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

Abstract

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.

Use, Usability, And Impact of A Tool To Support Conversations About End-of-Life Preferences In Residential Elder Care – A Qualitative Study of Staff Experiences

“…We found, as did Sussman et al [42], that interactive tools, such as card games, help target re ection and can cover a variety of aspects of EOL care. However, since most EOL conversation tools focus primarily on medical aspects of care, other important dimensions risk being overlooked [42]. Prior research has suggested that non-medical issues may even be more imperative to discuss as advanced age affects care preferences [43].…”

“…strengthening relationships and developing shared narratives and goals, which have been shown to act as major contributors to ACP bene t [39], particularly with older populations [40,41]. We found, as did Sussman et al [42], that interactive tools, such as card games, help target re ection and can cover a variety of aspects of EOL care. However, since most EOL conversation tools focus primarily on medical aspects of care, other important dimensions risk being overlooked [42].…”

Evaluating the Implementation of the Conversation Starter Kit in Long Term Care

“…The CSK booklet was selected because of several features that support its usability in LTC, including; (a) a self-directed paper-based format; (b) information on the role of family/friends in decisional-support; (c) a companion workbook for family/friends of persons with dementia, and (d) a moderate 12-page length ( Sussman et al, 2020 ). Two versions of the Conversation Starter Kit (CSK) booklet developed for LTC were used; one version was designed for self-use, which was given to all LTC residents who had capacity to complete it.…”

“…The structured interview was used to gather information about residents’ and family/friends’ use and perceptions of the CSK booklet; and for those who did not complete it, what their reasons were. The questions that were included in the structured interview questionnaire were chosen based on previous studies ( Kaasalainen et al, 2021 ; Sussman et al., 2020 ). Final decisions about the content of the questionnaire were made through deliberations among the study team.…”

“…The CSK booklet was selected because of several features that support its usability in LTC, including; (a) a self-directed paper-based format; (b) information on the role of family/ friends in decisional-support; (c) a companion workbook for family/friends of persons with dementia, and (d) a moderate 12-page length (Sussman et al, 2020). We used a multifaceted approach to implementing the intervention.…”