The role of end-of-life communication in contributing to palliative-oriented care at the end-of-life in nursing home

Abstract

Background: Clear communication about a person's poor prognosis and limited treatment choices improves the quality of end-of-life care. Aims: To investigate how end-of-life communication may contribute to palliative-oriented care at the end-of-life in nursing homes according to both families' and nurses' perspective. Secondly, to identify the contextual factors internal to the nursing home that may influence the timing and quality of communication. Thirdly, to confirm the foundations for a first theory of end-of-life communication. Method: This study is a descriptive two-tailed embedded multiple-case study. A secondary analysis of 23 family carer-nurse paired interviews was performed. Findings: Several contextual factors influenced the timing and quality of communication that, in turn, impacted end-of-life care by promoting family understanding, fostering shared decision-making between healthcare professionals and resident/family carers, and improving the knowledge of residents' and family carers' preferences (ie drivers of transition towards palliative-oriented care). Family carers' preferences had the strongest influence in guiding the care approach, while residents' preferences were poorly known and had a limited impact on the end-of-life care goal. Complex and dynamic interactions within and between drivers and contextual factors emerged, providing preliminary evidence for a first end-of-life communication theory. Conclusion: Findings suggest the need to promote a familiar atmosphere and quality relationships, and improve the knowledge of a resident's preferences to ensure that end-of-life care is consistent with their desires.

A Situation-Specific Theory of End-of-Life Communication in Nursing Homes

“…Although national consensus bodies recommend making end-of-life communication part of the routine care for seriously ill patients and their families [19,20], the theoretical basis for the role of communication in transitioning towards palliative-oriented care at the end of life is still limited [21]. Solid theoretical bases on how end-of-life communication may work could connect theory with research and practice, and can help guide and sustain the development of interventions aimed at improving the communication skills of HCPs, particularly at the end of life, and offer indications for policy, education, and research related to geropalliative care.…”

“…A theory of end-of-life communication and its role in contributing to the transition towards palliative-oriented care in NHs is already available [21]. According to this theory, the NH environment may influence the timing and quality of end-of-life communication that in turn impacts end-of-life care by affecting (a) the FCs' understanding; (b) the shared decision-making between HCPs and residents/FCs; and (c) the knowledge of residents' preferences and (d) FCs' preferences for end-of-life care.…”

“…Timely and thorough communication contributes to the transition towards palliative-oriented care by promoting family understanding, fostering shared decision-making between HCPs and residents/FCs, and improving the knowledge of residents' and FCs' preferences. Instead, when communication is delayed or poor, the provision of curative-oriented care is more likely due to FCs' lack of understanding, no shared decision-making, and residents' and FCs' preferences being unknown (Figure 1) [21]. This theory considers only how the environment internal to the NH may affect end-of-life communication, while the role of contextual lack of understanding, no shared decision-making, and residents' and FCs' preferences being unknown (Figure 1) [21].…”

“…Instead, when communication is delayed or poor, the provision of curative-oriented care is more likely due to FCs' lack of understanding, no shared decision-making, and residents' and FCs' preferences being unknown (Figure 1) [21]. This theory considers only how the environment internal to the NH may affect end-of-life communication, while the role of contextual lack of understanding, no shared decision-making, and residents' and FCs' preferences being unknown (Figure 1) [21]. This theory considers only how the environment internal to the NH may affect end-of-life communication, while the role of contextual factors external to the NH is not taken into account.…”

“…Based on the assumption that situation-specific theories are the best theories to explore complex phenomena such as end-of-life communication and that political, historical, social, and cultural factors are mandatory in the development of a situation-specific theory [26], an instrumental case study was performed to confirm that contextual factors influence the timing and quality of communication between NH staff and residents' families. Therefore, this study develops a situation-specific theory on the role of end-of-life communication in contributing to the transition towards palliative-oriented care in NHs by refining an existing theory [21].…”