How are older people’s care preferences documented towards the end of life?

Williams, Sue; Hwang, Kerry; Watt, James; Batchelor, Frances; Gerber, Katrin; Hayes, Barbara; Brijnath, Bianca

doi:10.1016/j.colegn.2019.09.008

Cited by 11 publications

(9 citation statements)

References 20 publications

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“…As many patients are hospitalized during the final year(s) of life [ 6 ], the EOL also needs to be addressed in hospitals. Patients living with a life-threatening disease express readiness to talk about the EOL before the healthcare professionals (HPs) address the issue [ 7 ], and these conversations take place very close to death, in the last week of life [ 8 ]. Thus, although the patients have thoughts about the EOL, the communication and documentation of their wishes are inadequate [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses

2020

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Background End-of-life (EOL) conversations are highly important for patients living with life-threatening diseases and for their relatives. Talking about the EOL is associated with reduced costs and better quality of care in the final weeks of life. However, there is therefore a need for further clarification of the actual wishes of patients and their relatives concerning EOL conversations in an acute hospital setting. Aim The purpose of this study was to explore the wishes of patients and their relatives with regard to talking about the EOL in an acute hospital setting when living with a life-threatening disease. Methods This study is a qualitative study using semi-structured in-depth interviews. A total of 17 respondents (11 patients and six spouses) participated. The patients were identified by the medical staff in a medical and surgical ward using SPICT™. The interview questions were focused on the respondents’ thoughts on and wishes about their future lives, as well as on their wishes regarding talking about the EOL in a hospital setting. Results This study revealed that the wish to talk about the EOL differed widely between respondents. Impairment to the patients’ everyday lives received the main focus, whereas talking about EOL was secondary. Conversations on EOL were an individual matter and ranged from not wanting to think about the EOL, to being ready to plan the funeral and expecting the healthcare professionals to be very open about the EOL. The conversations thus varied between superficial communication and crossing boundaries. Conclusion The wish to talk about the EOL in an acute hospital setting is an individual matter and great diversity exists. This individualistic stance requires the development of conversational tools that can assist both the patients and the relatives who wish to have an EOL conversation and those who do not. At the same time, staff should be trained in initiating and facilitating EOL discussions.

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Section: Introductionmentioning

confidence: 99%

Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses

2020

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“…They are key communicators between family members and physicians, and act as intermediaries to ensure that care decisions are made in the residents' best interests and in accordance with the family members' preferences. Ongoing discussions should be in place to ensure everchanging care preferences are understood ( Williams et al, 2020 ). With the increased adoption of information and communication technologies in healthcare, future interventions may benefit from the use of telehealth in NHs to bridge the physician-family communication gap through virtual channels, and also to conduct telemedicine consultations to facilitate communication on transfer decisions ( Edirippulige et al, 2013 ;Low et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore

et al. 2022

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“…For example, a chart review method cannot be reliable due to poor documentation of patients' care preferences (Williams et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, a standardised method to assess this outcome has not been agreed upon by researchers (Sudore et al, 2018). For example, a chart review method cannot be reliable due to poor documentation of patients' care preferences (Williams et al, 2020). Further investigations are warranted to validly assess this important outcome of ACP.…”

Section: Discussionmentioning

confidence: 99%

Advance care planning for older adults in community‐based settings: An umbrella review

Park

et al. 2021

Int J Older People Nursing

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Background Advance care planning (ACP) is critical to ensure better quality end of life care, and older adults are often a target of ACP. However, ACP interventions and their outcomes are neither standardised nor conclusive. Objectives To synthesise existing ACP systematic reviews and identify the types and outcomes of ACP interventions for older adults in community‐based settings. Methods An umbrella review of systematic reviews. The Joanna Briggs Institute Reviewer’s Manual was followed. Relevant systematic reviews were searched by utilising bibliographic databases, grey literature sources, and manual searches between April and July, 2019. Nine systematic reviews met the inclusion criteria. Critical appraisal on the selected reviews was conducted. Data were independently extracted using a data extraction tool by two researchers and synthesised based on consensus. Results The systematic reviews suggest the critical features of ACP interventions for older adults in community‐based settings including clinicians’ face‐to‐face communication with patients and their family members, comprehensive and individualized decisional aids, a proper intensity of ACP interventions, and professional training. When categorising ACP outcomes according to Sudore et al.’s (Journal of Pain and Symptom Management, 55, 2018, 245) framework, action outcomes (e.g., documentation, discussion) were frequently measured with positive outcomes. Quality of care outcomes such as congruence with care preference and healthcare outcomes such as health status were not reported sufficiently. Conclusions The reviews suggested essential features of ACP interventions, which were often omitted in ACP interventions for older adults. Although the outcomes were generally positive, it is inconclusive as to whether ACP interventions eventually improved quality of end of life care or health status of older adults in community‐based settings. Implications for practice For ACP interventions to be effective and comparable in their outcomes, we recommend adopting the key intervention components identified in this study. As the effects of ACP interventions are inconclusive, further investigations are warranted.

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How are older people’s care preferences documented towards the end of life?

Cited by 11 publications

References 20 publications

Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses

Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses

“Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore

Advance care planning for older adults in community‐based settings: An umbrella review

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