Preconditions for successful advance care planning in nursing homes: A systematic review

Gilissen, Joni; Pivodic, Lara; Smets, Tinne; Gastmans, Chris; Stichele, Robert Vander; Deliëns, Luc; Block, Lieve Van den

doi:10.1016/j.ijnurstu.2016.12.003

Cited by 119 publications

(175 citation statements)

References 66 publications

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“…Discussions about end‐of‐life care are not well integrated in other aspects of medical care outside of specialist palliative care . Effective leadership at the implementation sites and having sufficient manpower and time committed to ACP are essential for integrating complex interventions, such as ACP, in high‐pressured clinical environments . Time constraints have led to ACP being poorly integrated as part of routine patient care …”

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confidence: 99%

Implementing Advance Care Planning in Acute Hospitals: Leading the Transformation of Norms

Tan

Car

Lall

et al. 2019

J American Geriatrics Society

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BACKGROUND Despite being simply defined as a process to further one's understanding about future medical care, the process of implementing advance care planning (ACP) within acute hospital settings can be complex. AIM We describe different ACP service models adopted in Singapore, and the facilitators for, and barriers to, its effective implementation. DESIGN Qualitative focus group study with thematic analysis. SETTINGS/PARTICIPANTS We purposefully sampled four stakeholder groups involved in the implementation of ACP. Our sample included 63 participants, 12 physicians, 15 nurses, 24 medical social workers, and 12 ACP coordinators from seven public hospitals and one specialist center. RESULTS We describe three different acute‐care models adopted in Singapore, differentiated by leadership approach, target population, delivery process, and job roles. Our results revealed nine themes, organized into four categories, including: (1) hospital culture (curative norms, absence of preference‐supportive culture), (2) organizational priority and leadership (low priority on hospital agenda, inappropriate leadership), (3) goals and distinction (lack of shared purpose and goals, no clear differentiation from existing practices), and (4) work practices (pigeonholing of ACP practice, inappropriate resourcing, accountability and feedback). CONCLUSION We learned that to implement ACP effectively in an acute‐care setting, there needs to be a cultural and behavioral transformation, led by committed and empowered leaders. Organizations that can create a shared purpose built on an ethos of honoring patients' preferences, and support this with systematic processes and adequate resourcing, will be more equipped to implement ACP effectively.

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confidence: 99%

Implementing Advance Care Planning in Acute Hospitals: Leading the Transformation of Norms

Tan

Car

Lall

et al. 2019

J American Geriatrics Society

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“…Various explanations for not initiating ACP in NH residents are possible: residents were unwilling to discuss their preferences or rejected ACP; existing pre‐admission arrangements for end‐of‐life care (e.g. advance directives) might need no further discussion; residents trust their relatives and NH staff to make important decisions for them, in their best interest; residents were unaware of the possibility to discuss their preferences for future care; or ACP was not embedded in routine care . Research has shown that lack of knowledge of ACP is an important barrier to engage in or successfully implement ACP.…”

Section: Discussionmentioning

confidence: 99%

“…advance directives) might need no further discussion; residents trust their relatives and NH staff to make important decisions for them, in their best interest; residents were unaware of the possibility to discuss their preferences for future care; or ACP was not embedded in routine care. [24][25][26][27] Research has shown that lack of knowledge of ACP is an important barrier to engage in or successfully implement ACP. Informing residents and their family about ACP and the ACP policy within the NH is crucial for residents to be able to share their preferences for future care adequately.…”

Section: Associations Of Acp Initiation With Medication Usementioning

confidence: 99%

Initiation of advance care planning in newly admitted nursing home residents in Flanders, Belgium: A prospective cohort study

Paque

Ivanova

Elseviers

et al. 2018

Geriatrics Gerontology Int

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Aim To describe (i) the timing of initiation of advance care planning (ACP) after nursing home admission; (ii) the association of dementia and physical health with ACP initiation; and (iii) if and how analgesic use and use of lipid modifying agents is related to ACP, in a cohort of newly admitted residents. Methods A prospective, observational cohort study of nursing home residents was carried out. Data were collected 3 months, 15 months (year 1) and 27 months (year 2) after admission, using a structured questionnaire and validated measuring tools. Results ACP was never initiated during the 2‐year stay for 38% of the residents, for 22% ACP was initiated at admission, for 21% during year 1 and for 19% during year 2 (n = 323). ACP initiation was strongly associated with dementia, but not with physical health. Residents without dementia were more likely to have ACP initiation at admission or not at all, whereas ACP initiation was postponed for residents with dementia. Between admission and year 2, analgesic use increased (from 34% to 42%), and the use of lipid‐modifying agents decreased (from 28% to 21%). Analgesic use increased more in residents with ACP initiation during year 1 and year 2. The use of lipid‐modifying agents was not associated with ACP. Conclusions The timing of ACP initiation differed significantly for residents with and without dementia, which highlights the importance of an early onset of ACP before residents lose their decision‐making capacity. ACP conversations might create opportunities to discuss adequate pain and other symptom treatment, and deprescribing at the end of life. Geriatr Gerontol Int 2019; 19: 141–146.

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“…Some systematic reviews exist on EOL care in LTC settings for older adults, especially on advanced care planning (ACP) (Beck, McIlfatrick, Hasson, & Leavey, ; Gilissen et al, ; Mignani, Ingravallo, Mariani, & Chattat, ). For example, Gilissen et al () reviewed 37 publications and identified 17 preconditions for successful ACP in nursing homes. They claimed that health care professionals and nursing home structures play important roles in successful ACP.…”

Section: Introductionmentioning

confidence: 99%

End‐of‐life nursing care practice in long‐term care settings for older adults: A qualitative systematic review

Nasu

Konno

Fukahori

2019

Int J of Nursing Practice

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Aim To synthesize qualitative evidence on nurses' end‐of‐life care practices in long‐term care settings for older adults. Background Qualitative evidence on how nurses describe their own end‐of‐life care practice has not been reviewed systematically. Design Qualitative systematic review. Data Sources Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. Methods The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta‐aggregation. Results Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. Conclusion Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end‐of‐life care that ensures residents die with dignity.

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Preconditions for successful advance care planning in nursing homes: A systematic review

Cited by 119 publications

References 66 publications

Implementing Advance Care Planning in Acute Hospitals: Leading the Transformation of Norms

Implementing Advance Care Planning in Acute Hospitals: Leading the Transformation of Norms

Initiation of advance care planning in newly admitted nursing home residents in Flanders, Belgium: A prospective cohort study

End‐of‐life nursing care practice in long‐term care settings for older adults: A qualitative systematic review

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