<p>Significance of advance care planning in nursing homes: views from patients with cognitive impairment, their next of kin, health personnel, and managers</p>

Abstract

Purpose: Advance care planning (ACP) performed by regular staff, which also includes patients with cognitive impairment and their next of kin, is scarcely studied. Thus, we planned an implementation study including key stakeholders (patients, next of kin, and health care personnel) using a whole-ward/system approach to ACP. We explored how they experienced ACP and its significance. Patients and methods: This qualitative study is part of a mixed-method implementation study of ACP. In four nursing homes, we did qualitative interviews and audio-recordings of meetings. We completed 20 individual semistructured interviews with participants soon after ACP conversations. The interviews included patients with cognitive impairment, their next of kin, and health care personnel. We also conducted four focus group interviews with staff and managers in the nursing homes and audio-recorded four network meetings with the project teams implementing ACP. Results: All participants appreciated taking part in ACP. Patients and next of kin focused more on the past and present than future treatment preferences. Still, ACP seemed to contribute to a stronger patient focus on end-of-life conversations. More generally, ACP seemed to contribute to valuable information for future decision-making, trusting relations, improved end-of-life communication, and saving time and resources. Conclusion: Safeguarding a strong patient focus on ACP and fostering a person-centered care culture in nursing home wards seem to be achievable through implementation of ACP that includes regular staff, patients with cognitive impairment, and their next of kin.

Elephant in the room - Family members´ perspectives on advance care planning

“…These differences in views and wishes about the discussion on endof-life issues indicate staffs' need to be sensitive to and have attunement to the patient's and family members' desire and readiness to speak about issues regarding end-of-life. These findings also go in line with results from other studies pointing out that ACP should be seen as a process, not an one-time event, and should be based on discussions from several meetings [12,25] and that the patient's views on life and death are essential and must be taken into account in the ACP process [12,24].…”

Nursing home residents with cognitive impairment can participate in advance care planning: A qualitative study

“…We believe our findings support that a whole‐ward approach to ACP may contribute to a changed care culture and that implementation support has a great impact on such changes. Indications in this study of a changed culture and resident‐focused ACP conversations were corroborated through interviews of the participants observed in the present study (T. J. L. Sævareid, Førde et al., 2019). Furthermore, how to increase resident participation in ACP should be the focus of education and implementation support because nursing home physicians may be more intent on involving next of kin, rather than the resident, in end‐of‐life decision‐making (Romoren et al., 2016; Thoresen et al., 2019).…”

“…We believe our findings support that a whole-ward approach to ACP may contribute to a changed care culture and that implementation support has a great impact on such changes. Indications in this study of a changed culture and resident-focused ACP conversations were corroborated through interviews of the participants observed in the present study (T. J. L. Saevareid, Førde et al, 2019).…”

Feasibility and acceptability of introducing advance care planning on a thoracic medicine inpatient ward: an exploratory mixed method study

“…We practised a person-centred ACP using the guide only as a support while focusing on the patient’s wishes, needs and preferences, respecting individual limits for transparency, as recommended by Waldrop and Meeker, among others 20 27 28. A consequence of a person-centred focus may be that sensitive topics are avoided, with uncertainty about reasons for avoidance.…”