set aside time for communication, and prepare family caregivers for death. Conclusion:End-of-life communication was an all-encompassing experience for nursing home staff. The supportive role of colleagues was stressed across all existentials, suggesting that teamwork is essential in delivering effective communication at the end-of-life.

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“…Despite its relevance and the available qualitative (Bollig et al., 2016; Caron et al., 2005; Frey, Foster, Boyd, Robinson, & Gott, 2017) and quantitative studies (Mitchell et al, 2017; Reinhardt, Downes, Cimarolli, & Bomba, 2017; van Soest‐Poortvliet et al., 2014) on NH residents, relatives and HCPs communication, the challenges encountered during the research process as experienced by researchers have never been addressed to date. Discussing and reporting issues in designing and implementing study protocols about sensitive topics can increase a researcher's awareness, as well as can suggest how to design further studies to overcome challenges and to promote ethically and methodologically sound studies.…”

Section: Introductionmentioning

confidence: 99%

Qualitative research on end‐of‐life communication with family carers in nursing homes: A discussion of methodological issues and challenges

Gonella

Giulio²,

Palese

et al. 2020

Nursing Open

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Aim To identify and summarize the challenges of conducting qualitative research exploring end‐of‐life communication between healthcare providers and bereaved family carers in nursing homes. Design A descriptive qualitative study based on in‐the‐field‐notes and research diaries collected during a primary study involving 32 bereaved family carers and 14 nurses across 13 Italian nursing homes in 2018–2019. Methods Two trained female nurses conducted semi‐structured, in‐depth, open‐ended interviews and recorded “in action” (i.e. reflections reported as in‐the‐field‐notes) and “on action” (i.e. retrospective reflections within the team reported immediately in the research diaries) narratives, with the aim of identifying challenges encountered during the research process. A content analysis process was performed to analyse the narratives collected. Results We identified three major categories of challenges: (a) obtaining approval from the ethical committee; (b) approaching nursing homes and family carers; and (c) dealing with participant‐related impairments (i.e. memory, emotional, physical).

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End-of-Life Conversations and Hospice Placement: Association With Less Aggressive Care Desired in the Nursing Home

Cited by 3 publications

References 0 publications

Exploration of the acceptability and usability of advance care planning tools in long term care homes

Exploration of the acceptability and usability of advance care planning tools in long term care homes

Lived experiences of end‐of‐life communication among nursing home staff: An interpretive phenomenological study

Qualitative research on end‐of‐life communication with family carers in nursing homes: A discussion of methodological issues and challenges

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